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MRSI correlates of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder

Joseph O'Neill1, John C Piacentini, Susanna Chang

  • 1Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90024-1759, United States. joneill@mednet.ucla.edu

Progress in Neuro-Psychopharmacology & Biological Psychiatry
|October 11, 2011
PubMed

Insights

Cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) shows metabolic brain changes. Proton magnetic resonance spectroscopic imaging (1H MRSI) revealed altered metabolites in the pregenual anterior cingulate cortex (pACC) and thalamus, predicting treatment response.

Area of Science:

  • Neuroscience
  • Pediatric Psychiatry
  • Radiology

Background:

  • Cognitive-behavioral therapy (CBT) is effective for pediatric obsessive-compulsive disorder (OCD), but its brain mechanisms are unclear.
  • Adult OCD neuroimaging suggests CBT impacts metabolism in the striatum, thalamus, and anterior cingulate cortex.
  • Proton magnetic resonance spectroscopic imaging (1H MRSI) was used to investigate these metabolic effects in pediatric OCD.

Purpose of the Study:

  • To explore the metabolic brain changes associated with CBT in pediatric OCD patients.
  • To identify potential neuroimaging biomarkers for OCD and treatment response.

Main Methods:

  • Proton magnetic resonance spectroscopic imaging (1H MRSI) was performed on 5 unmedicated pediatric OCD patients and 9 healthy controls.
  • MRSI targeted the bilateral putamen, thalamus, and pregenual anterior cingulate cortex (pACC).
  • Patients were rescanned after 12 weeks of exposure-based CBT, with symptom severity assessed using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS).

Main Results:

  • Four out of five patients showed a positive response to CBT, with a significant reduction in CY-BOCS scores.
  • Pre-treatment, patients had higher N-acetyl-aspartate+N-acetyl-aspartyl-glutamate (tNAA) in the left pACC compared to controls.
  • Post-treatment, decreased tNAA and creatine (Cr) in the left pACC and increased choline compounds (Cho) in the right thalamus were observed. Lower baseline tNAA, glutamate+glutamine (Glx), and myo-inositol (mI) in the left thalamus predicted a greater symptom reduction.

Conclusions:

  • Metabolic alterations in the pACC and thalamus, measurable by MRSI, may serve as indicators of pediatric OCD.
  • These metabolic changes correlate with treatment response to CBT, offering potential biomarkers for predicting treatment outcomes.
  • Findings support the Glutamatergic Hypothesis of Pediatric OCD and highlight MRSI's utility in understanding treatment mechanisms.
Abstract

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