An fMRI study of cognitive planning before and after symptom provocation in pediatric obsessive-compulsive disorder

Fern Jaspers-Fayer; Sarah Yao Lin; John R Best; Anders Lillevik Thorsen; Juliana Negreiros; Elaine Chan; Rhonda Ellwyn; Boyee Lin; Stella de Wit; Odile A van den Heuvel; S Evelyn Stewart

doi:10.1503/jpn.220064

An fMRI study of cognitive planning before and after symptom provocation in pediatric obsessive-compulsive disorder

J Psychiatry Neurosci. 2022 Nov 22;47(6):E409-E420. doi: 10.1503/jpn.220064. Print 2022 Nov-Dec.

Affiliations

¹ From the Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the British Columbia Children's Hospital Research Institute, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway (Thorsen, van den Heuvel); the Centre for Crisis Psychology, University of Bergen, Bergen, Norway (Thorsen); the Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, Amsterdam, Netherlands (de Wit, van den Heuvel); the British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, B.C. (Stewart) ffayer@bcchr.ca.
² From the Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the British Columbia Children's Hospital Research Institute, Vancouver, B.C. (Jaspers-Fayer, S. Yao Lin, Best, Negreiros, Chan, Ellwyn, B. Lin, Stewart); the Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway (Thorsen, van den Heuvel); the Centre for Crisis Psychology, University of Bergen, Bergen, Norway (Thorsen); the Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Department of Psychiatry, Department of Anatomy and Neuroscience, Amsterdam Neuroscience, Amsterdam, Netherlands (de Wit, van den Heuvel); the British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, B.C. (Stewart).

Abstract

Background: Pediatric obsessive-compulsive disorder (OCD) has been associated with poorer planning in laboratory, school and home settings. It is unclear whether this impairment is a standalone cognitive issue or the result of OCD symptoms. No study has examined the influence of provoked distress on planning performance and neural correlates in pediatric OCD.

Methods: Before and after a symptom provocation task, youth with OCD (n = 23; 9 boys; mean age ± standard deviation 15.1 ± 2.6 years) and matched healthy controls (n = 23) completed the Tower of London task during functional MRI scanning.

Results: During planning, participants with OCD recruited the left superior frontal gyrus to a greater extent than healthy controls after symptom provocation (group × time point interaction; t ₄₄ = 5.22, p < 0.001). In a seeded, region of interest-constrained, functional connectivity analysis, we identified greater connectivity between the left superior frontal gyrus and the right middle frontal gyrus, left precuneus and left inferior parietal lobule in participants with OCD than healthy controls. We also identified greater connectivity between the right amygdala and right medial frontal gyrus in patients with OCD than healthy controls, but only before symptom provocation.

Limitations: The fixed-order design of the study and the number of participants taking medication (n = 20) should be noted.

Conclusion: Participants with OCD demonstrated greater amygdalar-cortical connectivity before symptom provocation, while sustaining greater recruitment and connectivity of task-related planning areas throughout the task. These results suggest that brain activity and connectivity is altered after symptom provocation, in the absence of impaired planning performance.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Cognition
Frontal Lobe
Humans
Magnetic Resonance Imaging* / methods
Male
Obsessive-Compulsive Disorder* / diagnostic imaging
Prefrontal Cortex / diagnostic imaging

Grants and funding

CIHR/Canada