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Doubt in the insula: risk processing in obsessive-compulsive disorder

機(jī)譯：懷疑：強(qiáng)迫癥的風(fēng)險(xiǎn)處理

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摘要

Extensive cleaning or checking of patients with obsessive-compulsive disorder (OCD) are often interpreted as strategies to avoid harm and as an expression of the widespread belief that OCD patients are more risk-averse. However, despite its clinical significance, the neural basis of risk attitude in OCD is unknown. Here, we investigated neural activity during risk processing using functional magnetic resonance imaging and simultaneously assessed risk attitude using a separate behavioral paradigm in OCD patients with different symptoms versus healthy controls (HCs). We found opposite insula responses to high versus low risk in OCD patients compared to HCs: a positive correlation between insula activity and risk-aversion in patients versus a negative correlation in controls. Although OCD patients overall were not more risk-averse than controls, there were differences between subgroups of OCD patients: patients with doubt/checking symptoms were more risk-averse than other patients. Taken together, OCD patients show a reversed pattern of risk processing by the insula compared to HCs. Moreover, the data suggest that increased activation of the insula signals an abnormal urge to avoid risks in the subpopulation of OCD patients with doubt and checking symptoms. These results indicate a role for the insula in excessive risk-avoidance relevant to OCD.
機(jī)譯：強(qiáng)迫癥（OCD）患者的廣泛清潔或檢查通常被解釋為避免傷害的策略，并且被廣泛認(rèn)為是強(qiáng)迫癥患者更傾向于風(fēng)險(xiǎn)。然而，盡管具有臨床意義，但OCD中風(fēng)險(xiǎn)態(tài)度的神經(jīng)基礎(chǔ)尚不清楚。在這里，我們調(diào)查了功能磁共振成像在風(fēng)險(xiǎn)處理過(guò)程中的神經(jīng)活動(dòng)，并同時(shí)使用單獨(dú)的行為范例評(píng)估了癥狀不同的強(qiáng)迫癥患者與健康對(duì)照（HCs）的風(fēng)險(xiǎn)態(tài)度。我們發(fā)現(xiàn)，與HCs相比，強(qiáng)迫癥患者對(duì)高風(fēng)險(xiǎn)和低風(fēng)險(xiǎn)的胰島素反應(yīng)相反：患者的胰島素活性與風(fēng)險(xiǎn)規(guī)避之間呈正相關(guān)，而對(duì)照組則呈負(fù)相關(guān)。盡管總體而言，強(qiáng)迫癥患者沒(méi)有比對(duì)照組更大的風(fēng)險(xiǎn)規(guī)避性，但強(qiáng)迫癥患者亞組之間存在差異：具有疑問(wèn)/檢查癥狀的患者比其他患者更具風(fēng)險(xiǎn)規(guī)避性。綜上所述，與HCs相比，OCD患者顯示出與絕緣體相反的風(fēng)險(xiǎn)處理模式。此外，數(shù)據(jù)表明，島突的激活增強(qiáng)表明有異常的沖動(dòng)，以避免懷疑和檢查癥狀的強(qiáng)迫癥患者亞群的風(fēng)險(xiǎn)。這些結(jié)果表明，絕緣體在與強(qiáng)迫癥相關(guān)的過(guò)度風(fēng)險(xiǎn)規(guī)避中發(fā)揮了作用。

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