Glutamate in Pediatric Obsessive-Compulsive Disorder and Response to Cognitive-Behavioral Therapy: Randomized Clinical Trial
| Autor: | Stefan Posse, Gerhard Hellemann, Ross Mudgway, Jeffry R. Alger, Tara S. Peris, Michelle Rozenman, Susanna Chang, Erika L. Nurmi, John Piacentini, Joseph O'Neill, Jennifer G. Levitt, Ronald Ly, Tsz M. Lai, Noriko Salamon, Casey C. Armstrong, Allison Vreeland, Lindsey Bergman, James T. McCracken |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Obsessive-Compulsive Disorder Magnetic Resonance Spectroscopy 6.6 Psychological and behavioural medicine.medical_treatment Medical and Health Sciences law.invention 0302 clinical medicine Randomized controlled trial law Medicine Child Depression (differential diagnoses) Pediatric Psychiatry Cross-Over Studies Serious Mental Illness Magnetic Resonance Imaging Cognitive behavioral therapy Psychiatry and Mental health Treatment Outcome Mental Health medicine.anatomical_structure Schizophrenia Biomedical Imaging Anxiety Original Article Female medicine.symptom Clinical psychology medicine.medical_specialty Adolescent Waiting Lists Clinical Trials and Supportive Activities Glutamic Acid behavioral disciplines and activities 03 medical and health sciences Clinical Research Internal medicine mental disorders Humans Anterior cingulate cortex Pharmacology Cognitive Behavioral Therapy business.industry Psychology and Cognitive Sciences Evaluation of treatments and therapeutic interventions medicine.disease Crossover study 030227 psychiatry Posterior cingulate business Mind and Body 030217 neurology & neurosurgery |
| Zdroj: | Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, vol 42, iss 12 |
| ISSN: | 1740-634X 0893-133X |
| DOI: | 10.1038/npp.2017.77 |
| Popis: | Cognitive-behavioral therapy (CBT) is effective for pediatric obsessive-compulsive disorder (OCD), but non-response is common. Brain glutamate (Glu) signaling may contribute to OCD pathophysiology and moderate CBT outcomes. We assessed whether Glu measured with magnetic resonance spectroscopy (MRS) was associated with OCD and/or CBT response. Youths aged 7–17 years with DSM-IV OCD and typically developing controls underwent 3 T proton echo-planar spectroscopic imaging (PEPSI) MRS scans of pregenual anterior cingulate cortex (pACC) and ventral posterior cingulate cortex (vPCC)—regions possibly affected by OCD—at baseline. Controls returned for re-scan after 8 weeks. OCD youth—in a randomized rater-blinded trial—were re-scanned after 12–14 weeks of CBT or after 8 weeks of minimal-contact waitlist; waitlist participants underwent a third scan after crossover to 12–14 weeks of CBT. Forty-nine children with OCD (mean age 12.2±2.9 years) and 29 controls (13.2±2.2 years) provided at least one MRS scan. At baseline, Glu did not differ significantly between OCD and controls in pACC or vPCC. Within controls, Glu was stable from scan-to-scan. Within OCD subjects, a treatment-by-scan interaction (p=0.034) was observed, driven by pACC Glu dropping 19.5% from scan-to-scan for patients randomized to CBT, with minor increases (3.8%) for waitlist participants. The combined OCD participants (CBT-only plus waitlist-CBT) also showed a 16.2% (p=0.004) post-CBT decrease in pACC Glu. In the combined OCD group, within vPCC, lower pre-CBT Glu predicted greater post-CBT improvement in symptoms (CY-BOCS; r=0.81, p=0.00025). Glu may be involved in the pathophysiology of OCD and may moderate response to CBT. |
| Databáze: | OpenAIRE |
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