Elsevier

Progress in Neurobiology

Volume 72, Issue 3, February 2004, Pages 195-221
Progress in Neurobiology

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

https://doi.org/10.1016/j.pneurobio.2004.02.004Get rights and content

Abstract

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.

Section snippets

General considerations

Obsessive–compulsive disorder (OCD) has long been considered a pathological model for which diverse theoretical constructs developed on the basis of numerous clinical observations have been proposed (Thompson et al., 1992). The new imaging techniques, such as positron emission tomography and functional magnetic resonance imaging, along with the recent clinical neuropsychological methods, which have been developed in the last 20 years, have made it possible to assess brain function

Brain regions of interest in OCD

In this section, we examine the evidence collected from separate and complementary approaches (phenomenology, neuropsychology, neuroimunology and neuroimagery) suggesting the involvement of specific brain regions in the pathophysiology of OCD.

Anatomo-functional approach in OCD

This section interprets the data collected with neuropsychological, neuroimmunologic and imaging studies in OCD patients in the light of our current knowledge of cortical and basal ganglia interactions.

The association of OCD with Parkinson’s disease and TS has long suggested that the basal ganglia play a central role in the pathogenesis of OCD (for review, see Saint-Cyr et al., 1995, Robertson, 2000, Jankovic, 2001, Mink, 2001). It has been postulated that a dysregulation in the circuits

Towards OCD models

To date, various OCD models have been proposed (Modell et al., 1989, Baxter, 1999; for review, see Schwartz, 1999). All point to a dysfunctioning of the loops connecting the limbic areas of the prefrontal cortex (orbitofrontal and cingulate) and basal ganglia through the medial thalamus, but each underlines a particular aspect of information processing disruption.

Impact and perspectives

The OCD represents the psychiatric pathology whose mechanisms are at present the best understood, thanks to ongoing progress in our knowledge of the physiology of the basal ganglia and of their pharmacologic reaction, on one hand, and on the other, to considerable advances in functional imaging and neuropsychology.

The demonstration of functional anatomical substrates involving cortico-subcortical circuits relatively similar to those regulating motor function raises the question of the eventual

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