Zhang Chencheng, Chen Yilin, Tian Shuaiwei, Wang Tao, Xie Yile, Jin Haiyan, Lin Guozhen, Gong Hengfen, Zeljic Kristina, Sun Bomin, Yang Tianming, Zhan Shikun
Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Institute of Neuroscience, Key Laboratory of Primate Neurobiology, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Shanghai, China.
Front Psychol. 2017 Oct 17;8:1814. doi: 10.3389/fpsyg.2017.01814. eCollection 2017.
Despite various lines of evidence implicating impaired decision-making ability in individuals with obsessive-compulsive disorder (OCD), neuropsychological investigation has generated inconsistent findings. Although the cortico-striato-thalamo-cortical (CSTC) circuitry has been suggested, the involvement of the cortex has not yet been fully demonstrated. Moreover, it is unknown whether surgical intervention on the CSTC circuitry results in a predicted improvement of decision-making ability of OCD. Here we present a study of decision making based on the Iowa Gambling Task (IGT) to investigate decision making in a large sample of individuals with treatment-resistant OCD with and without anterior capsulotomy (AC). Task performance was evaluated in healthy subjects, individuals with OCD that had not undergone surgery, and postsurgical OCD patients with AC. The latter group was further divided into a short-term postsurgical group and a long-term postsurgical group. We found that the OCD patients without surgery performed significantly worse than the healthy controls on the IGT. There were no significant differences in decision-making between the presurgical OCD patients and those at the short-term postsurgical follow-up. Decision-making ability of the long-term postsurgical OCD patients was improved to the level comparable to that of healthy controls. All clinical symptoms (OCD, depression, and anxiety) assessed by psychiatric rating scales were significantly alleviated post-surgically, but exhibited no correlation with their IGT task performance. Our findings provide strong evidence that OCD is linked to impairments in decision-making ability; that impaired CSTC circuitry function is directly involved in the manifestation of OCD; and that AC related improvements in cognitive functions are caused by long-term plasticity in the brain circuitry.
尽管有各种证据表明强迫症（OCD）患者存在决策能力受损的情况，但神经心理学调查结果并不一致。虽然有人提出皮质-纹状体-丘脑-皮质（CSTC）回路与该病有关，但皮质的参与尚未得到充分证实。此外，对CSTC回路进行手术干预是否能改善OCD患者的决策能力也尚不清楚。在此，我们基于爱荷华赌博任务（IGT）开展了一项决策研究，以调查大量难治性OCD患者在接受和未接受前扣带回切开术（AC）时的决策情况。我们评估了健康受试者、未接受手术的OCD患者以及接受AC手术的OCD术后患者的任务表现。后者又进一步分为术后短期组和术后长期组。我们发现，未接受手术的OCD患者在IGT任务中的表现明显比健康对照组差。术前OCD患者与术后短期随访患者在决策方面没有显著差异。术后长期OCD患者的决策能力提高到了与健康对照组相当的水平。通过精神科评定量表评估的所有临床症状（OCD、抑郁和焦虑）在术后均得到显著缓解，但与他们的IGT任务表现无关。我们的研究结果提供了强有力的证据，表明OCD与决策能力受损有关；CSTC回路功能受损直接参与了OCD的表现；以及与AC相关的认知功能改善是由大脑回路的长期可塑性引起的。
