Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.
Psychophysiology. 2019 Apr;56(4):e13348. doi: 10.1111/psyp.13348.
Obsessive-compulsive disorder (OCD) is a complex and heterogeneous disorder that is associated with high personal and societal costs. Feelings of doubt, worry, and repetitive behavior, key symptoms of OCD, have been linked to hyperactive error signals in the brain. The error-related negativity (ERN) represents a validated marker of error processing in the ERP. Increased ERN amplitudes in OCD have been reported very robustly over the last 20 years. This article integrates results from 38 studies analyzing the ERN in OCD, using a quantitative meta-analysis. Meta-regressions were used to examine potential moderators such as task type, symptom severity, age, and sample size. The meta-analysis reveals a robust increase of ERN in OCD patients compared to healthy participants in response-conflict tasks (SMD -0.55) that is not modulated by symptom severity and age. No increase in ERN in OCD was observed in tasks that do not induce response conflict (SMD -0.10). In addition to the meta-analysis, the current article reviews evidence supporting that increased ERN amplitudes in OCD fulfill central criteria for an endophenotype. Further, the specificity of increased ERN amplitudes for OCD and its suitability as a potential transdiagnostic endophenotype is discussed. Finally, the clinical utility and clinical applications are examined. Overall, the evidence that increased ERN amplitudes represent a promising endophenotype indicating vulnerability for OCD is compelling. Furthermore, alterations in ERN are not limited to OCD and may constitute a transdiagnostic endophenotype. Altered neural error signals might serve as a diagnostic or predictive marker and represent a promising target for interventions.
强迫症（OCD）是一种复杂且异质的障碍，与个人和社会的高成本相关。强迫症的主要症状包括疑虑、担忧和重复行为，这些症状与大脑中过度活跃的错误信号有关。错误相关负波（ERN）代表了事件相关电位（ERP）中错误处理的有效标志物。在过去的 20 年中，研究报告非常一致地显示强迫症患者的 ERN 振幅增加。本文整合了 38 项分析强迫症 ERN 的研究结果，使用了定量元分析。元回归用于检验潜在的调节因素，如任务类型、症状严重程度、年龄和样本量。元分析显示，与健康对照组相比，强迫症患者在反应冲突任务中ERN 振幅显著增加（SMD-0.55），而症状严重程度和年龄对其没有调节作用。在不引起反应冲突的任务中，未观察到强迫症患者 ERN 的增加（SMD-0.10）。除了元分析，本文还综述了支持强迫症患者 ERN 振幅增加符合内表型中心标准的证据。此外，还讨论了 ERN 振幅增加对强迫症的特异性及其作为潜在的跨诊断内表型的适用性。最后，还考察了其临床实用性和应用。总体而言，证据表明 ERN 振幅增加代表了 OCD 易感性的有前途的内表型。此外，ERN 的改变不仅限于 OCD，可能构成跨诊断内表型。改变的神经错误信号可能作为诊断或预测标志物，并代表有前途的干预靶点。
