Review of structural neuroimaging in patients with refractory obsessivecompulsive disorder

Abstract

The notion that some special brain regions may be involved in the pathogenesis of obsessive-compulsive disorder (OCD) dates back to the beginning of the twentieth century. Structural neuroimaging studies in the past 2 decades have revealed important findings that facilitate understanding of OCD pathogenesis. Current knowledge based on functional and structural neuroimaging investigations largely emphasizes abnormalities in fronto-striatal-thalamic-cortical and orbitofronto-striato-thalamic circuits in the pathophysiology of OCD. However, these neuroimaging studies did not focus on refractory OCD. The present review mainly focused on structural neuroimaging performed in OCD, which had been ignored previously, and highlighted current evidence supporting that orbito-frontal cortex and thalamus are key brain regions, and that the hippocampus-amygdala complex is associated with refractoriness to the available treatment strategies. However, to fully reveal the neuroanatomy of refractoriness, longitudinal studies with larger samples are required.

摘要

关于某些脑区参与强迫症的说法可追溯至20世纪初。 在过去20年间, 结构神经影像研究得到了很多重大发现, 大大促进了对强迫症病因的了解。 目前的功能和结构神经影像研究主要强调了额叶—纹状体—视丘—皮层和眶额—纹状体—视丘回路异常在强迫症中的作用。 然而, 难治性强迫症在研究中常常被忽略。 本综述主要回顾了强迫症结构神经影像的一些发现, 提示眶额皮层和丘脑是参与强迫症的关键区域, 而且杏仁海马复合体也与该病的难治性有关。 未来的研究只有增大样本量才能更全面地揭示难治性强迫症的神经结构学基础。