Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020, Salzburg, Austria.
Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria.
BMC Psychiatry. 2020 Nov 25;20(1):559. doi: 10.1186/s12888-020-02913-5.
While considerable progress has been made in exploring the psychological, the neural, and the neurochemical dimensions of OCD separately, their interplay is still an open question, especially their changes during psychotherapy.
Seventeen patients were assessed at these three levels by psychological questionnaires, fMRI, and venipuncture before and after inpatient psychotherapy. Seventeen controls were scanned at comparable time intervals. First, pre/post treatment changes were investigated for all three levels separately: symptom severity, whole-brain and regional activity, and the concentrations of cortisol, serotonin, dopamine, brain-derived neurotrophic factor (BDNF), and immunological parameters (IL-6, IL-10, TNFα). Second, stepwise linear modeling was used to find relations between the variables of the levels.
The obsessive-compulsive, depressive, and overall symptom severity was significantly reduced after psychotherapy. At the neural level, the activity in the anterior cingulate cortex (ACC), in frontal regions, in the precuneus, and in the putamen had significantly decreased. No significant changes were found on the neurochemical level. When connecting the levels, a highly significant model was found that explains the decrease in neural activity of the putamen by increases of the concentrations of cortisol, IL-6, and dopamine.
Multivariate approaches offer insight on the influences that the different levels of the psychiatric disorder OCD have on each other. More research and adapted models are needed.
尽管在分别探索强迫症的心理、神经和神经化学维度方面已经取得了相当大的进展，但它们之间的相互作用仍然是一个悬而未决的问题，尤其是在心理治疗期间的变化。
17 名患者在入院心理治疗前后分别通过心理问卷、fMRI 和静脉穿刺评估这三个水平。17 名对照者在可比的时间间隔内进行扫描。首先，分别研究所有三个水平的治疗前后变化：症状严重程度、全脑和区域活动以及皮质醇、血清素、多巴胺、脑源性神经营养因子 (BDNF) 和免疫参数（IL-6、IL-10、TNFα）的浓度。其次，使用逐步线性建模来寻找各水平变量之间的关系。
强迫症、抑郁和整体症状严重程度在心理治疗后显著减轻。在神经水平，前扣带皮层 (ACC)、额叶、楔前叶和壳核的活动显著减少。神经化学水平未发现显著变化。当连接各水平时，发现了一个高度显著的模型，该模型解释了壳核神经活动的减少是由皮质醇、IL-6 和多巴胺浓度的增加引起的。
多变量方法提供了关于强迫症 OCD 的不同水平相互影响的见解。需要更多的研究和适应的模型。
