Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan; Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, Michigan.
Biol Psychiatry. 2019 May 1;85(9):713-725. doi: 10.1016/j.biopsych.2018.11.010. Epub 2018 Nov 29.
Error processing and inhibitory control enable the adjustment of behaviors to meet task demands. Functional magnetic resonance imaging studies report brain activation abnormalities in patients with obsessive-compulsive disorder (OCD) during both processes. However, conclusions are limited by inconsistencies in the literature and small sample sizes. Therefore, the aim here was to perform a meta-analysis of the existing literature using unthresholded statistical maps from previous studies.
A voxelwise seed-based d mapping meta-analysis was performed using t-maps from studies comparing patients with OCD and healthy control subjects (HCs) during error processing and inhibitory control. For the error processing analysis, 239 patients with OCD (120 male; 79 medicated) and 229 HCs (129 male) were included, while the inhibitory control analysis included 245 patients with OCD (120 male; 91 medicated) and 239 HCs (135 male).
Patients with OCD, relative to HCs, showed longer inhibitory control reaction time (standardized mean difference = 0.20, p = .03, 95% confidence interval = 0.016, 0.393) and more inhibitory control errors (standardized mean difference = 0.22, p = .02, 95% confidence interval = 0.039, 0.399). In the brain, patients showed hyperactivation in the bilateral dorsal anterior cingulate cortex, supplementary motor area, and pre-supplementary motor area as well as right anterior insula/frontal operculum and anterior lateral prefrontal cortex during error processing but showed hypoactivation during inhibitory control in the rostral and ventral anterior cingulate cortices and bilateral thalamus/caudate, as well as the right anterior insula/frontal operculum, supramarginal gyrus, and medial orbitofrontal cortex (all seed-based d mapping z value >2, p < .001).
A hyperactive error processing mechanism in conjunction with impairments in implementing inhibitory control may underlie deficits in stopping unwanted compulsive behaviors in the disorder.
错误处理和抑制控制使行为能够适应任务需求。功能磁共振成像研究报告称，强迫症（OCD）患者在这两个过程中都存在大脑激活异常。然而，由于文献中的不一致和样本量小，结论受到限制。因此，本研究旨在使用以前研究的无阈值统计图谱对现有文献进行荟萃分析。
使用比较强迫症患者和健康对照组（HCs）在错误处理和抑制控制期间的 t 映射，进行基于体素的种子 d 映射荟萃分析。在错误处理分析中，纳入了 239 名强迫症患者（120 名男性；79 名接受药物治疗）和 229 名 HCs（129 名男性），而在抑制控制分析中，纳入了 245 名强迫症患者（120 名男性；91 名接受药物治疗）和 239 名 HCs（135 名男性）。
与 HCs 相比，强迫症患者的抑制控制反应时间更长（标准化均数差=0.20，p=0.03，95%置信区间=0.016，0.393），抑制控制错误更多（标准化均数差=0.22，p=0.02，95%置信区间=0.039，0.399）。在大脑中，患者在错误处理过程中双侧背侧前扣带回皮质、辅助运动区和前辅助运动区以及右侧前岛叶/额下回和额前外侧皮质显示出过度激活，但在抑制控制过程中，在前扣带回皮质的头侧和腹侧以及双侧丘脑/尾状核，以及右侧前岛叶/额下回、缘上回和内侧眶额皮质显示出激活不足（所有基于种子的 d 映射 z 值>2，p<0.001）。
过度活跃的错误处理机制与抑制控制执行能力受损可能是该疾病中停止不必要强迫行为缺陷的基础。
