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Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual

  • Giacomo Grassi (a1) (a2), Martijn Figee (a3) (a4), Pieter Ooms (a3), Lorenzo Righi (a5), Takashi Nakamae (a6), Stefano Pallanti (a1) (a2), Rick Schuurman (a7) and Damiaan Denys (a3)...

Abstract

Objective

Impulsivity and impaired decision-making have been proposed as obsessive-compulsive disorder (OCD) endophenotypes, running in OCD and their healthy relatives independently of symptom severity and medication status. Deep brain stimulation (DBS) targeting the ventral limb of the internal capsule (vALIC) and the nucleus accumbens (Nacc) is an effective treatment strategy for treatment-refractory OCD. The effectiveness of vALIC-DBS for OCD has been linked to its effects on a frontostriatal network that is also implicated in reward, impulse control, and decision-making. While vALIC-DBS has been shown to restore reward dysfunction in OCD patients, little is known about the effects of vALIC-DBS on impulsivity and decision-making. The aim of the study was to compare cognitive impulsivity and decision-making between OCD patients undergoing effective vALIC-DBS or treatment as usual (TAU), and healthy controls.

Methods

We used decision-making performances under ambiguity on the Iowa Gambling Task and reflection impulsivity on the Beads Task to compare 20 OCD patients effectively treated with vALIC-DBS, 40 matched OCD patients undergoing effective TAU (medication and/or cognitive behavioural therapy), and 40 healthy subjects. Effective treatment was defined as at least 35% improvement of OCD symptoms.

Results

OCD patients, irrespective of treatment modality (DBS or TAU), showed increased reflection impulsivity and impaired decision-making compared to healthy controls. No differences were observed between OCD patients treated with DBS or TAU.

Conclusion

OCD patients effectively treated with vALIC-DBS or TAU display increased reflection impulsivity and impaired decision-making independent of the type of treatment.

Copyright

Corresponding author

*Address for corespondence: Giacomo Grassi, M.D., University of Florence, via delle Gore 2H, 50141 Florence, Italy. (Email: giacomograssimd@gmail.com

References

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Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual

  • Giacomo Grassi (a1) (a2), Martijn Figee (a3) (a4), Pieter Ooms (a3), Lorenzo Righi (a5), Takashi Nakamae (a6), Stefano Pallanti (a1) (a2), Rick Schuurman (a7) and Damiaan Denys (a3)...

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