title: Case study: caudate glutamatergic changes with paroxetine persist after medication discontinuation in pediatric OCD.
abstract: Proton magnetic resonance spectroscopy (1H-MRS) was used to examine glutamatergic (Glx) abnormalities in the caudate nucleus in pediatric obsessive-compulsive disorder (OCD), associated with severity of illness and response to acute (12 weeks) treatment with paroxetine. In this report, OCD symptoms improved markedly in an 8-year-old girl treated for 14 months with the selective serotonin reuptake inhibitor paroxetine (titrated from 10 to 40 mg/day). Paroxetine dose was then decreased in 10-mg decrements and discontinued without symptom recurrence. Serial 1H-MRS examinations were acquired before and after 12 weeks of paroxetine treatment (40 mg/day) and 3 months after medication discontinuation. A striking decrease in caudate Glx was observed after 12 weeks of treatment which persisted after medication discontinuation. These data provide further support for a reversible glutamatergically mediated dysfunction of the caudate nucleus in OCD that may serve as a pathophysiological and treatment response marker.
authors.affiliation: Department of Psychiatry, Wayne State University School of Medicine, Detroit, MI 48201, USA.
authors.forename: J
authors.initials: J
authors.lastname: Bolton
authors.forename: G J
authors.initials: GJ
authors.lastname: Moore
authors.forename: S
authors.initials: S
authors.lastname: MacMillan
authors.forename: C M
authors.initials: CM
authors.lastname: Stewart
authors.forename: D R
authors.initials: DR
authors.lastname: Rosenberg
mesh_terms: D001923:Brain Chemistry / Q000187:drug effects; D002421:Caudate Nucleus / Q000187:drug effects*; D002648:Child; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D018698:Glutamic Acid / Q000187:drug effects / Q000378:metabolism*; D006801:Humans; D009682:Magnetic Resonance Spectroscopy; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy* / Q000378:metabolism; D017374:Paroxetine / Q000008:administration & dosage / Q000627:therapeutic use*; D012074:Remission Induction; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D018698:Glutamic Acid; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors