Neural correlates of moral sensitivity in obsessive-compulsive disorder

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Liste des auteurs: Soriano-Mas C
Editeur: AMA American Medical Association
Année de publication: 2012
Journal: Archives of General Psychiatry (0003-990X)
Numéro du volume: 69
Numéro de publication: 7
Page d'accueil: 741
Dernière page: 749
Nombre de pages: 9
ISSN: 0003-990X
Languages: Anglais-Royaume-Uni (EN-GB)


CONTEXT: Heightened moral sensitivity seems to characterize patients
with obsessive-compulsive disorder (OCD). Recent advances in social
cognitive neuroscience suggest that a compelling relationship may exist
between this disorder-relevant processing bias and the functional
activity of brain regions implicated in OCD. OBJECTIVE: To test the
hypothesis that patients with OCD demonstrate an increased response of
relevant ventromedial prefrontal and orbitofrontal cortex regions in a
functional magnetic resonance imaging study of difficult moral decision
making. DESIGN: Case-control cross-sectional study. SETTING: Hospital
referral OCD unit and magnetic resonance imaging facility. PARTICIPANTS:
Seventy-three patients with OCD (42 men and 31 women) and 73 control
participants matched for age, sex, and education level. MAIN OUTCOME
MEASURES: Functional magnetic resonance imaging activation maps
representing significant changes in blood oxygenation level-dependent
signal in response to 24 hypothetical moral dilemma vs nondilemma task
vignettes and additional activation maps representing significant linear
associations between patients' brain responses and symptom severity
ratings. RESULTS: In both groups, moral dilemma led to robust activation
of frontal and temporoparietal brain regions. Supporting predictions,
patients with OCD demonstrated significantly increased activation of the
ventral frontal cortex, particularly of the medial orbitofrontal
cortex. In addition, the left dorsolateral prefrontal cortex and left
middle temporal gyrus were more robustly activated in patients with OCD.
These results were unexplained by group differences in comorbid
affective symptoms. Patients' global illness severity predicted the
relative magnitude of orbitofrontal-striatal activation. The severity of
"harm/checking" symptoms and "sexual/religious" obsessions predicted
the magnitude of posterior temporal and amygdala-paralimbic activation,
respectively. CONCLUSIONS: The neural correlates of moral sensitivity in
patients with OCD partly coincide with brain regions that are of
general interest to pathophysiologic models of this disorder. In
particular, these findings suggest that the orbitofrontal cortex
together with the left dorsolateral prefrontal cortex may be relevant
for understanding the link between neurobiological processes and certain
maladaptive cognitions in OCD.


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