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Andrew R. Gilbert, MD; Gregory J. Moore, PhD; Matcheri S. Keshavan, MD; Lori Anne D. Paulson; Vikram Narula; Frank P. Mac Master; Carol M. Stewart, RNC; David R. Rosenberg, MD

Arch Gen Psychiatry. 2000;57:449-456.

Background  Thalamic dysfunction has been implicated in obsessive-compulsive disorder (OCD). While OCD frequently has its onset during childhood, to our knowledge, no prior study has measured neuroanatomical changes in the thalamus of patients with OCD near the onset of illness, and before and after treatment.

Methods  Volumetric magnetic resonance imaging studies were conducted in 21 psychotropic drug-naïve children, aged 8 to 17 years, with OCD and 21 case-matched healthy comparison subjects. Magnetic resonance imaging studies were also conducted in 10 of the 21 patients with OCD after 12 weeks of monotherapy with the selective serotonin reuptake inhibitor, paroxetine hydrochloride.

Results  Thalamic volumes were significantly greater in treatment-naïve patients with OCD than in controls but declined significantly after paroxetine monotherapy to levels comparable with those of controls. Decrease in thalamic volume in patients with OCD was associated with reduction in OCD symptom severity.

Conclusions  Our findings provide new evidence of thalamic abnormalities in pediatric OCD and further suggest that paroxetine treatment may be paralleled by a reduction in thalamic volume. These reductions may, however, not be specific to paroxetine treatment and could be due to a more general treatment response, and/or spontaneous improvement in symptoms. Our findings are preliminary given the small sample size and our inability to measure discrete thalamic nuclei.

From the Departments of Psychiatry and Behavioral Neurosciences (Drs Gilbert, Moore, and Rosenberg, Mss Paulson and Stewart, and Messrs Narula and Mac Master), Radiology (Dr Moore), and Pediatrics (Dr Rosenberg), Wayne State University School of Medicine, Detroit, Mich; and the Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, Pa (Dr Keshavan). Dr Gilbert is now with the Department of Psychiatry, University of Pittsburgh Medical Center.

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