Brain Regions and Neuropsychological Deficits in Obsessive-Compulsive Disorder

Yıl 2013, Cilt: 5 Sayı: 3, 343 - 354, 01.09.2013

Taner Öznur Murat Erdem Süleyman Akarsu

https://doi.org/10.5455/cap.20130523

Öz

Neurobiological factors had been shown to play an important role in the emergence of obsessive-compulsive disorder by the information obtained from the methods developed over the years. According to the neuropsychological perspective, the defects had been detected mainly in executive functions, in attention, memory, visual-spatial functions; and abnormalities had been described in the frontal lobe, cingulate cortex, basal ganglia, and thalamus regions of the patients with obsessive-compulsive disorder. The main and the most repeated abnormalities in patients with obsessive-compulsive disorder are dysfunctions in executive function and visual memory. Dysfunctions of the inhibitory processes associated with the dominant frontal area lead to an insufficiency on the inhibition of verbal functions. Excessive activation of the orbitofrontal cortex that mediate the behavioral response suppression function in obsessive-compulsive disorder demonstrated by functional imaging techniques. Repeated-resistant behaviors (eg: compulsions) are composed by the deteriorations of the inhibitions of motor or cognitive programs in basal ganglions provided through cycles of frontal lobe. The findings of clinical observations in patients with obsessive-compulsive disorder could be considered as a reflection of excessive work in 'error detection system' which is the cause of the thoughts that something goes wrong and efforts to achieve perfection. As neurobiological, this finding is observed as excessive activity in orbitofrontal cortex and anterior cingulate cortex representing the ability of humans to provide and detect errors. İt is is expected to develop the vehicles that are more sensitive to the characteristics of cognitive deficits in obsessive-compulsive disorder. In addition to the neuropsychological tests, using electrophysiological and advanced functional imaging techniques will put forward a better underlying the physiopathology of this disorder in order to show the more distinctive structural and functional impairments.

Anahtar Kelimeler

Obsessive-compulsive disorder, neuropsychology, affected brain regions

Obsesif Kompulsif Bozuklukta Nöropsikolojik Defisitlerin Beyin Bölgeleri İle İlişkisi

Öz

Obsesif kompulsif bozukluğun ortaya çıkışında nörobiyolojik etkenlerin önemli rol oynadığı gösterilmiştir. Obsesif kompulsif bozukluğu olan hastalarda nöropsikolojik açıdan başlıca yürütücü işlevlerde olmak üzere dikkat, hafıza, görsel-mekansal işlevlerde kusurlar saptanmış, bu hastalarının frontal lob, singulat korteks, bazal ganglion ve talamus bölgelerinde anormallikler tanımlanmıştır. Obsesif kompulsif bozukluğu olan hastalarda başlıca ve en çok tekrarlanan anormallik yürütücü işlevler ve görsel bellekteki fonksiyon bozukluğudur. Obsesif kompulsif bozukluğu olan hastaların bir şeylerin yanlış gittiğine dair düşüncelerinin ve mükemmele ulaşma çabalarının nedeni 'hata saptama sisteminin' aşırı çalışmasının bir yansıması olabilir. Bu bulgunun nörobiyolojik karşılığı ise insanda hata saptama va sağlama yeteneğini temsil eden kortikal alanlar olan orbitofrontal korteks ve anterior singulat korteksteki aşırı aktivitenin varlığıdır. Yapısal ve fonksiyonel bozulmaların daha ayırt edici olarak gösterilebilmesi için nöropsikolojik testlere ek olarak elektrofizyolojik ve ileri fonksiyonel görüntüleme yöntemlerinin de kullanılması bu hastalığın altında yatan fizyopatolojinin daha iyi ortaya konulmasını sağlayacaktır.

Anahtar Kelimeler

Obsesif kompulsif bozukluk, nöropsikoloji, beyin bölgeleri

Kaynakça

• Tükel R. Obsesif kompulsif bozuklukta bilişsel işlevler. Turkiye Klinikleri J Psychiatry-Special Topics 2012; 5:43-48.
• Karaman D, Durukan İ, Erdem M. Çocukluk çağı başlangıçlı obsesif kompulsif bozukluk, Psikiyatride Güncel Yaklaşımlar 2011; 3:278-295
• Varma GS, Tümkaya S, Karadağ F. Obsesif kompulsif bozuklukta silik nörolojik belirtiler. Turkiye Klinikleri J Psychiatry-Special Topics 2012; 5:33-37.
• Trivedi JK, Dhyani M, Goel D, Sharma S, Singh AP, Sinha PK et al. Neurocognitive dysfunction in patients with obsessive compulsive disorder. Afr J Psychiatry 2008; 11:204-209.
• Modell JG, Mountz JM, Curtis GC, Greden JF. Neurophysiologic dysfunction in basal ganglia/limbic striatal and thalamocortical circuits as a pathogenetic mechanism of obsessive–compulsive disorder. J Neuropsychiatry Clin. Neurosci 1989; 1:27-36.
• Baxter LR. Functional imaging of brain systems mediating obsessive–compulsive disorder: clinical studies. In Neurobiology of Mental Illness (Eds DS Charney, EJ Nestler, BS Bunney):534-537. New York, Oxford University Press, 1999.
• Schwartz JM. A role of volition and attention in the generation of new brain circuitry: toward a neurobiology of mental force. Journal of Consciousness Studies 1999; 6:115-142.
• Chamberlaina SR, Blackwella AD, Finebergb NA, Robbinsc TW, Sahakiana BJ. The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neurosci Biobehav Rev 2005; 29:399-419.
• Mesulam MM. Principles of Behavioral and Cognitive Neurology. New York, Oxford University Press, 2000.
• Şenormancı Ö, Konkan R, Güçlü OG, Sungur MZ. Obsesif kompulsif bozukluğun metakognitif modeli. Psikiyatride Güncel Yaklaşımlar 2012; 4:335-349.
• Yalçın Ö, Şener Ş, Sarıpınar EG, Soysal AŞ, Güney E, Sarı BA et al. Çocuk ve ergen obsesif-kompulsif bozukluk hastalarının bilişsel işlevlerinin kontrol grubuyla karşılaştırılması: geniş katılımlı nöropsikolojik bir çalışma. Nöropsikiyatri Arşivi 2012; 49:119-128.
• Işık E. Biyolojik Psikiyatri. İstanbul, Sigma Publishing, 2012.
• Del Casale A, Kotzalidis GD, Rapinesi C, Serata D, Ambrosi E, Simonetti A et al. Functional neuroimaging in obsessive-compulsive disorder. Neuropsychobiology 2011; 64:61-85.
• Martinez-Gonzalez AE, Piguersa-Rodriguez JA. Neuropsychological update on obsessive-compulsive disorder. Rev Neurol 2008; 46:618-625.
• Lacerda AL, Dalgalarrondo P, Caetano D, Camargo EE, Etchebehere EC, Soares JC. Elevated thalamic and prefrontal regional cerebral blood flow in obsessive-compulsive disorder: a SPECT study. Psychiatry Res 2003; 123:125-134.
• Lacerda AL, Dalgalarrondo P, Caetano D, Haas GL, Camargo EE, Keshavan MS. Neuropsychological performance and regional cerebral blood flow in obsessive– compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2003; 27:657-665. Zielinski CM, Taylor MA, Juzwin KR. Neuropsychological deficits in obsessive– compulsive disorder. Neuropsychiatry Neuropsychol Behav Neurol 1991; 14:1101
• Purcell R, Maruff P, Kyrios M, Pantelis C. Cognitive deficits in obsessive–compulsive disorder on tests of frontal-striatal function. Biol Psychiatry 1998; 43:348-357.
• Haynes WI, Millet B, Mallet L. Obsessive-compulsive disorder, a new model of basal ganglia dysfunction? elements from deep brain stimulation studies. Rev Neurol 2012; 168:649-654.
• Melloni M, Urbistondo C, Sedeño L, Gelormini C, Kichic R, Ibanez A. The extended frontostriatal model of obsessive compulsive disorder: convergence from eventrelated potentials, neuropsychology and neuroimaging. Front Hum Neurosci 2012; 6:2
• Kwon JS, Kim JJ, Lee DW, Lee JS, Lee DS, Kim MS et al. Neural correlates of clinical symptoms and cognitive dysfunctions in obsessive–compulsive disorder. Psychiatry Res 2003; 122:37-47.
• Pişkin İ, Özen DŞ. Çocukluktan erişkinliğe obsesif kompulsif bozuklukta hatalı değerlendirme ve inanç alanları. Psikiyatride Güncel Yaklaşımlar 2010; 2:117-131.
• Rassin E, Cougle JR, Muris P. Content difference between normal and abnormal obsessions. Behav Res Ther 2007; 45:2800-2803.
• Tolin DF, Hamlin C, Foa EB. Directed forgetting in obsessive compulsive disorder: replication and extension. Behav Res Ther 2002; 40:793-803.
• Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, SpeckensA, Phillips ML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive–compulsive disorder. Arch Gen Psychiatry 2004; 61:564-576.
• Kim MS, Kim YY, Yoo SY, Kwon JS. Electrophysiological correlates of behavioral response inhibition in patients with obsessive-compulsive disorder. Depress Anxiety 2007; 24:22-31.
• Bannon, S, Gonsalvez CJ, Croft RJ, Boyce PM. Response inhibition deficits in obsessive-compulsive disorder. Psychiatry Res 2002; 110:165-174.
• Aron AR, Fletcher PC, Bullmore ET, Sahakian BJ, Robbins TW. Stop-signal inhibition disrupted by damage to right inferior frontal gyrus in humans. Nat Neurosci 2003; 6:115-116.
• Horn NR, Dolan M, Elliott R, Deakin JF, Woodruff PW. Response inhibition and impulsivity: an fMRI study. Neuropsychologia 2003; 41:1959-1966.
• Bokura H, Yamaguchi S, Kobayashi S. Electrophysiological correlates for response inhibition in a Go/NoGo task. Clin Neurophysiol 2001; 12:2224-2232.
• Watkins LH, Sahakian BJ, Robertson MM, Veale DM, Rogers RD, Pickard KM et al. Executive function in Tourette’s syndrome and obsessive-compulsive disorder. Psychol Med 2005; 35:571-582.
• Evans DW, Lewis MD, Iobst E. The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive-compulsive disorder. Brain Cogn 2004; 55:220-234.
• Berlin HA, Rolls ET, Kischka U. Impulsivity, time perception, emotion and reinforcement in patients with orbitofrontal cortex lesions. Brain 2004; 127:1108-1126.
• Chudasama Y, Robbins TW. Dissociable contributions of the orbitofrontal and infralimbic cortex to pavlovian autoshaping and discrimination reversal learning: further evidence for the functional heterogeneity of the rodent frontal cortex. J Neurosci 2003; 23:8771-8780.
• Bonelli RM, Cummings JL. Frontal-subcortical circuitry and behavior. Dialogues Clin Neurosci. 2007; 9:141-151.
• Grisham JR, Anderson TM, Poulton R, Moffitt TE, Andrews G. Childhood neuropsychological deficits associated with adult obsessive compulsive disorder. Br J Psychiatry 2009; 195:138-141.
• Yorulmaz O. Obsesif kompulsif bozukluk: klinik görünüm. Turkiye Klinikleri J Psychiatry 2012; 5:1-5.
• Sassaroli S, Lauro LJ, Ruggiero GM, Mauri MC, Vinai P, Frost R. Perfectionism in depression, obsessive-compulsive disorder and eating disorders. Behav Res Ther 2008; 46:757-765.
• Kuelz AK, Hohagen F, Voderholzer U. Neuropsychological performance in obsessivecompulsive disorder: a critical review. Biol Psychol 2004; 65:185-236.
• Moritz S, Birkner C, Kloss M, Fricke S, Böthern A, Hand I. Impact of comorbid depressive symptoms on neuropsychological performance in obsessive-compulsive disorder. J Abnorm Psychol 2001; 110:653-657.
• Math SB, Janardhan Reddy YC. Issues in the pharmacological treatment of obsessivecompulsive disorder. Int J Clin Pract 2007; 61:1188-1197.
• Mataix-Cols D, Alonso P, Pifarré J, Menchón JM, Vallejo J. Neuropsychologcial performance inmedicated vs unmedicated patients with obsessive-compulsive disorder. Psychiatry Res 2002; 109:255-264.
• Meneses A. Could the 5-HT1B receptor inverse agonism affect learning consolidation? Neurosci Biobehav Rev 2001; 25:193-201. Taner Öznur, Dr., Gülhane Askeri Tıp Fakültesi Psikiyatri A.D, Ankara; Murat Erdem, Doç. Dr., Gülhane Askeri Tıp Fakültesi Psikiyatri A.D, Ankara; Süleyman Akarsu, Dr., Gülhane Askeri Tıp Fakültesi Psikiyatri A.D,Ankara Yazışma Adresi/Correspondence: Taner Öznur, Gülhane Askeri Tıp Fakültesi Psikiyatri A.D, Ankara, Turkey. E-mail: [e-mail] Yazarlar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemişlerdir. The authors reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol5/no3/ Çevrimiçi yayım / Published online 07 Eylül/September 07, 2013; doi:10.5455/cap.20130523