Brain activation of patients with obsessive-compulsive disorder during neuropsychological and symptom provocation tasks before and after symptom improvement: a functional magnetic resonance imaging study.
BACKGROUND
Functional neuroimaging studies have implicated hyperactivity of the frontal cortex in obsessive-compulsive disorder (OCD); however, relationships between abnormal brain activity, clinical improvement, and neuropsychological function have not been clarified in OCD. To clarify the pathophysiology of this disorder, regional changes in brain function were examined during administration of cognitive and symptom provocation tasks in patients with OCD before and after treatment.


METHODS
Ten outpatients with OCD participated in the study. Functional magnetic resonance imaging (fMRI) was performed before and after treatment. Stroop and symptom provocation tasks were administered during fMRI. Each patient was randomly allocated to receive either pharmacotherapy with fluvoxamine 200 mg/day (n = 4) or behavior therapy (n = 6) for 12 weeks.


RESULTS
After 12-week treatment, mean (+/- SD) total score on the Yale-Brown Obsessive-Compulsive Scale decreased from 29.00 +/- 3.59 to 14.60 +/- 9.22, representing symptomatic improvement from moderate to mild. After symptom improvement, symptom provocation-related activation in the orbitofrontal, dorsolateral-prefrontal, and anterior cingulate cortices decreased. Conversely, Stroop task-related activation in the parietal cortex and cerebellum increased.


CONCLUSIONS
After improvement of OCD with either fluvoxamine or behavioral therapy, hyperactivation of the frontal lobe related to a symptom-provocative state decreases, and posterior brain activity related to action-monitoring function increases.
Nakao
Tomohiro
T
Graduate School of Medical Sciences, Kyushu University, Okayama, Japan.
Nakagawa
Akiko
A
Yoshiura
Takashi
T
Nakatani
Eriko
E
Nabeyama
Maiko
M
Yoshizato
Chika
C
Kudoh
Akiko
A
Tada
Kyoko
K
Yoshioka
Kazuko
K
Kawamoto
Midori
M
Togao
Osamu
O
Kanba
Shigenobu
S
D018687:Antidepressive Agents, Second-Generation / Q000627:therapeutic use; D001921:Brain / Q000503:physiopathology*; D003071:Cognition / Q000502:physiology; D015928:Cognitive Behavioral Therapy; D016666:Fluvoxamine / Q000627:therapeutic use; D005625:Frontal Lobe / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology* / Q000523:psychology* / Q000628:therapy; D011569:Psychiatric Status Rating Scales
D018687:Antidepressive Agents, Second-Generation; D016666:Fluvoxamine