title: Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis.
abstract: Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region׳s role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry, emotional decision-making and CBTp responsiveness. Emotional decision-making was measured by the Iowa Gambling task (IGT). Thirty patients received CBTp+standard care (CBTp+SC; 25 completers) for 6-8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging. Patients׳ symptoms were assessed before and after therapy. Pre-therapy OFC GMV was measured using a region-of-interest approach, and IGT performance was measured as overall learning, attention to reward, memory for past outcomes and choice consistency. Both these measures, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC׳s function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness.
authors: Division of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK. Electronic address: Preethi.premkumar@ntu.ac.uk.
authors: Preethi
authors: P
authors: Premkumar
authors: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK.
authors: Dominic
authors: D
authors: Fannon
authors: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK.
authors: Adegboyega
authors: A
authors: Sapara
authors: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors: Emmanuelle R
authors: ER
authors: Peters
authors: South London and Maudsley NHS Foundation Trust, London, UK.
authors: Anantha P
authors: AP
authors: Anilkumar
authors: NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, UK.
authors: Andrew
authors: A
authors: Simmons
authors: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors: Elizabeth
authors: E
authors: Kuipers
authors: Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
authors: Veena
authors: V
authors: Kumari
mesh_terms: D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003657:Decision Making / Q000502:physiology*; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D017397:Prefrontal Cortex / Q000033:anatomy & histology*; D011618:Psychotic Disorders / Q000503:physiopathology / Q000628:therapy*; D012559:Schizophrenia / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Asymmetry; Prefrontal cortex; Schizophrenia