title: Altered brain activity during reward anticipation in pathological gambling and obsessive-compulsive disorder.
abstract: BACKGROUND
  Pathological gambling (PG) and obsessive-compulsive disorder (OCD) are conceptualized as a behavioral addiction, with a dependency on repetitive gambling behavior and rewarding effects following compulsive behavior, respectively. However, no neuroimaging studies to date have examined reward circuitry during the anticipation phase of reward in PG compared with in OCD while considering repetitive gambling and compulsion as addictive behaviors.
  
  
  RESULTS
  To elucidate the neural activities specific to the anticipation phase of reward, we performed event-related functional magnetic resonance imaging (fMRI) in young adults with PG and compared them with those in patients with OCD and healthy controls. Fifteen male patients with PG, 13 patients with OCD, and 15 healthy controls, group-matched for age, gender, and IQ, participated in a monetary incentive delay task during fMRI scanning. Neural activation in the ventromedial caudate nucleus during anticipation of both gain and loss decreased in patients with PG compared with that in patients with OCD and healthy controls. Additionally, reduced activation in the anterior insula during anticipation of loss was observed in patients with PG compared with that in patients with OCD which was intermediate between that in OCD and healthy controls (healthy controls < PG < OCD), and a significant positive correlation between activity in the anterior insula and South Oaks Gambling Screen score was found in patients with PG.
  
  
  CONCLUSIONS
  Decreased neural activity in the ventromedial caudate nucleus during anticipation may be a specific neurobiological feature for the pathophysiology of PG, distinguishing it from OCD and healthy controls. Correlation of anterior insular activity during loss anticipation with PG symptoms suggests that patients with PG fit the features of OCD associated with harm avoidance as PG symptoms deteriorate. Our findings have identified functional disparities and similarities between patients with PG and OCD related to the neural responses associated with reward anticipation.
authors.affiliation: Department of Psychiatry, Seoul National University College of Medicine, Korea.
authors.forename: Jung-Seok
authors.initials: JS
authors.lastname: Choi
authors.forename: Young-Chul
authors.initials: YC
authors.lastname: Shin
authors.forename: Wi Hoon
authors.initials: WH
authors.lastname: Jung
authors.forename: Joon Hwan
authors.initials: JH
authors.lastname: Jang
authors.forename: Do-Hyung
authors.initials: DH
authors.lastname: Kang
authors.forename: Chi-Hoon
authors.initials: CH
authors.lastname: Choi
authors.forename: Sam-Wook
authors.initials: SW
authors.lastname: Choi
authors.forename: Jun-Young
authors.initials: JY
authors.lastname: Lee
authors.forename: Jae Yeon
authors.initials: JY
authors.lastname: Hwang
authors.forename: Jun Soo
authors.initials: JS
authors.lastname: Kwon
mesh_terms: D000293:Adolescent; D000328:Adult; D059031:Anticipation, Psychological; D001921:Brain / Q000503:physiopathology*; D003192:Compulsive Behavior / Q000503:physiopathology; D005715:Gambling / Q000503:physiopathology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000503:physiopathology*; D012201:Reward; D055815:Young Adult