Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Bergen, Norway; Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands.
Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Anatomy and Neurosciences, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands; Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, De Boelelaan 1117, Amsterdam, The Netherlands.
Biol Psychiatry Cogn Neurosci Neuroimaging. 2021 Oct;6(10):973-982. doi: 10.1016/j.bpsc.2020.01.007. Epub 2020 Feb 6.
Exposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD), but it is unclear how symptom reduction is related to changes in the brain. We aimed to determine the effects of a 4-day concentrated exposure and response prevention program (Bergen 4-day treatment) on the static and dynamic functional connectome in patients with OCD.
Thirty-four patients with OCD (25 unmedicated) underwent resting-state functional magnetic resonance imaging the day before the Bergen 4-day treatment, and 28 (21 unmedicated) were rescanned after 1 week. Twenty-eight healthy control subjects were also scanned for baseline comparisons and 19 of them were rescanned after 1 week. Static and dynamic graph measures were quantified to determine network topology at the global, subnetwork, and regional levels (including efficiency, clustering, between-subnetwork connectivity, and node flexibility in module allegiance). The Yale-Brown Obsessive Compulsive Scale was used to measure symptom severity.
Twenty-four patients (86%) responded to treatment. We found significant group × time effects in frontoparietal-limbic connectivity (η = 0.19, p = .03) and flexibility of the right subgenual anterior cingulate cortex (η = 0.18, p = .03), where, in both cases, unmedicated patients showed significant decreases while healthy control subjects showed no significant changes. Healthy control subjects showed increases in global and subnetwork efficiency and clustering coefficient, particularly in the somatomotor subnetwork.
Concentrated exposure and response prevention in unmedicated patients with OCD leads to decreased connectivity between the frontoparietal and limbic subnetworks and less flexibility of the connectivity of the subgenual anterior cingulate cortex, suggesting a more independent and stable network topology. This may represent less limbic interference on cognitive control subnetworks after treatment.
暴露和反应预防是治疗强迫症（OCD）的有效方法，但目前尚不清楚症状的减轻与大脑的变化有何关系。我们旨在确定为期 4 天的集中暴露和反应预防方案（卑尔根 4 天治疗）对 OCD 患者静息态功能连接组的静态和动态功能的影响。
34 例强迫症患者（25 例未用药）在卑尔根 4 天治疗前一天进行静息态功能磁共振成像，28 例（21 例未用药）在治疗后 1 周进行复查。还对 28 名健康对照者进行了扫描以进行基线比较，其中 19 名在 1 周后进行了复查。为了确定全局、子网和区域水平的网络拓扑结构（包括效率、聚类、子网间连接性和模块内节点灵活性），量化了静态和动态图测量值。使用耶鲁-布朗强迫症量表（Yale-Brown Obsessive Compulsive Scale）来衡量症状严重程度。
24 例患者（86%）对治疗有反应。我们发现额叶顶叶-边缘连接（η=0.19，p=0.03）和右侧扣带回前皮质下亚区灵活性（η=0.18，p=0.03）的组间时间效应显著，在这两种情况下，未用药患者的下降幅度显著，而健康对照组无明显变化。健康对照组的全局和子网效率以及聚类系数增加，尤其是在躯体运动子网中。
未用药的强迫症患者集中暴露和反应预防导致额叶顶叶和边缘子网之间的连接减少，以及扣带回前皮质下亚区连接的灵活性降低，这表明网络拓扑结构更加独立和稳定。这可能代表治疗后边缘对认知控制子网的干扰减少。
