Miquel A Fullana1, Xi Zhu1, Pino Alonso1, Narcís Cardoner1, Eva Real1, Clara López-Solà1, Cinto Segalàs1, Marta Subirà1, Hanga Galfalvy1, José M Menchón1, H Blair Simpson1, Rachel Marsh1, Carles Soriano-Mas1. 1. From the Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona and IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (Fullana); CIBERSAM, Instituto de Salud Carlos III, Spain (Fullana, Alonso, Cardoner, Real, López-Solà, Segalàs, Subirà, Menchón, Soriano-Mas); the Department of Psychiatry, Autonomous University of Barcelona, Spain (Fullana, Cardoner); the Department of Psychiatry, Columbia University Medical Center, New York, NY, USA, and Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA (Fullana, Zhu, Simpson); the Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Hospitalet de Llobregat, Barcelona, Spain (Alonso, Real, Segalàs, Subirà, Menchón, Soriano-Mas); the Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain (Alonso, Menchón); the Depression and Anxiety Unit, Mental Health Department, Parc Taulí Sabadell University Hospital, Barcelona, Spain (Cardoner, López-Solà); the New York State Psychiatric Institute, New York, NY, USA, and Columbia Psychiatry, Columbia University, New York, NY, USA (Galfalvy); the Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York, NY, USA (Marsh); and the Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain (Soriano-Mas).
Abstract
BACKGROUND: Cognitive behavioural therapy (CBT), including exposure and ritual prevention, is a first-line treatment for obsessive-compulsive disorder (OCD), but few reliable predictors of CBT outcome have been identified. Based on research in animal models, we hypothesized that individual differences in basolateral amygdala-ventromedial prefrontal cortex (BLA-vmPFC) communication would predict CBT outcome in patients with OCD. METHODS: We investigated whether BLA-vmPFC resting-state functional connectivity (rs-fc) predicts CBT outcome in patients with OCD. We assessed BLA-vmPFC rs-fc in patients with OCD on a stable dose of a selective serotonin reuptake inhibitor who then received CBT and in healthy control participants. RESULTS: We included 73 patients with OCD and 84 healthy controls in our study. Decreased BLA-vmPFC rs-fc predicted a better CBT outcome in patients with OCD and was also detected in those with OCD compared with healthy participants. Additional analyses revealed that decreased BLA-vmPFC rs-fc uniquely characterized the patients with OCD who responded to CBT. LIMITATIONS: We used a sample of convenience, and all patients were receiving pharmacological treatment for OCD. CONCLUSION: In this large sample of patients with OCD, BLA-vmPFC functional connectivity predicted CBT outcome. These results suggest that future research should investigate the potential of BLA-vmPFC pathways to inform treatment selection for CBT across patients with OCD and anxiety disorders.
BACKGROUND: Cognitive behavioural therapy (CBT), including exposure and ritual prevention, is a first-line treatment for obsessive-compulsive disorder (OCD), but few reliable predictors of CBT outcome have been identified. Based on research in animal models, we hypothesized that individual differences in basolateral amygdala-ventromedial prefrontal cortex (BLA-vmPFC) communication would predict CBT outcome in patients with OCD. METHODS: We investigated whether BLA-vmPFC resting-state functional connectivity (rs-fc) predicts CBT outcome in patients with OCD. We assessed BLA-vmPFC rs-fc in patients with OCD on a stable dose of a selective serotonin reuptake inhibitor who then received CBT and in healthy control participants. RESULTS: We included 73 patients with OCD and 84 healthy controls in our study. Decreased BLA-vmPFC rs-fc predicted a better CBT outcome in patients with OCD and was also detected in those with OCD compared with healthy participants. Additional analyses revealed that decreased BLA-vmPFC rs-fc uniquely characterized the patients with OCD who responded to CBT. LIMITATIONS: We used a sample of convenience, and all patients were receiving pharmacological treatment for OCD. CONCLUSION: In this large sample of patients with OCD, BLA-vmPFC functional connectivity predicted CBT outcome. These results suggest that future research should investigate the potential of BLA-vmPFC pathways to inform treatment selection for CBT across patients with OCD and anxiety disorders.
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