Department of Psychiatry, New York University Grossman School of Medicine, New York, 10016, USA; Clinical Research Division, Nathan S. Kline Institute for Psychiatric Research, New York, 10962, USA.
Simches Division of Child and Adolescent Psychiatry, McLean Hospital, Harvard Medical School, Belmont, MA, 02478, USA.
J Psychiatr Res. 2024 Sep;177:129-139. doi: 10.1016/j.jpsychires.2024.06.052. Epub 2024 Jun 29.
Obsessive-compulsive disorder (OCD) is phenomenologically heterogeneous. While predominant models suggest fear and harm prevention drive compulsions, many patients also experience uncomfortable sensory-based urges ("sensory phenomena") that may be associated with heightened interoceptive sensitivity. Using an urge-to-blink eyeblink suppression paradigm to model sensory-based urges, we previously found that OCD patients as a group had more eyeblink suppression failures and greater activation of sensorimotor-interoceptive regions than controls. However, conventional approaches assuming OCD homogeneity may obscure important within-group variability, impeding precision treatment development. This study investigated the heterogeneity of urge suppression failure in OCD and examined relationships with clinical characteristics and neural activation. Eighty-two patients with OCD and 38 controls underwent an fMRI task presenting 60-s blocks of eyeblink suppression alternating with free-blinking blocks. Latent profile analysis identified OCD subgroups based on number of erroneous blinks during suppression. Subgroups were compared on behavior, clinical characteristics, and brain activation during task. Three patient subgroups were identified. Despite similar overall OCD severity, the subgroup with the most erroneous eyeblinks had the highest sensory phenomena severity, interoceptive sensitivity, and subjective urge intensity. Compared to other subgroups, this subgroup exhibited more neural activity in somatosensory and interoceptive regions during the early phase (first 30 s) of blink suppression and reduced activity in the middle frontal gyrus during the late phase (second 30 s) as the suppression period elapsed. Heterogeneity of urge suppression in OCD was associated with clinical characteristics and brain function. Our results reveal potential treatment targets that could inform personalized medicine.
强迫症（OCD）在表现上具有异质性。虽然主要的模型表明，恐惧和伤害预防是驱动强迫行为的原因，但许多患者也会经历不舒服的基于感觉的冲动（“感觉现象”），这可能与更高的内感受敏感性有关。我们使用眨眼抑制眨眼抑制范式来模拟基于感觉的冲动，之前发现 OCD 患者作为一个群体，比对照组有更多的眨眼抑制失败和更大的感觉运动-内感受区域的激活。然而，传统的假设 OCD 同质性的方法可能会掩盖重要的组内变异性，阻碍精准治疗的发展。本研究调查了 OCD 中冲动抑制失败的异质性，并研究了其与临床特征和神经激活的关系。82 名 OCD 患者和 38 名对照组接受了 fMRI 任务，该任务呈现了 60 秒的眨眼抑制块和自由眨眼块交替进行。潜在剖面分析根据抑制期间错误眨眼的数量确定 OCD 亚组。对行为、临床特征和任务期间的大脑激活进行了亚组比较。确定了三个患者亚组。尽管总体 OCD 严重程度相似，但错误眨眼最多的亚组具有最高的感觉现象严重程度、内感受敏感性和主观冲动强度。与其他亚组相比，该亚组在眨眼抑制的早期（前 30 秒）期间在体感和内感受区域表现出更多的神经活动，而在后期（后 30 秒）随着抑制期的过去，中额回的活动减少。OCD 中冲动抑制的异质性与临床特征和大脑功能有关。我们的结果揭示了潜在的治疗靶点，可为个性化治疗提供信息。
