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

Preethi Premkumar,Dominic Fannon,Adegboyega Sapara,Emmanuelle R Peters,Anantha P Anilkumar,Andrew Simmons,Elizabeth Kuipers,Veena Kumari

doi:10.1016/j.pscychresns.2015.01.013

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.

Highlights

Multiple lines of enquiry suggest that the effectiveness of cognitive behaviour therapy (CBT) in many disorders, including schizophrenia, is associated with the integrity of neural structures that support specific cognitive processes (Brody et al, 1998; Premkumar et al, 2009; Yamanishi et al, 2009)
The aim of the current study was to determine whether (a) patients receiving CBT for psychosis (CBTp) would differ from healthy individuals in pre-therapy orbitofrontal cortex (OFC) Grey matter volume (GMV), (b) greater pre-therapy OFC GMV/ asymmetry would relate to CBTp responsiveness in patients with schizophrenia or schizoaffective disorder, and (c) greater pretherapy OFC GMV/asymmetry in patients would relate to better Iowa Gambling task (IGT) performance
OFC GMV was larger in the right than left hemisphere

Summary

Introduction

Multiple lines of enquiry suggest that the effectiveness of cognitive behaviour therapy (CBT) in many disorders, including schizophrenia, is associated with the integrity of neural structures that support specific cognitive processes (Brody et al, 1998; Premkumar et al, 2009; Yamanishi et al, 2009). Making decisions about engaging in risky or safe behaviour requires emotional regulation (Bechara et al, 1994). Good emotional decision-making implies being able to successfully regulate one's emotions while under pressure to make risky decisions, such as deciding whether a deck of cards will lead to monetary gain or loss. It can reflect a decision-making style that is more rational and controlled, and less impulsive (Patrick et al, 2008).

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