title: Neural correlates of moral sensitivity in obsessive-compulsive disorder.
abstract: BACKGROUND
  Heightened moral sensitivity seems to characterize patients with obsessive-compulsive disorder (OCD). Recent advances in social cognitive neuroscience suggest that a compelling relationship may exist between this disorder-relevant processing bias and the functional activity of brain regions implicated in OCD.
  
  
  OBJECTIVE
  To test the hypothesis that patients with OCD demonstrate an increased response of relevant ventromedial prefrontal and orbitofrontal cortex regions in a functional magnetic resonance imaging study of difficult moral decision making.
  
  
  METHODS
  Case-control cross-sectional study.
  
  
  METHODS
  Hospital referral OCD unit and magnetic resonance imaging facility.
  
  
  METHODS
  Seventy-three patients with OCD (42 men and 31 women) and 73 control participants matched for age, sex, and education level.
  
  
  METHODS
  Functional magnetic resonance imaging activation maps representing significant changes in blood oxygenation level-dependent signal in response to 24 hypothetical moral dilemma vs nondilemma task vignettes and additional activation maps representing significant linear associations between patients' brain responses and symptom severity ratings.
  
  
  RESULTS
  In both groups, moral dilemma led to robust activation of frontal and temporoparietal brain regions. Supporting predictions, patients with OCD demonstrated significantly increased activation of the ventral frontal cortex, particularly of the medial orbitofrontal cortex. In addition, the left dorsolateral prefrontal cortex and left middle temporal gyrus were more robustly activated in patients with OCD. These results were unexplained by group differences in comorbid affective symptoms. Patients' global illness severity predicted the relative magnitude of orbitofrontal-striatal activation. The severity of "harm/checking" symptoms and "sexual/religious" obsessions predicted the magnitude of posterior temporal and amygdala-paralimbic activation, respectively.
  
  
  CONCLUSIONS
  The neural correlates of moral sensitivity in patients with OCD partly coincide with brain regions that are of general interest to pathophysiologic models of this disorder. In particular, these findings suggest that the orbitofrontal cortex together with the left dorsolateral prefrontal cortex may be relevant for understanding the link between neurobiological processes and certain maladaptive cognitions in OCD.
authors: Institut d’Alta Tecnologia–Parc de Recerca Biomèdica de Barcelona, Centro Radiológico Computerizado, Barcelona, Spain. habj@unimelb.edu.au
authors: Ben J
authors: BJ
authors: Harrison
authors: Jesus
authors: J
authors: Pujol
authors: Carles
authors: C
authors: Soriano-Mas
authors: Rosa
authors: R
authors: Hernández-Ribas
authors: Marina
authors: M
authors: López-Solà
authors: Hector
authors: H
authors: Ortiz
authors: Pino
authors: P
authors: Alonso
authors: Joan
authors: J
authors: Deus
authors: José M
authors: JM
authors: Menchon
authors: Eva
authors: E
authors: Real
authors: Cinto
authors: C
authors: Segalàs
authors: Oren
authors: O
authors: Contreras-Rodríguez
authors: Laura
authors: L
authors: Blanco-Hinojo
authors: Narcís
authors: N
authors: Cardoner
mesh_terms: D000328:Adult; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D016022:Case-Control Studies; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009014:Morals; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology* / Q000523:psychology; D011569:Psychiatric Status Rating Scales