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首页> 外文期刊>Journal of psychiatry & neuroscience: JPN >Increased orbitofrontal cortex activation associated with 'pro-obsessive' antipsychotic treatment in patients with schizophrenia
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Increased orbitofrontal cortex activation associated with 'pro-obsessive' antipsychotic treatment in patients with schizophrenia

机译：与精神分裂症患者的“强迫性”抗精神病药物治疗相关的眶额皮质激活增加

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Background: Patients with schizophrenia have an approximately 10-fold higher risk for obsessive-compulsive symptoms (OCS) than the general population. A large subgroup seems to experience OCS as a consequence of second-generation antipsychotic agents (SGA), such as clozapine. So far little is known about underlying neural mechanisms. Methods: To investigate the role of SGA treatment on neural processing related to OCS in patients with schizophrenia, we stratified patients according to their monotherapy into 2 groups (group I: clozapine or olanzapine; group II: amisulpride or aripiprazole). We used an fMRI approach, applying a goo-go task assessing inhibitory control and an n-back task measuring working memory. Results: We enrolled 21 patients in group I and 19 patients in group II. Groups did not differ regarding age, sex, education or severity of psychotic symptoms. Frequency and severity of OCS were significantly higher in group I and were associated with pronounced deficits in specific cognitive abilities. Whereas brain activation patterns did not differ during working memory, group I showed significantly increased activation in the orbitofrontal cortex (OFC) during response inhibition. Alterations in OFC activation were associated with the severity of obsessions and mediated the association between SGA treatment and co-occurring OCS on a trend level. Limitations: The main limitation of this study is its cross-sectional design. Conclusion: To our knowledge, this is the first imaging study conducted to elucidate SGA effects on neural systems related to OCS. We propose that alterations in brain functioning reflect a pathogenic mechanism in the development of SGA-induced OCS in patients with schizophrenia. Longitudinal studies and randomized interventions are needed to prove the suggested causal interrelations.
机译：背景：精神分裂症患者的强迫症（OCS）风险比普通人群高约10倍。由于第二代抗精神病药（SGA）（如氯氮平），一个很大的亚组似乎经历了OCS。到目前为止，对潜在的神经机制知之甚少。方法：为了研究SGA治疗在精神分裂症患者中与OCS相关的神经处理的作用，我们根据其单药治疗将患者分为两组（I组：氯氮平或奥氮平; II组：氨磺必利或阿立哌唑）。我们使用了功能磁共振成像方法，应用了执行/不执行任务来评估抑制性控制，并执行n后退任务来测量工作记忆。结果：我们招募了第一组21例患者和第二组19例患者。两组在年龄，性别，受教育程度或精神病症状的严重程度方面没有差异。 I组中OCS的频率和严重程度显着较高，并且与特定认知能力的明显缺陷有关。尽管在工作记忆期间脑部激活模式没有差异，但第一组在反应抑制过程中眼眶额叶皮层（OFC）的激活显着增加。 OFC激活的改变与痴迷的严重程度有关，并在趋势水平上介导了SGA治疗与同时发生的OCS之间的联系。局限性：这项研究的主要局限性是其横截面设计。结论：据我们所知，这是第一个阐明SGA对与OCS相关的神经系统影响的影像学研究。我们建议脑功能的改变反映了精神分裂症患者SGA诱导的OCS的发展中的致病机制。需要进行纵向研究和随机干预以证明建议的因果关系。

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