Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness characterized by obsessions and/or compulsions. Its pathophysiology is still not well understood but it is known that the cortico-striatal-thalamic-cortical (CSTC) circuitry plays an important role. Here, we used a multi-method MRI approach combining proton magnetic resonance spectroscopy (H1-MRS) and diffusion tensor imaging (DTI) techniques to investigate both the metabolic and the microstructural white matter (WM) changes of the anterior cingulate cortex (ACC) in OCD patients as compared to healthy controls. Twenty-three OCD patients and 21 age-, sex-, and education-matched healthy volunteers participated in the study. Our 1H-MRS findings show increased levels of Glx in ACC in OCD. Further, significantly lower fractional anisotropy (FA) values were observed in OCD patients’ left cingulate bundle (CB) as compared to healthy controls. Finally, there was a negative correlation between FA in the left CB and level of obsessions, as well as the duration of the illness. Our findings reinforce the involvement of CSTC bundles in pathophysiology of OCD, pointing to a specific role of glutamate (glutamine) and WM integrity.
Highlights
Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness characterized by obsessions and/or compulsions
The H1-MRS parameters used for the present study provided robust signals for both the healthy controls and OCD groups in the anterior cingulate cortex (ACC)
We investigated the association between Glx/creatine + phosphocreatine (Cr) levels in ACC with fractional anisotropy (FA) values in the cingulate bundle (CB) but failed to find any significant results (p = 0.794 and r = −0.041 for left CB; and p = 0.560 and r = 0.090 for right CB; see Supplementary Information)
Summary
Obsessive-compulsive disorder (OCD) is a neuropsychiatric illness characterized by obsessions and/or compulsions. Obsessions are recurrent, persistent, and unwanted thoughts, urges, or images that generate anxiety and/or distress that are alleviated transiently by compulsions, i.e., repetitive and ritualized behaviors (such as checking, washing, and ordering) or mental acts (such as counting, praying, or repeating words silently; American Psychiatric Association, 2013). Current first-line treatments for OCD include exposure and response prevention (ERP) and serotonin reuptake inhibitors (SRIs; Sookman and Fineberg, 2015). As not all patients respond satisfactorily to these treatments, other augmenting drugs (such as glutamate-modulating agents, among others) may need to be added to SRIs (Fineberg et al, 2006; Simpson et al, 2013; Modarresi et al, 2018). To develop more effective treatments for OCD, a greater understanding of its etiology and pathophysiology is required.
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