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Obsessive-Compulsive Disorder Research |
What is Obsessive-Compulsive Disorder?
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.
Typical Obsessions
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Dirt, germs, contamination
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Fear of acting on aggressive impulses
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Concern with ordering (symmetry), arranging, counting
Typical Compulsions
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Excessive handwashing or bathing
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Checking (for potential hazards)
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Repetitive actions such as touching
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Concern with counting and arranging
Etiology (cause) of OCD
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).
Available Treatment
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.
Imaging Protocol
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.
Proposed Results
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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.
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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.
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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
treatment response.
This proposal will help pioneer a state-of-the-art diagnosis and
treatment design that utilizes an innovative treatment modality for
refractory OCD (using IV clomipramine as a loading dose prior to oral
treatment) and advanced neuroimaging technology (high resolution fMRI).
Functional MRI does not expose an individual to ionizing radiation, and
thus has the potential to be used widely as a clinical tool. The
combination of innovative psychopharmacology with neuroimaging
technology will result in a powerful and comprehensive treatment
approach for individuals with OCD and other neuropsychiatric disorders.
Lucile Packard Children's Hospital is located in Palo Alto, adjacent to Stanford University Hospital, approximately 20 miles north of San Jose, CA and 40 miles south of San Francisco.
Lucile Packard Children's Hospital
725 Welch Road
Palo Alto, California 94304
(650) 497-8000
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