Cerebral Glucose Metabolism in Childhood-Onset Obsessive-Compulsive Disorder

Swedo, Susan E.; Pietrini, Pietro; Leonard, Henrietta L.; Schapiro, Mark B.; Rettew, David C.; Goldberger, E; Rapoport, Stanley I.; Rapoport, Judith L.; Grady, Cheryl L.

doi:10.1001/archpsyc.1992.01820090018003

Cited by 476 publications

(344 citation statements)

References 16 publications

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“…Also, these same results were garnered regardless of whether imaging data were obtained during a symptomatic (Provoked) or control (Neutral) state. The inverse correlation between rCBF in OFC and subsequent symptomatic improvement with SRI treatment is consistent with results from three previous studies of OCD employing other SRIs, PET-FDG, and ROI-based analytic methods Saxena et al 1999;Swedo et al 1992). Taken together, these studies underscore the reliability of this finding in OCD, across SRIs, imaging modalities, and data analytic methods.…”

Section: Discussionsupporting

confidence: 88%

“…Three prospective studies of OCD patients have already found that pre-treatment positron emission tomography (PET) measurements of cerebral metabolic rates within OFC significantly predict subsequent response to treatment with serotonergic reuptake inhibitors (SRIs) Saxena et al 1999;Swedo et al 1992). Specifically, lower pre-treatment rates of metabolism within OFC have consistently been associated with better subsequent responses to SRIs.…”

Section: The Purpose Of This Study Was To Identify Neuroimaging Predimentioning

confidence: 99%

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Predictors of Fluvoxamine Response in Contamination-related Obsessive Compulsive Disorder A PET Symptom Provocation Study

Rauch

2002

Neuropsychopharmacology

160

107

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The purpose of this study was to identify neuroimaging predictors of medication response in contamination-related obsessive compulsive disorder (OCD). Prior studies of OCD had indicated that glucose metabolic rates within orbitofrontal cortex (OFC) were inversely correlated with subsequent response to serotonergic reuptake inhibitors (SRIs) and that glucose metabolic rates within posterior cingulate cortex (PCC) Functional imaging research has contributed substantially to contemporary neurocircuitry models of obsessive compulsive disorder (OCD) (Rauch 2000;Rauch and Baxter 1998;Saxena et al. 1998 PET Predictors of Fluxoamine Response in OCD 783OCD. These areas exhibit hyperactivity at rest that is accentuated during symptom provocation and attenuated following successful treatment.One promising clinical application of neuroimaging is to identify predictors of treatment response. Three prospective studies of OCD patients have already found that pre-treatment positron emission tomography (PET) measurements of cerebral metabolic rates within OFC significantly predict subsequent response to treatment with serotonergic reuptake inhibitors (SRIs) Saxena et al. 1999;Swedo et al. 1992). Specifically, lower pre-treatment rates of metabolism within OFC have consistently been associated with better subsequent responses to SRIs. Conversely, in one of these reports , higher cerebral metabolic rates within left OFC were associated with better responses to behavioral therapy.Recently, an initial study was conducted examining PET cerebral metabolic correlates as potential predictors of response to anterior cingulotomy in patients with OCD (Rauch et al. 2001b). Rauch and colleagues found that higher cerebral metabolic rates within posterior cingulate cortex (PCC) were associated with better subsequent response to cingulotomy. However, the cingulotomy study differed from previous studies of SRIs in that statistical parametric mapping rather than region of interest (ROI)-based methods of data analysis were used. Therefore, it remained unclear whether the unique findings regarding the PCC were indicative of: (1) the difference in treatment type (i.e., cingulotomy vs. SRIs); (2) the difference in data analytic methods (i.e., statistical parametric mapping vs. ROI-based); or (3) differences in the patient groups studied (i.e., severe treatment-refractory patients on medications vs. a conventional sample of patients with OCD, off medications).In the current study, we sought to build on the previous body of research in this area. Specifically, we sought to study PET predictors of SRI treatment response using statistical parametric mapping methods. Moreover, we employed a symptom provocation design, so that we could compare the profiles of PET predictors of treatment response during a provoked symptomatic state versus a neutral state. Thus, we tested the a priori hypotheses that lower rCBF within OFC and higher rCBF within PCC would be associated with better subsequent response to SRIs. Moreover, we were able to investigate whether ...

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Section: Discussionsupporting

confidence: 88%

Section: The Purpose Of This Study Was To Identify Neuroimaging Predimentioning

confidence: 99%

Predictors of Fluvoxamine Response in Contamination-related Obsessive Compulsive Disorder A PET Symptom Provocation Study

Rauch

2002

Neuropsychopharmacology

160

107

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“…36,37 Taken together, the results of these studies suggest that reduction of thalamic activity, and a resultant decrease in thalamocortical excitation, 18 may represent a final common pathway to response to a variety of different treatments in nondepressed OCD patients. 19,38 As in many prior studies, 5,[8][9][10]12,17,36 the magnitude of change in thalamic metabolism did not correlate with the degree of response of OCD symptoms to intensive CBT. This suggests that while decreasing thalamic activity may be a marker of response to treatment in OCD it is not specifically related to the extent of symptom improvement.…”

Section: Discussionmentioning

confidence: 50%

“…Thus, decreasing cingulate activity may sometimes be associated with improvement in OCD symptoms but does not appear to be a necessary mechanism of action for treatment response. Instead, the functional changes most strongly associated with treatment response in OCD are decreases in activity in the right OFC, 8,[10][11][12][13]36,37,42,43 right caudate 9,11,12,14,16,17,36,37,42 and thalamus. 9,11,15,36,37 In contrast to the effects of pharmacotherapy on brain function, enhancement of dACC activity may be a primary mechanism of action of CBT for OCD.…”

Section: Discussionmentioning

confidence: 99%

“…Functional brain imaging studies of patients with obsessive-compulsive disorder (OCD) have repeatedly found elevated cerebral glucose metabolism and blood flow in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), basal ganglia and thalamus [1][2][3][4][5][6][7] that decrease with response to treatment with serotonin reuptake inhibitor (SRI) medications 5,[8][9][10][11][12][13][14][15] or cognitive-behavioral therapy (CBT). 9,16,17 These findings and others have led to the theory that the symptomatic expression of OCD is mediated by hyperactivity along frontal-subcortical circuits connecting the OFC, caudate, globus pallidus and the medial dorsal nucleus of the thalamus.…”

Section: Introductionmentioning

confidence: 99%

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Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Saxena

Gorbis²,

O’Neill³

et al. 2008

Mol Psychiatry

122

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Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

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Altered Corticostriatal Functional Connectivity in Obsessive-compulsive Disorder

Harrison

Soriano‐Mas

Pujol

et al. 2009

Arch Gen Psychiatry

513

454

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Cerebral Glucose Metabolism in Childhood-Onset Obsessive-Compulsive Disorder

Cited by 476 publications

References 16 publications

Predictors of Fluvoxamine Response in Contamination-related Obsessive Compulsive Disorder A PET Symptom Provocation Study

Predictors of Fluvoxamine Response in Contamination-related Obsessive Compulsive Disorder A PET Symptom Provocation Study

Rapid effects of brief intensive cognitive-behavioral therapy on brain glucose metabolism in obsessive-compulsive disorder

Altered Corticostriatal Functional Connectivity in Obsessive-compulsive Disorder

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