technetium-tc-99m-bicisate and Obsessive-Compulsive-Disorder

This case report describes the successful response to electroconvulsive therapy (ECT) in a patient with an unusual presentation of catatonia, whose onset occurred in the context of an extremely severe form of refractory obsessive-compulsive disorder (OCD). We correlated the clinical improvement in catatonic and OCD symptoms with specific changes in brain function as shown by regional cerebral blood flow scans, neurological soft signs examination, and neuropsychological testing. All assessments were conducted before and after the ECT course. The results strongly suggest that a right hemisphere dysfunction was the neural correlate of our patient's symptoms, and that ECT, by reverting this abnormality, may serve as an effective therapeutic approach for refractory catatonic OCD.

Topics: Behavior; Brain; Catatonia; Cerebrovascular Circulation; Cysteine; Electroconvulsive Therapy; Electroencephalography; Female; Humans; Nervous System Diseases; Neurologic Examination; Neuropsychological Tests; Obsessive-Compulsive Disorder; Organotechnetium Compounds; Psychiatric Status Rating Scales; Psychophysiology; Radiopharmaceuticals; Tomography, Emission-Computed, Single-Photon; Treatment Outcome; Young Adult

Little is known about the neuronal mechanism underpinning the pathophysiology of compulsive hoarding. We report the cerebral blood flow changes in an obsessive-convulsive patient with severe hoarding. The patient showed hyperperfusion of the fronto-temporal region and hypoperfusion of the striatal, the middle cingulate and the medial temporal regions during the stage with severe symptoms. Following improvement from the hoarding behaviors, the extent of hypoperfusion was expanded in the bilateral striatum, the anterior and middle cingulate gyrus. The result may substantiate evidence of the fronto-limbic abnormality involved in the pathophysiology of compulsive hoarding.

Topics: Antipsychotic Agents; Benzodiazepines; Cerebrovascular Circulation; Compulsive Behavior; Cysteine; Diagnostic and Statistical Manual of Mental Disorders; Female; Frontal Lobe; Humans; Image Processing, Computer-Assisted; Limbic System; Obsessive-Compulsive Disorder; Olanzapine; Organotechnetium Compounds; Radiopharmaceuticals; Recovery of Function; Risperidone; Tomography, Emission-Computed, Single-Photon; Young Adult

Neuroimaging studies have suggested that behavior therapy (BT) might change abnormal activity in the frontal-subcortical circuits of the brain in patients with obsessive-compulsive disorder (OCD). However, the results of these studies have been rather inconsistent. The aim of the present study was to use statistical parametric mapping (SPM) analysis to explore the effects of successful BT on regional cerebral blood flow (rCBF) in patients with OCD. Forty-five OCD patients who were treatment-resistant to a single serotonin reuptake inhibitor (SRI) trial were examined. Single photon emission computed tomography (SPECT) using 99mTc-ECD was performed before and after the completion of 12 weeks of BT. Although no significant differences in pre-treatment rCBF were observed between responders and nonresponders to BT, the post-treatment rCBF values in the left medial prefrontal cortex (Brodmann area 10) and bilateral middle frontal gyri (Brodmann area 10) were significantly lower in the responders than in the nonresponders. Furthermore, the baseline rCBF in the bilateral orbitofrontal cortex (OFC) was significantly correlated with the change in the Y-BOCS score among the responders. Our results support the hypothesis that while the OFC may be associated with the BT response, BT may result in changes in rCBF in the medial and middle frontal cortex.

Topics: Adult; Behavior Therapy; Brain; Cysteine; Female; Frontal Lobe; Humans; Image Processing, Computer-Assisted; Male; Obsessive-Compulsive Disorder; Organotechnetium Compounds; Prefrontal Cortex; Psychiatric Status Rating Scales; Tomography, Emission-Computed, Single-Photon; Treatment Outcome