title: Regional cerebral blood flow in obsessive-compulsive disordered patients at rest. Differential correlates with obsessive-compulsive and anxious-avoidant dimensions.
abstract: BACKGROUND
  We tested whether cortical and subcortical regional cerebral blood flow (rCBF) differs between patients with obsessive-compulsive disorder (OCD) and healthy controls. We then explored the relationship between rCBF and OCD mental state.
  
  
  METHODS
  Thirty out-patients from the Maudsley Hospital with OCD as defined in DSM-III-R were scanned at rest using brain-dedicated, high-resolution, single photon emission tomography. RCBF was measured as uptake of 99mTc-HMPAO in 15 regions of interest and compared with rCBF data in 30 healthy people matched for age, sex and handedness. Symptom ratings were obtained using standard measures on the scanning day. Principal components factor analysis identified two distinct clinical dimensions: obsessive-compulsive (OC) and anxious-avoidant (AA). These were correlated with patients' rCBF measurements, using Spearman's rank correlation coefficient, and multiple regression coefficients calculated.
  
  
  RESULTS
  We found significant reductions in rCBF measurements of OCD patients compared with resting, healthy controls (F = 1.92, P = 0.04) in seven brain regions: the right and left superior frontal cortex, right inferior frontal cortex, left temporal cortex, left parietal cortex, right caudate nucleus and right thalamus. Regional differences were not secondary to generalised reduction in patients' brain perfusion. Reduced blood flow to the right inferior frontal cortex correlated significantly with illness severity (r = 0.37, P = 0.02). There was no relationship with age, age-of-onset, sex, handedness, depression or medication status. OC clinical dimension, concerning obsessions, compulsions and low mood, was significantly negatively correlated with left inferior frontal, medial frontal and right parietal rCBF. AA dimension, concerning anxiety and avoidance, was significantly positively associated with left and right superior frontal, right inferior frontal, medial frontal cortical, and right and left caudate and thalamic rCBF.
  
  
  CONCLUSIONS
  rCBF differs significantly between resting OCD patients and healthy controls, and separate clinical dimensions are associated with functionally distinct rCBF patterns.
authors.affiliation: Institute of Psychiatry, London.
authors.forename: J V
authors.initials: JV
authors.lastname: Lucey
authors.forename: D C
authors.initials: DC
authors.lastname: Costa
authors.forename: T
authors.initials: T
authors.lastname: Blanes
authors.forename: G F
authors.initials: GF
authors.lastname: Busatto
authors.forename: L S
authors.initials: LS
authors.lastname: Pilowsky
authors.forename: N
authors.initials: N
authors.lastname: Takei
authors.forename: I M
authors.initials: IM
authors.lastname: Marks
authors.forename: P J
authors.initials: PJ
authors.lastname: Ell
authors.forename: R W
authors.initials: RW
authors.lastname: Kerwin
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000523:psychology; D001143:Arousal / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000098:blood supply; D003937:Diagnosis, Differential; D004292:Dominance, Cerebral / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000523:psychology; D015609:Organotechnetium Compounds; D010091:Oximes; D012039:Regional Blood Flow / Q000502:physiology; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D015609:Organotechnetium Compounds; D010091:Oximes; D019690:Technetium Tc 99m Exametazime