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Ben J. Harrison, PhD; Carles Soriano-Mas, PhD; Jesus Pujol, MD; Hector Ortiz, MS; Marina López-Solà, BSc; Rosa Hernández-Ribas, MD; Joan Deus, PhD; Pino Alonso, MD; Murat Yücel, PhD; Christos Pantelis, MD; José M. Menchon, MD; Narcís Cardoner, MD

Arch Gen Psychiatry. 2009;66(11):1189-1200.

Context  Neurobiological models of obsessive-compulsive disorder (OCD) emphasize disturbances in the function and connectivity of brain corticostriatal networks, or "loops." Although neuroimaging studies of patients have supported this network model of OCD, very few have applied measurements that are sensitive to brain connectivity features.

Objective  Using resting-state functional magnetic resonance imaging, we tested the hypothesis that OCD is associated with disturbances in the functional connectivity of primarily ventral corticostriatal regions, measured from coherent spontaneous fluctuations in the blood oxygenation level–dependent (BOLD) signal.

Design  Case-control cross-sectional study.

Setting  Hospital referral OCD unit and magnetic resonance imaging facility.

Participants  A total of 21 patients with OCD (10 men, 11 women) and 21 healthy control subjects matched for age, sex, and estimated intelligence.

Main Outcome Measures  Voxelwise statistical parametric maps testing the strength of functional connectivity of 4 striatal seed regions of interest (dorsal caudate nucleus, ventral caudate/nucleus accumbens, dorsal putamen, and ventral putamen) with remaining brain areas.

Results  For both groups, there was a clear distinction in the pattern of cortical connectivity of dorsal and ventral striatal regions, consistent with the notion of segregated motor, associative, and limbic corticostriatal networks. Between groups, patients with OCD had significantly increased functional connectivity along a ventral corticostriatal axis, implicating the orbitofrontal cortex and surrounding areas. The specific strength of connectivity between the ventral caudate/nucleus accumbens and the anterior orbitofrontal cortex predicted patients' overall symptom severity (r² = 0.57; P < .001). Additionally, patients with OCD showed evidence of reduced functional connectivity of the dorsal striatum and lateral prefrontal cortex, and of the ventral striatum with the region of the midbrain ventral tegmental area.

Conclusions  This study directly supports the hypothesis that OCD is associated with functional alterations of brain corticostriatal networks. Specifically, our findings emphasize abnormal and heightened functional connectivity of ventrolimbic corticostriatal regions in patients with OCD.

Author Affiliations: Institut d’Alta Tecnologia–Parc de Recerca Biomèdica de Barcelona, Centro Radiológico Computerizado Corporació Sanitària, Barcelona, Spain (Drs Harrison, Soriano-Mas, Pujol, Hernández-Ribas, Deus, and Cardoner, Ms López-Solà, and Mr Ortiz); Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Australia (Drs Harrison, Yücel, and Pantelis); Department of Electronic Engineering, Technical University of Catalonia, Barcelona, Spain (Mr Ortiz); Department of Clinical Sciences, Faculty of Medicine, University of Barcelona, Spain (Ms López-Solà); Department of Psychiatry, Bellvitge University Hospital, Centro de Investigación Biomédica en Red de Salud Mental, Barcelona, Spain (Drs Hernández-Ribas, Alonso, Menchon, and Cardoner); Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain (Dr Deus); Orygen Research Centre, Melbourne, Australia (Dr Yücel); Networking Research Center on Bioengineering, Biomaterials and Nanomedicine, Centro de Investigación Biomédica en Red en Bioenginiería, Biomaterials y Nanomedicina, Barcelona, Spain (Dr Pujol).

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