Neuroscientifically Informed Formulation and Treatment Planning for Patients with Obsessive-Compulsive Disorder: A Review
- Type: #article
- Year read:#read2018
- Subject: (in brackets, can also bracket keywords in text)
- Bibtex: @dougherty2018
- Bibliography: Dougherty, D. D., Brennan, B. P., Evelyn Stewart, S., Wilhelm, S., Widge, A. S., & Rauch, S. L. (2018). Neuroscientifically Informed Formulation and Treatment Planning for Patients With Obsessive-Compulsive Disorder: A Review. JAMA Psychiatry . https://doi.org/10.1001/jamapsychiatry.2018.0930
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Within negative-valence systems, both acute threat (fear) and potential threat (anxiety) are implicated in OCD. Numerous studies have demonstrated abnormal activation of fear circuitry during exposure to aversive stimuli in patients with OCD.7 Regarding anxiety, patients with OCD have elevated anxiety sensitivity and over- estimation of threat compared with healthy individuals.8 Other negative-valence abnormalities seen in OCD include attentional bias9 and intolerance of uncertainty.10 Another important group of constructs and subconstructs that is likely involved in the pathophysiology of OCD is the positive-valence system, specifically, reward learning and responsiveness to reward. Individuals with OCD are hypervigilant to reward feedback and opt for immediate relief (reduction of anxiety) at the cost of longer-term benefit (quality of life).11 In other words, patients with OCD seem unable to modulate their future behavior based on immediate feedback. Related to this, Habits formation appears to be abnormal in patients with OCD. In a neurocomputational study by Valerie Voon et al,12 the inves- tigators found that patients with OCD made choices based on model-free (ie, habit) vs model-based (ie, executive control) learn- ing. Finally, deficits within the cognitive systems, namely cognitive control13 and response selection, inhibition, or suppression,14 have been demonstrated in patients with OCD.