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- Title
Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial.
- Authors
Hoexter, Marcelo Queiroz; de Souza Duran, Fábio Luis; D'Alcante, Carina Chaubet; Dougherty, Darin Dean; Shavitt, Roseli Gedanke; Lopes, Antonio Carlos; Diniz, Juliana Belo; Deckersbach, Thilo; Batistuzzo, Marcelo Camargo; Bressan, Rodrigo Affonseca; Miguel, Euripedes Constantino; Busatto, Geraldo Filho
- Abstract
Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n=38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n=36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n=26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n=13), whereas no significant GM volume changes were observed in CBT-treated patients (n=13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action.
- Subjects
OBSESSIVE-compulsive disorder; ANTIDEPRESSANTS; COMPULSIVE behavior; CLINICAL medicine; MAGNETIC resonance
- Publication
Neuropsychopharmacology, 2012, Vol 37, Issue 3, p734
- ISSN
0893-133X
- Publication type
Academic Journal
- DOI
10.1038/npp.2011.250