Multi-level assessment of obsessive-compulsive disorder (OCD) reveals relations between neural and neurochemical levels
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RESEARCH ARTICLE
Open Access
Multi-level assessment of obsessivecompulsive disorder (OCD) reveals relations between neural and neurochemical levels Kathrin Viol1,2† , Günter Schiepek1,2,3*†, Martin Kronbichler4,5, Arnulf Hartl6, Carina Grafetstätter6, Peter Strasser7, Anna Kastinger1,2, Helmut Schöller1,2, Eva-Maria Reiter8, Sarah Said-Yürekli4,5,9, Lisa Kronbichler4,5, Brigitte Kravanja-Spannberger2, Barbara Stöger-Schmidinger2, Marc-Thorsten Hütt10, Wolfgang Aichhorn1,2 and Benjamin Aas11,12
Abstract Background: While considerable progress has been made in exploring the psychological, the neural, and the neurochemical dimensions of OCD separately, their interplay is still an open question, especially their changes during psychotherapy. Methods: Seventeen patients were assessed at these three levels by psychological questionnaires, fMRI, and venipuncture before and after inpatient psychotherapy. Seventeen controls were scanned at comparable time intervals. First, pre/post treatment changes were investigated for all three levels separately: symptom severity, whole-brain and regional activity, and the concentrations of cortisol, serotonin, dopamine, brain-derived neurotrophic factor (BDNF), and immunological parameters (IL-6, IL-10, TNFα). Second, stepwise linear modeling was used to find relations between the variables of the levels. Results: The obsessive-compulsive, depressive, and overall symptom severity was significantly reduced after psychotherapy. At the neural level, the activity in the anterior cingulate cortex (ACC), in frontal regions, in the precuneus, and in the putamen had significantly decreased. No significant changes were found on the neurochemical level. When connecting the levels, a highly significant model was found that explains the decrease in neural activity of the putamen by increases of the concentrations of cortisol, IL-6, and dopamine. Conclusion: Multivariate approaches offer insight on the influences that the different levels of the psychiatric disorder OCD have on each other. More research and adapted models are needed. Keywords: OCD, fMRI, Psychotherapy process, Treatment outcome, Neurochemistry, Multi-level, Dopamine, Cortisol, IL-6
* Correspondence: [email protected] † Kathrin Viol and Günter Schiepek contributed equally to this work. 1 Institute of Synergetics and Psychotherapy Research, Paracelsus Medical University, Ignaz-Harrer-Strasse 79, 5020 Salzburg, Austria 2 Department of Psychosomatics and Inpatient Psychotherapy, University Hospital for Psychiatry, Psychotherapy and Psychosomatics, Paracelsus Medical University, Salzburg, Austria Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if cha
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