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

Autor(es):Mostrar menos -

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]

Afiliação do(s) autor(es)

^[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

• Tipo de documento: Artigo Científico
• Fonte: European Neuropsychopharmacology; v. 23, n. 7, p. 569-580, JUL 2013.
• Citações Web of Science: 29

Resumo

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)

• Processo FAPESP: 05/55628-8 - Caracterização fenotípica, genética, imunológica e neurobiológica do transtorno obsessivo-compulsivo e suas implicações para o tratamento
• Beneficiário: Eurípedes Constantino Miguel Filho
• Modalidade de apoio: Auxílio à Pesquisa - Temático
• Processo FAPESP: 08/10257-0 - Capsulotomia ventro-capsular e ventro-estriatal por raios gama no transtorno obsessivo-compulsivo: Um ensaio clínico randomizado
• Beneficiário: Antonio Carlos Lopes
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 06/58286-3 - Caracteristicas neuropsicologicas no transtorno obsessivo-compulsivo e seu impacto na resposta ao tratamento.
• Beneficiário: Carina Chaubet Dalcante
• Modalidade de apoio: Bolsas no Brasil - Mestrado
• Processo FAPESP: 06/61459-7 - Fatores preditivos de resposta ao tratamento do transtorno obsessivo compulsivo no longo prazo.
• Beneficiário: Roseli Gedanke Shavitt
• Modalidade de apoio: Bolsas no Brasil - Pós-Doutorado
• Processo FAPESP: 06/50273-0 - Estratégia de potencialização medicamentosa no transtorno obsessivo-compulsivo resistente: um estudo duplo-cego controlado
• Beneficiário: Juliana Belo Diniz
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto
• Processo FAPESP: 05/04206-6 - Avaliação do transportador dopaminérgico no transtorno obsessivo compulsivo através de imagens de SPECT com 99mTc - TRODAT-1
• Beneficiário: Marcelo Queiroz Hoexter
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto