Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive-compulsive disorder

Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive-compulsive disorder

Author Hoexter, Marcelo Q. Autor UNIFESP Google Scholar
Dougherty, Darin D. Google Scholar
Shavitt, Roseli G. Google Scholar
D'Alcante, Carina C. Google Scholar
Duran, Fabio L. S. Google Scholar
Lopes, Antonio C. Google Scholar
Diniz, Juliana B. Google Scholar
Batistuzzo, Marcelo C. Google Scholar
Evans, Karleyton C. Google Scholar
Bressan, Rodrigo A. Autor UNIFESP Google Scholar
Busatto, Geraldo F. Google Scholar
Miguel, Euripedes C. Google Scholar
Institution Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Harvard Univ
Abstract Nearly one-third of patients with obsessive-compulsive disorder (OCD) fail to respond to adequate therapeutic approaches such as serotonin reuptake inhibitors and/or cognitive-behavioral therapy (CBT). This study investigated structural magnetic resonance imaging (MRI) correlates as potential pre-treatment brain markers to predict treatment response in treatment-naive OCD patients randomized between trials of fluoxetine or CBI Treatment-naive OCD patients underwent structural MRI scans before randomization to a 12-week clinical trial of either fluoxetine or group-based CBT. Voxel-based morphometry was used to identify correlations between pretreatment regional gray matter volume and changes in symptom severity on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Brain regional correlations of treatment response differed between treatment groups. Notably, symptom improvement in the fluoxetine treatment group (n=14) was significantly correlated with smaller pretreatment gray matter volume within the right middle lateral orbitofrontal cortex (OFC), whereas symptom improvement in the CBT treatment group (n=15) was significantly correlated with larger pretreatment gray matter volume within the right medial prefrontal cortex (mPFC). No significant a priori regional correlations of treatment response were identified as common between the two treatment groups when considering the entire sample (n=29). These findings suggest that pretreatment gray matter volumes of distinct brain regions within the lateral OFC and mPFC were differentially correlated to treatment response to fluoxetine versus CBT in OCD patients. This study further implicates the mPFC in the fear/anxiety extinction process and stresses the importance of lateral portions of the OFC in mediating fluoxetine's effectiveness in OCD. Clinical registration information: http://clinicaltrials.gov-NCT00680602. (C) 2012 Elsevier B.V. and ECNP. All rights reserved.
Keywords OCD
Neuroimaging
Gray matter
Serotonergic reuptake inhibitor
Cognitive-behavioral therapy
Language English
Sponsor Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Grant number FAPESP: 2005/55628-8
FAPESP: 06/61459-7
FAPESP: 06/50273-0
FAPESP: 2008/10257-0
FAPESP: 06/58286-3
FAPESP: 2005/04206-6
CAPES: 4375/08-4
Date 2013-07-01
Published in European Neuropsychopharmacology. Amsterdam: Elsevier B.V., v. 23, n. 7, p. 569-580, 2013.
ISSN 0924-977X (Sherpa/Romeo, impact factor)
Publisher Elsevier B.V.
Extent 569-580
Origin http://dx.doi.org/10.1016/j.euroneuro.2012.06.014
Access rights Closed access
Type Article
Web of Science ID WOS:000321083700002
URI http://repositorio.unifesp.br/handle/11600/36484

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