Pathophysiology of obsessive-compulsive disorder - A necessary link between phenomenology, neuropsychology, imagery and physiology

被引:259
作者
Aouizerate, B
Guehl, D
Cuny, E
Rougier, A
Bioulac, B
Tignol, J
Burbaud, P
机构
[1] Univ Bordeaux 2, Ctr Hosp Pellegrin, Serv Neurophysiol Clin, CNRS,UMR 5543, F-33076 Bordeaux, France
[2] Univ Bordeaux 2, Ctr Hosp Charles Perrens, Ctr Carreire, Serv Psychiat Adultes, F-33076 Bordeaux, France
[3] Univ Bordeaux 2, Ctr Hosp Pellegrin, Serv Neurochirurg, F-33076 Bordeaux, France
关键词
D O I
10.1016/j.pneurobio.2004.02.004
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Obsessive-compulsive disorder (OCD) is characterized by repetitive intrusive thoughts and compulsive time-consuming behaviors classified into three to five distinct symptom dimensions including: (1) aggressive/somatic obsessions with checking compulsions; (2) contamination concerns with washing compulsions; (3) symmetry obsessions with counting/ordering compulsions; (4) hoarding obsessions with collecting compulsions; and (5) sexual/religious concerns. Phenomenologically, OCD could be thought of as the irruption of internal signals centered on the erroneous perception that "something is wrong" in a specific situation. This generates severe anxiety, leading to recurrent behaviors aimed at reducing the emotional tension. In this paper, we examine how the abnormalities in brain activity reported in OCD can be interpreted in the light of physiology after consideration of various approaches (phenomenology, neuropsychology, neuroimmunology and neuroimagery) that contribute to proposing the central role of several cortical and subcortical regions, especially the orbitofrontal cortex (OFC). the anterior cingulate cortex (ACC), the dorsolateral prefrontal cortex (DLPC), the head of the caudate nucleus and the thalamus. The OFC is involved in the significance attributed to the consequences of action, thereby subserving decision-making, whereas the ACC is particularly activated in situations in which there are conflicting options and a high likelihood of making an error. The DLPC plays a critical part in the cognitive processing of relevant information. This cortical information is then integrated by the caudate nucleus. which controls behavioral programs. A dysfunction of these networks at one or several stages will result in the emergence and maintenance of repetitive thoughts and characteristic OCD behavior. (C) 2004 Elsevier Ltd. All rights reserved.
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页码:195 / 221
页数:27
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