Slick detective work is essential when it comes to understanding the neurobiology of OCD. But the hopeful part comes with how that work translates into relief. I mean, scientists can talk a good game, but who can’t? What say we get down to cases…
The docs then introduce the question: Can imaging be used to direct or predict treatment response? Well, just like using a brain scan to diagnose an individual case of OCD, which we discussed in Part 1…
Part 1 of our series handled the former. Now it’s time to address the latter.
Advances in Understanding the Neurobiology of OCD: Treatment Impact
As they did when discussing advances in understanding the neurobiology of obsessive-compulsive disorder (OCD), Grant and Chamberlain cleverly open their discussion of the impact on treatments with a vignette…
Joseph is 28 and has a 10-year history of severe OCD. Of particular significance are contamination obsessions and washing compulsions, extensive procrastination, and repetitive list-making/doodling. Joseph is incapacitated by his illness and has difficulty leaving the house to work or socialize. Joseph has been treated with assorted selective serotonin reuptake inhibitors (SSRIs), on occasion augmented by a low-dose antipsychotic and n-acetylcysteine. He’s also participated in extensive cognitive behavioral therapy (CBT) using exposure and response prevention.
After an ethics board review and approval, and making sure he understood risks and benefits, Joseph underwent a neurosurgical procedure to implant electrodes targeting his brain’s nucleus accumbens.
Some six months following this deep brain stimulation (DBS), and continuation of meds and CBT, Joseph reported a significant improvement in symptoms. He was even able to leave his home for work and social activities. With ongoing treatment, Joseph’s relief continued three years post-surgery.
According to Dr. Grant and Dr. Chamberlain, progression in neuroimaging has brought advances in the understanding of the neurobiology of OCD.
Still, how does that translate into the expansion of treatment approaches?
If you endure OCD, I’m thinking you know that current first-line, evidence-based treatments include SSRIs and/or CBT featuring exposure response prevention.
Grant and Chamberlain cite a recent systematic review and meta-analysis that indicates this approach shows superiority over placebo for the treatment of adult OCD. Fact is, these treatments have been used for over 30 years and haven’t been altered by advancing neurobiological research.
Neuroimaging has presented insights into brain mechanisms by which treatments may improve OCD. Study data show that structural and functional brain changes associated with OCD symptoms normalize to a degree with efficacious meds and psychotherapy treatment.
The docs then introduce the question: Can imaging be used to direct or predict treatment response?
Well, just like using a brain scan to diagnose an individual case of OCD, which we discussed in Part 1, there’s no existing evidence that treatment can be usefully predicted.
But the docs say that algorithms for treatment response can be built, including the ability to predict response to psychotherapy. Thing is, the approaches have yet to be generalized or show usefulness at the individual patient level in clinical practice. Sounds like there’s hope for the future, though.
More on Neurosurgical Techniques
As in Joseph’s deep brain stimulation or gamma ventral capsulotomy, neurosurgical techniques are at times used in the toughest treatment-resistant OCD cases. Well, results vary, to include no help at all.
That reality has led to researchers addressing the improvement of neurosurgical interventions based upon a more detailed understanding of the neurobiology of OCD.
For instance, a recent study used a clinical assessment and symptomatic provocation during functional MRI to enhance electrode placement for DBS in a sample of patients.
Let’s Wrap It Up
That three-pound mass of tissue and fluid encased in our skulls: I can’t think of anything more mysterious in the entire universe. And, of course, if you’re doing all you can to live with OCD – any emotional/mental disorder – mystery is the last thing you need.
Yes, I find work like Dr. Grant’s and Dr. Chamberlain’s slick and hopeful. And the cool thing is, they’re doing the investigative reporting on the creative and brilliant research work that marches onward.
For my money, that’s reason for tons of optimism.
Be sure to read Dr. Grant’s and Dr. Chamberlain’s article in Psychiatric Times – Exploring the Neurobiology of OCD: Clinical Implications
Hundreds and hundreds of Chipur mood and anxiety disorder-focused articles are waiting patiently for you. Do yourself a favor and check-out the titles.