title: Aberrant error processing in relation to symptom severity in obsessive-compulsive disorder: A multimodal neuroimaging study.
abstract: BACKGROUND
  Obsessive-compulsive disorder (OCD) is characterized by maladaptive repetitive behaviors that persist despite feedback. Using multimodal neuroimaging, we tested the hypothesis that this behavioral rigidity reflects impaired use of behavioral outcomes (here, errors) to adaptively adjust responses. We measured both neural responses to errors and adjustments in the subsequent trial to determine whether abnormalities correlate with symptom severity. Since error processing depends on communication between the anterior and the posterior cingulate cortex, we also examined the integrity of the cingulum bundle with diffusion tensor imaging.
  
  
  METHODS
  Participants performed the same antisaccade task during functional MRI and electroencephalography sessions. We measured error-related activation of the anterior cingulate cortex (ACC) and the error-related negativity (ERN). We also examined post-error adjustments, indexed by changes in activation of the default network in trials surrounding errors.
  
  
  RESULTS
  OCD patients showed intact error-related ACC activation and ERN, but abnormal adjustments in the post- vs. pre-error trial. Relative to controls, who responded to errors by deactivating the default network, OCD patients showed increased default network activation including in the rostral ACC (rACC). Greater rACC activation in the post-error trial correlated with more severe compulsions. Patients also showed increased fractional anisotropy (FA) in the white matter underlying rACC.
  
  
  CONCLUSIONS
  Impaired use of behavioral outcomes to adaptively adjust neural responses may contribute to symptoms in OCD. The rACC locus of abnormal adjustment and relations with symptoms suggests difficulty suppressing emotional responses to aversive, unexpected events (e.g., errors). Increased structural connectivity of this paralimbic default network region may contribute to this impairment.
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA.
authors: Yigal
authors: Y
authors: Agam
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Jennifer L
authors: JL
authors: Greenberg
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Marlisa
authors: M
authors: Isom
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Martha J
authors: MJ
authors: Falkenstein
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Eric
authors: E
authors: Jenike
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors: Sabine
authors: S
authors: Wilhelm
authors: Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA ; Athinoula A. Martinos Center for Biomedical Imaging, Harvard Medical School, Charlestown, MA, USA.
authors: Dara S
authors: DS
authors: Manoach
mesh_terms: D000328:Adult; D001931:Brain Mapping / Q000379:methods; D004569:Electroencephalography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D064847:Multimodal Imaging; D009415:Nerve Net / Q000503:physiopathology*; D059906:Neuroimaging / Q000379:methods*; D009483:Neuropsychological Tests; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000503:physiopathology*; D012438:Saccades / Q000502:physiology*; D012720:Severity of Illness Index; D055815:Young Adult
keywords: Anterior cingulate; Default network; ERN; Error processing; Multimodal neuroimaging; OCD