Skip to main content
Neuroscience Bulletin logoLink to Neuroscience Bulletin
. 2011 Jun 4;27(3):215. doi: 10.1007/s12264-011-1001-0

Review of structural neuroimaging in patients with refractory obsessivecompulsive disorder

结构神经影像在研究难治性强迫症中的应用

Murad Atmaca 1,
PMCID: PMC5560357  PMID: 21614103

Abstract

The notion that some special brain regions may be involved in the pathogenesis of obsessive-compulsive disorder (OCD) dates back to the beginning of the twentieth century. Structural neuroimaging studies in the past 2 decades have revealed important findings that facilitate understanding of OCD pathogenesis. Current knowledge based on functional and structural neuroimaging investigations largely emphasizes abnormalities in fronto-striatal-thalamic-cortical and orbitofronto-striato-thalamic circuits in the pathophysiology of OCD. However, these neuroimaging studies did not focus on refractory OCD. The present review mainly focused on structural neuroimaging performed in OCD, which had been ignored previously, and highlighted current evidence supporting that orbito-frontal cortex and thalamus are key brain regions, and that the hippocampus-amygdala complex is associated with refractoriness to the available treatment strategies. However, to fully reveal the neuroanatomy of refractoriness, longitudinal studies with larger samples are required.

Keywords: structural neuroimaging, refractory, obsessive-compulsive disorder, orbito-frontal cortex, thalamus

References

  • [1].Robins L.N., Hezler J.E., Orvaschel C., Anthony J.C., Blazer D.G., Burnham A., et al. The diagnostic interview schedule. In: Eaton W.W., Kessler L.G., et al., editors. Epidemiologic field methods in psychiatry: the NIMH epidemiologic catchment area program. Orlando: Academic Press; 1985. pp. 143–168. [Google Scholar]
  • [2].Whiteside S.P., Port J.D., Abramowitz J.S. A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res. 2004;132:69–79. doi: 10.1016/j.pscychresns.2004.07.001. [DOI] [PubMed] [Google Scholar]
  • [3].Perse T. Obsessive-compulsive disorder: a treatment review. J Clin Psychiatry. 1988;49:48–55. [PubMed] [Google Scholar]
  • [4].Jenike M.A., Rauch S.L. Managing the patient with treatment-resistant obsessive compulsive disorder: current strategies. J Clin Psychiatry. 1994;55:11–17. [PubMed] [Google Scholar]
  • [5].Rasmussen S.A., Eisen J.L. Treatment strategies for chronic and refractory obsessive-compulsive disorder. J Clin Psychiatry. 1997;58:9–13. [PubMed] [Google Scholar]
  • [6].Pallanti S., Hollander E., Bienstock C., Koran L., Leckman J., Marazziti D., et al. Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol. 2002;5:181–191. doi: 10.1017/S1461145702002900. [DOI] [PubMed] [Google Scholar]
  • [7].Whiteside S.P., Port J.D., Abramowitz J.S. A meta-analysis of functional neuroimaging in obsessive-compulsive disorder. Psychiatry Res. 2004;132:69–79. doi: 10.1016/j.pscychresns.2004.07.001. [DOI] [PubMed] [Google Scholar]
  • [8].Baxter L.R. Neuroimaging studies of obsessive-compulsive disorders. Psychiatr Clin North Am. 1992;15:871–884. [PubMed] [Google Scholar]
  • [9].Saxena S., Brody A.L., Maidment K.M., Dunkin J.J., Colgan M., Alborzian S., et al. Localized orbitofrontal and subcortical metabolic changes and predictors of response to paroxetine treatment in obsessive-compulsive disorder. Neuropsychopharmacology. 1999;21:683–693. doi: 10.1016/S0893-133X(99)00082-2. [DOI] [PubMed] [Google Scholar]
  • [10].Saxena S., Bota R.G., Brod A.L. Brain-behavior relationships in obsessive-compulsive disorder. Semin Clin Neuropsychiatry. 2001;6:82–101. doi: 10.1053/scnp.2001.21833. [DOI] [PubMed] [Google Scholar]
  • [11].Insel T.R. Toward a neuroanatomy of obsessive-compulsive disorder. Arch Gen Psychiatry. 1992;49:739–744. doi: 10.1001/archpsyc.1992.01820090067011. [DOI] [PubMed] [Google Scholar]
  • [12].Scarone S., Colombo C., Livian S., Abbruzzese M., Ronchi P., Locatelli M., et al. Increased right caudate nucleus size in obsessive-compulsive disorder: detection with magnetic resonance imaging. Psychiatr Res. 1992;45:115–121. doi: 10.1016/0925-4927(92)90005-O. [DOI] [PubMed] [Google Scholar]
  • [13].Atmaca M., Yildirim H., Ozdemir H., Aydin A., Tezcan E., Ozler S. Volumetric MRI assessment of brain regions in patients with refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2006;30:1051–1057. doi: 10.1016/j.pnpbp.2006.03.033. [DOI] [PubMed] [Google Scholar]
  • [14].Atmaca M., Yildirim H., Ozdemir H., Tezcan E., Poyraz A.K. Volumetric MRI study of key brain regions implicated in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:46–52. doi: 10.1016/j.pnpbp.2006.06.008. [DOI] [PubMed] [Google Scholar]
  • [15].Rosenberg D.R., Benazon N.R., Gilbert A., Sullivan A., Moore G.J. Thalamic volume in pediatric obsessive-compulsive disorder patients before and after cognitive behavioral therapy. Biol Psychiatry. 1995;48:294–300. doi: 10.1016/S0006-3223(00)00902-1. [DOI] [PubMed] [Google Scholar]
  • [16].Szeszko P.R., Robinson D., Alvir J.M., Bilder R.M., Lencz T., Ashtari M., et al. Orbital frontal and amygdala volume reductions in obsessive-compulsive disorder. Arch Gen Psychiatry. 1999;56:913–919. doi: 10.1001/archpsyc.56.10.913. [DOI] [PubMed] [Google Scholar]
  • [17].O’sullivan R.L., Rauch S.L., Breiter H.C., Grachev I.D., Baer L., Kennedy D.N., et al. Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry. 1997;42:39–45. doi: 10.1016/S0006-3223(96)00297-1. [DOI] [PubMed] [Google Scholar]
  • [18].Bartha R., Stein M.B., Williamson P.C., Drost D.J., Neufeld R.W., Carr T.J., et al. A short echo 1H spectroscopy and volumetric MRI study of the corpus striatum in patients with obsessive-compulsive disorder and comparison subjects. Am J Psychiatry. 1998;155:1584–1591. doi: 10.1176/ajp.155.11.1584. [DOI] [PubMed] [Google Scholar]
  • [19].Riffkin J., Yucel M., Maruff P., Wood S.J., Soulsby B., Olver J., et al. A manual and automated MRI study of anterior cingulate and orbitofrontal cortices, and caudate nucleus in obsessive-compulsive disorder: comparison with healthy controls and patients with schizophrenia. Psychiatry Res. 2005;138:99–113. doi: 10.1016/j.pscychresns.2004.11.007. [DOI] [PubMed] [Google Scholar]
  • [20].Pujol J., Soriano-Mas C., Alonso P., Cardoner N., Menchen J.M., Deus J., et al. Mapping structural brain alterations in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61:720–730. doi: 10.1001/archpsyc.61.7.720. [DOI] [PubMed] [Google Scholar]
  • [21].Choi J.S., Kang D.H., Kim J.J., Ha T.H., Lee J.M., Youn T., et al. Left anterior subregion of orbitofrontal cortex volume reduction and impaired organizational strategies in obsessive-compulsive disorder. J Psychiatr Res. 2004;38:193–199. doi: 10.1016/j.jpsychires.2003.08.001. [DOI] [PubMed] [Google Scholar]
  • [22].Radua J., Mataix-Cols D. Voxel-wise meta-analysis of grey matter changes in obsessive-compulsive disorder. Br J Psychiatry. 2009;195:393–402. doi: 10.1192/bjp.bp.108.055046. [DOI] [PubMed] [Google Scholar]
  • [23].Rotge J.Y., Guehl D., Diharreguy B., Tignol J., Bioulac B., Allard M., et al. Meta-analysis of brain volume changes in obsessive-compulsive disorder. Biol Psychiatry. 2009;65:75–83. doi: 10.1016/j.biopsych.2008.06.019. [DOI] [PubMed] [Google Scholar]
  • [24].Cecconi J.P., Lopes A.C., Duran F.L., Santos L.C., Hoexter M.Q., Gentil A.F., et al. Gamma ventral capsulotomy for treatment of resistant obsessive-compulsive disorder: a structural MRI pilot prospective study. Neurosci Lett. 2008;447:138–142. doi: 10.1016/j.neulet.2008.09.061. [DOI] [PubMed] [Google Scholar]
  • [25].Lawrence A.D., Sahakian B.J., Robbins T.W. Cognitive functions and corticostriatal circuits: insights from Huntington’s disease. Trend Cogn Sci. 1998;2:379–388. doi: 10.1016/S1364-6613(98)01231-5. [DOI] [PubMed] [Google Scholar]
  • [26].Phillips M.L., Drevets W.C., Rauch S.L., Lane R. Neurobiology of emotion perception I: the neural basis of normal emotion perception. Biol Psychiatry. 2003;54:504–514. doi: 10.1016/S0006-3223(03)00168-9. [DOI] [PubMed] [Google Scholar]
  • [27].McGuire P.K., Bench C.J., Frith C.D., Marks I.M., Frackowiak R.S., Dolan R.J. Functional anatomy of obsessive-compulsive phenomena. Br J Psychiatry. 1994;164:459–468. doi: 10.1192/bjp.164.4.459. [DOI] [PubMed] [Google Scholar]
  • [28].Adler C.M., McDonough-Ryan P., Sax K.W., Holland S.K., Arndt S., Strakowski S.M. fMRI of neuronal activation with symptom provocation in unmedicated patients with obsessive compulsive disorder. J Psychiatr Res. 2000;34:317–324. doi: 10.1016/S0022-3956(00)00022-4. [DOI] [PubMed] [Google Scholar]
  • [29].Szeszko P.R., MacMillan S., McMeniman M., Lorch E., Madden R., Ivey J., et al. Amygdala volume reductions in pediatric patients with obsessive-compulsive disorder treated with paroxetine: preliminary findings. Neuropsychopharmacology. 2004;29:826–832. doi: 10.1038/sj.npp.1300399. [DOI] [PubMed] [Google Scholar]
  • [30].Nagy J., Zambo K., Decsi L. Anti-anxiety action of diazepam after intra-amygdaloid application in the rat. Neuropharmacology. 1979;18:573–576. doi: 10.1016/0028-3908(79)90104-7. [DOI] [PubMed] [Google Scholar]
  • [31].Gonzalez L.E., Andrews N., File S.E. 5-HT1A and benzodiazepine receptors in the basolateral amygdala modulate anxiety in the social interaction test, but not in the elevated plus-maze. Brain Res. 1996;732:145–153. doi: 10.1016/0006-8993(96)00517-3. [DOI] [PubMed] [Google Scholar]
  • [32].Zangrossi H., Jr, Viana M.B., Graeff F.G. Anxiolytic effect of intraamygdala injection of midazolam and 8-hydroxy-2-(di-n-propylamino) tetralin in the elevated T-maze. Eur J Pharmacol. 1999;369:267–270. doi: 10.1016/S0014-2999(99)00075-8. [DOI] [PubMed] [Google Scholar]
  • [33].Gray J.A. The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford, England: Oxford University Press; 1982. [Google Scholar]
  • [34].Pitman R.K. A cybernetic model of obsessive-compulsive psychopathology. Compr Psychiatry. 1987;28:334–343. doi: 10.1016/0010-440X(87)90070-8. [DOI] [PubMed] [Google Scholar]
  • [35].Van Laere K., Nuttin B., Gabriels L., Dupont P., Rasmussen S., Greenberg B.D., et al. Metabolic imaging of anterior capsular stimulation in refractory obsessive-compulsive disorder: a key role for the subgenual anterior cingulate and ventral striatum. J Nucl Med. 2006;47:740–747. [PubMed] [Google Scholar]
  • [36].Atmaca M., Yildirim H., Ozdemir H., Ozler S., Kara B., Ozler Z., et al. Hippocampus and amygdalar volumes in patients with refractory obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2008;32:1283–1286. doi: 10.1016/j.pnpbp.2008.04.002. [DOI] [PubMed] [Google Scholar]
  • [37].Nuttin B., Cosyns P., Demeulemeester H., Gybels J., Meyerson B. Electrical stimulation in anterior limbs of internal capsules in patients with obsessive-compulsive disorder. Lancet. 1999;354:1526. doi: 10.1016/S0140-6736(99)02376-4. [DOI] [PubMed] [Google Scholar]
  • [38].Mian M.K., Campos M., Sheth S.A., Eskandar E.N. Deep brain stimulation for obsessive-compulsive disorder: past, present, and future. J Neurosurgery. 2010;29:1–9. doi: 10.3171/2010.4.FOCUS10107. [DOI] [PubMed] [Google Scholar]
  • [39].Greenberg B.D., George M.S., Martin J.D., Beniamin J., Schlaepfer T.E., Altemus M., et al. Effect of prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a preliminary study. Am J Psychiatry. 1997;154:867–869. doi: 10.1176/ajp.154.6.867. [DOI] [PubMed] [Google Scholar]
  • [40].Alonso P., Pujol J., Cardoner N., Benlloch L., Deus J., Menchón J.M., et al. Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double blind, placebo-controlled study. Am J Psychiatry. 2001;58:1143–1145. doi: 10.1176/appi.ajp.158.7.1143. [DOI] [PubMed] [Google Scholar]
  • [41].Sachdev P.S., McBride R., Loo C.K., Mitchell P.B., Malhi G.S., Croker V.M. Right versus left prefrontal transcranial stimulation for obsessive-compulsive disorder: a preliminary investigation. J Clin Psychiatry. 2001;62:981–984. doi: 10.4088/JCP.v62n1211. [DOI] [PubMed] [Google Scholar]
  • [42].Mantovani A., Lisanby S.H., Pieraccini F., Ulivelli M., Castrogiovanni P., Rossi S. Repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) and Tourette’s syndrome (TS) Int J Neuropsychopharmacol. 2006;9:95–100. doi: 10.1017/S1461145705005729. [DOI] [PubMed] [Google Scholar]
  • [43].Prasko J., Pasková B., Záleský R., Novák T., Kopecek M., Bares M., et al. The effect of repetitive transcranial magnetic stimulation (rTMS) on symptoms in obsessive-compulsive disorder: a randomized, double-blind, sham-controlled study. Neuro Endocrinol Lett. 2006;27:327–332. [PubMed] [Google Scholar]
  • [44].Ruffini C., Locatelli M., Lucca A., Benedetti F., Insacco C., Smeraldi E. Augmentation effect of repetitive transcranial magnetic stimulation over the orbitofrontal cortex in drug-resistant obsessive-compulsive disorder patients: A controlled investigation. Prim Care Companion J Clin Psychiatry. 2009;11:226–230. doi: 10.4088/PCC.08m00663. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Neuroscience Bulletin are provided here courtesy of Springer

RESOURCES