Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Melbourne, Australia.
Biol Psychiatry. 2013 Feb 15;73(4):321-8. doi: 10.1016/j.biopsych.2012.10.006. Epub 2012 Nov 28.
Functional neuroimaging studies have provided consistent support for the idea that obsessive-compulsive disorder (OCD) is associated with disturbances of brain corticostriatal systems. However, in general, these studies have not sought to account for the disorder's prominent clinical heterogeneity.
To address these concerns, we investigated the influence of major OCD symptom dimensions on brain corticostriatal functional systems in a large sample of OCD patients (n = 74) and control participants (n = 74) examined with resting-state functional magnetic resonance imaging. We employed a valid method for mapping ventral and dorsal striatal functional connectivity, which supported both standard group comparisons and linear regression analyses with patients' scores on the Dimensional Yale-Brown Obsessive-Compulsive Scale.
Consistent with past findings, patients demonstrated a common connectivity alteration involving the ventral striatum and orbitofrontal cortex that predicted overall illness severity levels. This common alteration was independent of the effect of particular symptom dimensions. Instead, we observed distinct anatomical relationships between the severity of symptom dimensions and striatal functional connectivity. Aggression symptoms modulated connectivity between the ventral striatum, amygdala, and ventromedial frontal cortex, while sexual/religious symptoms had a specific influence on ventral striatal-insular connectivity. Hoarding modulated the strength of ventral and dorsal striatal connectivity with distributed frontal regions.
Taken together, these results suggest that pathophysiological changes among orbitofrontal-striatal regions may be common to all forms of OCD. They suggest that a further examination of certain dimensional relationships will also be relevant for advancing current neurobiological models of the disorder.
功能神经影像学研究为强迫症（OCD）与大脑皮质纹状体系统紊乱有关的观点提供了一致的支持。然而，一般来说，这些研究并没有试图解释该疾病的突出临床异质性。
为了解决这些问题，我们使用静息态功能磁共振成像（rs-fMRI）对大量强迫症患者（n=74）和对照参与者（n=74）进行了研究，以调查主要 OCD 症状维度对大脑皮质纹状体功能系统的影响。我们采用了一种有效的方法来映射腹侧和背侧纹状体的功能连接，该方法支持对患者的耶鲁-布朗强迫症量表（Dimensional Yale-Brown Obsessive-Compulsive Scale）评分进行标准组比较和线性回归分析。
与过去的发现一致，患者表现出涉及腹侧纹状体和眶额皮层的共同连接改变，这预测了整体疾病严重程度水平。这种共同改变独立于特定症状维度的影响。相反，我们观察到症状维度的严重程度与纹状体功能连接之间存在独特的解剖关系。攻击性症状调节了腹侧纹状体、杏仁核和腹内侧前额叶皮层之间的连接，而性/宗教症状对腹侧纹状体-岛叶连接有特定影响。囤积症调节了腹侧和背侧纹状体与分布在前额区域的连接强度。
总的来说，这些结果表明，眶额-纹状体区域的病理生理变化可能与 OCD 的所有形式都有关。它们表明，进一步研究某些维度关系也将有助于推进该疾病的当前神经生物学模型。
