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18 - Molecular imaging of obsessive–compulsive disorder

from Section III - Anxiety Disorders

Published online by Cambridge University Press:  10 January 2011

By
Martijn Figee ,
Jan Booij  and
Damiaan Denys
Edited by
Martha E. Shenton  and
Bruce I. Turetsky
Martijn Figee
Affiliation:
Department of Psychiatry University of Amsterdam Amsterdam, The Netherlands
Jan Booij
Affiliation:
Department of Nuclear Medicine University of Amsterdam Amsterdam, The Netherlands
Damiaan Denys
Affiliation:
Department of Psychiatry University of Amsterdam Amsterdam, The Netherlands
Martha E. Shenton
Affiliation:
VA Boston Healthcare System and Brigham and Women's Hospital, Harvard Medical School
Bruce I. Turetsky
Affiliation:
University of Pennsylvania
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Summary

Introduction

Obsessive–compulsive disorder (OCD) is a chronic psychiatric disorder that is characterized by the presence of recurrent and anxiety-provoking thoughts, images or impulses (obsessions), typically followed by repetitive ritualistic behaviors (compulsions) to relieve anxiety. The prevalence of OCD is estimated to be between 1 and 3% (Ruscio et al.,2010; Fullana et al., 2009). Without adequate treatment, obsessions and compulsions can become extremely time-consuming, causing significant impairments in social and occupational functioning. Effective treatment options for OCD are cognitive behavioral therapy, pharmacotherapy or psychosurgical interventions.

Approximately 40–60% of OCD patients respond to pharmacotherapy with drugs that increase intrasynaptic serotonin (Denys 2006; Soomro et al., 2008). Hence, it is often suggested that OCD is related to a dysfunction of brain serotonin systems. Central dopaminergic systems are likely to be involved as well, since patients who do not respond to treatment with serotonin reuptake inhibitors (SRIs) can be successfully augmented with dopamine receptor antagonists (Fineberg et al., 2006; Bloch et al., 2006). Finally, the potential efficacy of glutamate modulating drugs in OCD (Denys, 2006) suggests glutaminergic abnormalities in OCD.

Functional imaging studies indicate involvement of the cortico-striatal–thalamic–cortical circuit in OCD pathophysiology (Saxena and Rauch, 2000; Menzies et al., 2008) and within this circuitry, the neurotransmitters serotonin, dopamine and glutamate are important regulators of neuronal activity. The exact function of these neurotransmitters in OCD is still unclear, however. They may be directly implicated in the pathophysiology of OCD, or only related to treatment effects.

Keywords

1H magnetic resonance spectroscopyobsessive-compulsive disorderpositron emission tomographysingle photon emission computed tomographyserotonin transporterserotonergic neurotransmissionserotonin reuptake inhibitors
Type
Chapter
Information
Understanding Neuropsychiatric Disorders
Insights from Neuroimaging
 , pp. 260 - 273
Publisher: Cambridge University Press
Print publication year: 2010

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