image: Obsessive-compulsive and related disorders. The obsessive-compulsive and related disorders chapter in the DSM-5 adds four items including substance/medication-induced obsessive-compulsive and related disorder, other specified obsessive-compulsive and related disorder, as well as hoarding disorder and excoriation (skin-picking) disorder.
Credit: Psychoradiology
Obsessive-compulsive disorder (OCD)，affecting 2-3% of the global population, manifests through distressing obsessions and compulsions. Its onset is typically around puberty or early adulthood, with variable incidence between genders. Despite treatments involving selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT), outcomes are inconsistent due to OCD's multifaceted nature and frequent co-occurrence with other conditions. A critical challenge is treating OCD lies in the differing levels of insight patients possess regarding their condition,which influences the severity of symptoms and response to treatment.
Marking a substantial advancement in understanding OCD, researchers from Zhejiang University School of Medicine have revealed key connections between clinical characteristics, neuroimaging and treatment, heralding new opportunities for improved diagnostic and therapeutic strategies. The study was published in Psychoradiology on 08 November, 2023.
The study involved a comprehensive review of the concept of insight in OCD, exploring its clinical characteristics, corresponding changes in neuroimaging, and how insight relates to treatment effectiveness. Insight in OCD refers to the patient's awareness of their thoughts and behaviors as symptoms of a disorder. Notably, about 13–36% of patients show poor insight, linked to more severe symptoms and poorer treatment outcomes.
Neuroimaging studies have played a pivotal role in understanding the neurological basis of insight. Structural and functional abnormalities have been observed in critical brain areas, including the frontal, temporal, and parietal lobes. Specifically, reduced cortical thickness in the dorsal medial prefrontal cortex, left anterior cingulate cortex, and right lateral parietal cortex has been associated with poor insight. These findings suggest that insight-related changes might reflect a reduction in neurons within cortical columns.
Although treatment like CBT and pharmacotherapy have shown some effectiveness in enhancing insight, the response to these treatments varies, emphasizing the need for personalized treatment strategies. Neuroleptics and atypical antipsychotics, often prescribed to patients with limited insight, have yet to show consistent effectiveness.
The study's leading researcher highlighted the importance of this study: “Our research not only advances our understanding of the neural underpinnings of OCD but also opens up new avenues for targeted treatments. By identifying specific neural networks associated with OCD severity, we can develop more personalized and effective interventions.”
The implications of this research are profound. By enhancing our understanding of the neural mechanisms underlying OCD, this study paves the way for more precise and personalized treatment approaches. It also underscores the potential of Connectome-based Predictive Modeling and other data-driven multimodal fusion techniques in psychiatric research, promising to transform diagnostic and therapeutic strategies for OCD and other complex psychiatric disorders.
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References
DOI
Original Source URL
https://doi.org/10.1093/psyrad/kkad025
Funding information
The National Key R&D Program of China (2021YFF0702200); The National Natural Science Foundation of China (82101323); The Zhejiang Provincial Natural Science Foundation of China under Grant (LGF19H090015); The Key R&D Program of Zhejiang Province (2021C03001); The Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (2022KY993); The Key Project for Hangzhou Medical Disciplines, and Fundamental Research Funds for the Central Universities (2019XZZX003-20).
About Psychoradiology
Psychoradiology is an open-access journal co-published by Oxford University Press and West China Hospital. It has been indexed by Scopus, DOAJ and the APC is waived during its early stage. We welcome interdisciplinary submissions in the fields of radiology, psychology, psychiatry, neurology and neuroscience, as well as medical imaging, interventional medicine, artificial intelligence, and computer science, etc. A fast-track production mode will be adopted to ensure the manuscript is published as soon as possible.
Journal
Psychoradiology
Subject of Research
Not applicable
Article Title
Insight in obsessive-compulsive disorder: conception, clinical characteristics, neuroimaging, and treatment
Article Publication Date
8-Nov-2023
COI Statement
The authors declare that they have no competing interests