Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States.
Division of Adult Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, United States.
Psychiatry Res Neuroimaging. 2016 Aug 30;254:34-40. doi: 10.1016/j.pscychresns.2016.05.005. Epub 2016 May 24.
Focal brain metabolic effects detected by proton magnetic resonance spectroscopy (MRS) in obsessive-compulsive disorder (OCD) represent prospective indices of clinical status and guides to treatment design. Sampling bilateral pregenual anterior cingulate cortex (pACC), anterior middle cingulate cortex (aMCC), and thalamus in 40 adult patients and 16 healthy controls, we examined relationships of the neurometabolites glutamate+glutamine (Glx), creatine+phosphocreatine (Cr), and choline-compounds (Cho) with OCD diagnosis and multiple symptom types. The latter included OC core symptoms (Yale-Brown Obsessive-Compulsive Scale - YBOCS), depressive symptoms (Montgomery-Åsberg Depression Rating Scale - MADRS), and general functioning (Global Assessment Scale - GAS). pACC Glx was 9.7% higher in patients than controls. Within patients, Cr and Cho correlated negatively with YBOCS and MADRS, while Cr correlated positively with the GAS. In aMCC, Cr and Cho correlated negatively with MADRS, while Cr in thalamus correlated positively with GAS. These findings present moderate support for glutamatergic and cingulocentric perspectives on OCD. Based on our prior metabolic model of OCD, we offer one possible interpretation of these group and correlational effects as consequences of a corticothalamic state of elevated glutamatergic receptor activity alongside below-normal glutamatergic transporter activity.
质子磁共振波谱（MRS）检测到的强迫症（OCD）患者大脑局部代谢效应，代表了临床状态的前瞻性指标，并为治疗方案设计提供了指导。我们对 40 名成年患者和 16 名健康对照者的双侧额极前扣带回皮质（pACC）、前中扣带回皮质（aMCC）和丘脑进行了采样，研究了神经代谢物谷氨酸+谷氨酰胺（Glx）、肌酸+磷酸肌酸（Cr）和胆碱化合物（Cho）与 OCD 诊断和多种症状类型的关系。后者包括 OC 核心症状（耶鲁-布朗强迫量表 - YBOCS）、抑郁症状（蒙哥马利-阿斯伯格抑郁评定量表 - MADRS）和一般功能（总体评估量表 - GAS）。与对照组相比，患者的 pACC Glx 高 9.7%。在患者中，Cr 和 Cho 与 YBOCS 和 MADRS 呈负相关，而 Cr 与 GAS 呈正相关。在 aMCC 中，Cr 和 Cho 与 MADRS 呈负相关，而丘脑的 Cr 与 GAS 呈正相关。这些发现为 OCD 的谷氨酸能和扣带中心观点提供了中等程度的支持。基于我们之前的 OCD 代谢模型，我们对这些组间和相关效应提供了一种可能的解释，即皮质丘脑状态下谷氨酸能受体活性升高，同时谷氨酸能转运体活性降低。
