Brain reactivity to specific symptom provocation indicates prospective therapeutic outcome in OCD.
A pertinent question in biological psychiatry is what differentiates responders and non-responders to pharmacological treatment. One possibility is that individual differences in the symptomatic spectrum as well as in the underlying biology of the disorder lead to the known 40% failure in pharmacological treatment. Our study aimed to maximize individual brain markers of obsessive-compulsive disorder (OCD) by applying single photon emission computed tomography (SPECT) during a provoked symptomatic state prior to and following treatment. Four brain SPECT scans were obtained from 26 OCD patients prior to and at 6 months of sertraline treatment. At each time point, two SPECT scans were performed in a counterbalanced order of two specific states; one a symptom-provoking condition and the other a relaxed condition. At 6 months of treatment, patients were divided into responders and non-responders according to a predetermined clinical criterion. Prospective responders showed significantly lower brain perfusion in the dorsal-caudal anterior cingulum and higher brain perfusion in the right caudate, when compared to non-responders, only during symptom provocation. When pre- and post-treatment scans during symptom provocation were compared, only responders showed significant change in brain response: increased perfusion in the left anterior temporal cortex and prefrontal cortex at 6 months' treatment. These findings suggest that obtaining functional brain imaging during specific symptom provocation emphasizes individual differences in brain reactivity. Thus can indicate prospective responders to symptom-related treatment in OCD and mark the relevant brain regions for effective response to treatment.
Hendler
Talma
T
Psychiatry Department, Chaim Sheba Medical Center, Ramat Gan, Tel Hashomer, Israel. talma@tasmc.health.gov.il
Goshen
Elinor
E
Tzila Zwas
S
S
Sasson
Yehuda
Y
Gal
Gilad
G
Zohar
Joseph
J
D000328:Adult; D001143:Arousal / Q000187:drug effects / Q000502:physiology*; D002421:Caudate Nucleus / Q000098:blood supply / Q000000981:diagnostic imaging / Q000187:drug effects; D002540:Cerebral Cortex / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects; D003463:Cues; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D006179:Gyrus Cinguli / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000503:physiopathology; D010555:Personality Inventory; D011379:Prognosis; D012039:Regional Blood Flow / Q000187:drug effects / Q000502:physiology; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D020280:Sertraline / Q000009:adverse effects / Q000627:therapeutic use*; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome
D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline