Microstructural Abnormality in Left Nucleus Accumbens Predicts Dysfunctional Beliefs in Treatment-Resistant Obsessive-Compulsive Disorder

Abstract

BackgroundThe aim of this study was to determine whether dysfunctional beliefs might predict treatment-resistance and to examine the relationship between fractional anisotropy (FA) in diffusion tensor imaging (DTI) and cognitive biases for optimal treatment choice.Material/MethodsWe recruited 11 non-resistant obsessive-compulsive disorder (OCD) patients, 11 resistant OCD patients, and 11 healthy subjects.ResultsOCD patients had higher Obsessive Beliefs Questionnaire (OBQ-87) subscale scores than subjects in non-resistant and resistant groups. A significant difference was found between non-resistant and resistant OCD patients in R-Scale and I-Scale. A significant decrease in FA was found in left dorsal frontal gyrus and left inferior parietal lobule in the non-resistant group as compared to the control group. FA also decreased significantly in left anterior cingulate cortex, putamen, and nucleus accumbens in the resistant group as compared to the control group. There was a significant decrease in FA in nucleus accumbens in the resistant group as compared to the non-resistant group. Reduced FA in left nucleus accumbens was negatively associated with OBQ-87 factor R and I and the total Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).ConclusionsAbnormalities in cortical-striatal white matter networks may contribute to the dysfunctional beliefs in patients with treatment-resistant OCD, and the left nucleus accumbens may be an important and promising target for the treatment of OCD.

Abnormalities of white matter microstructure in unmedicated patients with obsessive–compulsive disorder: Changes after cognitive behavioral therapy

“…Fan et al () found that drug treatment resulted in a reduction in radial diffusivity (RD) in the left striatum and right midbrain as well as a reduction in mean diffusivity (MD) of the right midbrain. However, an additional result showed that decreased FA values in WM of the nucleus accumbens may not be reversible by adequate treatment in OCD patients (Feng, ). The study conducted by Yoo et al () noted that WM alterations may be partly reversible with citalopram treatment.…”

“…Fan et al (2012) found that drug treatment resulted in a reduction in radial diffusivity (RD) in the left striatum and right midbrain as well as a reduction in mean diffusivity (MD) of the right midbrain. However, an additional result showed that decreased FA values in WM of the nucleus accumbens may not be reversible by adequate treatment in OCD patients (Feng, 2014) raphy study found that baseline regional cerebral blood flow in the bilateral OFC was significantly correlated with a change in clinical symptoms after CBT (Yamanishi et al, 2009). Using functional MRI, Nakao et al (2005) found that after a 12-week treatment program of CBT, the activation intensity of the orbital frontal cortex, the dorsolateral prefrontal cortex, and the anterior cingulate gyrus caused by symptoms was weakened, while the activation intensity of the temporal cortex and cerebellum increased in OCD patients.…”

Shared white matter alterations across emotional disorders: A voxel-based meta-analysis of fractional anisotropy

“…When studies reported separate results by illness subtype, these were included as separate studies, i.e. two studies with non-overlapping contrasts for BD I and BD II (Liu et al, 2010, Ha et al, 2011), one study with separate results for suicide attempters and non-attempters with MDD (Jia et al, 2010), and one study with separate results for OCD and treatment-resistant OCD (TROCD) (Li et al, 2014). The 37 VBA studies and 41 contrasts included in the meta-analysis are reported in Table 1.…”

Deep brain stimulation response in obsessive–compulsive disorder is associated with preoperative nucleus accumbens volume

“…Research into the role of the NAc in the context of predicting treatment outcome has been scarce, but earlier studies have linked the NAc to pharmacotherapy and psychotherapy resistance. Treatment-resistant OCD patients showed hypo-responsivity of the NAc during the anticipation of rewards ( Figee et al, 2011 ), as well as micro-structural alterations of the NAc as measured with diffusion tensor fractional anisotropy ( Li et al, 2014 ). More recently, a study investigating patients who received treatment with CBT and SSRIs for anxiety disorders found that larger baseline NAc volumes were associated with a larger reduction of anxiety symptoms ( Burkhouse et al, 2020 ).…”