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Impulsivity and decision-making in obsessive-compulsive disorder after effective deep brain stimulation or treatment as usual

Published online by Cambridge University Press:  06 April 2018

Giacomo Grassi ,
Martijn Figee ,
Pieter Ooms ,
Lorenzo Righi ,
Takashi Nakamae ,
Stefano Pallanti ,
Rick Schuurman  and
Damiaan Denys
Giacomo Grassi*
Affiliation:
University of Florence, Health Science, Florence, Italy Institute for Neuroscience, Florence, Italy
Martijn Figee
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, United States
Pieter Ooms
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
Lorenzo Righi
Affiliation:
University Hospitals of Geneva, Quality of Care Service, Geneva, Switzerland
Takashi Nakamae
Affiliation:
Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
Stefano Pallanti
Affiliation:
University of Florence, Health Science, Florence, Italy Institute for Neuroscience, Florence, Italy
Rick Schuurman
Affiliation:
Department of Neurosurgery, Academic Medical Center, Amsterdam, The Netherlands
Damiaan Denys
Affiliation:
Department of Psychiatry, Academic Medical Center, Amsterdam, The Netherlands
*
*Address for corespondence: Giacomo Grassi, M.D., University of Florence, via delle Gore 2H, 50141 Florence, Italy. (Email: [email protected]
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Abstract

Objective

Impulsivity and impaired decision-making have been proposed as obsessive-compulsive disorder (OCD) endophenotypes, running in OCD and their healthy relatives independently of symptom severity and medication status. Deep brain stimulation (DBS) targeting the ventral limb of the internal capsule (vALIC) and the nucleus accumbens (Nacc) is an effective treatment strategy for treatment-refractory OCD. The effectiveness of vALIC-DBS for OCD has been linked to its effects on a frontostriatal network that is also implicated in reward, impulse control, and decision-making. While vALIC-DBS has been shown to restore reward dysfunction in OCD patients, little is known about the effects of vALIC-DBS on impulsivity and decision-making. The aim of the study was to compare cognitive impulsivity and decision-making between OCD patients undergoing effective vALIC-DBS or treatment as usual (TAU), and healthy controls.

Methods

We used decision-making performances under ambiguity on the Iowa Gambling Task and reflection impulsivity on the Beads Task to compare 20 OCD patients effectively treated with vALIC-DBS, 40 matched OCD patients undergoing effective TAU (medication and/or cognitive behavioural therapy), and 40 healthy subjects. Effective treatment was defined as at least 35% improvement of OCD symptoms.

Results

OCD patients, irrespective of treatment modality (DBS or TAU), showed increased reflection impulsivity and impaired decision-making compared to healthy controls. No differences were observed between OCD patients treated with DBS or TAU.

Conclusion

OCD patients effectively treated with vALIC-DBS or TAU display increased reflection impulsivity and impaired decision-making independent of the type of treatment.

Keywords

DBSdecision-makingdeep brain stimulationOCDimpulsivitytreatment as usual
Type
Original Research
Information
CNS Spectrums , Volume 23 , Special Issue 5: Theme: Obsessive-Compulsive Disorder , October 2018 , pp. 333 - 339
Copyright
© Cambridge University Press 2018 

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