Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder

Emily R Stern,Alessandro S De Nadai,Russell H Tobe,Dan V Iosifescu,Katherine A Collins,Goi Khia Eng

doi:10.1038/s41398-022-01780-w

Abstract

Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the “unacceptable thoughts” symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles—areas that are part of, or closely linked to, the default mode network (DMN)—and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the “unacceptable thoughts” and “symmetry/not-just-right-experiences” symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.

Highlights

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions, defined as thoughts, urges, or images that cause anxiety and are experienced as intrusive and inappropriate, and/or compulsions, which are repetitive behaviors typically performed to relieve anxiety caused by obsessions
PTQ scores As would be expected, PTQ scores were significantly higher among OCD patients than HC (F1,133 = 157.7, p < 0.001, estimated marginal means covarying for site: OCD: 2.29, HC: 0.42)
An examination of the overlap between the temporal pole clusters identified in the present study and Yeo et al.’s 7-network parcellation revealed that approximately half of the voxels in each hemisphere were located in the default mode network (DMN) parcellation and half were in the limbic network

Summary

Introduction

Obsessive-compulsive disorder (OCD) is characterized by the presence of obsessions, defined as thoughts, urges, or images that cause anxiety and are experienced as intrusive and inappropriate, and/or compulsions, which are repetitive behaviors typically performed to relieve anxiety caused by obsessions. Between PTQ scores and local correlation in OCD (above and beyond variance associated with site and Y-BOCS score), there was a significant positive relationship of perseverative thinking with score, with patients with higher perseverative thinking exhibiting less “dominance” of pre/postcentral gyri connectivity.

Results

Conclusion