Regional cerebral blood flow measured during symptom provocation in obsessive-compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission tomography.
BACKGROUND
The study was designed to determine the mediating neuroanatomy of obsessive-compulsive disorder (OCD).


METHODS
The short half-life tracer oxygen 15-labeled carbon dioxide was used to allow for repeated positron emission tomographic determinations of regional cerebral blood flow on each of eight patients with OCD during a resting and a provoked (symptomatic) state.


RESULTS
Individually tailored provocative stimuli were successful in provoking OCD symptoms, in comparison with paired innocuous stimuli, as measured by self-report on OCD analogue scales (P = .002). Omnibus subtraction images demonstrated a statistically significant increase in relative regional cerebral blood flow during the OCD symptomatic state vs the resting state in right caudate nucleus (P < .006), left anterior cingulate cortex (P < .045), and bilateral orbitofrontal cortex (P < .008); increases in the left thalamus approached but did not reach statistical significance (P = .07).


CONCLUSIONS
These findings are consistent with results of previous functional neuroimaging studies and contemporary neurocircuitry models of OCD. The data further implicate orbitofrontal cortex, caudate nucleus, and anterior cingulate cortex in the pathophysiology of OCD and in mediating OCD symptoms.
Rauch
S L
SL
Department of Psychiatry, Massachusetts General Hospital, Boston.
Jenike
M A
MA
Alpert
N M
NM
Baer
L
L
Breiter
H C
HC
Savage
C R
CR
Fischman
A J
AJ
D000328:Adult; D001921:Brain / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002245:Carbon Dioxide; D002421:Caudate Nucleus / Q000098:blood supply; D002560:Cerebrovascular Circulation; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply; D006179:Gyrus Cinguli / Q000098:blood supply; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010104:Oxygen Radioisotopes; D013788:Thalamus / Q000098:blood supply; D014055:Tomography, Emission-Computed
D010104:Oxygen Radioisotopes; D002245:Carbon Dioxide