Please use this identifier to cite or link to this item: http://hdl.handle.net/10316/92854
Title: Imbalance in habitual versus goal directed neural systems during symptom provocation in obsessive-compulsive disorder
Authors: Banca, Paula 
Voon, Valerie 
Vestergaard, Martin D
Philipiak, Gregor
Almeida, Inês 
Pocinho, Fernando 
Relvas, João
Castelo-Branco, Miguel 
Keywords: Imbalanced circuitry; Live symptom provocation; Obsessive-compulsive disorder; Causality; Caudate/putamen
Issue Date: Mar-2015
Publisher: Oxford University Press
Project: SFRH/BD/33889/ 2009 
CENTRO-07-ST24-FEDER-00205 
FP7-HEALTH-2013- INNOVATION-1–602186 
PTDC/PSI/ 67381/2006 
PIC/IC/82986/2007 
PEst-C/SAU/UI3282/ 2013 
Serial title, monograph or event: Brain: a Journal of Neurosurgery
Volume: 138
Issue: Pt 3
Abstract: Intrusive thoughts and compulsive urges to perform stereotyped behaviours are typical symptoms of obsessive-compulsive disorder. Emerging evidence suggests a cognitive bias towards habit formation at the expense of goal-directed performance in obsessive-compulsive disorder. In this study, we test this hypothesis using a novel individualized ecologically valid symptom provocation design: a live provocation functional magnetic resonance imaging paradigm with synchronous video-recording of behavioural avoidance responses. By pairing symptom provocation with online avoidance responses on a trial-by-trial basis, we sought to investigate the neural mechanisms leading to the compulsive avoidance response. In keeping with the model of habit formation in obsessive-compulsive disorder, we hypothesized that this disorder would be associated with lower activity in regions implicated in goal-directed behaviours and higher activity in regions implicated in habitual behaviours. Fifteen patients with obsessive-compulsive disorder and 15 healthy control volunteers participated in this functional magnetic resonance imaging study. Online stimuli were individually tailored to achieve effective symptom provocation at neutral, intermediate and strong intensity levels. During the symptom provocation block, the participant could choose to reject or terminate the provoking stimuli resulting in cessation of the symptom provocation. We thus separately analysed the neural correlates of symptom provocation, the urge to avoid, rejection and relief. Strongly symptom-provoking conditions evoked a dichotomous pattern of deactivation/activation in patients, which was not observed either in control conditions or in healthy subjects: a deactivation of caudate-prefrontal circuits accompanied by hyperactivation of subthalamic nucleus/putaminal regions. This finding suggests a dissociation between regions engaged in goal-directed and habitual behaviours. The putaminal hyperactivity during patients' symptom provocation preceded subsequent deactivation during avoidance and relief events, indicating a pivotal role of putamen in regulation of behaviour and habit formation in obsessive-compulsive disorder. Effective connectivity analysis identified the ventromedial prefrontal cortex/orbitofrontal cortex as the main structure in this circuitry involved in the modulation of compulsivity in obsessive-compulsive disorder. These findings suggest an imbalance in circuitry underlying habitual and goal-directed action control, which may represent a fundamental mechanism underlying compulsivity in obsessive-compulsive disorder. Our results complement current models of symptom generation in obsessive-compulsive disorder and may enable the development of future therapeutic approaches that aim to alleviate this imbalance.
URI: http://hdl.handle.net/10316/92854
ISSN: 1460-2156
0006-8950
DOI: 10.1093/brain/awu379
Rights: openAccess
Appears in Collections:FMUC Medicina - Artigos em Revistas Internacionais

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