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Tomiyama H, Murayama K, Kato K, Matsuo A, Nishida N, Matsukuma K, Kawahito M, Kang M, Sashikata K, Yamashita K, Kikuchi K, Wada T, Togao O, Nakao T. Spontaneous activity and functional connectivity in patients with hoarding disorder comorbid with attention-deficit/hyperactive disorder. J Psychiatr Res 2025; 185:98-104. [PMID: 40174309 DOI: 10.1016/j.jpsychires.2025.03.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2024] [Revised: 03/16/2025] [Accepted: 03/26/2025] [Indexed: 04/04/2025]
Abstract
Despite recent studies suggesting an important association of hoarder disorder (HD) and attention-deficit/hyperactive disorder (ADHD), no neuroimaging study has investigated the differences between patients with HD comorbid with ADHD and those without ADHD. This study investigated the regional spontaneous activity and functional connectivity in HD, focusing on the comorbidity with ADHD. Resting-state functional magnetic resonance imaging (MRI) data were obtained from 24 patients with HD and 31 healthy individuals. We investigated the group differences using the fractional amplitude of low-frequency fluctuation (fALFF). The altered regions in the fALFF were used as seeds in a functional connectivity analysis where we conducted group comparisons among the three groups: healthy controls (HCs), HD with ADHD (HD +ADHD), and HD without ADHD (HD -ADHD). Compared to HCs, patients with HD had a reduced fALFF in the right inferior frontal gyrus (IFG). Functional connectivity analysis revealed that patients with HD + ADHD had reduced functional connectivity between the IFG and dorsolateral prefrontal cortex (DLPFC) compared to HCs, while the HD -ADHD group was intermediate level between HD +ADHD and HCs groups. In conclusion, patients with HD have altered spontaneous activity of the IFG. Additionally, patients with HD + ADHD had significantly reduced functional connectivity between the IFG and the DLPFC. Our findings suggest the potential need to distinguish between subgroups of HD+ADHD to identify novel neurobiological models of HD that could guide future therapeutic strategies.
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Affiliation(s)
- Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Kyushu University Hospital, Japan.
| | - Kenta Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Akira Matsuo
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Nami Nishida
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kou Matsukuma
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Makoto Kawahito
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Mingi Kang
- Department of Psychology, Kyushu University, Japan
| | | | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tatsuhiro Wada
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
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Matsuo A, Tomiyama H, Murayama K, Kato K, Nishida N, Matsukuma K, Kawahito M, Tsunoda K, Kang M, Sashikata K, Togao O, Yamashita K, Kikuchi K, Wada T, Nakao T. Hypogyrification in the medial regions of the temporal and occipital lobes in hoarding disorder. J Psychiatr Res 2025; 183:244-251. [PMID: 40010074 DOI: 10.1016/j.jpsychires.2025.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2024] [Revised: 02/01/2025] [Accepted: 02/20/2025] [Indexed: 02/28/2025]
Affiliation(s)
- Akira Matsuo
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Kyushu University Hospital, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Kyushu University Hospital, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Kenta Kato
- Department of Neuropsychiatry, Kyushu University Hospital, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Nami Nishida
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kou Matsukuma
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Makoto Kawahito
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kana Tsunoda
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mingi Kang
- Department of Neuropsychiatry, Kyushu University Hospital, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kenta Sashikata
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Koji Yamashita
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazufumi Kikuchi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tatsuhiro Wada
- Division of Radiology, Department of Medical Technology, Kyushu University Hospital, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Levy HC, Naples AJ, Collett S, McPartland JC, Tolin DF. Central and peripheral physiological responses to decision making in hoarding disorder. Int J Psychophysiol 2024; 205:112437. [PMID: 39265723 PMCID: PMC11502253 DOI: 10.1016/j.ijpsycho.2024.112437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 08/29/2024] [Accepted: 09/05/2024] [Indexed: 09/14/2024]
Abstract
Individuals with hoarding disorder (HD) have difficulty parting with personal possessions, which leads to the accumulation of excessive clutter. According to a proposed biphasic neurobiological model, HD is characterized by blunted central and peripheral nervous system activity at rest and during neutral (non-discarding) decisions, and exaggerated activity during decision-making about discarding personal possessions. Here, we compared the error-related negativity (ERN) and psychophysiological responses (skin conductance, heart rate and heart rate variability, and end tidal CO2) during neutral and discarding-related decisions in 26 individuals with HD, 37 control participants with anxiety disorders, and 28 healthy control participants without psychiatric diagnoses. We also compared alpha asymmetry between the HD and control groups during a baseline resting phase. Participants completed a series of Go/No Go decision-making tasks, one involving choosing certain shapes (neutral task) and the other involving choosing images of newspapers to imaginally "discard" (discarding task). While all participants showed expected increased frontal negativity to commission of an error, contrary to hypotheses, there were no group differences in the ERN or any psychophysiological measures. Alpha asymmetry at rest also did not differ between groups. The findings suggest that the ERN and psychophysiological responses may not differ in individuals with HD during simulated discarding decisions relative to control participants, although the null results may be explained by methodological challenges in using Go/No Go tasks as discarding tasks. Future replication and extension of these results will be needed using ecologically valid discarding tasks.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT 06106, USA.
| | - Adam J Naples
- Yale Child Study Center, Yale School of Medicine, 40 Temple Street, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 40 Temple Street, New Haven, CT 06510, USA
| | - Sarah Collett
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT 06106, USA
| | - James C McPartland
- Yale Child Study Center, Yale School of Medicine, 40 Temple Street, New Haven, CT 06510, USA; Center for Brain and Mind Health, Yale School of Medicine, 40 Temple Street, New Haven, CT 06510, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, 200 Retreat Avenue, Hartford, CT 06106, USA; Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA
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Worden BL, Tolin DF, Stevens MC. An exploration of neural predictors of treatment compliance in cognitive-behavioral group therapy for hoarding disorder. J Affect Disord 2024; 345:410-418. [PMID: 38706461 PMCID: PMC11068362 DOI: 10.1016/j.jad.2023.10.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/24/2023] [Accepted: 10/27/2023] [Indexed: 05/07/2024]
Abstract
A persistent and influential barrier to effective cognitive-behavioral therapy (CBT) for patients with hoarding disorder (HD) is treatment retention and compliance. Recent research has suggested that HD patients have abnormal brain activity identified by functional magnetic resonance (fMRI) in regions often engaged for executive functioning (e.g., right superior frontal gyrus, anterior insula, and anterior cingulate), which raises questions about whether these abnormalities could relate to patients' ability to attend, understand, and engage in HD treatment. We examined data from 74 HD-diagnosed adults who completed fMRI-measured brain activity during a discarding task designed to elicit symptom-related brain dysfunction, exploring which regions' activity might predict treatment compliance variables, including treatment engagement (within-session compliance), homework completion (between-session compliance), and treatment attendance. Brain activity that was significantly related to within- and between-session compliance was found largely in insula, parietal, and premotor areas. No brain regions were associated with treatment attendance. The results add to findings from prior research that have found prefrontal, cingulate, and insula activity abnormalities in HD by suggesting that some aspects of HD brain dysfunction might play a role in preventing the engagement needed for therapeutic benefit.
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Affiliation(s)
| | - David F Tolin
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
| | - Michael C Stevens
- Institute of Living/ Hartford Hospital, Hartford, CT
- Yale University School of Medicine, New Haven, CT
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Sethi P, Mehan S, Khan Z, Chhabra S. Acetyl-11-keto-beta boswellic acid(AKBA) modulates CSTC-pathway by activating SIRT-1/Nrf2-HO-1 signalling in experimental rat model of obsessive-compulsive disorder: Evidenced by CSF, blood plasma and histopathological alterations. Neurotoxicology 2023; 98:61-85. [PMID: 37549874 DOI: 10.1016/j.neuro.2023.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/23/2023] [Accepted: 08/03/2023] [Indexed: 08/09/2023]
Abstract
Obsessive-Compulsive disorder (OCD) is a long-term and persistent mental illness characterised by obsessive thoughts and compulsive behaviours. Numerous factors can contribute to the development or progression of OCD. These factors may result from the dysregulation of multiple intrinsic cellular pathways, including SIRT-1, Nrf2, and HO-1. Inhibitors of selective serotonin reuptake (SSRIs) are effective first-line treatments for OCD. In our ongoing research, we have investigated the role of SIRT-1, Nrf2, and HO-1, as well as the neuroprotective potential of Acetyl-11-keto-beta boswellic acid (AKBA) against behavioural and neurochemical changes in rodents treated with 8-OH-DPAT. In addition, the effects of AKBA were compared to those of fluvoxamine (FLX), a standard OCD medication. Injections of 8-OH-DPAT into the intra-dorso raphe nuclei (IDRN) of rats for seven days induced repetitive and compulsive behaviour accompanied by elevated oxidative stress, inflammatory processes, apoptosis, and neurotransmitter imbalances in CSF, blood plasma, and brain samples. Chronic administration of AKBA at 50 mg/kg and 100 mg/kg p.o. restored histopathological alterations in the cortico-striatal-thalamo-cortical (CSTC) pathway, including the cerebral cortex, striatum, and hippocampal regions. Our investigation revealed that when AKBA and fluvoxamine were administered together, the alterations were restored to a greater degree than when administered separately. These findings demonstrate that the neuroprotective effect of AKBA can serve as an effective basis for developing a novel OCD treatment.
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Affiliation(s)
- Pranshul Sethi
- Division of Neuroscience, Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Sidharth Mehan
- Division of Neuroscience, Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India.
| | - Zuber Khan
- Division of Neuroscience, Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
| | - Swesha Chhabra
- Division of Neuroscience, Division, Department of Pharmacology, ISF College of Pharmacy, Moga, Punjab, India
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Guazzini A, Gursesli MC, Serritella E, Tani M, Duradoni M. Obsessive-Compulsive Disorder (OCD) Types and Social Media: Are Social Media Important and Impactful for OCD People? Eur J Investig Health Psychol Educ 2022; 12:1108-1120. [PMID: 36005227 PMCID: PMC9407245 DOI: 10.3390/ejihpe12080078] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/09/2022] [Accepted: 08/12/2022] [Indexed: 11/23/2022] Open
Abstract
Social media (SM) are the new standard for social interaction and people with OCD use such platforms like everyone else. However, the research on these individuals provides limited, sporadic, and difficult-to-generalize data outside of social-media evidence for one specific context concerning how SM is experienced by people with OCD. Our cross-sectional study involved 660 participants (71.4% females, 28.6% males) with 22% of the sample surpassing the 90° percentile threshold to be identified as high-level OCD-symptomatic individuals. Our work highlighted that roughly all OCD types are affected by social media in terms of mood and that these individuals appeared to give SM more importance than non-OCD individuals. The evidence presented, although very narrow, can be conceived as the first building blocks to encourage future research considering how individuals with OCD experience social media, since they appear to be affected more by them compared to non-OCD individuals.
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Affiliation(s)
- Andrea Guazzini
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Florence, Italy
- Centre for the Study of Complex Dynamics, University of Florence, 50019 Sesto Fiorentino, Italy
| | - Mustafa Can Gursesli
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Florence, Italy
- Department of Information Engineering, University of Florence, 50139 Florence, Italy
| | - Elena Serritella
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Florence, Italy
| | - Margherita Tani
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Florence, Italy
| | - Mirko Duradoni
- Department of Education, Literatures, Intercultural Studies, Languages and Psychology, University of Florence, 50135 Florence, Italy
- Correspondence:
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Abnormal white matter structure in hoarding disorder. J Psychiatr Res 2022; 148:1-8. [PMID: 35081485 DOI: 10.1016/j.jpsychires.2022.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/23/2021] [Accepted: 01/13/2022] [Indexed: 11/23/2022]
Abstract
Although preliminary neuroimaging research suggests that patients with hoarding disorder (HD) show widespread abnormal task-related activity in the brain, there has been no research on alterations in the white matter tracts in these patients. The aim of this study was to investigate the characteristics of the major white matter tracts in patients with HD. Tract-based spatial statistics were used to search for white matter tract abnormalities throughout the brain in 25 patients with HD and 36 healthy controls. Post hoc analysis of regions of interest was performed to detect correlations with clinical features. Compared with the controls, patients with HD showed decreased fractional anisotropy and increased radial diffusivity in anatomically widespread white matter tracts. Post hoc analysis of regions of interest revealed a significant negative correlation between the severity of hoarding symptoms and fractional anisotropy in the left anterior limb of the internal capsule and a positive correlation between the severity of these symptoms and radial diffusivity in the right anterior thalamic radiation. Patients with HD showed a broad range of alterations in the frontal white matter tracts, including the frontothalamic circuit, frontoparietal network, and frontolimbic pathway. The findings of this study indicate associations between frontal white matter abnormalities related to the severity of hoarding symptoms in HD and the cortical regions involved in cognitive dysfunction. The insights provided would be useful for understanding the neurobiological basis of HD.
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Spivak NM, Tyler WJ, Bari AA, Kuhn TP. Ultrasound as a Neurotherapeutic: A Circuit- and System-Based Interrogation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:32-35. [PMID: 35746933 PMCID: PMC9063590 DOI: 10.1176/appi.focus.20210022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Focused ultrasound is a novel brain stimulation modality that combines the noninvasiveness of repetitive transcranial magnetic stimulation and the precision of deep brain stimulation. In this review, the authors examine low-intensity focused ultrasound for brain mapping and neuromodulation. They also discuss high-intensity focused ultrasound, which is used for incisionless surgeries, such as capsulotomies for obsessive-compulsive disorder. Future potential applications of focused ultrasound are also presented.
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Bratiotis C, Muroff J, Lin NXY. Hoarding Disorder: Development in Conceptualization, Intervention, and Evaluation. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:392-404. [PMID: 35747296 PMCID: PMC9063579 DOI: 10.1176/appi.focus.20210016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hoarding disorder is characterized by difficulty parting with possessions because of strong urges to save the items. Difficulty discarding often includes items others consider to be of little value and results in accumulation of a large number of possessions that clutter the home. Cognitive-behavioral therapy (CBT) with exposure and response prevention and selective serotonin reuptake inhibitor medications traditionally used to treat obsessive-compulsive disorder are generally not efficacious for people with hoarding problems. A specialized CBT approach for hoarding has shown progress in reaching treatment goals and has been modified to be delivered in group, peer-facilitated, and virtual models. Research on hoarding remains in the early phases of development. Animal, attachment, and genetic models are expanding. Special populations, such as children, older adults, and people who do not voluntarily seek treatment need special consideration for intervention. Community-based efforts aimed at reducing public health and safety consequences of severe hoarding are needed.
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Affiliation(s)
- Christiana Bratiotis
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Jordana Muroff
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
| | - Nancy X Y Lin
- School of Social Work, University of British Columbia, Vancouver, British Columbia, Canada (Bratiotis, Lin);School of Social Work, Boston University, Boston (Muroff)
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Germann J, Elias GJB, Neudorfer C, Boutet A, Chow CT, Wong EHY, Parmar R, Gouveia FV, Loh A, Giacobbe P, Kim SJ, Jung HH, Bhat V, Kucharczyk W, Chang JW, Lozano AM. Potential optimization of focused ultrasound capsulotomy for obsessive compulsive disorder. Brain 2021; 144:3529-3540. [PMID: 34145884 DOI: 10.1093/brain/awab232] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/19/2021] [Accepted: 05/21/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder is a debilitating and often refractory psychiatric disorder. Magnetic resonance-guided focused ultrasound is a novel, minimally invasive neuromodulatory technique that has shown promise in treating this condition. We investigated the relationship between lesion location and long-term outcome in obsessive-compulsive disorder patients treated with focused ultrasound to discern the optimal lesion location and elucidate the efficacious network underlying symptom alleviation. Postoperative images of eleven patients who underwent focused ultrasound capsulotomy were used to correlate lesion characteristics with symptom improvement at one year follow-up. Normative resting-state functional MRI and normative diffusion MRI-based tractography analyses were used to determine the networks associated with successful lesions. Obsessive-compulsive disorder patients treated with inferior thalamic peduncle deep brain stimulation (n = 5) and lesions from the literature implicated in obsessive-compulsive disorder (n = 18) were used for external validation. Successful long-term relief of obsessive-compulsive disorder was associated with lesions that included a specific area in the dorsal anterior limb of the internal capsule. Normative resting-state functional MRI analysis showed that lesion engagement of areas 24 and 46 was significantly associated with clinical outcomes (R = 0.79, p = 0.004). The key role of areas 24 and 46 was confirmed by (1) normative diffusion MRI-based tractography analysis showing that streamlines associated with better outcome projected to these areas, (2) association of these areas with inferior thalamic peduncle deep brain stimulation patients' outcome (R = 0.83, p = 0.003); (3) the connectedness of these areas to obsessive-compulsive disorder-causing lesions, as identified using literature-based lesion network mapping. These results provide considerations for target improvement, outlining the specific area of the internal capsule critical for successful magnetic resonance-guided focused ultrasound outcome and demonstrating that discrete frontal areas are involved in symptom relief. This could help refine focused ultrasound treatment for obsessive-compulsive disorder and provide a network-based rationale for potential alternative targets.
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Affiliation(s)
- Jürgen Germann
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Gavin J B Elias
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Clemens Neudorfer
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Alexandre Boutet
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Clement T Chow
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Emily H Y Wong
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Roohie Parmar
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Flavia Venetucci Gouveia
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Aaron Loh
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
| | - Peter Giacobbe
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Se Joo Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ho Jung
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Venkat Bhat
- Centre for Mental Health and Krembil Research Centre, University Health Network, Toronto, Canada
| | - Walter Kucharczyk
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada.,Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Jin Woo Chang
- Department of Neurosurgery, Yonsei University College of Medicine, Seoul, Korea
| | - Andres M Lozano
- Division of Neurosurgery, Department of Surgery, University Health Network and University of Toronto, Toronto, Canada
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11
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Levy HC, Poppe A, Hiser J, Wootton BM, Hallion LS, Tolin DF, Stevens MC. An Examination of the Association Between Subjective Distress and Functional Connectivity During Discarding Decisions in Hoarding Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1013-1022. [PMID: 33771533 DOI: 10.1016/j.bpsc.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/17/2020] [Accepted: 12/23/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Individuals with hoarding disorder (HD) demonstrate exaggerated subjective distress and hyperactivation of cingulate and insular cortex regions when discarding personal possessions. No prior study has sought to determine whether this subjective distress is associated with specific profiles of abnormal brain function in individuals with HD. METHODS We used multimodal canonical correlation analysis plus joint independent component analysis to test whether five hoarding-relevant domains of subjective distress when deciding to discard possessions (anxiety, sadness, monetary value, importance, and sentimental attachment) are associated with functional magnetic resonance imaging-measured whole-brain functional connectivity in 72 participants with HD and 44 healthy controls. RESULTS Three extracted components differed between HD participants and healthy control subjects. Each of these components depicted an abnormal profile of functional connectivity in HD participants relative to control subjects during discarding decisions, and a specific distress response profile. One component pair showed a relationship between anxiety ratings during discarding decisions and connectivity among the pallidum, perirhinal ectorhinal cortex, and dorsolateral prefrontal cortex. Another component comprised sadness ratings during discarding decisions and connectivity in the pallidum, nucleus accumbens, amygdala, and dorsolateral prefrontal cortex. The third component linked HD brain connectivity in several dorsolateral prefrontal cortex regions with perceived importance ratings during discarding decisions. CONCLUSIONS The findings indicate that in patients with HD, the subjective intensity of anxiety, sadness, and perceived possession importance is related to abnormal functional connectivity in key frontal and emotional processing brain regions. The findings are discussed in terms of emerging neurobiological models of HD.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut.
| | - Andrew Poppe
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut
| | - Jaryd Hiser
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut
| | - Bethany M Wootton
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, South Wales, Australia
| | - Lauren S Hallion
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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12
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Zhao Q, Xu T, Wang Y, Chen D, Liu Q, Yang Z, Wang Z. Limbic cortico-striato-thalamo-cortical functional connectivity in drug-naïve patients of obsessive-compulsive disorder. Psychol Med 2021; 51:70-82. [PMID: 31640827 DOI: 10.1017/s0033291719002988] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The pathophysiology of obsessive-compulsive disorder (OCD) remains unclear despite extensive neuroimaging work on the disorder. Exposure to medication and comorbid mental disorders can confound the results of OCD studies. The goal of this study was to explore differences in brain functional connectivity (FC) within the cortico-striato-thalamo-cortical (CSTC) loop of drug-naïve and drug-free OCD patients and healthy controls (HCs). METHODS A total of 29 drug-naïve OCD patients, 22 drug-free OCD patients, and 25 HCs matched on age, gender and education level underwent functional magnetic resonance imaging scanning at resting state. Seed-based connectivity analyses were conducted among the three groups. The Yale Brown Obsessive Compulsive Scale and clinical inventories were used to assess the clinical symptoms. RESULTS Compared with HCs, the drug-naïve OCD patients had reduced FC within the limbic CSTC loop. In the drug-naïve OCD participants, we also found hyperconnectivity between the supplementary motor area and ventral and dorsal putamen (p < 0.05, corrected for multiple comparisons). CONCLUSIONS Exposure to antidepressants such as selective serotonin reuptake inhibitors may affect the function of some brain regions. Future longitudinal studies could help to reveal the pharmacotherapeutic mechanisms in these loops.
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Affiliation(s)
- Qing Zhao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Tingting Xu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Yuan Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Dandan Chen
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Qiang Liu
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
| | - Zhi Yang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, P.R. China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
- Brain Science and Technology Research Center, Shanghai Jiao Tong University, Shanghai, China
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai, P.R. China
- Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
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13
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Vadalà M, Cistaro A, Quartuccio N, Calcagni ML, Fania P, Margotti S, Schiera IG, Laurino C, Palmieri B. 18F-FDG-PET brain imaging may highlight brain metabolic alterations in dysautonomic syndrome after human papilloma virus vaccination. Nucl Med Commun 2020; 41:1275-1282. [PMID: 32897935 DOI: 10.1097/mnm.0000000000001280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to evaluate brain glucose metabolism by means of [18F]-fluoro-deoxygluycose (F-FDG) PET in a group of patients presenting dysautonomic syndrome after human papilloma virus (HPV) immunization. METHODS Medical records of patients, referred to the 'Second Opinion Medical Consulting Network' Medical Centre (Modena, Italy) diagnosed with dysautonomic syndrome were searched. Inclusion criteria were presence in the medical history of adverse drug reactions following HPV vaccine; a Montreal Cognitive Assessment score <25 and good quality of a F-FDG-PET brain scan performed within 12 months from the diagnosis of dysautonomic syndrome. F-FDG-PET images of patients (HPV-group) were compared to a control group, matched for age and sex, using statistical parametric mapping (SPM). RESULTS The F-FDG-PET study was available for five female patients. The SPM-group analysis revealed significant hypometabolism (P < 0.05 false discovery rate corrected) in the right superior and medial temporal gyrus (Brodmann areas 22, 21) and insula (Brodmann area 13). At a threshold of P < 0.001 (uncorrected), further hypometabolic regions were revealed in the right superior temporal gyrus (Brodmann area 42) and caudate head and in the left superior temporal gyrus (Brodmann area 22), frontal subcallosal gyrus (Brodmann area 47) and insula (Brodmann area 13). Relative hypermetabolism (P = 0.001) was revealed in the right premotor cortex (Brodmann area 6). CONCLUSION This study revealed the possibility of altered brain glucose metabolism in subjects with dysautonomic syndrome post-immunization with HPV vaccine. These results could reinforce the hypothesis of a causal relationship between HPV vaccine, or some component included in the vaccine and the development of clinical manifestations.
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Affiliation(s)
- Maria Vadalà
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
| | - Angelina Cistaro
- Nuclear Medicine Department, Galliera Hospital, Genoa
- Coordinator of AIMN Paediatric Study Group, Milan, Italy
| | - Natale Quartuccio
- Nuclear Medicine Unit, A.R.N.A.S. Civico, Di Cristina and Benfratelli Hospitals, Palermo
| | | | | | | | | | - Carmen Laurino
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
| | - Beniamino Palmieri
- Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia Medical School, Surgical Clinic
- Network of the Second Opinion, Modena
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14
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Vaccaro LD, Jones MK, Menzies RG, Wootton BM. The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Lisa D. Vaccaro
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ross G. Menzies
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Bethany M. Wootton
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia,
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15
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Fajnerova I, Gregus D, Francova A, Noskova E, Koprivova J, Stopkova P, Hlinka J, Horacek J. Functional Connectivity Changes in Obsessive-Compulsive Disorder Correspond to Interference Control and Obsessions Severity. Front Neurol 2020; 11:568. [PMID: 32973642 PMCID: PMC7468468 DOI: 10.3389/fneur.2020.00568] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 05/19/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction: Deficits in neurocognitive mechanisms such as inhibition control and cognitive flexibility have been suggested to mediate the symptoms in obsessive-compulsive disorder (OCD). These mechanisms are proposedly controlled by the "affective" and "executive" orbitofronto-striato-thalamo-cortical (CSTC) circuits with well-documented morphological and functional alterations in OCD that are associated with OCD symptoms. The precuneus region has been suggested in OCD as another key structure associated with the mechanism of "thought-action fusion." Our study aimed to elucidate the association of the altered functional coupling of the CSTC nodes (and precuneus), the OCD symptoms, and interference control/cognitive flexibility. Methods: In a group of 36 (17 medicated and 19 drug-free) OCD patients and matched healthy volunteers, we tested functional connectivity (FC) within the constituents of the dorsolateral prefrontal cortex "executive" CSTC, the orbitofrontal cortex/anterior cingulate "affective" CSTC, and precuneus. The functional connections showing the strongest effects were subsequently entered as explanatory variables to multiple regression analyses to identify possible associations between observed alterations of functional coupling and cognitive (Stroop test) and clinical measures (obsessions, compulsions, and anxiety level). Results: We observed increased FC (FWE p < 0.05 corr.) between CSTC seeds and regions of the parieto-occipital cortex, and between the precuneus and the angular gyrus and dorsolateral prefrontal cortex. Decreased FC was observed within the CSTC loop (caudate nucleus and thalamus) and between the anterior cingulate cortex and the limbic lobe. Linear regression identified a relationship between the altered functional coupling of thalamus with the right somatomotor parietal cortex and the Stroop color-word score. Similar association of thalamus FC has been identified also for obsessions severity. No association was observed for compulsions and anxiety. Conclusions: Our findings demonstrate altered FC in OCD patients with a prevailing increase in FC originating in CSTC regions toward other cortical areas, and a decrease in FC within the constituents of CSTC loops. Moreover, our results support the role of precuneus in OCD. The association of the cognitive and clinical symptoms with the FC between the thalamus and somatomotor cortex indicates that cognitive flexibility and inhibitory control are strongly linked and both mechanisms might contribute to the symptomatology of OCD.
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Affiliation(s)
- Iveta Fajnerova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - David Gregus
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Anna Francova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Eliska Noskova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jana Koprivova
- National Institute of Mental Health (NIMH), Klecany, Czechia
| | - Pavla Stopkova
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
| | - Jaroslav Hlinka
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Institute of Computer Science, Czech Academy of Sciences, Prague, Czechia
| | - Jiri Horacek
- National Institute of Mental Health (NIMH), Klecany, Czechia.,Third Faculty of Medicine, Charles University, Prague, Czechia
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16
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Suñol M, Martínez-Zalacaín I, Picó-Pérez M, López-Solà C, Real E, Fullana MÀ, Pujol J, Cardoner N, Menchón JM, Alonso P, Soriano-Mas C. Differential patterns of brain activation between hoarding disorder and obsessive-compulsive disorder during executive performance. Psychol Med 2020; 50:666-673. [PMID: 30907337 DOI: 10.1017/s0033291719000515] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Preliminary evidence suggests that hoarding disorder (HD) and obsessive-compulsive disorder (OCD) may show distinct patterns of brain activation during executive performance, although results have been inconclusive regarding the specific neural correlates of their differential executive dysfunction. In the current study, we aim to evaluate differences in brain activation between patients with HD, OCD and healthy controls (HCs) during response inhibition, response switching and error processing. METHODS We assessed 17 patients with HD, 18 patients with OCD and 19 HCs. Executive processing was assessed inside a magnetic resonance scanner by means of two variants of a cognitive control protocol (i.e. stop- and switch-signal tasks), which allowed for the assessment of the aforementioned executive domains. RESULTS OCD patients performed similar to the HCs, differing only in the number of successful go trials in the switch-signal task. However, they showed an anomalous hyperactivation of the right rostral anterior cingulate cortex during error processing in the switch-signal task. Conversely, HD patients performed worse than OCD and HC participants in both tasks, showing an impulsive-like pattern of response (i.e. shorter reaction time and more commission errors). They also exhibited hyperactivation of the right lateral orbitofrontal cortex during successful response switching and abnormal deactivation of frontal regions during error processing in both tasks. CONCLUSIONS Our results support that patients with HD and OCD present dissimilar cognitive profiles, supported by distinct neural mechanisms. Specifically, while alterations in HD resemble an impulsive pattern of response, patients with OCD present increased error processing during response conflict protocols.
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Affiliation(s)
- Maria Suñol
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Maria Picó-Pérez
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Clara López-Solà
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Mental Health, Corporació Sanitaria Parc Taulí-i3PT, Sabadell, Spain
| | - Eva Real
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
| | - Miquel Àngel Fullana
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Psychiatry, Hospital Clínic-Institute of Neurosciences, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Pujol
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- MRI Research Unit, Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Narcís Cardoner
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Mental Health, Corporació Sanitaria Parc Taulí-i3PT, Sabadell, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José Manuel Menchón
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Pino Alonso
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute - IDIBELL, Barcelona, Spain
- Carlos III Health Institute, Centro de Investigación Biomedica en Red de Salud Mental - CIBERSAM, Barcelona, Spain
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain
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17
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Mitchell E, Tavares TP, Palaniyappan L, Finger EC. Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations. Cortex 2019; 121:443-453. [PMID: 31715541 DOI: 10.1016/j.cortex.2019.09.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 04/25/2019] [Accepted: 09/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010). METHODS Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer. RESULTS Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding. DISCUSSION The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.
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Affiliation(s)
- Eric Mitchell
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Tamara P Tavares
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada
| | - Lena Palaniyappan
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada
| | - Elizabeth C Finger
- Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Robarts Research Institute, Canada; Lawson Health Research Institute, Canada; Parkwood Institute, St. Josephs Health Care, Canada.
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18
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Olatunji BO, Christian C, Brosof L, Tolin DF, Levinson CA. What is at the core of OCD? A network analysis of selected obsessive-compulsive symptoms and beliefs. J Affect Disord 2019; 257:45-54. [PMID: 31299404 DOI: 10.1016/j.jad.2019.06.064] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/01/2019] [Accepted: 06/30/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous condition that consists of distinct subtypes, and identification of its core symptoms may inform how to best conceptualize the heterogeneity. Accordingly, we used network analysis to evaluate which symptoms (and associations between symptoms) are most central to OCD symptoms and beliefs. METHODS Participants consisted of a combined sample of adults with a primary diagnosis of OCD (N = 150), those with other primary diagnoses (N = 114), and an unselected nonclinical sample (N = 310). Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Obsessive-Compulsive Inventory-Revised and the Obsessional Beliefs Questionnaire-44. RESULTS The most central symptoms in the network were negative appraisals of intrusive thoughts (i.e., Having intrusive thoughts means I'm out of control). Some of the strongest associations between symptoms were also observed for those pertaining to intrusive thoughts and their negative appraisal. Furthermore, central symptoms in the network predicted depression and anxiety (over and above peripheral symptoms) among those with a primary diagnosis of OCD, but not the severity of OCD symptoms. LIMITATIONS The approach was exploratory rather than experimental and relied solely on self-report measures of OCD symptoms and beliefs. CONCLUSIONS Negative appraisals of intrusive thoughts were the most central symptoms in the OCD network, and they uniquely predict co-occurring symptoms of anxiety and depression, suggesting that these symptoms should be prioritized in theoretical and treatment models of OCD.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
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19
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Stevens MC, Levy HC, Hallion LS, Wootton BM, Tolin DF. Functional Neuroimaging Test of an Emerging Neurobiological Model of Hoarding Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 5:68-75. [PMID: 31676206 DOI: 10.1016/j.bpsc.2019.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/19/2019] [Accepted: 08/20/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Over the past decade, functional neuroimaging studies have found abnormal brain function in several cortical systems when patients with compulsive hoarding behaviors make decisions about personal possessions. The purpose of this study was to use functional magnetic resonance imaging to test a neurobiological model of hoarding disorder (HD) that has begun to emerge from these small studies by confirming HD-related brain dysfunction in previously implicated brain regions in the largest sample of HD patients examined to date. METHODS We compared 79 adults diagnosed with DSM-5 HD with 44 non-HD control participants using a functional magnetic resonance imaging task of decision making to acquire or discard material possessions and on a control task involving semantic processing. RESULTS HD brain activation profiles prominently featured insular and anterior cingulate cortex overengagement during possession-related choices that were not seen in non-HD brain activation profiles and also correlated with hoarders' clutter and difficulty discarding. Although HD patients overengaged the insula when deciding to discard, relative to when performing the non-decision making task contrast, the HD insula also was generally blunted. CONCLUSIONS This study links the defining behavioral symptoms of HD to localized brain dysfunction within cingulo-opercular brain systems and firmly establishes the context-dependent importance of this network dysfunction in HD. The relevance of dysfunction in these brain regions is highlighted by a failure to replicate HD-related abnormalities in other brain regions implicated in prior HD functional magnetic resonance imaging studies. This study also raises the novel possibility that HD may involve abnormality in the inferior frontal cortex engaged for executive control over semantic processing.
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Affiliation(s)
- Michael C Stevens
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Hannah C Levy
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut
| | - Lauren S Hallion
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bethany M Wootton
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - David F Tolin
- Olin Neuropsychiatry Research Center, Institute of Living, Hartford, Connecticut; Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
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20
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Miguel SRPDS, Ligabue-Braun R. Hypothesis: Compulsive hoarding as an atavism. Med Hypotheses 2019; 130:109273. [PMID: 31383336 DOI: 10.1016/j.mehy.2019.109273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 06/06/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
In this hypothesis paper, we propose that hoarding disorder may be an ancestral mammalian behavior, possibly hard-wired but dormant in present-day humans, that can be activated by traumatic experiences. To support this claim, we describe hoarding in ancestral mammals and provide examples of recurrence of traits, or atavisms, in humans and other mammals, highlighting its implications for neuropsychiatric diseases. We highlight the potential of using shrews as animal models for hoarding behavior and, considering the current knowledge on the molecular underpinnings of the disorder, we also point to limitations of the proposed connection.
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Affiliation(s)
| | - Rodrigo Ligabue-Braun
- Graduate Program in Biological Sciences (PPGBio) and Department of Pharmaceutical Sciences, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil.
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21
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Nakao T, Kanba S. Pathophysiology and treatment of hoarding disorder. Psychiatry Clin Neurosci 2019; 73:370-375. [PMID: 31021515 DOI: 10.1111/pcn.12853] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 03/29/2019] [Accepted: 04/18/2019] [Indexed: 11/28/2022]
Abstract
Hoarding disorder (HD) is a newly listed disease in the new category of Obsessive-Compulsive and Related Disorders in the DSM-5. Patients with HD find it difficult to discard possessions regardless of their actual value and to organize those things. As a result, the possessions overflow the living space and hinder living functions. Though the hoarding symptom had been regarded as a subtype of obsessive-compulsive disorder (OCD) to date, recent studies have revealed many differences in clinical characteristics, including onset, course, degree of insight, and treatment responses, between hoarding and other subtypes. Moreover, several neuroimaging studies have found specific changes of brain structure and function in OCD patients with hoarding symptoms compared to patients with non-hoarding OCD. Meanwhile, strategies for treatment of HD have not been standardized. At present, psychological treatment using cognitive behavioral therapy techniques has a certain effect. In this review, we outline the pathophysiology and treatment of HD.
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Affiliation(s)
- Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Worden B, Levy HC, Das A, Katz BW, Stevens M, Tolin DF. Perceived emotion regulation and emotional distress tolerance in patients with hoarding disorder. J Obsessive Compuls Relat Disord 2019; 22:100441. [PMID: 32818134 PMCID: PMC7430655 DOI: 10.1016/j.jocrd.2019.100441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emotional distress tolerance (EDT) and emotion regulation (ER) appear to be highly relevant to hoarding pathology, as excessive saving and/or acquiring may be motivated by emotional avoidance or other attempts to regulate negative affect. While findings with nonclinical samples have suggested and EDT/ER predicts hoarding symptoms, there is little data on clinical samples. The aim of the current study was to examine several self-report measures of EDT and ER in individuals with HD (n = 87) and age-matched nonclinical controls (n = 46), and to explore whether this was predictive of treatment compliance and/or outcome in group CBT for HD. Results suggested that, the Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004) total score, DERS goals and awareness subscales, and Intolerance of Uncertainty Scale (IUS; Buhr & Dugas, 2002) were predictive of hoarding severity. However, EDT/ER did not change with treatment, did not mediate treatment outcome, and did not predicted treatment retention, compliance, or outcome. Results suggest that some EDT/ER constructs, such as uncertainty intolerance, difficulty persisting in goal behaviors when upset, and low emotional awareness, may explain significant variance in HD symptoms, although they did not appear to be mechanisms of change in CBT for HD.
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Affiliation(s)
| | | | | | | | - Michael Stevens
- Institute of Living, Hartford, CT
- Yale University School of Medicine
| | - David F. Tolin
- Institute of Living, Hartford, CT
- Yale University School of Medicine
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Levy HC, Stevens MC, Glahn DC, Pancholi K, Tolin DF. Distinct resting state functional connectivity abnormalities in hoarding disorder and major depressive disorder. J Psychiatr Res 2019; 113:108-116. [PMID: 30928618 PMCID: PMC6486431 DOI: 10.1016/j.jpsychires.2019.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 02/27/2019] [Accepted: 03/21/2019] [Indexed: 02/03/2023]
Abstract
Emerging research suggests that hoarding disorder (HD) is associated with abnormal hemodynamic activity in frontal brain regions. Prior studies have not examined intrinsic network connectivity in HD during unstructured "resting state" fMRI. Furthermore, it remains unclear whether previously observed HD abnormalities might be better explained by the presence of other disorders frequently comorbid with HD, such as major depressive disorder (MDD). The current study compared resting state functional connectivity in HD-only patients (n = 17), MDD-only patients (n = 8), patients with co-occurring HD and MDD (n = 10), and healthy control participants (n = 18). Using independent component analysis, we found that HD-only patients exhibited lower functional connectivity in a "task positive" cognitive control network, compared to the other three groups. The HD group also had greater connectivity in regions of the "task negative" default mode network than did the other groups. Findings suggest that HD is associated with a unique neurobiological profile, and are discussed in terms of recent neurological and neuropsychological findings and models in HD and related disorders.
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Affiliation(s)
- Hannah C. Levy
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106 USA,Correspondence concerning this article should be addressed to Hannah Levy, Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106. Tel.: 860-545-7847. Fax: 860-545-7105.
| | - Michael C. Stevens
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
| | - David C. Glahn
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
| | - Krishna Pancholi
- Olin Neuropsychiatry Research Center, Institute of Living/Hartford Hospital, 400 Washington Street, Hartford, CT 06106 USA
| | - David F. Tolin
- Anxiety Disorders Center, Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT 06106 USA,Department of Psychiatry, Yale University School of Medicine, 300 George Street, New Haven, CT 06511 USA
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Zaboski BA, Merritt OA, Schrack AP, Gayle C, Gonzalez M, Guerrero LA, Dueñas JA, Soreni N, Mathews CA. Hoarding: A meta-analysis of age of onset. Depress Anxiety 2019; 36:552-564. [PMID: 30958911 DOI: 10.1002/da.22896] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/28/2019] [Accepted: 03/22/2019] [Indexed: 12/25/2022] Open
Abstract
Hoarding disorder is present in 2-6% of the population and can have an immense impact on the lives of patients and their families. Before its inclusion the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, pathological hoarding was often characterized as a symptom of obsessive-compulsive disorder, and several different diagnostic assessment methods were used to identify and characterize it. Although the age of onset of pathological hoarding is an important epidemiological measure, as clarifying the age of onset of hoarding symptoms may allow for early identification and implementation of evidence-based treatments before symptoms become clinically significant, the typical age of onset of hoarding is still uncertain. To that end, this study is a systematic review and meta-analysis of research published in English between the years 1900 and 2016 containing information on age of onset of hoarding symptoms. Twenty-five studies met inclusion criteria. The mean age of onset of hoarding symptoms across studies was 16.7 years old, with evidence of a bimodal distribution of onset. The authors conclude by discussing practice implications for early identification and treatment.
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Affiliation(s)
- Brian A Zaboski
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Olivia A Merritt
- Department of Psychiatry and Behavioral Neurosciences, Pediatric OCD Consultation Service, Anxiety Treatment and Research Clinic, McMaster University, Hamilton, Ontario
| | - Anna P Schrack
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Cindi Gayle
- Department of Psychiatry, Division of Psychology, Gainesville, Florida
| | - Melissa Gonzalez
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Lisa A Guerrero
- Department of Psychiatry, Division of Psychology, Gainesville, Florida.,Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Julisa A Dueñas
- Department of School of Special Education, School Psychology, and Early Childhood Studies, University of Florida, Gainesville, Florida
| | - Noam Soreni
- Department of Psychiatry and Behavioral Neurosciences, Pediatric OCD Consultation Service, Anxiety Treatment and Research Clinic, McMaster University, Hamilton, Ontario
| | - Carol A Mathews
- Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida
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25
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Hombali A, Sagayadevan V, Tan WM, Chong R, Yip HW, Vaingankar J, Chong SA, Subramaniam M. A narrative synthesis of possible causes and risk factors of hoarding behaviours. Asian J Psychiatr 2019; 42:104-114. [PMID: 31003207 DOI: 10.1016/j.ajp.2019.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/07/2019] [Accepted: 04/07/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Hoarding is a disorder characterized by excessive acquisition and persistent difficulty in discarding possessions. The behaviour has adverse emotional, physical, social, financial, and legal outcomes for the person with the disorder and family members, and might pose a significant public health problem. Hoarding has been included as a distinct disorder in the Diagnostic and Statistical Manual of Mental Disorders Fifth edition (DSM-5). The prevalence of hoarding disorder is approximately 2-6% globally. The current state of the evidence does not offer clear understanding of the causes of hoarding behaviours. A systematic review of the extant literature was carried out to determine the possible causal factors of hoarding behaviours. METHODS This review is conducted in line with PRISMA guidelines. The following electronic databases: Medline through Ovid, EMBASE and PsycINFO were searched for relevant articles published between January 2000 and November 2018. Only articles published in English language were included. Two reviewers independently scrutinized the studies and included them in this review. RESULTS Our search strategy returned a total of 396 references. Preliminary findings suggest that individuals with hoarding behaviours may have a genetic susceptibility; abnormal neural activity in the fronto-temporal, para-hippocampal gyrus and insular parts of the brain has also been identified. Traumatic life experiences have also been posited to predispose individuals to hoard. CONCLUSION Although the understanding of hoarding disorder hasgrown in recent years, greater efforts are still needed to clarify the etiology and mechanisms of hoarding disorder as these may help in planning of more holistic interventions to treat the problem.
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Affiliation(s)
- Aditi Hombali
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Vathsala Sagayadevan
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Weng Mooi Tan
- Agency for Integrated Care, Community Mental Health Division, Singapore
| | - Rebecca Chong
- Agency for Integrated Care, Community Mental Health Division, Singapore
| | - Hon Weng Yip
- Policy & Planning Division, Municipal Services Office, Singapore
| | - Janhavi Vaingankar
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
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Clarke C. Can Occupational Therapy Address the Occupational Implications of Hoarding? Occup Ther Int 2019; 2019:5347403. [PMID: 30956628 PMCID: PMC6425346 DOI: 10.1155/2019/5347403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/18/2018] [Accepted: 02/17/2019] [Indexed: 11/30/2022] Open
Abstract
Hoarding is often described as a medical disorder, defined by a persistent difficulty in discarding possessions and associated high levels of emotional distress when forced to part with these. This article will discuss how having a different view of hoarding, seeing hoarding as a daily occupation which provides value, purpose, and meaning and with a relationship to self-identity and life purpose, could offer alternate interventions to support an individual who hoards. The article will consider the components of hoarding activity and how these relate to health and wellbeing and doing, being, belonging, and becoming as understood by occupational therapists. The article will consider what occupational therapy, a profession which considers a person's daily occupations, the things that occupy their time and which give meaning to their existence, could offer as an alternative to current hoarding interventions. Proposals for occupational therapy interventions will be suggested which would support occupational choice, support engagement in activities which have more positive outcomes on a person's health, and seek to address barriers which limit engagement and occupational performance in activities within the person's home environment.
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Affiliation(s)
- Cathy Clarke
- School of Allied Health Professions and Midwifery, Faculty of Health Studies, University of Bradford, Richmond Road, Bradford BD7 1DP, UK
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27
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Zhang H, Wang B, Li K, Wang X, Li X, Zhu J, Zhao Q, Yang Y, Lv L, Zhang M, Zhang H. Altered Functional Connectivity Between the Cerebellum and the Cortico-Striato-Thalamo-Cortical Circuit in Obsessive-Compulsive Disorder. Front Psychiatry 2019; 10:522. [PMID: 31396115 PMCID: PMC6667674 DOI: 10.3389/fpsyt.2019.00522] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 07/02/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Altered resting-state functional connectivity of the cerebellum in obsessive-compulsive disorder (OCD) has been previously reported. However, the previous study investigating cerebellar-cerebral functional connectivity relied on a priori-defined seeds from specific networks. In this study, we aimed to explore the connectivity alterations of the cerebellum in OCD under resting-state conditions with a hypothesis-free approach. Methods: Thirty patients with OCD and 26 healthy controls (HCs) underwent functional magnetic resonance imaging (fMRI) scanning at resting state. Regional cerebral function was evaluated by measuring the fraction of amplitude of low-frequency fluctuation (fALFF). Regions with mean fALFF (mfALFF) alterations were used as seeds in seed correlation analysis (SCA). An independent samples t test was used to compare the differences in mfALFF and functional connection (FC) between the two groups. Pearson correlation analysis was performed to identify the association between functional neural correlates and OCD symptom severity evaluated using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results: Compared with the HC group, the OCD group showed significantly increased mfALFF values in bilateral cerebellar. The results of FC analysis showed weakened connectivity among the left Crus II, lobule VIII, and right striatum and between the right lobule VIII and the right striatum, and cingulate in the OCD group compared with the HC group. Some of the abovementioned results were associated with symptom severity. Conclusions: OCD patients showed abnormal spontaneous cerebellar activity and weakened functional connectivity between the cerebellum and the cortico-striato-thalamo-cortical (CSTC) circuit (striatum and cingulate), suggesting that the cerebellum may play an essential role in the pathophysiology of OCD.
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Affiliation(s)
- Haisan Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, China
| | - Bi Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, China
| | - Kun Li
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, China
| | - Xiaoyue Wang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, China
| | - Xianrui Li
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Jianli Zhu
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Qingjiang Zhao
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Xinxiang Key Laboratory of Multimodal Brain Imaging, Xinxiang, China
| | - Yongfeng Yang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, China
| | - Luxian Lv
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,Henan Key Lab of Biological Psychiatry of Xinxiang Medical University, Xinxiang, China.,International Joint Research Laboratory for Psychiatry and Neuroscience of Henan, Xinxiang, China
| | - Meng Zhang
- School of Psychology, Xinxiang Medical University, Xinxiang, China
| | - Hongxing Zhang
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, China.,School of Psychology, Xinxiang Medical University, Xinxiang, China
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Pertusa A, Lopez Gaston R, Choudry A. Hoarding revisited: there is light at the end of the living room. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSince 2013, hoarding disorder has been recognised as a standalone diagnosis in the DSM, affecting an estimated 2–6% of the general population. This article outlines the arguments for and against this separate classification and considers the differentiation of hoarding disorder from normative collecting. It then discusses aetiology, assessment, course and treatment (both psychological and pharmacological interventions). It concludes with a discussion of ethical and legal considerations, in particular the fact that the inclusion of hoarding disorder as a distinct diagnosis in DSM-5 confers specific protections for people with the disorder under the Equality Act 2010.LEARNING OBJECTIVES•Be able to define the criteria of hoarding disorder•Be able to recognise the difference between hoarding and collecting•Understand potential treatment options for patients with hoarding disorderDECLARATION OF INTERESTNone.
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29
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Yin D, Zhang C, Lv Q, Chen X, Zeljic K, Gong H, Zhan S, Jin H, Wang Z, Sun B. Dissociable Frontostriatal Connectivity: Mechanism and Predictor of the Clinical Efficacy of Capsulotomy in Obsessive-Compulsive Disorder. Biol Psychiatry 2018; 84:926-936. [PMID: 29778276 DOI: 10.1016/j.biopsych.2018.04.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 04/09/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Little is known about the neural mechanism and response variability underlying neurosurgical interventions for intractable obsessive-compulsive disorder (OCD). METHODS Of 81 OCD patients screened for capsulotomy identified in our institutional database, 36 patients with clinical assessment before and after capsulotomy and imaging data (9 of 36 patients without postoperative imaging data used as an independent test group), and 29 healthy control subjects were retrospectively recruited. Twenty of 36 patients (56%) responded to the lesion procedure (determined as a ≥35% reduction in Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score). Seed-based (i.e., ventral and dorsal caudate, medial dorsal thalamus, and ventral and dorsal putamen) resting-state functional connectivity was used to examine alterations in frontostriatal circuitry after capsulotomy. RESULTS The Y-BOCS score significantly decreased (p < .001) after capsulotomy in OCD patients. Functional connectivity between the ventral striatum/nucleus accumbens and the dorsal anterior cingulate cortex was reduced (p < .05, corrected) after the surgical procedure. Moreover, change in connectivity significantly correlated with alteration in Y-BOCS score (r = .41, p = .033). In addition, preoperative connectivity between the dorsal caudate and the dorsal anterior cingulate cortex could differentiate nonresponders from responders and predict changes in Y-BOCS score (R2 = .23, F1,25 = 7.56, p = .011), which was generalized in an independent test group. CONCLUSIONS We demonstrated that restoration of ventral frontostriatal connectivity was associated with clinical improvement in refractory OCD, suggesting a therapeutic mechanism of capsulotomy. Moreover, preoperative variations in dorsal frontostriatal connectivity predicted clinical response, which may offer a predictor of treatment outcome.
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Affiliation(s)
- Dazhi Yin
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
| | - ChenCheng Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiming Lv
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China
| | - Xiaoyu Chen
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China
| | - Kristina Zeljic
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China; University of Chinese Academy of Sciences, Beijing, China
| | - Hengfen Gong
- Department of Psychiatry, Pudong District Mental Health Center, Shanghai, China
| | - Shikun Zhan
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zheng Wang
- Institute of Neuroscience, State Key Laboratory of Neuroscience, Chinese Academy of Sciences Center for Excellence in Brain Science and Intelligence Technology, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China.
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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30
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Lockwood R. Animal hoarding: The challenge for mental health, law enforcement, and animal welfare professionals. BEHAVIORAL SCIENCES & THE LAW 2018; 36:698-716. [PMID: 30191593 DOI: 10.1002/bsl.2373] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/11/2018] [Accepted: 08/02/2018] [Indexed: 06/08/2023]
Abstract
Animal hoarding has been considered a significant problem by animal welfare and law enforcement professionals for over a century. However, it has only been recognized as an indication of a mental disorder in the last decade. I review the different forms that animal hoarding can take and the current understanding of the prevalence, demographics and possible etiology of this disorder. Conventional animal cruelty laws have often been inadequate to respond to animal hoarding cases until they reach levels that may involve serious harm to animals and people. I document how prosecution of such cases can be difficult and often does not adequately consider the mental health issues underlying the problem or the high likelihood of recidivism. Attempts to solve these problems by enacting new laws specifically addressing animal hoarding have been controversial and ineffective. I explore new approaches that coordinate a variety of community resources in response to hoarding cases that offer the best opportunity to respond to both the human and animal problems associated with animal hoarding.
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Affiliation(s)
- Randall Lockwood
- American Society for the Prevention of Cruelty to Animals, Response and Engagement, Anti-Cruelty Special Projects/Policy, Falls Church, VA, USA
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31
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Yamada S, Nakao T, Ikari K, Kuwano M, Murayama K, Tomiyama H, Hasuzawa S, Togao O, Hiwatashi A, Kanba S. A unique increase in prefrontal gray matter volume in hoarding disorder compared to obsessive-compulsive disorder. PLoS One 2018; 13:e0200814. [PMID: 30011337 PMCID: PMC6047811 DOI: 10.1371/journal.pone.0200814] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/03/2018] [Indexed: 01/31/2023] Open
Abstract
Background Hoarding disorder (HD) is a disease concept newly presented in DSM-5. As far as we know, no studies have examined the structural changes relevant to hoarding by applying the diagnostic criteria of HD in DSM-5. In the present study, we aimed to find abnormalities in gray matter (GM) structures of patients with HD. Methods Seventeen patients who met the DSM-5 criteria for HD, 17 obsessive-compulsive disorder (OCD) patients, and 17 healthy controls (HCs) participated in this study. All participants underwent MRI scanning of the brain by a 3.0-Tesla MRI scanner. In a voxel-based morphometric procedure, preprocessed GM structural images were used to compare the three groups. Thereafter we investigated the correlation between the clinical data (age of onset, symptomatic severity) and GM volume. Results The HD group showed a significantly increased GM volume compared to the OCD and healthy control groups (p<0.05) in both Brodmann area (BA)10 and BA11. There was no significant difference between OCD and healthy control groups. No significant correlation between the clinical data including age of onset, symptom severity score, and GM volume was observed in HD and OCD groups. Conclusions The results might help to explain the inconsistency of previous studies. As with OCD, HD is considered to have cognitive dysfunction as its basis. This result is convincing after considering the clinical features of HD and suggested that structural abnormalities in the prefrontal regions might relate to the pathophysiology of HD.
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Affiliation(s)
- Satoshi Yamada
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomohiro Nakao
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- * E-mail:
| | - Keisuke Ikari
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masumi Kuwano
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Keitaro Murayama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hirofumi Tomiyama
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Suguru Hasuzawa
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Osamu Togao
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akio Hiwatashi
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shigenobu Kanba
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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32
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Gürsel DA, Avram M, Sorg C, Brandl F, Koch K. Frontoparietal areas link impairments of large-scale intrinsic brain networks with aberrant fronto-striatal interactions in OCD: a meta-analysis of resting-state functional connectivity. Neurosci Biobehav Rev 2018; 87:151-160. [DOI: 10.1016/j.neubiorev.2018.01.016] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/18/2018] [Accepted: 01/29/2018] [Indexed: 01/01/2023]
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Edemann-Callesen H, Habelt B, Wieske F, Jackson M, Khadka N, Mattei D, Bernhardt N, Heinz A, Liebetanz D, Bikson M, Padberg F, Hadar R, Nitsche MA, Winter C. Non-invasive modulation reduces repetitive behavior in a rat model through the sensorimotor cortico-striatal circuit. Transl Psychiatry 2018; 8:11. [PMID: 29317605 PMCID: PMC5802458 DOI: 10.1038/s41398-017-0059-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/19/2023] Open
Abstract
Involuntary movements as seen in repetitive disorders such as Tourette Syndrome (TS) results from cortical hyperexcitability that arise due to striato-thalamo-cortical circuit (STC) imbalance. Transcranial direct current stimulation (tDCS) is a stimulation procedure that changes cortical excitability, yet its relevance in repetitive disorders such as TS remains largely unexplored. Here, we employed the dopamine transporter-overexpressing (DAT-tg) rat model to investigate behavioral and neurobiological effects of frontal tDCS. The outcome of tDCS was pathology dependent, as anodal tDCS decreased repetitive behavior in the DAT-tg rats yet increased it in wild-type (wt) rats. Extensive deep brain stimulation (DBS) application and computational modeling assigned the response in DAT-tg rats to the sensorimotor pathway. Neurobiological assessment revealed cortical activity changes and increase in striatal inhibitory properties in the DAT-tg rats. Our findings show that tDCS reduces repetitive behavior in the DAT-tg rat through modulation of the sensorimotor STC circuit. This sets the stage for further investigating the usage of tDCS in repetitive disorders such as TS.
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Affiliation(s)
- Henriette Edemann-Callesen
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
- International Graduate Program Medical Neurosciences, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Bettina Habelt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Franziska Wieske
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Mark Jackson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Niranjan Khadka
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Daniele Mattei
- Cellular Neuroscience, Max-Delbrueck-Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Nadine Bernhardt
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David Liebetanz
- Department of Clinical Neurophysiology, University Medical Center, Georg-August-University, Goettingen, Germany
| | - Marom Bikson
- Department of Biomedical Engineering, The City College of The City University of New York, New York, NY, USA
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich, Germany
| | - Ravit Hadar
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael A Nitsche
- Department of Psychology and Neurosciences, Leibniz Research Centre for Working Environment and Human Factors, Dortmund, Germany
- Department of Neurology, University Medical Hospital Bergmannsheil, Bochum, Germany
| | - Christine Winter
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Psychiatry and Psychotherapy, Medical Faculty Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Gaston RL, Kiran-Imran F, Hassiem F, Vaughan J. Hoarding behaviour: building up the ‘R factor’. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.107.005215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryHoarding seems to be a non-specific symptom, as it has been associated with a wide range of psychiatric disorders. Validating hoarding as pathological is controversial and its nosological status remains unresolved. ‘Diogenes syndrome’ has been paradigmatic in this area, but its clinical use seems limited. Hoarding is not explicitly covered in either DSM–IV or ICD–10 and literature suggests that diagnosis of mental illness may consequently be missed in this population. In the context of these theoretical uncertainties, clinicians still need to accurately assess and treat patients who show hoarding behaviour. To this end, we summarise the available evidence, and present assessment and management algorithms together with a multicomponent psychological intervention that aims to teach patients to successfully apply the three Rs (reduce, recycle, reuse).
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Fineberg NA, Apergis-Schoute AM, Vaghi MM, Banca P, Gillan CM, Voon V, Chamberlain SR, Cinosi E, Reid J, Shahper S, Bullmore ET, Sahakian BJ, Robbins TW. Mapping Compulsivity in the DSM-5 Obsessive Compulsive and Related Disorders: Cognitive Domains, Neural Circuitry, and Treatment. Int J Neuropsychopharmacol 2018; 21:42-58. [PMID: 29036632 PMCID: PMC5795357 DOI: 10.1093/ijnp/pyx088] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Compulsions are repetitive, stereotyped thoughts and behaviors designed to reduce harm. Growing evidence suggests that the neurocognitive mechanisms mediating behavioral inhibition (motor inhibition, cognitive inflexibility) reversal learning and habit formation (shift from goal-directed to habitual responding) contribute toward compulsive activity in a broad range of disorders. In obsessive compulsive disorder, distributed network perturbation appears focused around the prefrontal cortex, caudate, putamen, and associated neuro-circuitry. Obsessive compulsive disorder-related attentional set-shifting deficits correlated with reduced resting state functional connectivity between the dorsal caudate and the ventrolateral prefrontal cortex on neuroimaging. In contrast, experimental provocation of obsessive compulsive disorder symptoms reduced neural activation in brain regions implicated in goal-directed behavioral control (ventromedial prefrontal cortex, caudate) with concordant increased activation in regions implicated in habit learning (presupplementary motor area, putamen). The ventromedial prefrontal cortex plays a multifaceted role, integrating affective evaluative processes, flexible behavior, and fear learning. Findings from a neuroimaging study of Pavlovian fear reversal, in which obsessive compulsive disorder patients failed to flexibly update fear responses despite normal initial fear conditioning, suggest there is an absence of ventromedial prefrontal cortex safety signaling in obsessive compulsive disorder, which potentially undermines explicit contingency knowledge and may help to explain the link between cognitive inflexibility, fear, and anxiety processing in compulsive disorders such as obsessive compulsive disorder.
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Affiliation(s)
- Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Annemieke M Apergis-Schoute
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Matilde M Vaghi
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Paula Banca
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Valerie Voon
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Samuel R Chamberlain
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
- Cambridge and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Eduardo Cinosi
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
| | - Jemma Reid
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
- University of Hertfordshire, Department of Postgraduate Medicine, College Lane Hatfield, United Kingdom
| | - Sonia Shahper
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, Hertfordshire, United Kingdom
| | - Edward T Bullmore
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Barbara J Sahakian
- Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Addenbrooke’s Hospital, Cambridge, United Kingdom
| | - Trevor W Robbins
- Behavioral and Clinical Neurosciences Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
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Compulsive Hoarding in an Older Adult with Aggression, Delusions and Memory Loss: A Multimodality Neuroimaging Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/bf03379920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Multimodal assessment practices offer enriching contributions to linkages between clinical presentation and brain presen-tation. The following case study is an illustration of the effectiveness of structural and functional imaging in the diagnosis process. In this article a clinical vignette is given in which the client (Mr. B) presents with aggressive behavior, delu-sions, memory complaints and hoarding behaviors. The findings of the case of presented based on multimodal structural and functional imaging. Mr. B was evaluated using MRI (magnetic resonance imaging), EEG (electroencephalography), qEEG (quantitative EEG), LORETA (low resolution electromagnetic tomography), SPECT (single photon emission computed tomography), quantitative SPECT and neuropsychological testing.
Visual analysis of EEG recording revealed sharp waves with reversals primarily in the mid-central region (Cz). Quantita-tive analysis of background activity acquired in eyes closed and alert state revealed increased absolute and relative beta power maximally distributed to the mid-central region (Cz). This was consistent with the source analysis obtained from LORETA. Visual inspection of SPECT data indicated increased blood perfusion in the posterior cingulate cortex. The quantitative analysis of SPECT images, on the contrary revealed decreased perfusion in both anterior and posterior cingu-late cortex. Furthermore, increased perfusion in bilateral sensori-motor cortices (right more than left) and decreased per-fusion in the left posterior temporal lobe was observed. T-1 based MRI of the brain showed generalized cerebral atrophy. On neuropsychological testing Mr. B was able to complete only tests of lesser complexity. Base on published data Mr. B’s structural and functional imaging can be linked to his clinical presentation and a potential diagnosis of Frontal Tem-poral lobe Disorder (FTD). The use of multimodalities and objective analysis of data can lead to more accurate case con-ceptualizations and linkages between brain structure/functionality and clinical presentation.
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Qiu L, Fu X, Wang S, Tang Q, Chen X, Cheng L, Zhang F, Zhou Z, Tian L. Abnormal regional spontaneous neuronal activity associated with symptom severity in treatment-naive patients with obsessive-compulsive disorder revealed by resting-state functional MRI. Neurosci Lett 2017; 640:99-104. [PMID: 28104431 DOI: 10.1016/j.neulet.2017.01.024] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 12/26/2016] [Accepted: 01/11/2017] [Indexed: 12/22/2022]
Abstract
A large number of neuroimaging studies have revealed the dysfunction of brain activities in obsessive-compulsive disorder (OCD) during various tasks. However, regional spontaneous activity abnormalities in OCD are gradually being revealed. In this current study, we aimed to investigate cerebral regions with abnormal spontaneous activity using resting-state functional magnetic resonance imaging (fMRI) and further explored the relationship between the spontaneous neuronal activity and symptom severity of patients with OCD. Thirty-one patients with OCD and 32 age-and sex-matched normal controls received the fMRI scans and fractional amplitude of low-frequency fluctuation (fALFF) approach was applied to identify the abnormal brain activity. We found that patients with OCD showed decreased fALFF not only in the cortical-striato-thalamo-cortical (CSTC) circuits like the thalamus, but also in other cerebral systems like the cerebellum, the parietal cortex and the temporal cortex. Additionally, OCD patients demonstrated significant associations between decreased fALFF and obsessive-compulsive symptom severity in the thalamus, the paracentral lobule and the cerebellum. Our results provide evidence for abnormal spontaneous neuronal activity in distributed cerebral areas and support the notion that brain areas outside the CSTC circuits may also play an important role in the pathophysiology of OCD.
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Affiliation(s)
- Linlin Qiu
- Department of Medical Psychology, Anhui Medical University, Hefei, China; Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Xiangshuai Fu
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China; Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Shuai Wang
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China; Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Qunfeng Tang
- Department of Medical Imaging, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China
| | - Xingui Chen
- Laboratory of Neuropsychology, Anhui Medical University, Hefei, China
| | - Lin Cheng
- Mental Health Center of Anhui Province, Hefei, China
| | - Fuquan Zhang
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China; Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Zhenhe Zhou
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China; Wuxi Tongren International Rehabilitation Hospital, Wuxi, China
| | - Lin Tian
- Department of Psychiatry, Wuxi Mental Health Center, Nanjing Medical University, Wuxi, China; Wuxi Tongren International Rehabilitation Hospital, Wuxi, China.
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Rangwala SD, Tobin MK, Birk DM, Butts JT, Nikas DC, Hahn YS. Pica in a Child with Anterior Cingulate Gyrus Oligodendroglioma: Case Report. Pediatr Neurosurg 2017; 52:279-283. [PMID: 28704833 DOI: 10.1159/000477816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Accepted: 05/28/2017] [Indexed: 11/19/2022]
Abstract
The anterior cingulate gyrus (ACG) is a continued focus of research as its exact role in brain function and vast connections with other anatomical locations is not fully understood. A review of the literature illustrates the role the ACG likely plays in cognitive and emotional processing, as well as a modulating role in motor function and goal-oriented behaviors. While lesions of the cingulate gyrus are rare, each new case broadens our understanding of its role in cognitive neuroscience and higher order processing. The authors present the case of an 8-year-old boy with a 1-month history of staring spells, agitated personality, and hyperphagia notable for the consumption of paper, who was found to have a 3-cm tumor in the left ACG. Following surgical resection of the tumor, his aggressive behavior and pica were ameliorated and the patient made an uneventful recovery, with no evidence of recurrence over the last 6 years since surgical resection. Here we discuss a unique behavioral presentation of pica, along with a review of the current literature, to illustrate functions of the ACG relevant to the location of the lesion.
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Affiliation(s)
- Shivani D Rangwala
- Department of Pediatric Neurosurgery/Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
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Tao J, Wang X, Zhong Z, Han H, Liu S, Wen S, Guan N, Li L. Alterations of white matter fractional anisotropy in unmedicated obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2017; 13:69-76. [PMID: 28096674 PMCID: PMC5207449 DOI: 10.2147/ndt.s123669] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Abnormalities in white matter (WM) have previously been reported in patients with obsessive-compulsive disorder (OCD). However, there was some inconsistency in the results obtained for altered regions of WM. The aim of this study was to investigate fractional anisotropy (FA) in the WM of the whole brain in patients with OCD by using diffusion tensor imaging (DTI). METHODS In total, 28 unmedicated patients with OCD and 28 healthy volunteers underwent DTI scan. A voxel-based analysis was used to compare FA values in WM of the two groups at a voxel threshold of P<0.005 with an extent threshold of k>72 voxels (P<0.05; Alphasim correction). Subsequently, correlation analysis was conducted in order to find the correlation between the mean FA values in significantly altered brain regions and Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores of the OCD patients. RESULTS Compared with healthy volunteers, the OCD patients had lower FA value in the left lingual gyrus, right midbrain, and right precuneus. There were no regions with significantly higher FA values in OCD patients compared with healthy volunteers. The mean FA values in the above regions (left lingual, r=0.019, P=0.923; right midbrain, r=-0.208, P=0.289; and right precuneus, r=-0.273, P=0.161) had no significant correlation with the Y-BOCS scores of the OCD patients. CONCLUSION The findings of this study suggest that alterations in WM of the left lingual gyrus, right midbrain, and right precuneus are associated with the pathophysiology mechanism of OCD, and these microstructural alterations do not correlate with symptom severity of OCD.
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Affiliation(s)
- Jiong Tao
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha; Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Xianglan Wang
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Zhiyong Zhong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha; Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Hongying Han
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Sha Liu
- Department of Radiology, Guangzhou Huiai Hospital, Guangzhou
| | - Shenglin Wen
- Department of Psychiatry, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, People's Republic of China
| | - Nianhong Guan
- Department of Psychiatry, The Third Affiliated Hospital of Sun Yat-sen University
| | - Lingjiang Li
- Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha
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Hough CM, Luks TL, Lai K, Vigil O, Guillory S, Nongpiur A, Fekri SM, Kupferman E, Mathalon DH, Mathews CA. Comparison of brain activation patterns during executive function tasks in hoarding disorder and non-hoarding OCD. Psychiatry Res 2016; 255:50-59. [PMID: 27522332 PMCID: PMC5014569 DOI: 10.1016/j.pscychresns.2016.07.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 07/09/2016] [Accepted: 07/11/2016] [Indexed: 12/20/2022]
Abstract
We examined differences in regional brain activation during tests of executive function in individuals with Hoarding Disorder (HD), Obsessive Compulsive Disorder (OCD), and healthy controls (HC) using functional magnetic resonance imaging (fMRI). Participants completed computerized versions of the Stroop and Go/No-Go task. We found that during the conflict monitoring and response inhibition condition in the Go/No-Go task, individuals with HD had significantly greater activity than controls in the anterior cingulate cortex (ACC) and right dorsolateral prefrontal cortex (DLPFC). HD also exhibited significantly greater right DLPFC activity than OCD. We also observed significant differences in activity between HD and HC and between HD and OCD in regions (ACC, anterior insula, orbitofrontal cortex, and striatum) involved in evaluating stimulus-response-reward associations, or the personal and task-relevant value of stimuli and behavioral responses to stimuli. These results support the hypothesis that individuals with HD have difficulty deciding on the value or task relevance of stimuli, and may perceive an abnormally high risk of negative feedback for difficult or erroneous cognitive behavior.
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Affiliation(s)
- Christina M Hough
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Tracy L Luks
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, USA
| | - Karen Lai
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Ofilio Vigil
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Sylvia Guillory
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Arvind Nongpiur
- Department of Psychiatry, University of Florida, Gainesville, FL, USA; Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong, Meghalaya, India
| | - Shiva M Fekri
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Eve Kupferman
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA
| | - Daniel H Mathalon
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Carol A Mathews
- Department of Psychiatry, UCSF Weill Institute for Neurosciences, University of California, San Francisco, USA; Department of Psychiatry, University of Florida, Gainesville, FL, USA.
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Frost RO, Ong C, Steketee G, Tolin DF. Behavioral and emotional consequences of thought listing versus cognitive restructuring during discarding decisions in hoarding disorder. Behav Res Ther 2016; 85:13-22. [PMID: 27537707 DOI: 10.1016/j.brat.2016.08.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 08/05/2016] [Accepted: 08/08/2016] [Indexed: 11/30/2022]
Abstract
An essential criterion for hoarding disorder (HD) is difficulty discarding or parting with possessions, yet few studies have examined reactions to actual discarding behaviors. The present study examined whether individuals with HD differed from non-hoarding community controls (CC) in discarding behavior and emotional reactions to discarding. A second purpose was to examine the course of experienced distress following discarding. A third purpose was to determine whether HD participants responded differently to a simple thought listing (TL) instruction or to a cognitive restructuring (CR) protocol. Participants were asked to decide whether to keep or discard (a) a personal possession and (b) a newly acquired object (magazine). HD participants anticipated more and longer distress and reported stronger attachment motives than community controls, but they did not differ significantly from community controls in actual discarding behavior. TL was somewhat more effective than CR in improving discarding behavior and reducing negative emotions and attachments to discarded objects among HD participants. Reductions in distress were observed for both HD-TL and HD-CR groups. Thought listing may have reduced avoidance of decision-making about discarding or perhaps CR, but not TL, provoked therapeutic reactance. Discarding was not related to reductions in distress or hoarding-related beliefs.
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Affiliation(s)
- Randy O Frost
- Department of Psychology, Smith College, Northampton, MA 01063, USA.
| | - Clarissa Ong
- Department of Psychology, Smith College, Northampton, MA 01063, USA
| | - Gail Steketee
- Boston University School of Social Work, 264 Bay State Rd., Boston, MA 02215, USA
| | - David F Tolin
- Anxiety Disorders Center, Institute of Living, 200 Retreat Ave., Hartford, CT 06106, USA; Yale University School of Medicine, New Haven, CT, USA
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Pelletier JF, Boisvert C, Galipeau-Leduc MC, Ducasse C, Pouliot-Morneau D, Bordeleau J. De l’Université du rétablissement. SANTE MENTALE AU QUEBEC 2016. [DOI: 10.7202/1036973ar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
La neuro-imagerie permet d’observer et de comparer des groupes d’individus réagissant différemment lorsqu’exposés, en laboratoire, à des images provocatrices ou à des situations particulières. Pour certains, cette réaction impliquera des zones cérébrales davantage associées à l’émotivité, ce qui peut expliquer des déficits dits cognitifs ou d’attention faisant obstacle à leurs capacités d’apprentissage, d’abstraction et d’adaptation. On peut ainsi comparer des schémas de réactions qui ont été assez souvent répétés et observés pour que l’on puisse tirer certaines conclusions statistiques : en présence d’un même stimulus ou en situation de stress, le cerveau des personnes présentant par exemple un trouble obsessif-compulsif réagit différemment de celui de la population en général. Pour certains d’entre nous il est rassurant de constater, images à l’appui, que c’est telle partie du cerveau plutôt qu’une autre qui est surtout sollicitée dans une situation donnée. Cela « prouverait » que ce n’est pas intentionnellement que la réaction est plus émotive que rationnelle, le cas échéant. Par contre, pour d’autres, il est important d’être informés au moins autant des possibilités du rétablissement que d’identifier les dysfonctions et les causes apparemment anatomiques d’un problème de santé mentale. Dans un cas comme dans l’autre, cet accès à de l’information médicale et la possibilité pour les étudiants en rétablissement de dialoguer avec un scientifique sont à la base de tout un programme dit d’éducation thérapeutique et cette « Université du rétablissement » est ici introduite pour la première fois.
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Affiliation(s)
- Jean-François Pelletier
- Ph. D., Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal – Professeur sous octroi, Département de psychiatrie, Université de Montréal – Assistant Clinical Professor, Yale Program for Recovery & Community Health, School of Medicine
| | - Christine Boisvert
- M.D., Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Marie-Claude Galipeau-Leduc
- Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Christian Ducasse
- Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal
| | - Denis Pouliot-Morneau
- Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal – erg., étudiant à la maîtrise en sociologie, Université du Québec à Montréal
| | - Julie Bordeleau
- Paire aidante certifiée, Programme international de recherche action participative/Centre de recherche de l’Institut universitaire en santé mentale de Montréal
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Weidt S, Lutz J, Rufer M, Delsignore A, Jakob NJ, Herwig U, Bruehl AB. Common and differential alterations of general emotion processing in obsessive-compulsive and social anxiety disorder. Psychol Med 2016; 46:1427-1436. [PMID: 26804333 DOI: 10.1017/s0033291715002998] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) and social anxiety disorder (SAD) are characterized by biased perception and processing of potentially threatening stimuli. A hyper-reactivity of the fear-circuit [e.g. amygdala, anterior cingulate (ACC)] has been consistently reported using functional magnetic resonance imaging (fMRI) in SAD in comparison with healthy controls (HCs). Studies investigating the processing of specific emotional stimuli in OCD reported mainly orbitofrontal-striatal abnormalities. The goal of this study was to examine similar/common and differential neurobiological responses in OCD and SAD using unspecific emotional stimuli. METHOD Fifty-four subjects participated: two groups (each n = 18) of outpatients with a current diagnosis of OCD or SAD, and 18 HCs. All subjects underwent fMRI while anticipating and perceiving unspecific visual stimuli with prior announced emotional valence (e.g. positive). RESULTS Compared to HCs, the combined patient group showed increased activation in amygdala, caudate and prefrontal/orbitofrontal cortex while anticipating unspecific emotional stimuli. Caudate was more active in the combined patient group during perception. A comparison between the OCD and the SAD samples revealed increased amygdala and decreased rostral ACC activation in OCD patients during perception, but no differences in the anticipation phase. CONCLUSIONS Overall, we could identify common fronto-subcortical hyper-reactivity in OCD and SAD while anticipating and perceiving unspecific emotional stimuli. While differential neurobiological responses between OCD and SAD when processing specific stimuli are evident from the literature, differences were less pronounced using unspecific stimuli. This could indicate a disturbance of emotion regulation common to both OCD and SAD.
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Affiliation(s)
- S Weidt
- Department of Psychiatry and Psychotherapy,University Hospital,University of Zurich,Zurich,Switzerland
| | - J Lutz
- Department of Psychiatry, Psychotherapy and Psychosomatics,Psychiatric Hospital,University of Zurich,Switzerland
| | - M Rufer
- Department of Psychiatry and Psychotherapy,University Hospital,University of Zurich,Zurich,Switzerland
| | - A Delsignore
- Department of Psychiatry and Psychotherapy,University Hospital,University of Zurich,Zurich,Switzerland
| | - N J Jakob
- Sanatorium Kilchberg,Kilchberg,Switzerland
| | - U Herwig
- Department of Psychiatry, Psychotherapy and Psychosomatics,Psychiatric Hospital,University of Zurich,Switzerland
| | - A B Bruehl
- Behavioural and Clinical Neuroscience Institute and Department of Psychiatry,University of Cambridge,UK
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44
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Han HJ, Jung WH, Yun JY, Park JW, Cho KK, Hur JW, Shin NY, Lee TY, Kwon JS. Disruption of effective connectivity from the dorsolateral prefrontal cortex to the orbitofrontal cortex by negative emotional distraction in obsessive-compulsive disorder. Psychol Med 2016; 46:921-932. [PMID: 26619965 DOI: 10.1017/s0033291715002391] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has been associated with abnormal cognitive and emotional functions and these dysfunctions may be dependent on the disruption of dynamic interactions within neuronal circuits associated with emotion regulation. Although several studies have shown the aberrant cognitive-affective processing in OCD patients, little is known about how to characterize effective connectivity of the disrupted neural interactions. In the present study, we applied effective connectivity analysis using dynamic causal modeling to explore the disturbed neural interactions in OCD patients. METHOD A total of 20 patients and 21 matched healthy controls performed a delayed-response working memory task under emotional or non-emotional distraction while undergoing functional magnetic resonance imaging. RESULTS During the delay interval under negative emotional distraction, both groups showed similar patterns of activations in the amygdala. However, under negative emotional distraction, the dorsolateral prefrontal cortex (DLPFC) and the orbitofrontal cortex (OFC) exhibited significant differences between groups. Bayesian model averaging indicated that the connection from the DLPFC to the OFC was negatively modulated by negative emotional distraction in patients, when compared with healthy controls (p < 0.05, Bonferroni-corrected). CONCLUSIONS Exaggerated recruitment of the DLPFC may induce the reduction of top-down prefrontal control input over the OFC, leading to abnormal cortico-cortical interaction. This disrupted cortico-cortical interaction under negative emotional distraction may be responsible for dysfunctions of cognitive and emotional processing in OCD patients and may be a component of the pathophysiology associated with OCD.
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Affiliation(s)
- H J Han
- Department of Brain and Cognitive Sciences,College of Natural Sciences,Seoul National University,Seoul,South Korea
| | - W H Jung
- Medical Research Center,Seoul National University Hospital,Seoul,South Korea
| | - J-Y Yun
- Medical Research Center,Seoul National University Hospital,Seoul,South Korea
| | - J W Park
- Department of Psychiatry,Seoul National University College of Medicine,Seoul,South Korea
| | - K K Cho
- Department of Brain and Cognitive Sciences,College of Natural Sciences,Seoul National University,Seoul,South Korea
| | - J-W Hur
- Department of Brain and Cognitive Sciences,College of Natural Sciences,Seoul National University,Seoul,South Korea
| | - N Y Shin
- Medical Research Center,Seoul National University Hospital,Seoul,South Korea
| | - T Y Lee
- Medical Research Center,Seoul National University Hospital,Seoul,South Korea
| | - J S Kwon
- Department of Brain and Cognitive Sciences,College of Natural Sciences,Seoul National University,Seoul,South Korea
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45
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Dunlop K, Woodside B, Olmsted M, Colton P, Giacobbe P, Downar J. Reductions in Cortico-Striatal Hyperconnectivity Accompany Successful Treatment of Obsessive-Compulsive Disorder with Dorsomedial Prefrontal rTMS. Neuropsychopharmacology 2016; 41:1395-403. [PMID: 26440813 PMCID: PMC4793124 DOI: 10.1038/npp.2015.292] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 08/05/2015] [Accepted: 08/12/2015] [Indexed: 01/22/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a disabling illness with high rates of nonresponse to conventional treatments. OCD pathophysiology is believed to involve abnormalities in cortico-striatal-thalamic-cortical circuits through regions such as dorsomedial prefrontal cortex (dmPFC) and ventral striatum. These regions may constitute therapeutic targets for neuromodulation treatments, such as repetitive transcranial magnetic stimulation (rTMS). However, the neurobiological predictors and correlates of successful rTMS treatment for OCD are unclear. Here, we used resting-state functional magnetic resonance imaging (fMRI) to identify neural predictors and correlates of response to 20-30 sessions of bilateral 10 Hz dmPFC-rTMS in 20 treatment-resistant OCD patients, with 40 healthy controls as baseline comparators. A region of interest in the dmPFC was used to generate whole-brain functional connectivity maps pre-treatment and post treatment. Ten of 20 patients met the response criteria (⩾50% improvement on Yale-Brown Obsessive-Compulsive Scale, YBOCS); response to dmPFC-rTMS was sharply bimodal. dmPFC-rTMS responders had higher dmPFC-ventral striatal connectivity at baseline. The degree of reduction in this connectivity, from pre- to post-treatment, correlated to the degree of YBOCS symptomatic improvement. Baseline clinical and psychometric data did not predict treatment response. In summary, reductions in fronto-striatal hyperconnectivity were associated with treatment response to dmPFC-rTMS in OCD. This finding is consistent with previous fMRI studies of deep brain stimulation in OCD, but opposite to previous reports on mechanisms of dmPFC-rTMS in major depression. fMRI could prove useful in predicting the response to dmPFC-rTMS in OCD.
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Affiliation(s)
- Katharine Dunlop
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada,MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada
| | - Blake Woodside
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Eating Disorders Program, University Health Network, Toronto, ON, Canada
| | - Marion Olmsted
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Eating Disorders Program, University Health Network, Toronto, ON, Canada
| | - Patricia Colton
- Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Eating Disorders Program, University Health Network, Toronto, ON, Canada
| | - Peter Giacobbe
- MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Jonathan Downar
- Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada,MRI-Guided rTMS Clinic, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto, ON, Canada,Toronto Western Research Institute, University Health Network, Toronto, ON, Canada,Department of Psychiatry, University of Toronto, Toronto Western Research Institute, MRI-Guided rTMS Clinic, University Health Network, 399 Bathurst Street 7M-415, Toronto, ON M5T 2S8, Canada, Tel: +416 603 5667, Fax: +416 603 5292, E-mail:
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46
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Lavigne B, Hamdan M, Faure B, Merveille H, Pareaud M, Tallon E, Bouthier A, Clément JP, Calvet B. [Diogenes syndrome and Hoarding disorder: Same or different?]. Encephale 2016; 42:421-425. [PMID: 27017316 DOI: 10.1016/j.encep.2016.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 03/02/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION In 2013, the American Psychiatric Association published the DSM-5. In this new version, new diagnoses were proposed including the Hoarding disorder. In the French semeiology, the Diogenes syndrome is described, among other symptoms, by a pathological tendency to accumulate objects called syllogomania which is very close to hoarding. This paper explores the similarities and differences between the two syndromes. DESCRIPTION The Diogenes syndrome was first described in 1966 but was officially named for the ancient Greek philosopher in 1975 by Clark. Its frequency is around five for 100,000 persons. Many aetiologies have been known to be associated with the Diogenes syndrome: schizophrenia, dementia - especially frontotemporal type, anxiety disorders, mood disorders, and substance abuse - especially alcohol abuse. The diagnostic requires one major criterion, the inability to ask for medical or social help, and one of three minor criteria: a pathological relationship to the body, which leads to somatic illness; a pathological relationship to the society, which leads to a progressive exclusion from it; and finally, a pathological link with objects. This last criterion is very interesting because it is closely related to the Hoarding syndrome: indeed, patients with syllogamania, as also named, have a tendency to hoard every object they find. At the end, their homes are full of useless objects, and some living places can be unusable because they are cluttered and congested. This last point is similar to the definition given in the DSM-5 for the Hoarding disorder which describes a persistent difficulty parting with possessions; distress associated with discarding possessions; and accumulations that congest and clutter active living areas. The Hoarding disorder was first part of the Obsessive and compulsive disorders, but it has progressively appeared that it could be individualized with its own prevalence of 2.3% to 14% lifetime. Genetical studies have shown that at least 50% of patients suffering from excessive hoarding had a relative with a dimension of hoarding. Finally, Mattaix-Cols et al. decided to create a new syndrome in the DSM-5, and the Hoarding disorder was born. DISCUSSION The discussion begins with relationships between the Hoarding disorder and the Diogenes syndrome. A patient with hoarding, and a poor insight, could be very isolated, and could persist in a lack of calling for help, because of not being aware of his pathology. Thus, it could be diagnosed as a Hoarding syndrome with a poor insight, or as a Diogenes syndrome, with the first major criterion (lack of calling for help) and one of the three minor criteria, the syllogomania, or hoarding. Moreover, some authors have described old people living for many years with a tendency to hoard. Progressively, some of them had a congested and cluttered home, and a few were living in squalor, a description very close to the Diogenes syndrome. Finally, we discuss the comorbidity of Hoarding disorder and Diogenes syndrome. In particular, the first one is associated with Attention deficit and hyperactivity disorders; and some authors also described the links between ADHD, bipolar disorder and frontotemporal dementia which is one of the aetiologies of the Diogenes syndrome. A psychodynamic model in which ADHD, Hoarding disorder and Diogenes syndrome are linked can be imagined, and the last one could be an overlooked evolution of the two first syndromes. CONCLUSION In conclusion, we can imagine a dimensional model, based on two dimensions: hoarding and squalor. Hoarding disorder is the major expression of the first dimension, and Diogenes syndrome the major expression of the second. Both of them could be a different expression of one central aetiology. More studies are needed to complete this vision.
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Affiliation(s)
- B Lavigne
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87000 Limoges, France.
| | - M Hamdan
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87000 Limoges, France
| | - B Faure
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87000 Limoges, France
| | - H Merveille
- Équipe mobile d'évaluation et de suivi de la personne âgée, pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 87000 Limoges, France
| | - M Pareaud
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre Jean-Marie-Léger, centre hospitalier Esquirol, 87000 Limoges, France
| | - E Tallon
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre Jean-Marie-Léger, centre hospitalier Esquirol, 87000 Limoges, France
| | - A Bouthier
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 15, rue du Docteur-Marcland, 87000 Limoges, France
| | - J-P Clément
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre hospitalier Esquirol, 87000 Limoges, France
| | - B Calvet
- Pôle universitaire de psychiatrie de l'adulte et de la personne âgée, centre Jean-Marie-Léger, centre hospitalier Esquirol, 87000 Limoges, France
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Hartmann CJ, Lujan JL, Chaturvedi A, Goodman WK, Okun MS, McIntyre CC, Haq IU. Tractography Activation Patterns in Dorsolateral Prefrontal Cortex Suggest Better Clinical Responses in OCD DBS. Front Neurosci 2016; 9:519. [PMID: 26834544 PMCID: PMC4717315 DOI: 10.3389/fnins.2015.00519] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/23/2015] [Indexed: 01/21/2023] Open
Abstract
Background: Medication resistant obsessive-compulsive disorder (OCD) patients can be successfully treated with Deep Brain Stimulation (DBS) which targets the anterior limb of the internal capsule (ALIC) and the nucleus accumbens (NA). Growing evidence suggests that in patients who respond to DBS, axonal fiber bundles surrounding the electrode are activated, but it is currently unknown which discrete pathways are critical for optimal benefit. Our aim was to identify axonal pathways mediating clinical effects of ALIC-NA DBS. Methods: We created computational models of ALIC-NA DBS to simulate the activation of fiber tracts and to identify connected cerebral regions. The pattern of activated axons and their cortical targets was investigated in six OCD patients who underwent ALIC-NA DBS. Results: Modulation of the right anterior middle frontal gyrus (dorsolateral prefrontal cortex) was associated with an excellent response. In contrast, non-responders showed high activation in the orbital part of the right inferior frontal gyrus (lateral orbitofrontal cortex/anterior ventrolateral prefrontal cortex). Factor analysis followed by step-wise linear regression indicated that YBOCS improvement was inversely associated with factors that were predominantly determined by gray matter activation results. Discussion: Our findings support the hypothesis that optimal therapeutic results are associated with the activation of distinct fiber pathways. This suggests that in DBS for OCD, focused stimulation of specific fiber pathways, which would allow for stimulation with lower amplitudes, may be superior to activation of a wide array of pathways, typically associated with higher stimulation amplitudes.
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Affiliation(s)
- Christian J Hartmann
- Department of Biomedical Engineering, Cleveland Clinic FoundationCleveland, OH, USA; Department of Neurology, Medical Faculty, Institute of Clinical Neuroscience and Medical Psychology, Heinrich-Heine University DüsseldorfDüsseldorf, Germany
| | - J Luis Lujan
- Department of Neurologic Surgery, Mayo ClinicRochester, MN, USA; Department of Physiology and Biomedical Engineering, Mayo ClinicRochester, MN, USA
| | - Ashutosh Chaturvedi
- Department of Biomedical Engineering, Case Western Reserve University Cleveland, OH, USA
| | - Wayne K Goodman
- Department of Psychiatry, Friedman Brain Institute and Mount Sinai School of Medicine New York, NY, USA
| | - Michael S Okun
- Department of Neurology and Neurosurgery, Center for Movement Disorders and Neurorestoration, University of Florida Gainesville, FL, USA
| | - Cameron C McIntyre
- Department of Biomedical Engineering, Case Western Reserve University Cleveland, OH, USA
| | - Ihtsham U Haq
- Department of Neurology, Wake Forest University School of Medicine Winston-Salem, NC, USA
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48
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Mathews CA, Perez VB, Roach BJ, Fekri S, Vigil O, Kupferman E, Mathalon DH. Error-related brain activity dissociates hoarding disorder from obsessive-compulsive disorder. Psychol Med 2016; 46:367-79. [PMID: 26415671 PMCID: PMC5079649 DOI: 10.1017/s0033291715001889] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is associated with an abnormally large error-related negativity (ERN), an electrophysiological measure of error monitoring in response to performance errors, but it is unclear if hoarding disorder (HD) also shows this abnormality. This study aimed to determine whether the neurophysiological mechanisms underlying error monitoring are similarly compromised in HD and OCD. METHOD We used a visual flanker task to assess ERN in response to performance errors in 14 individuals with HD, 27 with OCD, 10 with HD+OCD, and 45 healthy controls (HC). Age-corrected performance and ERN amplitudes were examined using analyses of variance and planned pairwise group comparisons. RESULTS A main effect of hoarding on ERN (p = 0.031) was observed, indicating ERN amplitudes were attenuated in HD relative to non-HD subjects. A group × age interaction effect on ERN was also evident. In HD-positive subjects, ERN amplitude deficits were significantly greater in younger individuals (r = -0.479, p = 0.018), whereas there were no significant ERN changes with increasing age in OCD and HC participants. CONCLUSIONS The reduced ERN in HD relative to OCD and HC provides evidence that HD is neurobiologically distinct from OCD, and suggests that deficient error monitoring may be a core pathophysiological feature of HD. This effect was particularly prominent in younger HD participants, further suggesting that deficient error monitoring manifests most strongly early in the illness course and/or in individuals with a relatively early illness onset.
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Affiliation(s)
- Carol A. Mathews
- Department of Psychiatry, University of California, San Francisco
- Department of Psychiatry, University of Florida
| | - Veronica B. Perez
- California School of Professional Psychology (CSPP), Alliant International University
- Department of Psychiatry, University of California, San Diego
- VISN-22 VA San Diego Healthcare System
| | - Brian J. Roach
- Department of Psychiatry, University of California, San Francisco
- San Francisco VA Medical Center
| | - Shiva Fekri
- Department of Psychiatry, University of California, San Francisco
| | - Ofilio Vigil
- Department of Psychiatry, University of California, San Francisco
| | - Eve Kupferman
- Department of Psychiatry, University of California, San Francisco
| | - Daniel H. Mathalon
- Department of Psychiatry, University of California, San Francisco
- San Francisco VA Medical Center
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49
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Brakoulias V, Eslick GD, Starcevic V. A meta-analysis of the response of pathological hoarding to pharmacotherapy. Psychiatry Res 2015; 229:272-276. [PMID: 26213378 DOI: 10.1016/j.psychres.2015.07.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2015] [Revised: 05/02/2015] [Accepted: 07/07/2015] [Indexed: 11/18/2022]
Abstract
This meta-analysis aimed to identify all studies that have assessed treatment response for pathological hoarding treated with pharmacological agents. Seven studies were identified with a total of 92 participants. Most participants had a diagnosis of obsessive-compulsive disorder. Studies assessed response to serotonin-reuptake inhibitors (SRIs); venlafaxine; methylphenidate; and augmentation of SRIs with quetiapine, minocycline and naltrexone. More than half (ER=0.58, 95% CI=0.37-0.76) of the participants treated with pharmacotherapy responded. This study encourages us to consider the use of SRIs in patients with hoarding disorder. The study also encourages more studies of pharmacotherapy for pathological hoarding, noting that these studies should use validated outcome measures that specifically assess pathological hoarding and novel agents that target the unique neurobiological correlates of pathological hoarding.
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Affiliation(s)
- Vlasios Brakoulias
- Discipline of Psychiatry, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia.
| | - Guy D Eslick
- The Whiteley-Martin Research Centre, The Discipline of Surgery, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia
| | - Vladan Starcevic
- Discipline of Psychiatry, The University of Sydney, Sydney Medical School - Nepean, Penrith, New South Wales, Australia
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50
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Brennan E, Flessner C. An interrogation of cognitive findings in pediatric obsessive-compulsive and related disorders. Psychiatry Res 2015; 227:135-43. [PMID: 25912428 DOI: 10.1016/j.psychres.2015.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 02/23/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
Current findings in the field of psychology have led to increased interest and a new conceptualization of disorders characterized by repetitive behaviors, namely the obsessive compulsive and related disorders (OCRDs). Scant research, however, has sought to collect and categorize the extant research on pediatric OCRDs. Particularly, no adequate review of the pediatric cognitive literature existed until now, despite the clear implication of abnormalities in neuroanatomical structures and cognitive functioning in adult samples. While evidence for cognitive dysfunction in pediatric samples is presented, this paper also suggests that differences in cognitive dysfunction may indeed exist between adults and youth with OCRDs. Specifically, those irregularities present in said youth at varying developmental stages may impact the origination and maintenance of OCRDs across time. Finally, this paper seeks to formulate potential future goals for the research field, particularly through transdiagnostic approaches to processes linked with symptom presentations. This is of particular importance as an improved understanding of the interaction of cognitive function and growth is key to further comprehension of the OCRDs.
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Affiliation(s)
- Elle Brennan
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA.
| | - Christopher Flessner
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA
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