Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
Curr Top Behav Neurosci. 2021;49:125-145. doi: 10.1007/7854_2020_198.
Cognitive inflexibility is suggested by the hallmark symptoms of obsessive-compulsive disorder (OCD), namely the occurrence of repetitive thoughts and/or behaviours that persist despite being functionally impairing and egodystonic to the individual. As well as being implied by the top-level symptoms, cognitive inflexibility in OCD, and some related conditions, has also been objectively quantified in case-control studies using computerised cognitive tasks. This chapter begins by considering the objective measurement of different aspects of cognitive flexibility using neuropsychological paradigms, with a focus on neural and neurochemical substrates. It moves on to conduct a systematic review and meta-analysis of findings from a widely deployed flexibility task: the Intra-Dimensional/Extra-Dimensional Set-Shift Task (IDED). By pooling data from 11 studies (335 OCD patients and 311 controls), we show that Extra-Dimensional (ED) shift deficits are a robust and reproducible finding (effect size medium-large) in OCD across the literature, and that this deficit is not attributable to group differences in age or IQ. The OCD ED deficit is then discussed in terms of dysfunction of fronto-striatal pathways (as exemplified, for example, by functional connectivity data), and the putative role of different neurotransmitters. We consider evidence that impaired ED shifting constitutes a candidate vulnerability marker (or 'endophenotype') for OCD. The available literature is then surveyed as to ED findings in other obsessive-compulsive (OC) related disorders (e.g. hoarding, body-dysmorphic disorder, and trichotillomania), as well as in non-OC disorders (schizophrenia and anxiety symptoms in general). Lastly, we consider more recent, emerging developments in the quantification of compulsivity using cognitive tasks and questionnaires, as well as key directions for future research, including the need to refine compulsivity and its composite cognitive processes.
认知灵活性受到强迫症（OCD）标志性症状的暗示，即反复出现的想法和/或行为的发生，尽管这些想法和行为对个体具有功能损害和自我失调，但仍持续存在。除了由顶级症状暗示之外，OCD 和一些相关疾病中的认知灵活性也在病例对照研究中使用计算机认知任务进行了客观量化。本章首先考虑使用神经心理学范式客观测量认知灵活性的不同方面，重点是神经和神经化学基础。然后，它对广泛部署的灵活性任务——内-外维度集转移任务（IDED）的研究结果进行了系统回顾和荟萃分析。通过汇总来自 11 项研究的数据（335 名 OCD 患者和 311 名对照组），我们表明，ED 转换缺陷是 OCD 文献中一种稳健且可重复的发现（中等至较大效应量），并且该缺陷不是由于组间年龄或智商的差异所致。然后，根据前额叶-纹状体通路的功能障碍（例如，通过功能连接数据示例），以及不同神经递质的潜在作用，讨论了 OCD 的 ED 缺陷。考虑到受损的 ED 转换构成 OCD 的候选脆弱性标志物（或“内表型”）的证据。然后调查了其他强迫症（OC）相关疾病（例如囤积症、躯体变形障碍和拔毛癖）以及非 OC 疾病（例如精神分裂症和一般焦虑症状）中的 ED 发现。最后，我们考虑了使用认知任务和问卷对强迫性进行量化的最新、新兴发展，以及未来研究的关键方向，包括需要细化强迫性及其复合认知过程。
