JAMA Psychiatry：强迫症患者眶额皮质连接高度异常

　　4月17日在线发表于《美国医学会杂志·精神病学》（JAMA Psychiatry）上的一项病例对照的横向研究提示，在未应用抗抑郁药治疗的强迫症（OCD）患者中，眶额皮质和基底核高度连接。眶额皮质和基底核远端连接性改变这一发现代表了皮质纹状体回路以外的远端皮质区域连接性更强的初始证据。而且，这些数据表明，抗抑郁药可能降低OCD患者皮质基底核-丘脑-皮质回路的连接性。

　　OCD的神经生物学模型预测包括眶额皮质和基底核在内的大脑回路活动过度，但是这些区域是否也具有大脑网络特点改变尚不清楚。

　　该研究旨在确定强迫症患者中异常连接的大脑区域并研究OCD患者的连接指标是否受抗抑郁药的影响。

　　研究入选了门诊OCD患者，包括23名未接受药物治疗的OCD患者，23名接受抗抑郁药物治疗的OCD患者，和2个同样大小的匹配了年龄、性别、用右手或左手的习惯、教育水平及IQ的对照样本。

　　与健康对照者相比，在未用药的OCD患者中，应用备用状态的功能性磁共振成像（fMRI）和一种由数据驱动的无模型方法来检测全脑、远端和局部连接程度的改变情况来进行病例对照的横向研究。

　　主要转归指标为统计学参数地图检测每个三维像素的远端和局部功能性连接程度和OCD症状严重程度。

　　结果显示，未用药的OCD患者眶额皮质和丘脑底核的远端连接性更强，眶额皮质和豆状核壳的局部连接性更强。而且，眶额皮质和豆状核的远端连接性与总体OCD症状的严重程度呈正相关。与未用药的患者相比，用药的OCD患者复侧纹状体的局部连接性降低。

与强迫症相关的拓展阅读：

• J Affect Disord：强迫症共病具有临床意义
• J Cerebr Blood F Met：PET研究显示部分脑区代谢改变与强迫症症状改善相关
• J REPROD MED ：新妈妈易患强迫症 更多信息请点击：有关强迫症更多资讯

Abnormally High Degree Connectivity of the Orbitofrontal Cortex in Obsessive-Compulsive Disorder
Importance 
Neurobiological models of obsessive-compulsive disorder (OCD) predict hyperactivity in brain circuits involving the orbitofrontal cortex and the basal ganglia, but it is unclear whether these areas are also characterized by altered brain network properties.
Objectives 
To determine regions of abnormal degree connectivity in patients with OCD and to investigate whether connectivity measures are affected by antidepressant medication in OCD.
Design 
Case-control cross-sectional study using resting-state functional magnetic resonance imaging and a data-driven, model-free method to test for alterations in the degree of whole-brain, distant, and local connectivity in unmedicated patients with OCD compared with healthy controls.
Setting 
Outpatient clinic for OCD.
Participants 
Twenty-three patients with OCD (12 women, 11 men) receiving no medication, 23 patients with OCD (14 women, 9 men) treated with antidepressant medication, and 2 equally sized control samples matched for age, sex, handedness, educational level, and IQ.
Main Outcome Measures 
Statistical parametric maps testing the degree of distant and local functional connectivity of each voxel (hub analysis at voxel level) and OCD symptom severity.
Results 
Unmedicated patients with OCD showed greater distant connectivity in the orbitofrontal cortex and subthalamic nucleus and greater local connectivity in the orbitofrontal cortex and the putamen. Furthermore, distant connectivity of the orbitofrontal cortex and the putamen positively correlated with global OCD symptom severity. Medicated patients with OCD showed reduced local connectivity of the ventral striatum compared with the unmedicated patients.
Conclusions and Relevance 
Consistent with neurobiological models of OCD, the orbitofrontal cortex and the basal ganglia are hyperconnected in unmedicated patients. The finding of distant connectivity alterations of the orbitofrontal cortex and the basal ganglia represents initial evidence of greater connections with distant cortical areas outside of corticostriatal circuitry. Furthermore, these data suggest that antidepressant medication may reduce connectivity within corticobasal ganglia-thalamo-cortical circuits in OCD.