A study of cognitive function in treatment-refractory obsessive-compulsive disorder treated with capsulotomy.
OBJECTIVE Anterior capsulotomy (AC) is sometimes used as a last resort for treatment-refractory obsessive-compulsive disorder (OCD). Previous studies assessing neuropsychological outcomes in patients with OCD have identified several forms of cognitive dysfunction that are associated with the disease, but few have focused on changes in cognitive function in OCD patients who have undergone surgery. In the present study, the authors investigated the effects of AC on the cognitive function of patients with treatment-refractory OCD. METHODS The authors selected 14 patients with treatment-refractory OCD who had undergone bilateral AC between 2007 and 2013, 14 nonsurgically treated OCD patients, and 14 healthy control subjects for this study. The 3 groups were matched for sex, age, and education. Several neuropsychological tests, including Similarities and Block Design, which are subsets of the Wechsler Abbreviated Scale of Intelligence; Immediate and Delayed Logical Memory and Immediate and Delayed Visual Reproduction, which are subsets of the Wechsler Memory Scale-Revised; and Corrects, Categories, Perseverative Errors, Nonperseverative Errors, and Errors, subtests of the Wisconsin Card Sorting Test, were conducted in all 42 subjects at baseline and after AC, after nonsurgical treatment, or at 6-month intervals, as appropriate. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms in all 28 OCD patients. RESULTS The Y-BOCS scores decreased significantly in both OCD groups during the 12-month follow-up period. Surgical patients showed higher levels of improvement in verbal memory, visual memory, visuospatial skills, and executive function than the nonsurgically treated OCD patients. CONCLUSIONS The findings of this study suggest that AC not only reduces OCD symptoms but also attenuates moderate cognitive deficits.
Departments of1Neurosurgery and.
Feilong
F
Gong
Departments of1Neurosurgery and.
Peng
P
Li
2Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People'sRepublic of China.
Bin
B
Li
Departments of1Neurosurgery and.
Shizhen
S
Zhang
Departments of1Neurosurgery and.
Xinjie
X
Zhang
Departments of1Neurosurgery and.
Sen
S
Yang
Departments of1Neurosurgery and.
Hongbin
H
Liu
Departments of1Neurosurgery and.
Wei
W
Wang
D000293:Adolescent; D000328:Adult; D003071:Cognition; D004351:Drug Resistance; D056344:Executive Function; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020772:Internal Capsule / Q000601:surgery; D008297:Male; D057567:Memory, Long-Term; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000379:methods*; D009771:Obsessive-Compulsive Disorder / Q000523:psychology* / Q000601:surgery*; D064727:Posterior Capsulotomy / Q000379:methods*; D011569:Psychiatric Status Rating Scales; D011597:Psychomotor Performance; D013028:Space Perception; D016896:Treatment Outcome; D014888:Wechsler Scales; D055815:Young Adult
AC = anterior capsulotomy; CBT = cognitive behavioral therapy; DSM = Diagnostic and Statistical Manual of Mental Disorders; GVC = gamma ventral capsulotomy; OCD = obsessive-compulsive disorder; RCT = randomized controlled trial; S1, . . . S14 = surgical patient 1, . . . . surgical patient 14; SSRI = selective serotonin reuptake inhibitor; VC/VS = ventral capsular/ventral striatal; WASI = Wechsler Abbreviated Scale of Intelligence; WCST = Wisconsin Card Sorting Test; WMS-R = Wechsler Memory Scale–Revised; Y-BOCS = Yale-Brown Obsessive Compulsive Scale; anterior capsulotomy; functional neurosurgery; neuropsychology; treatment-refractory obsessive-compulsive disorder