Basolateral amygdala–ventromedial prefrontal cortex connectivity predicts cognitive behavioural therapy outcome in adults with obsessive–compulsive disorder

Basolateral amygdala–ventromedial prefrontal cortex connectivity predicts cognitive behavioural therapy outcome in adults with obsessive–compulsive disorder

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J Psychiatry Neurosci 2017;42(6):378-385

Miquel A. Fullana, PhD;* Xi Zhu, PhD;* Pino Alonso, MD, PhD; Narcís Cardoner, MD, PhD; Eva Real, MD, PhD; Clara López-Solà, PhD; Cinto Segalàs, MD, PhD; Marta Subirà, MD, PhD; Hanga Galfalvy, PhD; José M. Menchón, MD, PhD; H. Blair Simpson, MD, PhD; Rachel Marsh, PhD;† Carles Soriano-Mas, PhD†

Abstract

Background: Cognitive behavioural therapy (CBT), including exposure and ritual prevention, is a first-line treatment for obsessive–compulsive disorder (OCD), but few reliable predictors of CBT outcome have been identified. Based on research in animal models, we hypothesized that individual differences in basolateral amygdala–ventromedial prefrontal cortex (BLA–vmPFC) communication would predict CBT outcome in patients with OCD.

Methods: We investigated whether BLA–vmPFC resting-state functional connectivity (rs-fc) predicts CBT outcome in patients with OCD. We assessed BLA–vmPFC rs-fc in patients with OCD on a stable dose of a selective serotonin reuptake inhibitor who then received CBT and in healthy control participants.

Results: We included 73 patients with OCD and 84 healthy controls in our study. Decreased BLA–vmPFC rs-fc predicted a better CBT outcome in patients with OCD and was also detected in those with OCD compared with healthy participants. Additional analyses revealed that decreased BLA–vmPFC rs-fc uniquely characterized the patients with OCD who responded to CBT.

Limitations: We used a sample of convenience, and all patients were receiving pharmacological treatment for OCD.

Conclusion: In this large sample of patients with OCD, BLA–vmPFC functional connectivity predicted CBT outcome. These results suggest that future research should investigate the potential of BLA–vmPFC pathways to inform treatment selection for CBT across patients with OCD and anxiety disorders.


Submitted Nov. 7, 2016; Revised Mar. 24, 2017; Accepted Apr. 18, 2017; Early-released June 20, 2017

*Share first authorship; †share senior authorship.

Affiliations: From the Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Barcelona and IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain (Fullana); CIBERSAM, Instituto de Salud Carlos III, Spain (Fullana, Alonso, Cardoner, Real, López-Solà, Segalàs, Subirà, Menchón, Soriano-Mas); the Department of Psychiatry, Autonomous University of Barcelona, Spain (Fullana, Cardoner); the Department of Psychiatry, Columbia University Medical Center, New York, NY, USA, and Division of Clinical Therapeutics, New York State Psychiatric Institute, New York, NY, USA (Fullana, Zhu, Simpson); the Department of Psychiatry, Bellvitge University Hospital- IDIBELL, Hospitalet de Llobregat, Barcelona, Spain (Alonso, Real, Segalàs, Subirà, Menchón, Soriano-Mas); the Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain (Alonso, Menchón); the Depression and Anxiety Unit, Mental Health Department, Parc Taulí Sabadell University Hospital, Barcelona, Spain (Cardoner, López-Solà); the New York State Psychiatric Institute, New York, NY, USA, and Columbia Psychiatry, Columbia University, New York, NY, USA (Galfalvy); the Division of Child and Adolescent Psychiatry, Department of Psychiatry, New York State Psychiatric Institute and College of Physicians and Surgeons, Columbia University, New York, NY, USA (Marsh); and the Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain (Soriano-Mas).

Funding: Funding for this study was provided by Instituto de Salud Carlos III (ISCIII) (PI12/01306, PI13/01958, PI14/00413, PI16/ 00889), FEDER funds/European Regional Development Fund (ERDF) — a way to build Europe — and AGAUR (2014 SGR 1672). CIBERSAM is an initiative of the Carlos III Health Institute. E. Real was supported by a Juan Rodés contract (JR14/00038), M. Subirà by a Rio Hortega contract (CM15/00189) and C. Soriano- Mas by a Miguel Servet contract (CPII16/00048) from the ISCIII. C. López-Solà was supported by the Ministerio de Educación, Cultura y Deporte de España (FPU12/01636). The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Competing interests: H. Simpson reports royalties from UpToDate, Inc. and Cambridge University Press outside the submitted work.

Contributors: M. Fullana designed the study. P. Alonso, N. Cardoner, E. Real, C. López-Solà, C. Segalàs, M. Subirà and J. Menchón acquired the data, which M. Fullana, X. Zhu, H. Gafalvy, J. Menchón, H. Simpson, R. Marsh and C. Soriano-Mas analyzed. M. Fullana, H. Simpson, R. Marsh and C. Soriano-Mas wrote the article, which all authors reviewed and approved for publication.

DOI: 10.1503/jpn.160215

Correspondence to: M.A. Fullana, Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, Passeig Marítim, 25/29, 08003 Barcelona, Spain; miguelangelfullana@gmail.com