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9.6 - Obsessive–Compulsive and Related Disorders

from 9 - Integrated Neurobiology of Specific Syndromes and Treatments

Published online by Cambridge University Press:  08 November 2023

Mary-Ellen Lynall
Affiliation:
University of Cambridge
Peter B. Jones
Affiliation:
University of Cambridge
Stephen M. Stahl
Affiliation:
University of California, San Diego
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Summary

Of the obsessive compulsive or related disorders (OCRDs), obsessive–compulsive disorder (OCD) remains the most well studied. In this section we review the integrated neurobiology of the OCRDs, focusing on OCD as the exemplar, touching upon phenotypes, cognitive endophenotypes and neural circuitry. Converging evidence from the neurosciences identifies core deficits in behavioural inhibition, cognitive flexibility, habit learning, fear extinction and safety signalling, underpinned by specific abnormalities in corticostriatal-thalamic circuits. Treatments found to be effective include serotonin reuptake inhibitor drugs, cognitive behavioural forms of psychotherapy, invasive or non-invasive neuromodulation or ablation of specific nodes or tracts within the corticostriatal-thalamic circuits. We conclude with a synthesis of the theoretical neural mechanisms leading to successful therapeutic intervention.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

World Health Organization. International Classification of Diseases, 11th ed. (ICD-11). World Health Organization, 2018,Google Scholar
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). American Psychiatric Association, 2013.Google Scholar
Fineberg, NA, Apergis-Schoute, AM, Vaghi, MM et al. Mapping compulsivity in the DSM-5 obsessive compulsive and related disorders: cognitive domains, neural circuitry, and treatment. Int J Neuropsychopharmacol 2018; 21(1): 4258.CrossRefGoogle ScholarPubMed
Robbins, TW, Vaghi, MM, Banca, P. Obsessive–compulsive disorder: puzzles and prospects. Neuron 2019; 102(1): 2747.CrossRefGoogle ScholarPubMed
Graybiel, AM, Rauch, SL. Toward a neurobiology of obsessive–compulsive disorder. Neuron 2000; 28(2): 343347.CrossRefGoogle Scholar
Dickinson, A. Actions and habits: the development of behavioral autonomy. Philos Trans R Soc London B 1985; 308(1135): 6778.Google Scholar
Gillan, CM, Morein-Zamir, S, Urcelay, GP et al. Enhanced avoidance habits in obsessive–compulsive disorder. Biol Psychiatry 2014; 75(8): 631638.CrossRefGoogle ScholarPubMed
Gillan, CM, Robbins, TW. Goal-directed learning and obsessive–compulsive disorder. Philos Trans R Soc London B 2014; 369(1655): 20130475.CrossRefGoogle ScholarPubMed
Voon, V, Derbyshire, K, Ruck, C et al. Disorders of compulsivity: a common bias towards learning habits. Mol Psychiatry 2015; 20(3): 345352.CrossRefGoogle ScholarPubMed
Apergis-Schoute, AM, Gillan, CM, Fineberg, NA et al. Neural basis of impaired safety signaling in obsessive compulsive disorder. Proc Natl Acad Sci USA 2017; 114(12): 32163221.CrossRefGoogle ScholarPubMed
Milad, MR, Furtak, SC, Greenberg, JL et al. Deficits in conditioned fear extinction in obsessive–compulsive disorder and neurobiological changes in the fear circuit. JAMA Psychiatry 2013; 70(6): 608–518.CrossRefGoogle ScholarPubMed
Saxena, S, Brody, AL, Schwartz, JM, Baxter, LR. Neuroimaging and frontal-subcortical circuitry in obsessive–compulsive disorder. Br J Psychiatry Suppl 1998; 35: 2637.CrossRefGoogle Scholar
Haber, SN. Corticostriatal circuitry. Dialogues Clin Neurosci 2016; 18(1): 721.CrossRefGoogle ScholarPubMed
Rolls, ET. The functions of the orbitofrontal cortex. Brain Cogn 2004; 55(1): 1129.CrossRefGoogle ScholarPubMed
Milad, MR, Rauch, SL. Obsessive–compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci 2012; 16(1): 4351.CrossRefGoogle ScholarPubMed
Fineberg, NA, Hengartner, MP, Bergbaum, CE et al. A prospective population-based cohort study of the prevalence, incidence and impact of obsessive–compulsive symptomatology. Int J Psychiatry Clin Pract 2013; 17: 170178.CrossRefGoogle ScholarPubMed
Hauser, TU. On the development of OCD. Curr Top Behav Neurosci 2021; 49: 1730.CrossRefGoogle ScholarPubMed
Goodman, WK, Price, LH, Rasmussen, SA, Mazure, C et al. The Yale–Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Arch Gen Psychiatry 1989; 46: 10061011.CrossRefGoogle ScholarPubMed
Grancini, B, Craig, KJ, Cinosi, E et al. Pharmacotherapy for OCD. In Simon, NM, Hollander, E, Rothbaum, BO, Stein, DJ (eds.), The American Psychiatric Association Publishing Textbook of Anxiety, Trauma, and OCD-Related Disorders, 3rd ed. American Psychiatric Publishing, 2019, pp. 321352.Google Scholar
Reid, JE, Laws, KR, Drummond, L et al. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive–compulsive disorder: a systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry 2021; 106: 152223.CrossRefGoogle ScholarPubMed
Skapinakis, P, Caldwell, DM, Hollingworth, W et al. Pharmacological and psychotherapeutic interventions for management of obsessive–compulsive disorder in adults: a systematic review and network meta-analysis. Lancet Psychiatry 2016; 3: 730739.CrossRefGoogle ScholarPubMed
Fineberg, NA, Reghunandanan, S, Simpson, HB et al. Obsessive–compulsive disorder (OCD): practical strategies for pharmacological and somatic treatment in adults. Psychiatry Res 2015; 227: 114125CrossRefGoogle ScholarPubMed
Brown, LT, Mikell, CB, Youngerman, BE et al. Dorsal anterior cingulotomy and anterior capsulotomy for severe, refractory obsessive–compulsive disorder: a systematic review of observational studies. J Neurosurg 2016; 124(1): 7789.CrossRefGoogle ScholarPubMed
Figee, M, Luigjes, J, Smolders, R et al. Deep brain stimulation restores frontostriatal network activity in obsessive–compulsive disorder. Nat Neurosci 2013; 16(4): 386387.CrossRefGoogle ScholarPubMed
Carmi, L, Tendler, A, Bystritsky, A et al. Efficacy and safety of deep transcranial magnetic stimulation for obsessive–compulsive disorder: a prospective multicenter randomized double-blind placebo-controlled trial. Am J Psychiatry 2019; 176(11): 931938.CrossRefGoogle ScholarPubMed

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