Mapping structural brain alterations in obsessive-compulsive disorder.

BACKGROUND Recent technical developments have made it feasible to comprehensively assess brain anatomy in psychiatric populations. OBJECTIVE To describe the structural brain alterations detected in the magnetic resonance images of a large series of patients with obsessive-compulsive disorder (OCD) using imaging procedures that allow the evaluation of volume changes throughout the brain. DESIGN Case-control study. SETTING Referral OCD unit in a tertiary hospital. PARTICIPANTS A consecutive sample of 72 outpatients with OCD and 72 age- and sex-matched control subjects. INTERVENTIONS Three-dimensional sequences were obtained in all participants. A statistical parametric mapping approach was used to delineate possible anatomical alterations in the entire brain. To preserve volumetric information, voxel values were modulated by the Jacobian determinants (volume change measurement) derived from spatial normalization. MAIN OUTCOME MEASURES Voxelwise brain volumes. RESULTS The brains of patients with OCD showed reduced gray matter volume in the medial frontal gyrus, the medial orbitofrontal cortex, and the left insulo-opercular region. A relative increase in gray matter volume was observed bilaterally in the ventral part of the putamen and in the anterior cerebellum. All these brain alterations were abnormally correlated in patients with OCD, and age statistically significantly contributed to the relative enlargement observed in the striatal areas. Disease severity, the nature of symptoms, and comorbidities were not related to the changes described. Nevertheless, patients with prominent aggressive obsessions and checking compulsions showed reduced amygdala volume in the right hemisphere. CONCLUSIONS The pattern of anatomical features depicted by this voxelwise approach is consistent with data from functional studies. The reported anatomical maps identified the specific parts of the frontostriatal system that were altered in patients with OCD and detected changes in anatomically connected distant regions. These data further define the structural brain alterations in OCD and may contribute to constraining the prevailing biological models of this psychiatric process.

[1]  M. Hamilton.  The assessment of anxiety states by rating. , 1959, The British journal of medical psychology.

[2]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[3]  R. C. Oldfield.  The assessment and analysis of handedness: the Edinburgh inventory. , 1971, Neuropsychologia.

[4]  S P Wise,et al.  Obsessive-compulsive disorder: evidence for basal ganglia dysfunction. , 1988, Psychopharmacology bulletin.

[5]  Rapoport Jl,et al.  Obsessive-compulsive disorder: evidence for basal ganglia dysfunction. , 1988 .

[6]  J. Talairach,et al.  Co-Planar Stereotaxic Atlas of the Human Brain: 3-Dimensional Proportional System: An Approach to Cerebral Imaging , 1988 .

[7]  J. Rapoport,et al.  Neuroanatomical abnormalities in obsessive-compulsive disorder detected with quantitative X-ray computed tomography. , 1988, The American journal of psychiatry.

[8]  B Mazoyer,et al.  Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions. A neuropsychological, magnetic resonance imaging and positron tomography study. , 1989, Brain : a journal of neurology.

[9]  G C Curtis,et al.  Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive-compulsive disorder. , 1989, The Journal of neuropsychiatry and clinical neurosciences.

[10]  W. Goodman,et al.  The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. , 1989, Archives of general psychiatry.

[11]  R. Gur,et al.  Volunteers for biomedical research. Recruitment and screening of normal controls. , 1991, Archives of general psychiatry.

[12]  Michele Laraia,et al.  Brain MRI in obsessive-compulsive disorder , 1991, Psychiatry Research.

[13]  J. Mazziotta,et al.  Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. , 1992, Archives of general psychiatry.

[14]  T. Insel,et al.  Toward a neuroanatomy of obsessive-compulsive disorder. , 1992, Archives of general psychiatry.

[15]  E. Smeraldi,et al.  Increased right caudate nucleus size in obsessive-compulsive disorder: Detection with magnetic resonance imaging , 1992, Psychiatry Research: Neuroimaging.

[16]  A. L. Leiner,et al.  Cognitive and language functions of the human cerebellum , 1993, Trends in Neurosciences.

[17]  D. Pandya,et al.  Striatal connections of the parietal association cortices in rhesus monkeys , 1993, The Journal of comparative neurology.

[18]  L. Baer.  Factor analysis of symptom subtypes of obsessive compulsive disorder and their relation to personality and tic disorders. , 1994, The Journal of clinical psychiatry.

[19]  M Ashtari,et al.  Reduced caudate nucleus volume in obsessive-compulsive disorder. , 1995, Archives of general psychiatry.

[20]  P. Mcguire,et al.  The brain in obsessive-compulsive disorder. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[21]  V S Caviness,et al.  Cerebral structural abnormalities in obsessive-compulsive disorder. A quantitative morphometric magnetic resonance imaging study. , 1996, Archives of general psychiatry.

[22]  H. Groenewegen,et al.  Patterns of overlap and segregation between insular cortical, intermediodorsal thalamic and basal amygdaloid afferents in the nucleus accumbens of the rat , 1996, Neuroscience.

[23]  J. Kulisevsky,et al.  Obsessive-compulsive disorder associated with brain lesions , 1996, Neurology.

[24]  E. Aylward,et al.  Normal caudate nucleus in obsessive-compulsive disorder assessed by quantitative neuroimaging. , 1996, Archives of general psychiatry.

[25]  Karl J. Friston,et al.  A unified statistical approach for determining significant signals in images of cerebral activation , 1996, Human brain mapping.

[26]  C. McDougle,et al.  Symptoms of obsessive-compulsive disorder. , 1997, The American journal of psychiatry.

[27]  Karl J. Friston,et al.  Incorporating Prior Knowledge into Image Registration , 1997, NeuroImage.

[28]  J. Pierri,et al.  Frontostriatal measurement in treatment-naive children with obsessive-compulsive disorder. , 1997, Archives of general psychiatry.

[29]  Dan J Stein,et al.  Magnetic resonance brain imaging in women with obsessive-compulsive disorder and trichotillomania , 1997, Psychiatry Research: Neuroimaging.

[30]  R W Neufeld,et al.  A short echo 1H spectroscopy and volumetric MRI study of the corpus striatum in patients with obsessive-compulsive disorder and comparison subjects. , 1998, The American journal of psychiatry.

[31]  A L Brody,et al.  Neuroimaging and frontal-subcortical circuitry in obsessive-compulsive disorder , 1998, British Journal of Psychiatry.

[32]  N. Alpert,et al.  Neural Correlates of Factor-Analyzed OCD Symptom Dimensions: A PET Study , 1998, CNS Spectrums.

[33]  R. Gur,et al.  Subcortical MRI volumes in neuroleptic-naive and treated patients with schizophrenia. , 1998, The American journal of psychiatry.

[34]  M Ashtari,et al.  Orbital frontal and amygdala volume reductions in obsessive-compulsive disorder. , 1999, Archives of general psychiatry.

[35]  J. Ashburner,et al.  Nonlinear spatial normalization using basis functions , 1999, Human brain mapping.

[36]  S. Rauch,et al.  Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. , 1999, The American journal of psychiatry.

[37]  Adriaan A. Lammertsma,et al.  Neuroimaging in obsessive-compulsive and related disorders: investigation of the frontal-striatal and limbic circuits , 1999 .

[38]  Karl J. Friston,et al.  Voxel-Based Morphometry—The Methods , 2000, NeuroImage.

[39]  S. Rauch,et al.  Relation of factor‐analyzed symptom dimensions of obsessive‐compulsive disorder to personality disorders , 2000, Acta psychiatrica Scandinavica.

[40]  P. Strick,et al.  Basal ganglia and cerebellar loops: motor and cognitive circuits , 2000, Brain Research Reviews.

[41]  J. Schmahmann.  The role of the cerebellum in affect and psychosis , 2000, Journal of Neurolinguistics.

[42]  D. Murphy,et al.  Neuroanatomically based approaches to obsessive-compulsive disorder. Neurosurgery and transcranial magnetic stimulation. , 2000, The Psychiatric clinics of North America.

[43]  M. Keshavan,et al.  Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine. , 2000, Archives of general psychiatry.

[44]  Alfons Schnitzler,et al.  The Somatosensory System , 2000 .

[45]  J N Giedd,et al.  MRI assessment of children with obsessive-compulsive disorder or tics associated with streptococcal infection. , 2000, The American journal of psychiatry.

[46]  S. Rauch,et al.  Functional neuroimaging and the neuroanatomy of obsessive-compulsive disorder. , 2000, The Psychiatric clinics of North America.

[47]  J. Mazziotta,et al.  Brain mapping : the systems , 2000 .

[48]  Jesús Pujol,et al.  Beck Depression Inventory factors related to demyelinating lesions of the left arcuate fasciculus region , 2000, Psychiatry Research: Neuroimaging.

[49]  Karl J. Friston,et al.  Why Voxel-Based Morphometry Should Be Used , 2001, NeuroImage.

[50]  J. Pujol,et al.  Right prefrontal repetitive transcranial magnetic stimulation in obsessive-compulsive disorder: a double-blind, placebo-controlled study. , 2001, The American journal of psychiatry.

[51]  Jun Soo Kwon,et al.  Grey matter abnormalities in obsessive–compulsive disorder , 2001, British Journal of Psychiatry.

[52]  Alan C. Evans,et al.  Focal gray matter density changes in schizophrenia. , 2001, Archives of general psychiatry.

[53]  Jesús Pujol,et al.  CSF Spaces of the Sylvian Fissure Region in Severe Melancholic Depression , 2002, NeuroImage.

[54]  Karl J. Friston,et al.  A Voxel-Based Morphometric Study of Ageing in 465 Normal Adult Human Brains , 2001, NeuroImage.

[55]  Jesús Pujol,et al.  The Lateral Asymmetry of the Human Brain Studied by Volumetric Magnetic Resonance Imaging , 2002, NeuroImage.