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Title: Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial
Authors: Hoexter, Marcelo Queiroz [UNIFESP]
Souza Duran, Fabio Luis de
D'Alcante, Carina Chaubet
Dougherty, Darin Dean
Shavitt, Roseli Gedanke
Lopes, Antonio Carlos
Diniz, Juliana Belo
Deckersbach, Thilo
Batistuzzo, Marcelo Camargo
Bressan, Rodrigo Affonseca [UNIFESP]
Miguel, Euripedes Constantino
Busatto, Geraldo Filho
Universidade de São Paulo (USP)
Universidade Federal de São Paulo (UNIFESP)
Harvard Univ
Keywords: OCD
magnetic resonance imaging
serotonin reuptake inhibitors
cognitive-behavior therapy
randomized clinical trial
Issue Date: 1-Feb-2012
Publisher: Nature Publishing Group
Citation: Neuropsychopharmacology. London: Nature Publishing Group, v. 37, n. 3, p. 734-745, 2012.
Abstract: Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n = 38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n = 36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n = 26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n = 13), whereas no significant GM volume changes were observed in CBT-treated patients (n = 13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action. Neuropsychopharmacology (2012) 37, 734-745; doi: 10.1038/npp.2011.250; published online 26 October 2011
ISSN: 0893-133X
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