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