Departamento de Psiquiatria, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil.
Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK.
Braz J Psychiatry. 2022 Mar-Abr;44(2):187-200. doi: 10.1590/1516-4446-2020-1709.
Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.
强迫症（OCD）是一种常见的精神疾病，其特征通常为强迫观念（反复出现、侵入性和不必要的想法）和强迫行为（过度、重复和仪式化的行为或思维）。OCD 在临床表现上存在异质性，并非所有患者对一线治疗都有反应。已经提出了几种 OCD 的神经回路模型，旨在更好地理解该疾病涉及的神经和认知机制。这些模型利用神经科学的进展以及神经心理学和神经影像学研究的结果，提出了反映患者症状和体验的临床特征与特定神经回路功能障碍之间的联系。一些模型提出，如果针对特定的神经回路功能障碍进行治疗，OCD 的治疗方法可能会得到改善，从而恢复有效的神经认知功能，并改善每个相关临床特征的症状。然而，OCD 的神经回路模型存在几个重要的局限性。本综述的目的是强调其中的一些局限性，包括与大脑和认知功能的复杂性、OCD 的临床表现和病程、病因因素以及模型提出的治疗方法有关的问题。我们还为推进 OCD 的神经回路模型并促进其向临床应用的转化提供了未来研究的建议。
