Summary
We postulated that activity in the caudate nucleus plays a key role in the brain system that mediates the symptomatic expression of obsessive-compulsive disorder (OCD). If this is so, successful treatment of OCD by any method might be accompanied by changes in caudate function. To test this, we studied regional brain glucose metabolic rates in OCD patients before and after 10 weeks of treatment with either fluoxetine or a specific behavior therapy, cognitive-biobehavioral self-treatment.
There were nine closely matched subjects in each group. For each treatment, responders (Yale-Brown Obsessive-Compulsive Scale — Y-BOCS) showed a significant (p < 0.01) decrease in normalized right caudate metabolic rates. Non-responders did not show this change; responders and non-responders differed significantly (p < 0.05). Of 24 brain structures, only the right caudate metabolic rate changed significantly with behavior therapy; the right anterior cingulate gyms metabolic rate also decreased (p = 0.03) with drug therapy.
Differences were found between drug and behaviour therapy as to which brain structures correlated with clinical changes on the Y-BOCS. Behavior therapy subjects showed a significant correlation (p = 0.03) between their change on the Y-BOCS and left anterior cingulate gyrus metabolic rate change after treatment (tau = −0.62). Drug therapy subjects showed a correlation (p < 0.05) between change on the Y-BOCS and right caudate metabolic rate change.
OCD responds to both drug therapy and behavioral therapy. PET studies before and after each treatment may be a powerful tool to dissect the neuroanatomy of symptom mediation and treatment response. These data also provide support for a theory of mind-brain interaction.
Zusammenfassung
Wir haben postuliert, daß die Aktivität im N. caudatus eine Schlüsselrolle in dem Gehirnsystem spielt, das die Symptomatik von Zwangsstörungen (OCD) auslöst. Wenn das so ist, dann müßte die erfolgreiche Behandlung von OCD unabhängig von der jeweiligen Methode durch Veränderungen der Funktion des N. caudatus begleitet werden. Um das zu prüfen, haben wir die Menge der regionalen Gehirngluko-semetaboliten bei OCD-Patienten vor und 10 Wochen nach der Behandlung mit Fluoxetin oder einer spezifischen Verhaltenstherapie, der kognitiv-verhaltenstherapeutischen Selbstbehandlung gemessen.
In jeder Gruppe waren 9 sehr weitgehend übereinstimmende Patienten; bei jeder Behandlung zeigten die Responder (Y-BOCS) eine signifikante (p < 0,01) Abnahme der normalisierten Menge der Metaboliten im rechten N. caudatus. Non-Responder zeigten diese Veränderung nicht; Responder und Non-Responder unterschieden sich signifikant (p < 0,05). In 24 Gehirnstrukturen veränderte sich die Menge der Metaboliten im rechten N. caudatus nur durch Verhaltenstherapie signifikant; die Metabolitenmenge im rechten vorderen Gyrus cinguli sank auch bei Arzneimitteltherapie (p = 0,03).
Unterschiede zwischen Arzneimittel- und Verhaltenstherapie wurden auch im Hinblick darauf gesehen, welche Veränderungen von Gehirnstrukturen mit klinischen Veränderungen auf der Y-BOCS korrelierten. Patienten, die mit Verhaltenstherapie behandelt wurden, zeigten eine signifikante Korrelation (p = 0,03) zwischen den Veränderungen auf der Y-BOCS und der Metabolitenrate im linken vorderen Gyrus cinguli (tau = −0,62). Patienten, die mit Arzneimitteltherapie behandelt wurden, zeigten eine Korrelation (p < 0,05) zwischen Veränderungen auf der Y-BOCS und der Metabolitenrate im rechten N. caudatus.
Die Zwangsstörung reagiert sowohl auf Arzneimittel als auch auf Verhaltenstherapie. PET-Untersuchungen vor und nach jeder Behandlung können ein wirksames Instrument sein, um die Neuroanatomie der Symptomauslösung und der Behandlungserfolge aufzuklären. Diese Daten können auch dazu beitragen, eine Theorie zu Interaktionen von Geist und Gehirn aufzustellen.
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References
Barlow DH (1990) Long term outcome of patients with panic disorder treated with cognitive behavioral therapy. J Clin Psychiatry 51 Suppl A: 17–23
Baxter LR, Phelps ME, Mazziotta JC et al. (1987) Local cerebral metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry 44:211–218
Baxter LR, Schwartz JM, Mazziotta JC et al. (1988) Cerebral glucose metabolic rates in nondepressed patients with obsessive-compulsive disorder. Am J Psychiatry 145:1560–1563
Baxter LR, Schwartz JM, Guze BH et al. (1990) Neuroimaging in obsessive-compulsive disorder: seeking the mediating neuroanatomy. In: Jenike MA, Baer L, Minichiello WE (eds) Obsessive-compulsive disorders: theory and management, 2nd edn. Year Book Medical Publishers, Chicago, pp 167–188
Baxter LR, Schwartz JM, Guze BH (1991) Brain imaging: toward a neuroanatomy of OCD. In: Zohar J, Insel TR, Rasmussen SA (eds) The psychobiology of obsessive-compulsive disorder. Springer, Berlin Heidelberg New York, pp 101–125
Baxter LR, Schwartz JM, Bergman et al. (1992) Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry (in press)
Churchland PS (1986) Neurophilosophy: toward a unified science of the mind-brain. MIT Press, Cambridge
Cummings JL, Frankel M (1986) Gilles de la Tourette’s syndrome and the neurological basis of obsessions and compulsions. Biol Psychiatry 20:1117–1126
Eccles JC (1989) Evolution of the brain: creation of the self. Routledge, New York
Emmelkamp PMG, van der Helm M, van Zanten BL et al. (1980) Treatment of obsessive-compulsive patients: the contribution of self-instructional training to the effectiveness of exposure. Behav Res Ther 18:61–66
Foa EB, Steketee GS, Ozarow BJ (1985) Behavior therapy with obsessive-compulsives: from theory to treatment. In: Mavissakalian M, Turner SM, Michelson L (eds) Obsessive-compulsive disorder: psychological and pharmacological treatment. Plenum, New York, pp 49–129
Freeman A, Simon KM, Beutler LE et al. (eds) (1989) Comprehensive handbook of cognitive therapy. Plenum, New York
Goldman AI (1986) Epistemology and cognition. Harvard University Press, Cambridge
Goodman WK, Price LH, Rasmussen SA et al. (1989a) The Yale-Brown obsessive compulsive scale: II: Validity. Arch Gen Psychiatry 46:1012–1016
Goodman WK, Price LH, Rasmussen SA et al. (1989b) The Yale-Brown obsessive compulsive scale: I. Development, use, and reliability. Arch Gen Psychiatry 46:1006–1011
Goodman WK, Price LH, Rasmussen SA, et al. (1989c) Efficacy of fluvoxamine in obsessive-compulsive disorder: a double-blind comparison with placebo. Arch Gen Psychiatry 46:36–44
Hand I (1988) Obsessive-compulsive patients and their families. In: Faloon IRH (ed) Handbook of behavioral family therapy. Guilford, New York, pp 231–256
Honderich T (1990) Mind and brain. Oxford University Press, New York (A theory of determinism, vol 1)
Insel TR (1988) Obsessive-compulsive disorder: a neuroethological perspective. Psychopharmacol Bull 24:365–369
Liebowitz MR, Hollander E, Schneier F et al. (1989) Fluoxetine treatment of obsessive-compulsive disorder: an open clinical trial. J Clin Psychopharmacol 9:423–427
Macfie AL (1967) The individual in society: papers on Adam Smith. Allen and Unwin, London
MacLean PD (1986) Culminating developments in the evolution of the limbic system: the thalamocingulate division. In: Doane BK, Livingston KE (eds) The limbic system: functional organization and clinical disorders. Raven, New York, pp 1–28
Marks IM (1987) Fears, phobias, and rituals. Oxford University Press, New York
Marks IM, Lelliott P, Basoglu M et al. (1988) Clomipramine, self-exposure and therapist-aided exposure for obsessive-compulsive rituals. Br J Psychiatry 152:522–534
Menger C (1871) Principles of economics. Translated by Dingwall J, Hoselitz BF (1976) New York University Press, New York
Modell JG, Mountz JM, Curtis GC et al. (1989) Neurophysiological dysfunction in the basal ganglia/limbic striatal and thalamocortical circuits as a pathogenic mechanism of obsessive-compulsive disorder. J Neuropsychiatry 1:27–36
Nagel E (1961) The structure of science: problems in the logic of scientific explanation. Harcourt, Brace and World, New York
Nauta WJH (1986) Circuitous connections linking cerebral cortex, limbic system, and corpus striatum. In: Doane BK, Livingstone KE (eds) The limbic system: functional organization and clinical disorders. Raven, New York, pp 43–54
Nauta WJH (1989) Reciprocal links of the corpus striatum with the cerebral cortex and limbic system: a common substrate for movement and thought? In: Mueller J (ed) Neurology and psychiatry: a meeting of minds. Karger, New York, pp 43–63
Pandya DN, Van Hoesen GW, Mesulam MM (1981) Efferent connections of the cingulate gyrus in the rhesus monkey. Exp Brain Res 42:319–330
Pato MT, Zohar-Kadouch R, Zohar J et al. (1988) Return of symptoms after discontinuation of clomipramine in patients with obsessive-compulsive disorder. Am J Psychiatry 145:1521–1525
Penfield W (1975) The mystery of the mind: a critical study of consciousness and the human brain. Princeton University Press, Princeton
Penfield W, Perot P (1963) The brain’s record of auditory and visual experience: a final summary and discussion. Brain 86:595–696
Popper KR, Eccles JC (1977) The self and its brain. Springer Berlin Heidelberg New York
Raphael DD (1947) The moral sense. Oxford University Press, London
Raphael DD (1975) The impartial spectator. In: Skinner AS, Wilson T (eds) Essays on Adam Smith. Oxford University Press, London, pp 83–99
Rapoport JL (1989a) The boy who couldn’t stop washing: the experience and treatment of obsessive-compulsive disorder. Dutton, New York
Rapoport JL (1989b) The biology of obsessions and compulsions. Scientific American 260 3:82–89
Rapoport JL (1991) Recent advances in obsessive-compulsive disorder. Neuropsychopharmacology 5:1–10
Reed GF (1985) Obsessional experience and compulsive behavior: a cognitive-structural approach. Academic, Orlando, pp 209–215
Rendall J (1979) The origins of the Scottish Enlightenment. Macmillan, London
Rush AJ, Beck AT (section eds) (1988) Cognitive therapy. In: Frances AJ, Hales RE (eds) Review of psychiatry, vol 7. American Psychiatric Press, Washington, pp 530–669
Salkovskis PM, Clark DM (1986) Cognitive and physiological processes in the maintenance and treatment of panic attacks. In: Hand I, Wittchen HU (eds) Panic and phobias: empirical evidence of theoretical models and longterm effects of behavioral treatments. Springer, Berlin Heidelberg New York, pp 90–103
Schneider JS (1987) Functions of the basal ganglia: an overview. In: Schneider JS, Lidsky TI (eds) Basal ganglia and behavior: sensory aspects of motor functioning. Huber, Lewiston, pp 1–8
Smith A (1790) The theory of moral sentiments, or an essay towards an analysis of the principles by which men naturally judge concerning the conduct and character, first of their neighbours, and afterwards of themselves. (Raphael DD, Macfie AL (eds) (1976) 6th edn. Oxford University Press, Oxford)
Stuss DT, Benson DF (1986) The frontal lobes. Raven, New York, p 243
Swedo SE, Rapoport JL (1991) The neurobiology of obsessive-compulsive disorder in childhood. In: Jenike M, Asberg M (eds) Understanding obsessive-compulsive disorder (OCD). Hogrefe and Huber, Toronto, pp 28–39
Swedo SE, Schapiro MB, Grady CL et al. (1989) Cerebral glucose metabolism in childhood-onset obsessive-compulsive disorder. Arch Gen Psychiatry 46:518–523
Villabianca JR, Olmstead CE (1982) The striatum: a fine tuner of the brain. Acta Neurobiol Exp (Warsz) 42:227–299
von Mises L (1957) Theory and history: an interpretation of social and economic evolution. Yale University Press, New Haven, pp 1–2, 264–284
von Mises L (1966) Human action: a treatise on economics, 3rd edn. Contemporary Books. Chicago
von Mises L (1978) The ultimate foundation of economic science: an essay on method, 2nd edn. Andrews and McMeel, Mission
Wise SP, Rapoport JL (1989) Obsessive-compulsive disorder: a basal ganglia disease? In: Rapoport JL (ed) Obsessive-compulsive disorder in children and adolescents. American Psychiatric Press, Washington, pp 327–346
Zohar J, Insel TR (1987) Obsessive-compulsive disorder: psychobiological approaches to diagnosis, treatment, and pathophysiology. Biol Psychiatry 22:667–687
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Schwartz, J.M., Martin, K.M., Baxter, L.R. (1992). Neuroimaging and Cognitive-Biobehavioral Self-Treatment for Obsessive Compulsive Disorder: Practical and Philosophical Considerations. In: Hand, I., Goodman, W.K., Evers, U. (eds) Zwangsstörungen / Obsessive-Compulsive Disorders. Die Reihe dupbar med communication wird / Series dupbar med communication. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-77608-3_8
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