Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience, Los Angeles, CA, USA.
UCLA Department of Radiological Sciences, UCLA Medical Center, Los Angeles, CA, USA.
Neuropsychopharmacology. 2017 Nov;42(12):2414-2422. doi: 10.1038/npp.2017.77. Epub 2017 Apr 4.
Cognitive-behavioral therapy (CBT) is effective for pediatric obsessive-compulsive disorder (OCD), but non-response is common. Brain glutamate (Glu) signaling may contribute to OCD pathophysiology and moderate CBT outcomes. We assessed whether Glu measured with magnetic resonance spectroscopy (MRS) was associated with OCD and/or CBT response. Youths aged 7-17 years with DSM-IV OCD and typically developing controls underwent 3 T proton echo-planar spectroscopic imaging (PEPSI) MRS scans of pregenual anterior cingulate cortex (pACC) and ventral posterior cingulate cortex (vPCC)-regions possibly affected by OCD-at baseline. Controls returned for re-scan after 8 weeks. OCD youth-in a randomized rater-blinded trial-were re-scanned after 12-14 weeks of CBT or after 8 weeks of minimal-contact waitlist; waitlist participants underwent a third scan after crossover to 12-14 weeks of CBT. Forty-nine children with OCD (mean age 12.2±2.9 years) and 29 controls (13.2±2.2 years) provided at least one MRS scan. At baseline, Glu did not differ significantly between OCD and controls in pACC or vPCC. Within controls, Glu was stable from scan-to-scan. Within OCD subjects, a treatment-by-scan interaction (p=0.034) was observed, driven by pACC Glu dropping 19.5% from scan-to-scan for patients randomized to CBT, with minor increases (3.8%) for waitlist participants. The combined OCD participants (CBT-only plus waitlist-CBT) also showed a 16.2% (p=0.004) post-CBT decrease in pACC Glu. In the combined OCD group, within vPCC, lower pre-CBT Glu predicted greater post-CBT improvement in symptoms (CY-BOCS; r=0.81, p=0.00025). Glu may be involved in the pathophysiology of OCD and may moderate response to CBT.
认知行为疗法（CBT）对儿童强迫症（OCD）有效，但非应答很常见。大脑谷氨酸（Glu）信号可能与 OCD 病理生理学和 CBT 结果有关。我们评估了磁共振波谱（MRS）测量的 Glu 是否与 OCD 和/或 CBT 反应有关。年龄在 7-17 岁之间的 DSM-IV 强迫症和正常发育对照者在基线时接受了质子回波平面光谱成像（PEPSI）MRS 扫描，扫描部位为额前扣带回皮质（pACC）和腹后扣带回皮质（vPCC）-可能受 OCD 影响的区域。对照组在 8 周后返回进行重新扫描。在一项随机评分者盲法试验中，OCD 青少年在接受 12-14 周 CBT 或 8 周最低限度接触候补名单后进行重新扫描；候补名单参与者在交叉到 12-14 周 CBT 后进行第三次扫描。49 名 OCD 儿童（平均年龄 12.2±2.9 岁）和 29 名对照者（13.2±2.2 岁）至少提供了一次 MRS 扫描。在基线时，OCD 组和对照组在 pACC 或 vPCC 中的 Glu 没有显著差异。在对照组中，Glu 从一次扫描到另一次扫描都很稳定。在 OCD 患者中，观察到治疗与扫描的相互作用（p=0.034），这是由接受 CBT 治疗的患者的 pACC Glu 从扫描到扫描降低 19.5%驱动的，候补名单参与者的 Glu 略有增加（3.8%）。合并的 OCD 参与者（仅 CBT 加候补名单-CBT）也显示 pACC Glu 在 CBT 后降低了 16.2%（p=0.004）。在合并的 OCD 组中，在 vPCC 中，较低的预 CBT Glu 预测了 CY-BOCS 症状（强迫症耶鲁布朗症状量表）的更大的 CBT 后改善（r=0.81，p=0.00025）。Glu 可能参与 OCD 的病理生理学，并可能调节 CBT 的反应。
