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Functional connectivity in obsessive-compulsive disorder and its subtypes

Published online by Cambridge University Press:  23 May 2019

Arun Ravindran ,
Margaret Richter ,
Tania Jain ,
Lakshmi Ravindran ,
Neil Rector  and
Norman Farb
Arun Ravindran*
Affiliation:
Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaM6J 1H4 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Margaret Richter
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Tania Jain
Affiliation:
Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaM6J 1H4
Lakshmi Ravindran
Affiliation:
Division of Mood and Anxiety Disorders, Centre for Addiction and Mental Health, Toronto, Ontario, CanadaM6J 1H4 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Neil Rector
Affiliation:
Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
Norman Farb
Affiliation:
Department of Psychology, University of Toronto at Mississauga, Toronto, Ontario, Canada
*
Author for correspondence: Arun V. Ravindran, E-mail: arun.ravindran@camh.ca
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Abstract

Background

Obsessive-compulsive disorder (OCD) is an anxiety disorder with significant morbidity whose pathophysiology is not fully understood. Neuroimaging studies have characterized OCD in terms of elevated striatal and prefrontal reactivity to emotion provocation. This neural model may be informed by investigation of functional connectivity in OCD, identifying alterations in how sensory information is integrated into frontostriatal regions.

Methods

The current study employed functional magnetic resonance imaging (fMRI) to compare neural activity and connectivity in 31 OCD patients (12 washing and 19 checking subtypes) and 17 healthy volunteers in an emotion provocation paradigm using visual stimuli.

Results

OCD status was associated with hyper-activation of the posterior cingulate (PCg) in response to emotion provocation. Additionally, OCD patients demonstrated elevated PCg functional connectivity with the visual cortices and frontostriatal regions. Exploratory analyses suggested that stimulus-provoked activity and connectivity was elevated for checking subtypes in motor cortices, and elevated in washing subtypes in the anterior insula and orbitofrontal cortex.

Conclusions

The PCg's role in moderating connectivity between the visual cortex and frontolimbic regions is muted in OCD, consistent with the PCg's suggested role in regulating attention towards emotional stimuli. Exploratory analyses suggest distinct PCg connectivity profiles in OCD subtypes, with checking linked to motor activation, but washing linked to a network supporting emotional salience. The study was not powered to fully investigate the effects of medication, patients often endorsed secondary symptom subtypes that muddied washing/checking distinctions, and the emotion provocation paradigm was of limited intensity compared to life stressors.

Keywords

CheckingemotionfMRIfunctional connectivityOCDreactivitysubtypewashing
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 7 , May 2020 , pp. 1173 - 1181
Copyright
Copyright © Cambridge University Press 2019

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