Gonçalves Óscar F, Carvalho Sandra, Leite Jorge, Fernandes-Gonçalves Ana, Carracedo Angel, Sampaio Adriana
Neuropsychophysiology Lab, CIPsi, School of Psychology, University of Minho, Braga, Portugal.
Spaulding Center of Neuromodulation, Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Porto Biomed J. 2016 Jul-Aug;1(3):92-105. doi: 10.1016/j.pbj.2016.07.005. Epub 2016 Jul 1.
There is a common agreement on the existence of dysfunctional cortico-striatal-thalamus-cortical pathways in OCD. Despite this consensus, recent studies showed that brain regions other than the CSTC loops are needed to understand the complexity and diversity of cognitive and emotional deficits in OCD. This review presents examples of research using functional neuroimaging, reporting abnormal brain processes in OCD that may underlie specific cognitive/executive (inhibitory control, cognitive flexibility, working memory), and emotional impairments (fear/defensive, disgust, guilt, shame). Studies during resting state conditions show that OCD patients have alterations in connectivity not only within the CSTC pathways but also in more extended resting state networks, particularly the default mode network and the fronto-parietal network. Additionally, abnormalities in brain functioning have been found in several cognitive and emotionally task conditions, namely: inhibitory control (e.g., CSTC loops, fronto-parietal networks, anterior cingulate); cognitive flexibility (e.g., CSTC loops, extended temporal, parietal, and occipital regions); working memory (e.g., CSTC loops, frontal parietal networks, dorsal anterior cingulate); fear/defensive (e.g., amygdala, additional brain regions associated with perceptual - parietal, occipital - and higher level cognitive processing - prefrontal, temporal); disgust (e.g., insula); shame (e.g., decrease activity in middle frontal gyrus and increase in frontal, limbic, temporal regions); and guilt (e.g., decrease activity anterior cingulate and increase in frontal, limbic, temporal regions). These findings may contribute to the understanding of OCD as both an emotional (i.e., anxiety) and cognitive (i.e., executive control) disorder.
关于强迫症中存在功能失调的皮质-纹状体-丘脑-皮质通路这一点，人们已达成普遍共识。尽管有这一共识，但最近的研究表明，要理解强迫症认知和情绪缺陷的复杂性与多样性，除了皮质-纹状体-丘脑-皮质环路之外，还需要考虑其他脑区。本综述展示了一些使用功能神经影像学的研究实例，报告了强迫症中可能是特定认知/执行功能（抑制控制、认知灵活性、工作记忆）和情绪障碍（恐惧/防御、厌恶、内疚、羞耻）基础的异常脑过程。静息状态下的研究表明，强迫症患者不仅在皮质-纹状体-丘脑-皮质通路内的连接性存在改变，而且在更广泛的静息状态网络中也有改变，特别是默认模式网络和额顶网络。此外，在几种认知和情绪任务条件下也发现了脑功能异常，具体如下：抑制控制（例如，皮质-纹状体-丘脑-皮质环路、额顶网络、前扣带回）；认知灵活性（例如，皮质-纹状体-丘脑-皮质环路、颞叶、顶叶和枕叶的扩展区域）；工作记忆（例如，皮质-纹状体-丘脑-皮质环路、额顶网络、背侧前扣带回）；恐惧/防御（例如，杏仁核、与感知相关的其他脑区 - 顶叶、枕叶 - 以及与高级认知处理相关的脑区 - 前额叶、颞叶）；厌恶（例如，脑岛）；羞耻（例如，额中回活动减少，额叶、边缘叶、颞叶区域活动增加）；以及内疚（例如，前扣带回活动减少，额叶、边缘叶、颞叶区域活动增加）。这些发现可能有助于将强迫症理解为一种兼具情绪（即焦虑）和认知（即执行控制）的障碍。
