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Regional Cerebral Blood Flow in Obsessive-Compulsive Disordered Patients at Rest: Differential Correlates with Obsessive–Compulsive and Anxious–Avoidant Dimensions

  • James V. Lucey (a1), Durval C. Costa (a2), Tomas Blanes (a3), Geraldo F. Busatto (a1), Lyn S. Pilowsky (a1), N. Takei (a1), Isaac M. Marks (a1), Peter J. Ell (a2) and Robert W. Kerwin (a1)...

Abstract

Background

We tested whether cortical and subcortical regional cerebral blood flow (rCBF) differs between patients with obsessive-compulsive disorder (OCD) and healthy controls. We then explored the relationship between rCBF and OCD mental state.

Method

Thirty out-patients from the Maudsley Hospital with OCD as defined in DSM–III–R were scanned at rest using brain-dedicated, high-resolution, single photon emission tomography. RCBF was measured as uptake of 99mTc-HMPAO in 15 regions of interest and compared with rCBF data in 30 healthy people matched for age, sex and handedness. Symptom ratings were obtained using standard measures on the scanning day. Principal components factor analysis identified two distinct clinical dimensions: obsessive–compulsive (OC) and anxious–avoidant (AA). These were correlated with patients' rCBF measurements, using Spearman's rank correlation coefficient, and multiple regression coefficients calculated.

Results

We found significant reductions in rCBF measurements of OCD patients compared with resting, healthy controls (F = 1.92, P = 0.04) in seven brain regions: the right and left superior frontal cortex, right inferior frontal cortex, left temporal cortex, left parietal cortex, right caudate nucleus and right thalamus. Regional differences were not secondary to generalised reduction in patients' brain perfusion. Reduced blood flow to the right inferior frontal cortex correlated significantly with illness severity (r = 0.37, P = 0.02). There was no relationship with age, age-of-onset, sex, handedness, depression or medication status. OC clinical dimension, concerning obsessions, compulsions and low mood, was significantly negatively correlated with left inferior frontal, medial frontal and right parietal rCBF. AA dimension, concerning anxiety and avoidance, was significantly positively associated with left and right superior frontal, right inferior frontal, medial frontal cortical, and right and left caudate and thalamic rCBF.

Conclusions

rCBF differs significantly between resting OCD patients and healthy controls, and separate clinical dimensions are associated with functionally distinct rCBF patterns.

Copyright

Corresponding author

Dr Lucey, Department of Psychological Medicine, St Bartholomew's Hospital, West Smithfield, London EC1A 7BE

References

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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM–III–R). Washington, DC: APA.
Annett, M. (1970) A classification of hand preference by association analysis. British Journal of Psychology, 61, 303321.
Baxter, L. R., Phelps, M. E., Mazziotta, J. C., et al (1987) Local cerebral glucose metabolic rates in obsessive-compulsive disorder. Archives of General Psychiatry, 44, 211218.
Beck, A. T., Ward, C. H., Mendleson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561571.
Bench, C. J., Friston, K. J., Brown, R. G., et al (1993) Regional cerebral blood flow in depression measured by positron emission tomography: the relationship with clinical dimensions. Psychological Medicine, 23, 579590.
Borkovec, T. D. (1985) Cognitive avoidance, anticipated frustrative non-reward and issues of control in human anxiety. In Anxiety and Anxiety Disorders (eds Tuma, H. & Maser, J.), pp 463547. Erlbaum: Hillsdale, New Jersey.
Costa, D. C., Ell, P. J., Burns, A., et al (1988) CBF tomograms with 99mTc-HMPAO in patients with dementia (Alzheimer type and HIV) and Parkinson's disease – initial results. Journal of Cerebral Metabolism and Blood Flow, 8, S109S115.
Edmonstone, Y., Austin, M. P., Prentice, N., et al (1994) Uptake of 99mTc-exametazime shown by single photon emission computerized tomography in obsessive-compulsive disorder compared with major depression and normal controls. Acta Psychiatrica Scandinavica, 90, 298303.
Ell, P. J., Cullum, I. & Costa, D. (1985) Regional cerebral blood flow mapping with a new Tc99m-labelled compound. Lancet, ii, 5051.
Eslinger, P. J. & Grattan, L. M. (1993) Frontal lobe and frontal–striatal substrates for different forms of human cognitive flexibility. Neuropsychologia, 31, 1728.
Goodman, W. K., Price, L. H., Rasmussen, S. A., et al (1989) The Yale Brown Obsessive-Compulsive Scale 1: development use and reliability. Archives of General Psychiatry, 46, 10061011.
Gur, R. C., Gur, R. E., Resnick, S. M., et al (1987) The effect of anxiety on cerebral blood flow and metabolism. Journal of Cerebral Blood Flow and Metabolism, 1, 173177.
Guy, W. (1976) ECDEU Assessment Manual For Psychopharmacology (revised). Published by DUEW, No (ADM) 76–338, Rockville, MD: National Institute of Mental Health.
Hollander, E., Schiffman, E., Cohen, B., et al (1990) Signs of central nervous system dysfunction in obsessive-compulsive disorder. Archives of General Psychiatry, 47, 2732.
Kouris, K., Jarrit, P. H., Costa, D. C., et al (1992) Physical assessment of the GE/CGR NEUROCAM and comparison to a single rotating gamma camera. European Journal of Nuclear Medicine, 19, 236242.
McGuire, P. K., Bench, C. J., Frith, C. D., et al (1994) Functional anatomy of obsessive-compulsive phenomena. British Journal of Psychiatry, 164, 459468.
Marks, I.M. & Mathews, A. M. (1979) Brief standard rating for phobic patients. Behaviour Research and Therapy, 17, 263267.
Martinot, J. L., Allilaire, J. F., Mazoyer, B. M., et al (1990) Obsessive–compulsive disorder: a clinical, neuropsychological and positron emission study. Acta Psychiatrica Scandinavica, 82, 233242.
O'Carroll, R. E., Mofoot, A. P. R., Van Beck, M., et al (1993) The effect of anxiety on the regional uptake of 99mTc-exametazime in simple phobia as shown by single photon emission tomography (SPET). Journal of Affective Disorders, 28, 203210.
Rapoport, J. L. (1990) Obsessive-compulsive disorder and basal ganglia dysfunction. Psychological Medicine, 20, 465469.
Rubin, R., Villanueva-Meyer, J., Ananth, J., et al (1992) Regional Xenon-133 cerebral blood flow and cerebral technetium 99m-HMPAO uptake in unmedicated patients with obsessive–compulsive disorder and matched normal controls. Archives of General Psychiatry, 49, 695702.
Zohar, J., Insel, T. R., Berman, K. F., et al (1989) Anxiety and cerebral blood flow during behavioral challenge. Archives of General Psychiatry, 46, 505510.

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Regional Cerebral Blood Flow in Obsessive-Compulsive Disordered Patients at Rest: Differential Correlates with Obsessive–Compulsive and Anxious–Avoidant Dimensions

  • James V. Lucey (a1), Durval C. Costa (a2), Tomas Blanes (a3), Geraldo F. Busatto (a1), Lyn S. Pilowsky (a1), N. Takei (a1), Isaac M. Marks (a1), Peter J. Ell (a2) and Robert W. Kerwin (a1)...
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