Elsevier

Biological Psychiatry

Volume 73, Issue 4, 15 February 2013, Pages 321-328
Biological Psychiatry

Archival Report
Brain Corticostriatal Systems and the Major Clinical Symptom Dimensions of Obsessive-Compulsive Disorder

https://doi.org/10.1016/j.biopsych.2012.10.006Get rights and content

Background

Functional neuroimaging studies have provided consistent support for the idea that obsessive-compulsive disorder (OCD) is associated with disturbances of brain corticostriatal systems. However, in general, these studies have not sought to account for the disorder’s prominent clinical heterogeneity.

Methods

To address these concerns, we investigated the influence of major OCD symptom dimensions on brain corticostriatal functional systems in a large sample of OCD patients (n = 74) and control participants (n = 74) examined with resting-state functional magnetic resonance imaging. We employed a valid method for mapping ventral and dorsal striatal functional connectivity, which supported both standard group comparisons and linear regression analyses with patients’ scores on the Dimensional Yale-Brown Obsessive-Compulsive Scale.

Results

Consistent with past findings, patients demonstrated a common connectivity alteration involving the ventral striatum and orbitofrontal cortex that predicted overall illness severity levels. This common alteration was independent of the effect of particular symptom dimensions. Instead, we observed distinct anatomical relationships between the severity of symptom dimensions and striatal functional connectivity. Aggression symptoms modulated connectivity between the ventral striatum, amygdala, and ventromedial frontal cortex, while sexual/religious symptoms had a specific influence on ventral striatal-insular connectivity. Hoarding modulated the strength of ventral and dorsal striatal connectivity with distributed frontal regions.

Conclusions

Taken together, these results suggest that pathophysiological changes among orbitofrontal-striatal regions may be common to all forms of OCD. They suggest that a further examination of certain dimensional relationships will also be relevant for advancing current neurobiological models of the disorder.

Section snippets

Participants

Seventy-four adult outpatients were recruited from the Obsessive-Compulsive Disorders Unit of the University Hospital of Bellvitge, Barcelona, Spain. Patients were selected from a slightly larger cohort after having satisfied DSM-IV diagnostic criteria for OCD (for at least 1 year before the study), in the absence of relevant medical, neurologic, and other major psychiatric illness, as well as imaging data quality control checks (see below). Nineteen of these patients (26%) were included in our

Initial Group Analyses

Robust functional connectivity maps were obtained in each group that reproduced the expected connectional anatomy of the ventral and dorsal caudate regions 19, 20, 21, 27, 28, 29. Figure 1 highlights the significant within-group effects for each region, as well as the relative overlap seen between control subjects and OCD patients. Table S1 in Supplement 1 lists all significant regional clusters for these within-group effects.

Significant between-group differences in functional connectivity were

Discussion

The notion that OCD should be understood as a spectrum of multiple potentially overlapping clinical syndromes has gained traction over the past decade with the introduction of the multidimensional model 8, 9 and the development of specific instruments to assess its proposed major symptom dimensions (23). Despite heuristic appeal, it has nevertheless remained unclear whether these dimensions may actually reflect distinct, or partially distinct, pathophysiological mechanisms. Our current results

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