Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-18T01:25:39.322Z Has data issue: false hasContentIssue false
  • English
  • Français

Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual

Published online by Cambridge University Press:  06 April 2018

Giacomo Grassi ,
Martijn Figee ,
Pieter Ooms ,
Lorenzo Righi ,
Takashi Nakamae ,
Stefano Pallanti ,
Rick Schuurman  and
Damiaan Denys
Giacomo Grassi*
Affiliation:
University of Florence, Health Science, Florence, Italy Institute for Neuroscience, Florence, Italy
Martijn Figee
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Pieter Ooms
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
Lorenzo Righi
Affiliation:
University Hospitals of Geneva, Quality of Care Service, Geneva, Switzerland
Takashi Nakamae
Affiliation:
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Stefano Pallanti
Affiliation:
University of Florence, Health Science, Florence, Italy Institute for Neuroscience, Florence, Italy
Rick Schuurman
Affiliation:
Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
Damiaan Denys
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
*
*Address for corespondence: Giacomo Grassi, M.D., University of Florence, via delle Gore 2H, 50141 Florence, Italy. (Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Impulsivity and impaired decision-making have been proposed as obsessive-compulsive disorder (OCD) endophenotypes, running in OCD and their healthy relatives independently of symptom severity and medication status. Deep brain stimulation (DBS) targeting the ventral limb of the internal capsule (vALIC) and the nucleus accumbens (Nacc) is an effective treatment strategy for treatment-refractory OCD. The effectiveness of vALIC-DBS for OCD has been linked to its effects on a frontostriatal network that is also implicated in reward, impulse control, and decision-making. While vALIC-DBS has been shown to restore reward dysfunction in OCD patients, little is known about the effects of vALIC-DBS on impulsivity and decision-making. The aim of the study was to compare cognitive impulsivity and decision-making between OCD patients undergoing effective vALIC-DBS or treatment as usual (TAU), and healthy controls.

Methods

We used decision-making performances under ambiguity on the Iowa Gambling Task and reflection impulsivity on the Beads Task to compare 20 OCD patients effectively treated with vALIC-DBS, 40 matched OCD patients undergoing effective TAU (medication and/or cognitive behavioural therapy), and 40 healthy subjects. Effective treatment was defined as at least 35% improvement of OCD symptoms.

Results

OCD patients, irrespective of treatment modality (DBS or TAU), showed increased reflection impulsivity and impaired decision-making compared to healthy controls. No differences were observed between OCD patients treated with DBS or TAU.

Conclusion

OCD patients effectively treated with vALIC-DBS or TAU display increased reflection impulsivity and impaired decision-making independent of the type of treatment.

Keywords

DBSdecision-makingdeep brain stimulationOCDimpulsivitytreatment as usual
Type
Original Research
Information
CNS Spectrums , Volume 23 , Special Issue 5: Theme: Obsessive-Compulsive Disorder , October 2018 , pp. 333 - 339
Copyright
© Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

[1] Cavedini, P, Zorzi, C, Piccinni, M, Cavallini, MC, Bellodi, L. Executive dysfunctions in obsessive-compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biol Psychiatry. 2010; 67(12): 1178–1184.Google Scholar
[2] Chamberlain, SR, Fineberg, NA, Menzies, LA, et al. Impaired cognitive flexibility and motor inhibition in unaffected first-degree relatives of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007; 164(2): 335–338.Google Scholar
[3] Grassi, G, Pallanti, S, Righi, L, et al. Think twice: impulsivity and decision making in obsessive-compulsive disorder. J Behav Addict. 2015; 4(4): 263–272.Google Scholar
[4] Benatti, B, Dell’Osso, B, Arici, C, Hollander, E, Altamura, AC. Characterizing impulsivity profile in patients with obsessive-compulsive disorder. Int J Psychiatry Clin Pract. 2014; 18(3): 156–160.Google Scholar
[5] Pushkarskaya, H, Tolin, D, Ruderman, L, et al. Decision-making under uncertainty in obsessive-compulsive disorder. J Psychiatr Res. 2015; 69: 166–173.Google Scholar
[6] Zhang, L, Dong, Y, Ji, Y, et al. Trait-related decision making impairment in obsessive-compulsive disorder: evidence from decision making under ambiguity but not decision making under risk. Sci Rep. 2015; 5: 17312.Google Scholar
[7] Alonso, P, Cuadras, D, Gabriëls, L, et al. Deep brain stimulation for obsessive-compulsive disorder: a meta-analysis of treatment outcome and predictors of response. PLoS One. 2015; 10(7): e0133591.Google Scholar
[8] Denys, D, Mantione, M, Figee, M, et al. Deep brain stimulation of the nucleus accumbens for treatment-refractory obsessive-compulsive disorder. Arch Gen Psychiatry. 2010; 67(10): 1061–1068.Google Scholar
[9] Figee, M, Luigjes, J, Smolders, R, et al. Deep brain stimulation restores frontostriatal network activity in obsessive-compulsive disorder. Nat Neurosci. 2013; 16(4): 386–390.Google Scholar
[10] Figee, M, Vink, M, de Geus, F, et al. Dysfunctional reward circuitry in obsessive-compulsive disorder. Biol Psychiatry. 2011; 69(9): 867–874.Google Scholar
[11] Ruff, CC, Fehr, E. The neurobiology of rewards and values in social decision making. Nat Rev Neurosci. 2014; 15(8): 549–562.Google Scholar
[12] Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev. 2008; 32(3): 525–549.Google Scholar
[13] Esslinger, C, Braun, U, Schirmbeck, F, et al. Activation of midbrain and ventral striatal regions implicates salience processing during a modified beads task. Plos One. 2013; 8(3): e58536.Google Scholar
[14] Li, X, Lu, ZL, D’Argembeau, A, Ng, M, Bechara, A. The Iowa Gambling Task in fMRI images. Hum Brain Mapp. 2010; 31(3): 410–423.Google Scholar
[15] Yamamuro, K, Ota, T, Iida, J, Kishimoto, N, Nakanishi, Y, Kishimoto, T. Persistence of impulsivity in pediatric and adolescent patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci. 2017; 71(1): 36–43.Google Scholar
[16] Luigjes, J, Mantione, M, van den Brink, W, Schuurman, PR, van den Munckhof, P, Denys, D. Deep brain stimulation increases impulsivity in two patients with obsessive-compulsive disorder. Int Clin Psychopharmacol. 2011; 26(6): 338–340.Google Scholar
[17] Grant, JE, Odlaug, BL, Chamberlain, SR. Neurocognitive response to deep brain stimulation for obsessive-compulsive disorder: a case report. Am J Psychiatry. 2011; 168(12): 1338–1339.Google Scholar
[18] Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). I. Development, use, and reliability. Arch Gen Psychiatry. 1989; 46(11): 1006–1011.Google Scholar
[19] Goodman, WK, Price, LH, Rasmussen, SA, et al. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). II. Validity. Arch Gen Psychiatry. 1989; 46(11): 1012–1016.Google Scholar
[20] Pallanti, S, Hollander, E, Bienstock, C, et al. Treatment non-response in OCD: methodological issues and operational definitions. Int J Neuropsychopharmacol. 2002; 5(2): 181–191.Google Scholar
[21] van den Munckhof, P, Bosch, DA, Mantione, MH, Figee, M, Denys, DA, Schuurman, PR. Active stimulation site of nucleus accumbens deep brain stimulation in obsessive-compulsive disorder is localized in the ventral internal capsule. Acta Neurochir Suppl. 2013; 117: 53–59.Google Scholar
[22] First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Patient Edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
[23] First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). Washington, DC: American Psychiatry Press Inc; 1997.Google Scholar
[24] First, MB, Spitzer, RL, Gibbon, M, Williams, JBW. Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition (SCID-I/NP). New York: Biometrics Research, New York State Psychiatric Institute; 2002.Google Scholar
[25] Brakoulias, V, Starcevic, V, Berle, D, et al. Further support for five dimensions of obsessive-compulsive symptoms. J Nerv Ment Dis. 2013; 201(6): 452–459.Google Scholar
[26] Phillips, LD, Edwards, W. Conservatism in a simple probability inference task. J Exp Psychol. 1966; 72(3): 346–354.Google Scholar
[27] Stratta, P, Pacifico, R, Patriarca, S, Rossi, A. “Jumping to conclusions” in alcohol-dependent subjects: relationship with decision making and impulsiveness. Italian J Addict. 2013; 3(4): 10–14.Google Scholar
[28] Ormrod, J, Shaftoe, D, Cavanagh, K, et al. A pilot study exploring the contribution of working memory to “jumping to conclusions” in people with first episode psychosis. Cogn Neuropsychiatry. 2012; 17(2): 97–114.Google Scholar
[29] Bechara, A, Damasio, AR, Damasio, H, Anderson, SW. Insensitivity to future consequences following damage to human prefrontal cortex. Cognition. 1994; 50(1–3): 7–15.Google Scholar
[30] Brand, M, Recknor, EC, Grabenhorst, F, Bechara, A. Decision under ambiguity and decision under risk: correlations with executive functions and comparisons of two different gambling tasks with implicit and explicit rules. J Clin Exp Neuropsychol. 2007; 29(1): 86–99.Google Scholar
[31] Cavedini, P, Zorzi, C, Baraldi, C, et al. The somatic marker affecting decisional processes in obsessive-compulsive disorder. Cogn Neuropsychiatry. 2012; 17(2): 177–190.Google Scholar
[32] Lochner, C, Chamberlain, SR, Kidd, M, Fineberg, NA, Stein, DJ. Altered cognitive response to serotonin challenge as a candidate endophenotype for obsessive-compulsive disorder. Psychopharmacology (Berl). 2016; 233(5): 883–891.Google Scholar
[33] Fineberg, NA, Chamberlain, SR, Goudriaan, AE, et al. New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr. 2014; 19(1): 69–89.Google Scholar
[34] Ersche, KD, Turton, AJ, Pradhan, S, Bullmore, ET, Robbins, TW. Drug addiction endophenotypes: impulsive versus sensation-seeking personality traits. Biol Psychiatry. 2010; 68(8): 770–773.Google Scholar
[35] Prochazkova, L, Parkes, L, Dawson, A, et al. Unpacking the role of self-reported compulsivity and impulsivity in obsessive-compulsive disorder. CNS Spectr. 2018; 23(1): 51–58.Google Scholar
[36] Bergfeld, IO, Mantione, M, Hoogendoorn, ML, Denys, D. Cognitive functioning in psychiatric disorders following deep brain stimulation. Brain Stimul. 2013; 6(4): 532–537.Google Scholar
[37] Mantione, M, Nieman, D, Figee, M, van den Munckhof, P, Schuurman, R, Denys, D. Cognitive effects of deep brain stimulation in patients with obsessive-compulsive disorder. J Psychiatry Neurosci. 2015; 40(6): 378–386.Google Scholar