Obsessive-Compulsive Disorder Research
Obsessive-compulsive disorder (OCD) is the fourth most common neurobiological illness with one in forty adults and one in two hundred children having a lifetime occurrence. OCD is characterized by recurrent, disturbing thoughts (obsessions) and/or repetitive, ritualistic behaviors that the individual feels compelled to perform (compulsions). While individuals with OCD recognize these symptoms as irrational, they have little control over them.
Dirt, germs, contamination
Fear of acting on aggressive impulses
Concern with ordering (symmetry), arranging, counting
Excessive handwashing or bathing
Checking (for potential hazards)
Repetitive actions such as touching
Concern with counting and arranging
OCD is believed to be a neurobiological illness that affects specific neural pathways in the brain using the neurotransmitter serotonin. Currently there is significant research that is trying to pinpoint the pathways and neurobiological mechanisms involved. One of the research tools which holds significant promise for characterizing the OCD pathway is functional magnetic resonance imaging (fMRI).
While impairment caused by OCD ranges from mild to severe, many people with OCD will require treatment. Two types of treatment have been demonstrated to be helpful: Cognitive Behavioral Therapy (CBT) and medication. Selective serotonin reuptake inhibitors (SSRI's) including fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and a tricyclic antidepressant, clomipramine (Anafranil), have been approved for the treatment of OCD. In spite of the improvement in medication therapy for people with OCD, a significant number do not respond to several trials of medication.
Using Functional MRI to Predict and Assess Treatment Response
Goal of the OCD fMRI Project (currently study is for adults only)
This study is designed to add an innovative research tool, functional magnetic resonance imaging (fMRI), to a clinical trial involving patients with treatment-refractory OCD. We predict that fMRI can be successfully used as a new clinical approach to predict and follow the response of individuals with OCD to new pharmacological therapies such as IV clomipramine. The overarching goal is to use fMRI to increase our understanding of the neurobiology of OCD.
These subjects will undergo fMRI scanning the day prior to starting the pharmacological study and then four days after receiving the loading phase of the study. Each research subject will then again be scanned at the end of the three month treatment period. While in the scanner, the subjects will perform cognitive and behavioral tasks that assess key information processing abilities of individuals with OCD.
Baseline brain activation patterns associated with the first scan will
provide critical knowledge about activation in the frontal-striatal
neural circuit thought to be involved in the etiology of OCD. Detection
of varying patterns of frontal- striatal activation in individuals with
OCD will provide information about biological mechanisms that underlie
heterogeneity in this condition.
The characterization of OCD as a deficit in a neurobiological pathway
will lead to more accurate diagnosis of this illness as well as a better
understanding of the symptoms and associated neurocognitive deficits.
Scans obtained after IV clomipramine will demonstrate differential brain
activation patterns, indicating dynamic changes that occur in
OCD-specific neural pathways with treatment. The third set of fMRI scans
will monitor long-term changes in brain activation that correspond to