Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Brain Imaging Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Sci Rep. 2017 Dec 12;7(1):17464. doi: 10.1038/s41598-017-17593-7.
Neurobiological models of obsessive-compulsive disorder (OCD) posit that its clinical symptoms such as repetitive thoughts and behaviors are related to hyperactivity in the cortico-striato-thalamo-cortical (CSTC) circuit. Small scale neuroimaging studies have shown that treatment of OCD is associated with reduced activity across different brain structures within this circuitry. We performed the first meta-analysis of positron emission tomography (PET) and single photon emission computed tomography (SPECT) studies that investigated cerebral blood flow or glucose metabolism in patients with OCD before and after pharmacological or psychological treatment. We calculated standardized mean differences for the regions-of-interest most often reported. The meta-analysis revealed small reductions in activity in the caudate nucleus and orbitofrontal cortex after treatment with a serotonin reuptake inhibitor or cognitive behavioral therapy. Small reductions were also observed in the thalamus when one SPECT study with a large opposite effect was excluded from the analysis. Meta-regression analyses for the caudate nucleus showed no significant effect of the type of treatment, decrease in symptom severity, mean duration until the follow-up scan, or year of publication. These results show that pharmacological and psychological treatments reduce resting CSTC circuit activity, and provide further support for the CSTC circuit model in OCD.
神经生物学模型假设强迫症（OCD）的临床症状，如重复的想法和行为，与皮质纹状体丘脑皮质（CSTC）回路的过度活跃有关。小规模的神经影像学研究表明，强迫症的治疗与该回路中不同脑结构的活动减少有关。我们对强迫症患者在药物或心理治疗前后进行正电子发射断层扫描（PET）和单光子发射计算机断层扫描（SPECT）研究的大脑血流或葡萄糖代谢进行了首次荟萃分析。我们计算了最常报告的感兴趣区域的标准化均数差。荟萃分析显示，在使用 5-羟色胺再摄取抑制剂或认知行为疗法治疗后，尾状核和眶额皮层的活动减少。当排除一项具有相反大效应的 SPECT 研究后，丘脑也观察到了较小的减少。尾状核的荟萃回归分析显示，治疗类型、症状严重程度的降低、直到随访扫描的平均持续时间或出版年份均无显著影响。这些结果表明，药物和心理治疗可降低静息 CSTC 回路的活动，为 OCD 中的 CSTC 回路模型提供了进一步支持。
