Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway.
Obsessive-Compulsive Disorder (OCD) team, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2018 Jun;3(6):563-571. doi: 10.1016/j.bpsc.2018.01.009. Epub 2018 Feb 3.
Patients with obsessive-compulsive disorder (OCD) experience aversive emotions in response to obsessions, motivating avoidance and compulsive behaviors. However, there is considerable ambiguity regarding the brain circuitry involved in emotional processing in OCD, especially whether activation is altered in the amygdala.
We conducted a systematic literature review and performed a meta-analysis-seed-based d mapping-of 25 whole-brain neuroimaging studies (including 571 patients and 564 healthy control subjects) using functional magnetic resonance imaging or positron emission tomography, comparing brain activation of patients with OCD and healthy control subjects during presentation of emotionally valenced versus neutral stimuli. Meta-regressions were employed to investigate possible moderators.
Patients with OCD, compared with healthy control subjects, showed increased activation in the bilateral amygdala, right putamen, orbitofrontal cortex extending into the anterior cingulate and ventromedial prefrontal cortex, and middle temporal and left inferior occipital cortices during emotional processing. Right amygdala hyperactivation was most pronounced in unmedicated patients. Symptom severity was related to increased activation in the orbitofrontal and anterior cingulate cortices and precuneus. Greater comorbidity with mood and anxiety disorders was associated with higher activation in the right amygdala, putamen, and insula as well as with lower activation in the left amygdala and right ventromedial prefrontal cortex.
Patients with OCD show increased emotional processing-related activation in limbic, frontal, and temporal regions. Previous mixed evidence regarding the role of the amygdala in OCD has likely been influenced by patient characteristics (such as medication status) and low statistical power.
强迫症（OCD）患者会对强迫观念产生厌恶情绪，从而促使他们回避和进行强迫行为。然而，目前对于 OCD 患者情绪处理相关的大脑回路仍存在较大争议，尤其是杏仁核的激活情况是否改变。
我们进行了系统性文献回顾，并使用功能磁共振成像或正电子发射断层扫描，对 25 项全脑神经影像学研究（包括 571 名患者和 564 名健康对照者）进行了基于种子的荟萃分析，比较了 OCD 患者和健康对照者在呈现情绪效价与中性刺激时的大脑激活情况。采用元回归分析来探讨可能的调节因素。
与健康对照组相比，强迫症患者在情绪处理过程中双侧杏仁核、右侧壳核、眶额皮质（延伸至前扣带回和腹内侧前额叶皮质）以及中颞叶和左侧枕下回皮质的激活增加。未用药患者的右侧杏仁核激活最为明显。症状严重程度与眶额皮质和前扣带回以及楔前叶的激活增加有关。与心境障碍和焦虑障碍的共病更多与右侧杏仁核、壳核和岛叶的更高激活以及左侧杏仁核和右侧腹内侧前额叶皮质的更低激活有关。
强迫症患者在边缘、额叶和颞叶区域的情绪处理相关激活增加。之前关于杏仁核在 OCD 中的作用的混合证据可能受到患者特征（如用药情况）和低统计效能的影响。
