title: The caudate nucleus in obsessive-compulsive disorder. Reduced metabolism following treatment with paroxetine: a PET study.
abstract: Several neuroimaging studies of patients with OCD have pointed to basal ganglia and the frontal cortical regions being relevant for an understanding of the pathophysiology and therapy of OCD. In a search for the neural substrate underlying the therapeutic action of paroxetine in the therapy of OCD we measured regional glucose metabolism in a PET study of 20 OCD patients before and after at least 3 months of treatment. We used 18-fluoro-deoxyglucose PET-scanning to measure regional cerebral glucose metabolic rate (rCMRglc) in 20 non-depressed patients fulfilling DSM-IV criteria for OCD. Patients were studied before and after 12-20 wk of treatment with the serotonin re-uptake inhibitor paroxetine. Clinical assessment rating with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was performed before the first and after the second study. The PET data was analysed regionally using statistical parametric mapping (SPM-96). A clinical improvement was indicated by a mean decrease of 55% in the Y-BOCS score. There was no difference in global cerebral metabolism before and after treatment whereas a post-treatment reduction in normalized rCMRglc was found in the right caudate nucleus. This finding also showed a significant positive correlation with symptom severity. Our results support hypotheses regarding a malfunction of the cortico-striato-thalamic system in the pathophysiology of OCD and particularly point to the caudate nucleus playing an important role for the therapeutic action of paroxetine in the treatment of OCD.
authors.affiliation: Department of Psychiatry, Copenhagen University Hospital, Roghospitalet, Copenhagen, Denmark.
authors.forename: Elsebet Steno
authors.initials: ES
authors.lastname: Hansen
authors.forename: Steen
authors.initials: S
authors.lastname: Hasselbalch
authors.forename: Ian
authors.initials: I
authors.lastname: Law
authors.forename: Tom G
authors.initials: TG
authors.lastname: Bolwig
mesh_terms: D000328:Adult; D002421:Caudate Nucleus / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D005260:Female; D019788:Fluorodeoxyglucose F18; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging / Q000378:metabolism* / Q000523:psychology; D017374:Paroxetine / Q000627:therapeutic use*; D011569:Psychiatric Status Rating Scales; D019275:Radiopharmaceuticals; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D014055:Tomography, Emission-Computed
chemical_list: D019788:Fluorodeoxyglucose F18; D005947:Glucose; D017374:Paroxetine; D019275:Radiopharmaceuticals; D017367:Selective Serotonin Reuptake Inhibitors