Altered reward-related effective connectivity in obsessive-compulsive disorder: an fMRI study

Altered reward-related effective connectivity in obsessive-compulsive disorder: an fMRI study

J Psychiatry Neurosci 2019;44(6):395-406 | PDF

Ana Alves-Pinto, PhD; Oana Georgiana Rus, PhD; Tim Jonas Reess, PhD; Afra Wohlschläger, PhD; Gerd Wagner, PhD; Götz Berberich, MD; Kathrin Koch, PhD

Background: Obsessive–compulsive disorder (OCD) is characterized by anxiety-provoking, obsessive thoughts. Patients usually react to these thoughts with repetitive behaviours that reduce anxiety and are perceived as rewarding. Hence, reward plays a major role in the psychopathology of OCD. Previous studies showed altered activation in frontostriatal networks, among others, in association with the processing of reward in patients with OCD. Potential alterations in connectivity within these networks have, however, barely been explored.

Methods: We investigated a sample of patients with OCD and healthy controls using functional MRI and a reward learning task presented in an event-related design. Dynamic causal modelling (DCM) was used to estimate effective connectivity.

Results: Our sample included 37 patients with OCD and 39 healthy controls. Analyses of task-related changes in connectivity showed a significantly altered effective connectivity between the ventromedial prefrontal cortex (vmPFC) and the orbitofrontal cortex (OFC), among others, both in terms of endogenous connectivity as well as modulatory effects under positive feedback. Clinical measures of compulsion correlated with the effect of feedback input on visual sensory areas.

Limitations: The reported alterations should be interpreted within the context of the task and the a priori–defined network considered in the analysis.

Conclusion: This disrupted connectivity in parts of the default mode network and the frontostriatal network may indicate increased rumination and self-related processing impairing the responsiveness toward external rewards. This, in turn, may underlie the general urge for reinforcement accompanying compulsive behaviours.


Submitted Oct. 18, 2018; Revised Jan. 16, 2019; Accepted Jan. 28, 2019; Published online Apr. 9, 2019

Acknowledgement: This work was supported by the German Research Foundation (DFG) and the Technical University of Munich within the funding programme Open Access Publishing.

Affiliations: From the Department of Neuroradiology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (Rus, Reess, Wohlschläger, Koch); the TUM-Neuroimaging Center (TUM-NIC) School of Medicine of Klinikum rechts der Isar, Technische Universität München TUM, Ismaninger Strasse 22, 81675 Munich, Germany (Rus, Reess, Wohlschläger, Koch); the Research Unit of the Buhl-Strohmaier Foundation for Pediatric Neuroorthopaedics and Cerebral Palsy, Department of Orthopedics and Sports Orthopedics, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany (Alves-Pinto); the Graduate School of Systemic Neurosciences GSN, Ludwig-Maximilians-Universität, Biocenter, Munich, Germany (Rus, Reess, Koch); the Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany (Wagner); the Windach Institute and Hospital of Neurobehavioural Research and Therapy (WINTR), Windach, Germany (Berberich); and the Department of Neuroradiology, University of Zürich, Zürich, Switzerland (Rus).

Funding: This study was supported by a Deutsche Forschungsgemeinschaft grant to K. Koch (KO 3744/2-1) and G. Wagner (WA3001/3-1).

Competing interests: None declared.

Contributors: O. Rus, G. Wagner, G. Berberich and K. Koch designed the study. O. Rus, T. Reess, G. Berberich and K. Koch acquired the data, which A. Alves-Pinto, A. Wohlschläger and K. Koch analyzed. A. Alves-Pinto and K. Koch wrote the article, which all authors reviewed. All authors approved the final version to be published and can certify that no other individuals not listed as authors have made substantial contributions to the paper.

DOI: 10.1503/cjs.180195

Correspondence to: A. Alves-Pinto, Department of Orthopedics and Sports Orthopedics, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaningerstr 22, 81675 Munich, Bavaria, Germany; ana.alves-pinto@tum.de