Symposium 24
Pathophysiological investigation into OCD by neuroimaging methods and their clinical application
シンポジウム24
画像研究による強迫症の病態解明とその臨床応用 |
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| SY24-1
A biological investigation of OCD and hoarding disorder by neuroimaging methods
ためこみ症とOCDの生物学的病態差異の検討
Nakao Tomohiro（中尾 智博）
Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
Backgrounds: Although many neuroimaging studies of obsessive-compulsive disorder (OCD) have reported broad abnormalities in gray matter (GM), their results remain inconsistent. One reason for this inconsistency could be the heterogeneity of OCD. We aimed to investigate alterations in brain anatomy by OCD subtype and Hoarding Disorder (HD), newly presented in DSM-5. Methods: Magnetic resonance imaging examinations were conducted using a 3.0-Tesla scanner. By voxel-based morphometric procedure, we explored 1) structural differences among symptom dimension in OCD, 2) aging-related changes between early- and late-onset OCD, 3) structural differences between HD and OCD without hoarding symptoms.Results: 1) Concerning symptom dimension, we found specific negative correlations between dimension scores and GM volumes, mainly as decreased right cerebellum in ‘aggression/checking’ and decreased right insula in ‘contamination/washing’. 2) As for aging-related changes, the volume loss in medial temporal regions was greater in late-onset OCD patients compared to early-onset OCD. 3) Regarding HD, the HD group showed a significantly increased GM volume compared to the OCD and healthy control groups in prefrontal areas including BA10 and BA11.Conclusions: Our results suggested that there were distinct correlations among symptomatic dimensions and structural changes, aging-related changes in temporal areas and specific prefrontal changes in HD. These characteristic changes of GM volumes might bring the clinical diversity of OCD and HD. | | SY24-2
Evaluations of hemodynamic changes using Near-Infrared Spectroscopy among patients with tic-related obsessive-compulsive disorder
チック関連強迫症（OCD）患者におけるNIRSによる脳機能評価について
Mukai Keiichiro（向井 馨一郎）
The department of neuro-psychiatry, Hyogo College of Medicine, Nishinomiya, Japan
Introduction: Obsessive-compulsive disorder (OCD) is a heterogenous condition characterized by intrusive thought and repetitive behavior. Especially in DSM-5, a “tic-related” specifier has been included in diagnostic criteria for OCD, because OCD patients with a lifetime tic disorder (TD) tend to exhibit specific characteristics regarding OCD symptomatology, comorbidity course and pattern of familial transmission. Some biological studies have been assessed features in tic-related OCD.Purpose: In the present study, therefore, we attempted to examine differences in hemodynamic changes in the prefrontal cortex (PFC) between OCD patients with and without a history of TD during various neuropsychological tasks by using near infrared spectroscopy (NIRS) and to verify relationship among clinical data, hemodynamic changes and task performances by structural equation modeling.Methods: Twenty-nine OCD patients diagnosed according to DSM-IV-TR were divided into two groups by presence or absence of a lifetime history of TD (TD+; 11, TD-; 18). Along with standardized clinical interviews, they were evaluated using a variety of psychometric tests. Prefrontal hemodynamic changes were measured using multi-channel NIRS during the verbal fluency task (VFT), trail making task (TMT), and Tower of London (TOL).Results: There are significant differences in brain activities in front polar cortex (FPC) between OCD patients with and without TD during VFT and ToL. Hemodynamic changes in left dorsolateral prefrontal cortex were related directly to compulsion and indirectly to obsession through anxious and depressive symptom.Conclusion: Current study suggested that differences in hemodynamic changes in FPC were existed between patients with and without TD. | | SY24-3
Neuromodulation for obsessive-compulsive disorder
強迫症に対するニューロモデュレーション
Nakamae Takashi（中前 貴）
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine
Many treatment strategies including neuromodulation have been proposed for obsessive-compulsive disorder (OCD) patients who do not respond to conventional pharmacotherapy and behavioral therapy. Neuromodulation that could be effective for OCD include deep brain stimulation (DBS), electroconvulsive therapy (ECT), transcranial direct current stimulation (tDCS), and repetitive transcranial magnetic stimulation (rTMS). DBS could be effective for half of patients with severe and refractory OCD while it is invasive therapy. ECT will bring some sort of good effect for 60% of patients with OCD while there is no randomized controlled study so far. tDCS is non-invasive neuromodulation, but the number of clinical trial is low. Finally, rTMS have been well investigated and some meta-analyses showed its efficacy, but the optimal setting is still unknown. As there are advantage and disadvantage for each treatment, further research is needed. | | SY24-4
The effect of early life trauma on the neurocircuitry of patients with obsessive-compulsive disorder
若齢期トラウマによる強迫症の神経回路への影響
Wang Zhen
Vice President, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, P.R.China
Childhood trauma is a risk factor for mental disorders, such as obsessive-compulsive disorder (OCD). Thalamus, the onward direction pathway of most types of sensory information coming in to the brain, has a critical role in cortico-striato- thalamo-cortical (CSTC) circuits which was highly associated with OCD in behavioral control functions such as motor, cognitive, affective and motivational processing. However, it’s still not clear that the long lasting impact of child trauma on thalamo-cortical resting-state functional connectivity (rsFC) in OCD.
RS-fMRI was collected on 47 healthy controls and 79 individuals with OCD, including 22 patients with high child trauma and 57 patients with low child trauma. They were matched in gender, age and education. The thalamus was parceled into functional regions-of-interest (ROIs) on the basis of connectivity with seven a-priori defined cortical ROIs. Seed-based connectivity analyses were performed to examine the group differences in thalamic ROIs and whole brain functional connectivity.
ROI analysis revealed that compared with healthy controls, OCD patients with high trauma had increased rsFC between thalamic subdivisions and bilateral VLPFC; we also found increased rsFC between thalamus and right inferior parietal lobe, left associative visual cortex, right angular gyrus, right DLPFC, right primary somatosensory cortex; Compared with healthy control, OCD patients with low trauma had decreased FC between thalamus "occipital seed” and bilateral caudate. Compared with OCD patients with low trauma, OCD patients with high trauma had increased FC between thalamus and several brain regions (bilateral VLPFC, bilateral premotor cortex, right DLPFC, bilateral auditory cortex, left associative visual cortex, bilateral angular gyrus, left middle temporal gyrus, left caudate, left lingual gyrus).F
Thalamo-cortical dysconnectivity is presented in OCD patients with high trauma, includes increased connectivity with many brain regions associated with executive inhibition.
【Key words】child trauma; thalamus; OCD; rsFC | |
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