Obessive Compulsive Disorder (OCD)

What is Obsessive-Compulsive Disorder?

Obsessive-compulsive disorder (OCD) is the fourth most common neurobiological illness with one in forty adults and one in two hundred children having a lifetime occurrence. OCD is characterized by recurrent, disturbing thoughts (obsessions) and/or repetitive, ritualistic behaviors that the individual feels compelled to perform (compulsions). While individuals with OCD recognize these symptoms as irrational, they have little control over them.

Typical Obsessions or Compulsions

  • Dirt, germs, contamination Excessive handwashing or bathing
  • Fear of acting on aggressive impulses Checking (for potential hazards)
  • Uncomfortable religious or sexual thoughts Repetitive actions such as touching
  • Concern with ordering, arranging, counting. counting, arranging.
    Etiology of OCD

OCD is believed to be a neurobiological illness that affects specific neural pathways in the brain using the neurotransmitter serotonin. Currently there is significant research that is trying to pinpoint the pathways and neurobiological mechanisms involved. One of the research tool which holds significant promise for characterizing the OCD pathway is functional magnetic resonance imaging fMRI.

Available Treatment

While impairment caused by OCD ranges from mild to severe, many people with OCD will require treatment. Two types of treatment have been demonstrated to be helpful: Cognitive Behavioral Therapy (CBT) and medication. Selective serotonin reuptake inhibitors (SSRI's) including fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil), sertraline (Zoloft), and clomipramine (Anafranil) have been approved for the treatment of OCD. In spite of the improvement in medication therapy for people with OCD, a significant number do not respond to several trials of medication.

Using Functional MRI to Predict and Assess Treatment Response

Goal of the OCD fMRI Project

This study is designed to add an innovative research tool, functional magnetic resonance imaging (fMRI), to a clinical trial involving patients with treatment-refractory OCD. We predict that fMRI can be successfully used as a new clinical approach: (1) to predict and follow the response of individuals with OCD to new pharmacological therapies such as IV clomipramine and (2) to augment our knowledge base concerning the neurobiology of OCD. To use fMRI to increase our understanding of the neurobiology of OCD

Imaging Protocol

These subjects will undergo fMRI scanning the day prior to starting the pharmacological study and then four days after receiving the loading dose. Each research subject will then again be scanned at the end of the three month treatment period. While in the scanner, the subjects will perform cognitive and behavioral tasks that assess key information processing abilities of individuals with OCD.

Proposed Results

  1. Baseline brain activation patterns associated with the first scan will provide critical knowledge about activation in the frontal-striatal neural circuit thought to be involved in the etiology of OCD. Detection of varying patterns of frontal- striatal activation in individuals with OCD will provide information about biological mechanisms that underlie heterogeneity in this condition.
  2. The characterization of OCD as a deficit in a neurobiological pathway will lead to more accurate diagnosis of this illness as well as a better understanding of the symptoms and associated neurocognitive deficits.
  3. Scans obtained after IV clomipramine will demonstrate differential brain activation patterns, indicating dynamic changes that occur in OCD-specific neural pathways with treatment. The third set of fMRI scans will monitor long-term changes in brain activation that correspond to treatment response.

This proposal will help pioneer a state-of-the-art diagnosis and treatment design that utilizes an innovative treatment modality for refractory OCD (using I.V. clomipramine as a loading dose prior to oral treatment) and advanced neuroimaging technology (high resolution fMRI). Functional MRI does not expose an individual to ionizing radiation, and thus has the potential to be used widely as a clinical tool. The combination of innovative psychopharmacology with neuroimaging technology will result in a powerful and comprehensive treatment approach for individuals with OCD and other neuropsychiatric disorders.