Brain reactivity to specific symptom provocation indicates prospective therapeutic outcome in OCD

Psychiatry Res. 2003 Oct 30;124(2):87-103. doi: 10.1016/s0925-4927(03)00091-x.


A pertinent question in biological psychiatry is what differentiates responders and non-responders to pharmacological treatment. One possibility is that individual differences in the symptomatic spectrum as well as in the underlying biology of the disorder lead to the known 40% failure in pharmacological treatment. Our study aimed to maximize individual brain markers of obsessive-compulsive disorder (OCD) by applying single photon emission computed tomography (SPECT) during a provoked symptomatic state prior to and following treatment. Four brain SPECT scans were obtained from 26 OCD patients prior to and at 6 months of sertraline treatment. At each time point, two SPECT scans were performed in a counterbalanced order of two specific states; one a symptom-provoking condition and the other a relaxed condition. At 6 months of treatment, patients were divided into responders and non-responders according to a predetermined clinical criterion. Prospective responders showed significantly lower brain perfusion in the dorsal-caudal anterior cingulum and higher brain perfusion in the right caudate, when compared to non-responders, only during symptom provocation. When pre- and post-treatment scans during symptom provocation were compared, only responders showed significant change in brain response: increased perfusion in the left anterior temporal cortex and prefrontal cortex at 6 months' treatment. These findings suggest that obtaining functional brain imaging during specific symptom provocation emphasizes individual differences in brain reactivity. Thus can indicate prospective responders to symptom-related treatment in OCD and mark the relevant brain regions for effective response to treatment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Arousal / drug effects
  • Arousal / physiology*
  • Caudate Nucleus / blood supply
  • Caudate Nucleus / diagnostic imaging
  • Caudate Nucleus / drug effects
  • Cerebral Cortex / blood supply*
  • Cerebral Cortex / diagnostic imaging
  • Cerebral Cortex / drug effects
  • Cues
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Gyrus Cinguli / blood supply*
  • Gyrus Cinguli / diagnostic imaging
  • Gyrus Cinguli / drug effects
  • Humans
  • Male
  • Middle Aged
  • Obsessive-Compulsive Disorder / diagnostic imaging*
  • Obsessive-Compulsive Disorder / drug therapy
  • Obsessive-Compulsive Disorder / physiopathology
  • Personality Inventory
  • Prognosis
  • Regional Blood Flow / drug effects
  • Regional Blood Flow / physiology
  • Serotonin Uptake Inhibitors / adverse effects
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Sertraline / adverse effects
  • Sertraline / therapeutic use*
  • Tomography, Emission-Computed, Single-Photon*
  • Treatment Outcome


  • Serotonin Uptake Inhibitors
  • Sertraline