Department of Neuropsychiatry, Hyogo College of Medicine, Nishinomiya, Japan.
Faculty of Education, Mie University, Tsu, Japan.
Psychiatry Clin Neurosci. 2021 Jun;75(6):191-199. doi: 10.1111/pcn.13207. Epub 2021 Mar 24.
A tic-related specifier is included in the DSM-5 diagnostic criteria to identify a clinically specific obsessive-compulsive disorder (OCD) subtype. The current study sought to evaluate hemodynamic changes during executive function tasks among OCD patients with and without a lifetime history of tic disorder (TD) and healthy controls, and to investigate the relation between brain activation and clinical variables in each group using structured equation modeling.
Twenty-nine OCD patients diagnosed according to the DSM-IV-TR and 15 healthy controls were recruited. Patients were divided into two groups according to the presence or absence of a lifetime history of TD (TD+, n = 11; TD-, n = 18). Prefrontal hemodynamic changes were measured using multi-channel near-infrared spectroscopy during the Verbal Fluency Task, Trail-Making Task, and Tower of London (ToL) Task.
There were significant brain activation differences in the frontopolar cortex between OCD patients with and without TD during Verbal Fluency Task and ToL performance. Brain activation in the dorsolateral prefrontal cortex (DLPFC) during the ToL Task in OCD patients with TD exerted a direct causal effect on the severity of compulsions. In addition, we detected a direct causal effect of the severity of obsessions in OCD patients without TD on brain activation in the DLPFC during the ToL Task.
Brain activation in the frontopolar cortex exhibits different hemodynamics depending on the task, and DLPFC function may play a different role in the neural basis of developing OCD symptoms between OCD patients with and without TD.
DSM-5 诊断标准中包含了与抽搐相关的特定说明,以确定一种具有临床特异性的强迫症(OCD)亚型。本研究旨在评估 OCD 患者是否存在抽动障碍(TD)的终生病史,并与健康对照组相比,在执行功能任务期间的血液动力学变化,并使用结构方程模型研究每组大脑激活与临床变量之间的关系。
根据 DSM-IV-TR 标准诊断为 OCD 的 29 名患者和 15 名健康对照组被招募。根据是否存在 TD 的终生病史(TD+,n=11;TD-,n=18),将患者分为两组。在言语流畅性任务、T 型迷宫任务和伦敦塔任务期间,使用多通道近红外光谱测量前额叶血液动力学变化。
在言语流畅性任务和伦敦塔任务中,OCD 患者中有 TD 与无 TD 之间的额极皮层存在明显的大脑激活差异。TD 患者在伦敦塔任务中的背外侧前额叶皮层(DLPFC)的大脑激活对强迫症状的严重程度具有直接的因果影响。此外,我们还检测到无 TD 的 OCD 患者的强迫观念严重程度对伦敦塔任务中 DLPFC 大脑激活的直接因果影响。
额极皮层的大脑激活表现出不同的血液动力学,DLPFC 功能可能在 TD 患者和无 TD 的 OCD 患者的 OCD 症状发展的神经基础中发挥不同的作用。