Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis

Abstract

Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region׳s role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry, emotional decision-making and CBTp responsiveness. Emotional decision-making was measured by the Iowa Gambling task (IGT). Thirty patients received CBTp+standard care (CBTp+SC; 25 completers) for 6–8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging. Patients׳ symptoms were assessed before and after therapy. Pre-therapy OFC GMV was measured using a region-of-interest approach, and IGT performance was measured as overall learning, attention to reward, memory for past outcomes and choice consistency. Both these measures, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC׳s function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness.

Cognitive Behaviour Therapy for Psychosis: Insights from Neuroimaging

“…Patients with greater grey matter volume in the areas associated with a good CBTp response were perhaps relatively better at coordination of mental activity, cognitive flexibility, verbal learning, and memory, all of which can be expected to facilitate CBTp. A more recent study [31], using a region-of-interest approach and the same sample reported previously by Premkumar and colleagues [30], demonstrated an association between larger grey matter volume of the orbitofrontal cortex and symptom reduction following CBTp. This association is most likely explained by the role of orbitofrontal cortex in emotional decision-making and cognitive flexibility [73].…”

“…The search was run on 12th May 2017 with no time range specified for the date of publication. Our search revealed 9 papers in total [24][25][26][27][28][29][30][31][32], all published within the last 10 years (see Table 1 for greater details).…”

“…A formal pre-therapy assessment of relevant cognitive functions followed by targeted cognitive remediation therapies [81] may be helpful. There are promising data showing that cognitive remediation therapies can normalise activity in many brain areas, including the prefrontal and cingulate regions that commonly show activation deficits during working memory and affect processing paradigms in schizophrenia [82] and also found predict CBTp response [24][25][26][27][28][29][30][31][32].…”

Cognitive-behavioral therapy for schizophrenia: an overview on efficacy, recent trends and neurobiological findings

“…80 There was a significant correlation between pre-treatment orbitofrontal cortex gray matter volume and positive symptom improvement (r = 0.530; p = 0.01) after a CBT protocol. The authors also found an association between rightward orbitofrontal cortex asymmetry and reduction of negative (r = 0.542; p = 0.01) and general psychopathology (r = 0.482; p = 0.02).…”

Emerging behavioral and psychotherapeutic interventions for schizophrenia

“…Kumari et al (70) revealed that changes in activation in regions responsible for language processing, attention, insight and self-awareness were associated with symptom improvement. Premkumar et al (71) demonstrated that increased gray matter in the orbitofrontal cortex, a region associated with impulsivity and emotional decision making, was also associated with response to CBTp. Increases in the anterior cingulate cortex (ACC) of a metabolite associated with mitochondrial and NMDA receptor function as well as neuronal longevity known as N-acetyl aspartate (NAA) were also associated with symptom improvement after CBTp (72).…”