Abstract
ObjectiveTo analyze the correlation between the pharmacotherapy response and the characteristics of the pre-treatment regional cerebral blood flow (rCBF) in patients with obsessive-compulsive disorder (OCD).MethodsSingle-photon emission-computed tomography (SPECT) was used to determine the pre-treatment rCBF in 30 OCD patients and 30 normal controls. Based on their clinical remission response, the subjects were divided into two groups: selective serotonin reuptake inhibitors (SSRIs) and SSRIs plus quetiapine. The subjects with clinical remission response were identified after treatment for a period of 24 weeks, and the rCBF imaging data were processed using statistical parametric mapping (SPM) software with two-sample Z-tests.ResultsNineteen OCD patients who achieved clinical remission were included in the study. Increased rCBF in forebrain regions, including the frontal lobe, cingulate gyrus, hypothalamus, and basal ganglia, was found in 11 responders to SSRIs compared to normal control patients. The eight SSRI plus quetiapine responders exhibited a decrease in rCBF within posterior brain regions, including the parietal lobe, cerebellar vermis, and occipital lobe, and an increase in rCBF in the frontal lobe, thalamus, basal ganglia, and cerebellum tonsil compared to normal control patients.ConclusionsThe characteristics of increased rCBF in forebrain regions and decreased rCBF in posterior brain regions before treatment of OCD patients was a potentially predictor of treatment response to guide treatment options.
Highlights
Functional imaging studies using positron emission tomography (PET), functional and structural magnetic resonance imaging, and single-photon emission tomography (SPECT) techniques have indicated that the pathophysiology of obsessive–compulsive disorder (OCD) involves widely distributed, large-scale brain systems including the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus, and the thalamus [1,2,3]
Several functional imaging studies of OCD patients both before and after treatments using either selective serotonin reuptake inhibitors (SSRIs) or behavioral therapy suggested that the activity in the OFC, ACC, DLPC, thalamus, and caudate nucleus was decreased by successful treatments [10,11,12]
On the basis of previous studies, we proposed that abnormal activation involving forebrain and posterior brain regions might affect the interference processes that are associated with the pathophysiology of OCD, and that a difference in pre-treatment regional cerebral blood flow (rCBF) might predict the pharmacotherapy response to different treatments
Summary
Functional imaging studies using positron emission tomography (PET), functional and structural magnetic resonance imaging (fMRI), and single-photon emission tomography (SPECT) techniques have indicated that the pathophysiology of obsessive–compulsive disorder (OCD) involves widely distributed, large-scale brain systems including the orbitofrontal cortex (OFC), the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus, and the thalamus [1,2,3]. Several functional imaging studies of OCD patients both before and after treatments using either SSRIs or behavioral therapy suggested that the activity in the OFC, ACC, DLPC, thalamus, and caudate nucleus was decreased by successful treatments [10,11,12]. Buchsbaum [18] found that the successful treatment with SSRIs plus risperidone of OCD patients who were non-respondent to serotonin reuptake inhibitors alone was associated with relatively low metabolic rates in the striatum and anterior cingulate gyrus. On the basis of previous studies, we proposed that abnormal activation involving forebrain and posterior brain regions might affect the interference processes that are associated with the pathophysiology of OCD, and that a difference in pre-treatment rCBF might predict the pharmacotherapy response to different treatments
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