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

Chencheng Zhang,Bomin Sun,Tianming Yang,Haiyan Jin,Shikun Zhan,Yile Xie,Shuaiwei Tian,Tao Wang,Guozhen Lin,Hengfen Gong,Yilin Chen,Kristina Zeljic

doi:10.3389/fpsyg.2017.01814

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.

Highlights

Obsessive–compulsive disorder (OCD) is a symptomatologically heterogeneous psychiatric disorder with a worldwide lifetime prevalence ranging from 2 to 3% that often leads to chronic disability (Abramowitz et al, 2009)
Post hoc analyses showed that the healthy subjects (HCs) group was older than the preO group (z = 2.63, p = 0.0086) and the postST group (z = 2.74, p = 0.0062), and the postST group was younger than the postLT group (z = -2.15, p = 0.032) (Table 1)
It is unlikely that this age difference can explain the differences in task performance reported as previous reports have indicated that there are no effects of gender, age, or education on Iowa Gambling Task (IGT) performance (Brand et al, 2006)

Summary

Introduction

Obsessive–compulsive disorder (OCD) is a symptomatologically heterogeneous psychiatric disorder with a worldwide lifetime prevalence ranging from 2 to 3% that often leads to chronic disability (Abramowitz et al, 2009). Research in humans has been heavily informed by findings in animals, and brain imaging studies have been extensively employed in the investigation and refinement of the CSTC model (Whiteside et al, 2004; Norman et al, 2016). This area of research has yielded variable results in terms of specific regions and the direction of dysfunction (increased vs decreased activity) in different studies, abnormal activity in the frontostriatal regions is consistently reported. Resting-state functional magnetic resonance imaging (fMRI) studies most often find increased activity in the orbitofrontal cortex (OFC) and striatum, while symptom provocation paradigms most often find increases in the OFC, caudate and anterior cingulate cortex (ACC) (Saxena et al, 2001; Schlösser et al, 2010; Nakao et al, 2014)

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Conclusion