The Second Hospital of Xinxiang Medical University, Xinxiang Medical University, Xinxiang City, Henan Province, PR China.
School of Medical Engineering, Xinxiang Medical University, Xinxiang, Henan Province, PR China.
Mol Psychiatry. 2021 Nov;26(11):6952-6962. doi: 10.1038/s41380-021-01131-z. Epub 2021 May 7.
It is of great clinical importance to explore more efficacious treatments for OCD. Recently, cognitive-coping therapy (CCT), mainly focusing on recognizing and coping with a fear of negative events, has been reported as an efficacious psychotherapy. However, the underlying neurophysiological mechanism remains unknown. This study of 79 OCD patients collected Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and resting-state functional magnetic resonance imaging (rs-fMRI) scans before and after four weeks of CCT, pharmacotherapy plus CCT (pCCT), or pharmacotherapy. Amygdala seed-based functional connectivity (FC) analysis was performed. Compared post- to pretreatment, pCCT-treated patients showed decreased left amygdala (LA) FC with the right anterior cingulate gyrus (cluster 1) and with the left paracentral lobule/the parietal lobe (cluster 2), while CCT-treated patients showed decreased LA-FC with the left middle occipital gyrus/the left superior parietal/left inferior parietal (cluster 3). The z-values of LA-FC with the three clusters were significantly lower after pCCT or CCT than pretreatment in comparisons of covert vs. overt and of non-remission vs. remission patients, except the z-value of cluster 2 in covert OCD. CCT and pCCT significantly reduced the Y-BOCS score. The reduction in the Y-BOCS score was positively correlated with the z-value of cluster 1. Our findings demonstrate that both pCCT and CCT with large effect sizes lowered LA-FC, indicating that FCs were involved in OCD. Additionally, decreased LA-FC with the anterior cingulate cortex (ACC) or paracentral/parietal cortex may be a marker for pCCT response or a marker for distinguishing OCD subtypes. Decreased LA-FC with the parietal region may be a common pathway of pCCT and CCT. Trial registration: ChiCTR-IPC-15005969.
探索更有效的强迫症治疗方法具有重要的临床意义。最近，认知应对疗法（CCT）主要侧重于识别和应对对负面事件的恐惧，已被报道为一种有效的心理治疗方法。然而，其潜在的神经生理机制尚不清楚。这项针对 79 名强迫症患者的研究在接受 4 周的 CCT、药物治疗加 CCT（pCCT）或药物治疗前后采集了耶鲁-布朗强迫症量表（Y-BOCS）和静息态功能磁共振成像（rs-fMRI）扫描数据。进行了杏仁核种子的功能连接（FC）分析。与治疗前相比，pCCT 治疗组患者的左杏仁核（LA）与右侧前扣带回（簇 1）和左侧旁中央小叶/顶叶（簇 2）的 FC 降低，而 CCT 治疗组患者的 LA 与左侧中枕叶/左侧顶上回/左侧顶下回（簇 3）的 FC 降低。与治疗前相比，在隐匿性与显性强迫症患者、缓解与未缓解患者的比较中，pCCT 或 CCT 后 LA 与三个簇的 FC 的 z 值在治疗后均显著降低，除了隐匿性强迫症患者的簇 2 的 z 值。CCT 和 pCCT 显著降低了 Y-BOCS 评分。Y-BOCS 评分的降低与簇 1 的 z 值呈正相关。我们的研究结果表明，pCCT 和 CCT 均显著降低了 LA-FC，表明 FCs 参与了强迫症。此外，LA 与前扣带皮层（ACC）或旁中央/顶叶皮层的 FC 降低可能是 pCCT 反应的标志物或区分强迫症亚型的标志物。LA 与顶叶区域的 FC 降低可能是 pCCT 和 CCT 的共同途径。试验注册：ChiCTR-IPC-15005969。
