Effects of Anterior Capsulotomy on Decision Making in Patients with Refractory Obsessive–Compulsive Disorder

Abstract

Despite various lines of evidence implicating impaired decision-making ability in individuals with obsessive–compulsive disorder (OCD), neuropsychological investigation has generated inconsistent findings. Although the cortico-striato-thalamo-cortical (CSTC) circuitry has been suggested, the involvement of the cortex has not yet been fully demonstrated. Moreover, it is unknown whether surgical intervention on the CSTC circuitry results in a predicted improvement of decision-making ability of OCD. Here we present a study of decision making based on the Iowa Gambling Task (IGT) to investigate decision making in a large sample of individuals with treatment-resistant OCD with and without anterior capsulotomy (AC). Task performance was evaluated in healthy subjects, individuals with OCD that had not undergone surgery, and postsurgical OCD patients with AC. The latter group was further divided into a short-term postsurgical group and a long-term postsurgical group. We found that the OCD patients without surgery performed significantly worse than the healthy controls on the IGT. There were no significant differences in decision-making between the presurgical OCD patients and those at the short-term postsurgical follow-up. Decision-making ability of the long-term postsurgical OCD patients was improved to the level comparable to that of healthy controls. All clinical symptoms (OCD, depression, and anxiety) assessed by psychiatric rating scales were significantly alleviated post-surgically, but exhibited no correlation with their IGT task performance. Our findings provide strong evidence that OCD is linked to impairments in decision-making ability; that impaired CSTC circuitry function is directly involved in the manifestation of OCD; and that AC related improvements in cognitive functions are caused by long-term plasticity in the brain circuitry.

Bilateral thermal capsulotomy with magnetic resonance‐guided focused ultrasound for patients with treatment‐resistant depression: A proof‐of‐concept study

“…With regards to the underlying mechanism of action of MRgFUS, it may relate to an important endophenotype of MDD known as ‘blunted reward learning’. Neuroimaging studies after capsulotomy for OCD have demonstrated normalized metabolism of brain structures associated with the reward circuit, as well as a restored reward system 5 . These results raise the possibility that capsulotomy by MRgFUS improves depressive symptoms by influencing the reward system.…”

The comparison of risky and ambiguity decision making and cool executive functions between patients with obsessive compulsive disorder and healthy controls

“…It has been proposed that a poor decision-making performance is correlated with a poor response to treatment 27 . Zhang recently reported that the refractory OCD patients presented significant improvements in the IGT performance after anterior capsulotomy 38 .…”

Ablative neurosurgery and deep brain stimulation for obsessive-compulsive disorder

“…[43] Two other studies have compared neuropsychological functioning patients with severe treatment-refractory OCD who undergo capsulotomy versus those treated nonsurgically. [144445] Along with decrease in obsessive-compulsive symptoms, patients receiving GVC had improved neuropsychological functioning (verbal and visual memory, visuospatial skills, and executive functions). Earlier reports describe personality changes following thermocapsulotomy.…”