期刊
NEUROPSYCHOPHARMACOLOGY
卷 37, 期 3, 页码 734-745出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/npp.2011.250
关键词
OCD; neuroimaging; magnetic resonance imaging; serotonin reuptake inhibitors; cognitive-behavior therapy; randomized clinical trial
资金
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP, Foundation for the Support of Research in the State of Sao Paulo) [2005/55628-8]
- FAPESP [06/61459-7, 06/50273-0, 2008/10257-0, 06/58286-3, 2005/04206-6]
- Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior (CAPES, Agency for Support and Evaluation of Graduate Education) [4375/08-4]
- Medtronic
- Eli Lilly
- McNeil
- Cyberonics
- NIMH
- NARSAD
- TSA
- OCF
- Tufts University
- MGH Psychiatry Academy
- BrainCells
- Systems Research and Applications Corporation
- Boston University
- Catalan Agency for Health Technology Assessment and Research
- National Association of Social Workers Massachusetts
- Massachusetts Medical Society
- NIDA
- German Research Foundation/Federal Ministry for Education and Research
- Oxford University Press
- NIH
- NIA
- AHRQ
- Janssen Pharmaceuticals
- Forest Research Institute
- Shire Development
- Northstar
- Janssen
- AstraZeneca
- Lundbeck
- Solvay
- Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP) [06/50273-0] Funding Source: FAPESP
Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n = 38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n = 36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n = 26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n = 13), whereas no significant GM volume changes were observed in CBT-treated patients (n = 13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action. Neuropsychopharmacology (2012) 37, 734-745; doi: 10.1038/npp.2011.250; published online 26 October 2011
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