Altered response to risky decisions and reward in patients with obsessive–compulsive disorder

Altered response to risky decisions and reward in patients with obsessive–compulsive disorder

J Psychiatry Neurosci 2020;45(2):98-107 | PDF | Appendix

Pedro Silva Moreira, MSc, PhD; Julian Macoveanu, MSc, PhD; Paulo Marques, MEng, PhD; Ana Coelho, MEng; Ricardo Magalhães, MEng, PhD; Hartwig R. Siebner, MD, DMSc; José Miguel Soares, MEng, PhD; Nuno Sousa, MD, PhD; Pedro Morgado, MD, PhD

Background: Patients with obsessive–compulsive disorder (OCD) employ ritualistic behaviours to reduce or even neutralize the anxiety provoked by their obsessions. The presence of excessive rumination and indecision has motivated the view of OCD as a disorder of decision-making. Most studies have focused on the “cold,” cognitive aspects of decision-making. This study expands current understanding of OCD by characterizing the abnormalities associated with affective, or “hot” decision-making.

Methods: We performed a functional MRI study in a sample of 34 patients with OCD and 33 sex- and age-matched healthy controls, during which participants made 2-choice gambles taking varying levels of risk.

Results: During risky decisions, patients showed significantly reduced task-related activation in the posterior cingulum, lingual gyrus and anterior cingulate cortex. We identified significant group × risk interactions in the calcarine cortex, precuneus, amygdala and anterior cingulate cortex. During the outcome phase, patients with OCD showed stronger activation of the orbitofrontal cortex, anterior cingulate cortex and putamen in response to unexpected losses.

Limitations: The group of patients not receiving medication was very small (n = 5), which precluded us from assessing the effect of medication on risk-taking behaviour in these patients.

Conclusion: Obsessive–compulsive disorder is associated with abnormal brain activity patterns during risky decision-making in a set of brain regions that have been consistently implicated in the processing of reward prediction errors. Alterations in affective “hot” processes implicated in decision-making may contribute to increased indecisiveness and intolerance to uncertainty in patients with OCD.


Submitted Nov. 16, 2018; Revised Mar. 27, 2019; Accepted Apr. 29, 2019; Published online Sept. 11, 2019

Acknowledgements: The authors thank Edward Ganz, MD, for his assistance in reviewing the English language of the manuscript.

Affiliations: From the Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the ICVS/3Bs, PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Clinical Academic Centre, Braga, 4710-057 Braga, Portugal (Moreira, Marques, Coelho, Magalhães, Soares, Sousa, Morgado); the Psychiatric Centre Copenhagen, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark (Macoveanu); the Danish Research Centre for Magnetic Resonance, Centre for Functional and Diagnostic Imaging and Research, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650 Hvidovre, Denmark (Macoveanu, Siebner); the Department of Neurology, Copenhagen University Hospital Bispebjerg, Bispebjerg Bakke 23, 2400 København, Denmark (Siebner); and the Institute for Clinical Medicine, Faculty of Medical and Health Sciences, University of Copenhagen, Copenhagen, Denmark (Siebner).

Funding: P. Moreira and R. Magalhães are supported by FCT fellowship grants (PhD-iHES program) with the references PDE/BDE/113601/2015 and PDE/BDE/113604/2015, respectively. P. Marques was funded by the Fundação Calouste Gulbenkian (Contract grant number P-139977, project “Better mental health during aging based on temporal prediction of individual brain aging trajectories [TEMPO]”). A. Coelho is supported by a scholarship from the project NORTE-08-5639-FSE-000041 (Norte Portugal Regional Operational Programme, NORTE 2020; UMINHO/BD/51/2017). The present work was supported by SwitchBox-FP7-HEALTH-2010 grant 259772-2 and cofinanced by the Portuguese North Regional Operational Program (ON.2 – O Novo Norte) under the National Strategic Reference Framework (QREN), through the European Regional Development Fund (FEDER). H. Siebner holds a 5-year professorship in precision medicine at the Faculty of Health Sciences and Medicine, University of Copenhagen, which is sponsored by the Lundbeck Foundation (grant no. R186-2015-2138).

Competing interests: H. Siebner has received honoraria as a speaker from Sanofi Genzyme and Novartis, as a consultant from Sanofi Genzyme, and as a senior editor (NeuroImage) from Elsevier. He has received royalties as a book editor from Springer. P. Moreira, J. Macoveanu, P. Marques, A. Coelho, R. Magalhães, J. Soares, N. Sousa and P. Morgado declare no competing interests.

Contributors: J. Macoveanu, H. Siebner, J. Soares, N. Sousa and P. Morgado designed the study. P. Moreira, P. Marques, R. Magalhães and J. Soares acquired the data, which P. Moreira, P. Marques, A. Coelho, H. Siebner, N. Sousa and P. Morgado analyzed. P. Moreira, P. Marques and A. Coelho 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/jpn.180226

Correspondence to: P.S. Moreira, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Campus Gualtar, 4710-057 Braga, Portugal; pedromsmoreira@gmail.com