Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
School of Psychology and Cognitive Science, East China Normal University, Shanghai, China.
Compr Psychiatry. 2024 May;131:152462. doi: 10.1016/j.comppsych.2024.152462. Epub 2024 Feb 10.
Mindfulness-based cognitive therapy (MBCT) has been documented to be effective in treating obsessive-compulsive disorder (OCD). However, the neurobiological basis of MBCT remains largely elusive, which makes it clinically challenging to predict which patients are more likely to respond poorly. Hence, identifying biomarkers for predicting treatment outcomes holds both scientific and clinical values. This prognostic study aims to investigate whether pre-treatment brain morphological metrics can predict the effectiveness of MBCT, compared with psycho-education (PE) as an active placebo, among patients with OCD.
A total of 32 patients with OCD were included in this prognostic study. They received magnetic resonance imaging (MRI) brain scans before treatment. Subsequently, 16 patients received 10 weeks of MBCT, while the other 16 patients underwent a 10-week PE program. The effectiveness of the treatments was primarily assessed by the reduction rate of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) total score before and after the treatment. We investigated whether several predefined OCD-associated brain morphological metrics, selected based on prior published studies by the ENIGMA Consortium, could predict the treatment effectiveness.
Both the MBCT and PE groups exhibited substantial reductions in Y-BOCS scores over 10 weeks of treatment, with the MBCT group showing a larger reduction. Notably, the pallidum total volume was associated with treatment effectiveness, irrespective of the intervention group. Specifically, a linear regression model utilizing the pre-treatment pallidum volume to predict the treatment effectiveness suggested that a one-cubic-centimeter increase in pallidum volume corresponded to a 22.3% decrease in the Y-BOCS total score reduction rate.
Pallidum volume may serve as a promising predictor for the effectiveness of MBCT and PE, and perhaps, other treatments with the shared mechanisms by MBCT and PE, among patients with OCD.
正念认知疗法（MBCT）已被证明对治疗强迫症（OCD）有效。然而，MBCT 的神经生物学基础在很大程度上仍然难以捉摸，这使得临床预测哪些患者反应较差具有挑战性。因此，确定预测治疗结果的生物标志物具有科学和临床价值。这项预后研究旨在调查在强迫症患者中，与作为积极安慰剂的心理教育（PE）相比，治疗前脑形态计量学指标是否可以预测 MBCT 的有效性。
这项预后研究共纳入 32 名强迫症患者。他们在治疗前接受了磁共振成像（MRI）脑部扫描。随后，16 名患者接受了 10 周的 MBCT，而另外 16 名患者接受了 10 周的 PE 计划。治疗效果主要通过治疗前后耶鲁-布朗强迫症量表（Y-BOCS）总分的降低率来评估。我们研究了是否可以根据 ENIGMA 联盟先前发表的研究选择的几个预先定义的 OCD 相关脑形态计量学指标来预测治疗效果。
MBCT 和 PE 组在 10 周的治疗中均显著降低了 Y-BOCS 评分，MBCT 组的降低幅度更大。值得注意的是，苍白球总容积与治疗效果相关，与干预组无关。具体来说，使用治疗前苍白球体积预测治疗效果的线性回归模型表明，苍白球体积增加一立方厘米，Y-BOCS 总分降低率降低 22.3%。
苍白球体积可能是 OCD 患者 MBCT 和 PE 以及可能具有 MBCT 和 PE 共同机制的其他治疗方法有效性的有前途的预测指标。
