From the Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea (T. Kim, Kwak, Kwon); Department of Psychology, Korea University, Seoul, Republic of Korea (Hur); Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea (J. Lee, T.Y. Lee, M. Kim, Kwon); Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea (Shin, T.Y. Lee, Kwon); and Department of Neuropsychiatry, Seoul National University Hospital, Republic of Korea (M. Kim).
J Psychiatry Neurosci. 2020 Jul 1;45(4):234-242. doi: 10.1503/jpn.190028.
Using biological evidence to define subtypes within the heterogeneous population with obsessive–compulsive disorder (OCD) is important for improving treatment response. Based on age at onset, OCD can be clustered into 2 groups, each of which is more homogeneous with respect to clinical and cognitive phenotype. However, the neural bases for these phenotypic differences need to be established to construct evidence-based homogeneous groups.
We compared brain volumes, clinical symptoms, and neurocognitive function for 49 people with early-onset OCD and 52 with late-onset OCD (participants in both groups were unmedicated or drug-naïve), and 103 healthy controls. We performed regression analyses to examine group × volume interaction effects on clinical outcomes or neurocognitive function in people with OCD.
We observed larger volumes in the precentral, orbitofrontal, middle frontal, and middle temporal gyri in people with early-onset OCD compared to those with late-onset OCD. Poorer visuospatial construction in early-onset OCD was correlated with a larger left middle frontal gyrus volume. Impaired visuospatial memory in people with early-onset OCD and cognitive inflexibility in people with late-onset OCD were correlated with increased and decreased volume in the left middle frontal gyrus, respectively. We found group × volume interactions for obsessive–compulsive symptom scores in the left middle temporal gyrus of people with OCD.
Although we divided the subtypes using the commonly adopted criterion of age at onset, this criterion is still somewhat controversial.
We provided the neural bases for clinical and neurocognitive differences to demonstrate that biological evidence underlies the distinctions between early- and late-onset OCD. This study suggests that different treatment options should be considered for the OCD subtypes, because their neurobiology differs and is related to distinct phenotypic profiles.
在强迫症（OCD）异质人群中，使用生物学证据来定义亚型对于提高治疗反应很重要。根据发病年龄，OCD 可分为 2 组，每组在临床和认知表型方面更为同质。然而，需要确定这些表型差异的神经基础，以构建基于证据的同质组。
我们比较了 49 例早发性 OCD 患者和 52 例晚发性 OCD 患者（两组患者均未服用药物或药物-naive）与 103 名健康对照者的脑体积、临床症状和神经认知功能。我们进行了回归分析，以检查 OCD 患者的组×体积相互作用对临床结果或神经认知功能的影响。
我们观察到早发性 OCD 患者的中央前回、眶额回、额中回和颞中回体积较大，与晚发性 OCD 患者相比。早发性 OCD 患者的视觉空间构建能力较差，与左额中回体积较大有关。早发性 OCD 患者的视觉空间记忆受损和晚发性 OCD 患者的认知灵活性受损与左额中回的体积增加和减少分别相关。我们发现 OCD 患者左颞中回的强迫症状评分存在组×体积的相互作用。
尽管我们使用发病年龄的常用标准来划分亚型，但该标准仍存在一定争议。
我们提供了临床和神经认知差异的神经基础，证明了早发性和晚发性 OCD 之间的区别存在生物学证据。这项研究表明，应该考虑 OCD 亚型的不同治疗选择，因为它们的神经生物学不同，与不同的表型特征相关。
