Subjective uncertainty and limbic hyperactivation in obsessive-compulsive disorder

Department of Psychiatry, University of Michigan, Ann Arbor, Michigan. .
Human Brain Mapping (Impact Factor: 6.92). 08/2013; 34(8). DOI: 10.1002/hbm.22038
Source: PubMed

ABSTRACT Obsessive-compulsive disorder (OCD) is often associated with pathological uncertainty regarding whether an action has been performed correctly or whether a bad outcome will occur, leading to compulsive "evidence gathering" behaviors aimed at reducing uncertainty. The current study used event-related functional magnetic resonance imaging to investigate neural functioning in OCD patients and controls as subjective certainty was rated in response to sequential pieces of evidence for a decision. Uncertainty was experimentally manipulated so that some decisions were associated with no "objective" uncertainty (all observed evidence pointed to one correct choice), whereas other decisions contained calculable but varying levels of objective uncertainty based on displayed probabilities. Results indicated that OCD patients differed from controls on decisions that contained no objective uncertainty, such that patients rated themselves as more uncertain. Patients also showed greater activation in a network of brain regions previously associated with internally-focused thought and valuation including ventromedial prefrontal cortex, parahippocampus, middle temporal cortex, as well as amygdala and orbitofrontal cortex/ventral anterior insula. In the patient group, a significantly greater number of positive intersubject correlations were found among several of these brain regions, suggesting that this network is more interconnected in patients. OCD patients did not differ from controls on decisions where task parameters led to uncertainty. These results indicate that OCD is associated with hyperactivation in a network of limbic/paralimbic brain regions when making decisions, which may contribute to the greater subjective experience of doubt that characterizes the disorder. Hum Brain Mapp, 2012. © 2012 Wiley Periodicals, Inc.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Efficient, adaptive behavior relies on the ability to flexibly move between internally focused (IF) and externally focused (EF) attentional states. Despite evidence that IF cognitive processes such as event imagination compromise a significant amount of awake cognition, the consequences of internal absorption on the subsequent recruitment of brain networks during EF tasks are unknown. The present functional magnetic resonance imaging (fMRI) study employed a novel attentional state switching task. Subjects imagined positive and negative events (IF task) or performed a working memory task (EF task) before switching to a target detection (TD) task also requiring attention to external information, allowing for the investigation of neural functioning during external attention based on prior attentional state. There was a robust increase of activity in frontal, parietal, and temporal regions during TD when subjects were previously performing the EF compared with IF task, an effect that was most pronounced following negative IF. Additionally, dorsolateral prefrontal cortex was less negatively coupled with ventromedial prefrontal and posterior cingulate cortices during TD following IF compared with EF. These findings reveal the striking consequences for brain activity following immersion in an IF attentional state, which have strong implications for psychiatric disorders characterized by excessive internal focus.
    Cerebral Cortex 06/2014; DOI:10.1093/cercor/bhu115 · 8.31 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Attention to self and environment form the basis of effective social exchange and relationships. Although implicit in this basic social competency is the ability to be self-aware and responsive to the circumstances of others, many neuropsychologists have yet to understand or measure its basic functions, let alone recognize the brain-behavior relationships that govern this area. Several years ago, interest in "emotional intelligence" rose to the forefront of popular psychology, but we are still unraveling the cortical, subcortical, and neurocellular interactions that produce this nebulous construct, and we are determining how dysfunctional frontal-subcortical and cortico-cerebellar circuitry can lead to aberrant social dynamics and ultimately psychopathology when maladaptive patterns become routinized. In this article, we explore the orbital-ventral medial circuitry thought to govern emotional attention, personal self-regulation, social concern and exchange, and affective aspects of interpersonal relationships. Our examination notes both the dearth of and need for neuropsychological research on the biological basis and measurement of executive regulation of emotional attention, behavioral regulation, and social competence. We conclude with a call for development of neuropsychological measures and methods that can foster differential diagnosis and targeted treatment strategies for children with orbital-ventral medial circuit dysfunction.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Cognitive neuroscience investigates neural responses to cognitive and emotional probes, an approach that has yielded critical insights into the neurobiological mechanisms of psychiatric disorders. This article reviews some of the major findings from neuroimaging studies using a cognitive neuroscience approach to investigate obsessive-compulsive disorder (OCD). It evaluates the consistency of results and interprets findings within the context of OCD symptoms, and proposes a model of OCD involving inflexibility of internally focused cognition. Although further research is needed, this body of work probing cognitive-emotional processes in OCD has already shed considerable light on the underlying mechanisms of the disorder.
    Psychiatric Clinics of North America 09/2014; DOI:10.1016/j.psc.2014.05.004 · 2.13 Impact Factor


Available from
May 21, 2014