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

Author(s):Show less -

Hoexter, Marcelo Q. ^{[1, 2, 3]} ; Dougherty, Darin D. ^[3] ; Shavitt, Roseli G. ^[2] ; D'Alcante, Carina C. ^[2] ; Duran, Fabio L. S. ^[2] ; Lopes, Antonio C. ^[2] ; Diniz, Juliana B. ^[2] ; Batistuzzo, Marcelo C. ^[2] ; Evans, Karleyton C. ^[3] ; Bressan, Rodrigo A. ^[1] ; Busatto, Geraldo F. ^[2] ; Miguel, Euripedes C. ^[2]

Affiliation

^[1] Fed Univ Sao Paulo UNIFESP, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LiNC, Sao Paulo - Brazil

^[2] Univ Sao Paulo, Sch Med, Dept & Inst Psychiat, BR-05403010 Sao Paulo - Brazil

^[3] Harvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Psychiat, Boston, MA - USA

• Document type: Journal article
• Source: European Neuropsychopharmacology; v. 23, n. 7, p. 569-580, JUL 2013.
• Web of Science Citations: 29

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. (AU)

• FAPESP's process: 05/55628-8 - Phenotypic, genetic, immunological and neurobiological characterization of the obsessive compulsive disorder and its implications for treatment
• Grantee: Eurípedes Constantino Miguel Filho
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 08/10257-0 - Ventral striatal/ventral capsular Gamma capsulotomy for obsessive-compulsive disorder: a randomized controlled trial
• Grantee: Antonio Carlos Lopes
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 06/50273-0 - Pharmacological augmentation strategies in treatment of resistant obsessive-compulsive disorder: a double-blind placebo-controlled trial
• Grantee: Juliana Belo Diniz
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)