OCD

<p>Post-traumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety.
• The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.
• Mood changes (Emotionally Labile).
• Changes in social behavior.
• Changes in personality.
• Diminished Executive Functions.
Obsessive-Compulsive Disorder and Traumatic Brain Injury: Behavioral, Cognitive, and Neuroimaging Findings. Marcelo L. Berthier, M.D., Jaime Kulisevsky, M.D., Alexandre Gironell, M.D., and Oscar L. López, M.D. Dept of Medicine and Dermatology, University of Malaga, Malaga, Spain; Dept of Neurology, Sant Pau Hospital, Autonomous University of Barcelona, Barcelona, Spain; and Dept of Neurology and Alzheimer’s Disease Research Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania</p>

<p>From: <a href="https://neurocritic.blogspot.com/2011/04/mental-imagery-and-right-parietal-lobe.html">The Neurocritic: Mental Imagery and the Right Parietal Lobe in OCD</a></p>

<p>Neuroanatomical circuit models of the underlying brain dysfunction have implicated fronto-striatal loops that control thoughts and actions. For example, OCD has been associated with overactivity in the <a href="http://en.wikipedia.org/wiki/Orbitofrontal_cortex">orbitofrontal cortex</a> (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18061263">Menzies et al., 2008</a>), overactive error monitoring processes in the <a href="http://en.wikipedia.org/wiki/Anterior_cingulate_cortex">anterior cingulate cortex</a> (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15691530">Fitzgerald et al., 2005</a>), and reduced activation in dorsal prefrontal-striatal regions during planning (<a href="http://www.ncbi.nlm.nih.gov/pubmed/15753243">van den Heuvel et al., 2005</a>) and task switching (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18065438">Gu et al., 2008</a>). In summary, OCD has been conceptualized as an impulse control disorder marked by a breakdown of high-level executive control over behavior.

However, a new study by <a href="http://dx.doi.org/10.1016/j.bandc.2011.03.020">Koçak et al. (2011)</a> has expanded the range of cognitive processes and brain regions that might be implicated in OCD. </p>

<p>From: <a href="https://www.sciencedirect.com/science/article/pii/S2444866416300319">Cognitive and emotional impairments in obsessive–compulsive disorder: Evidence from functional brain alterations - ScienceDirect</a></p>

<p id="par0315">OCD patients show alterations in connectivity in regions associated with the CSTC pathways, with evidence for a dissociation/imbalance between patterns of connectivity in the dorsal versus ventral CSTC loops.</p>

</dd>

<p id="par0320">There is also evidence for connectivity abnormalities between CSTC loops and other brain regions.</p>

</dd>

<p id="par0325">Different nodes of the DMN showed altered connectivity in OCD.</p>

</dd>

<p id="par0330">There is evidence for altered connectivity in several resting state brain networks (e.g., top-down network, salience network, fronto-parietal network).</p>

</dd>

<p id="par0335">Impaired inhibitory control in OCD has been associated with functional abnormalities in the CSTC loops, and fronto-parietal networks. Additionally, anterior cingulate seems to be particularly active in overmonitoring performance in these tasks.</p>

</dd>

<p id="par0340">OCD's cognitive flexibility impairments are related with decreased activations not only in the OCD loops but also extended temporal, parietal and <a title="Learn more about Occiput" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/occiput">occipital regions</a>.</p>

</dd>

<p id="par0345">Working memory performance in OCD patients is affected by functional abnormalities in the CSTC and frontal parietal networks. Again, the dorsal anterior cingulate seems to modulate the activity the remaining brain regions during the course of working memory tasks.</p>

</dd>

<p id="par0350">The predominance of fear/defensive affective motivational system is associated with increased amygdala responsiveness but also increased activity in additional brain regions associated with perceptual (e.g., parietal, occipital) and higher level cognitive processing (e.g. prefrontal, temporal).</p>

</dd>

<p id="par0355">Increased activity in the insula seems to be a brain marker of increased OCD sensitivity to disgust, while propensity for shame and guilt may be attributed to an increase in widespread brain (e.g. frontal, limbic, temporal) and a deactivation in other regions such as the middle frontal gyrus and inferior parietal <a title="Learn more about Lobe (anatomy)" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/lobe-anatomy">lobe</a> (shame) and anterior cingulate (guilt).</p>

</dd>

</dl>

<p id="par0360">The studies reported here bring evidence for regional and <a title="Learn more about Resting state fMRI" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/resting-state-fmri">connectivity functional</a>abnormalities evident during resting state and task conditions that may help understand OCD as both an emotional (i.e., anxiety) and cognitive (i.e. inhibitory control) disorder with a diversity of psychological and symptomatic expressions. Despite this evidence little is known about the specificity of the present results for OCD. It remains to be known if these findings are transdiagnostic to other psychiatry disorders (particularly within the OCRD and anxiety spectra). Additionally, distinct OCD subtypes (e.g., washers, hoarders, checkers) and <a title="Learn more about Endophenotype" href="https://www.sciencedirect.com/topics/medicine-and-dentistry/endophenotype">endophenotypes</a> (genetic risk versus environmental) were reported to be associated with specific brain activation patterns.<a class="workspace-trigger" href="https://www.sciencedirect.com/science/article/pii/S2444866416300319#bib0865" name="bbib0865">86</a>, <a class="workspace-trigger" href="https://www.sciencedirect.com/science/article/pii/S2444866416300319#bib0870" name="bbib0870">87</a> Future studies should try to differentiate distinct OCD subtypes and endophenotypes as well as including as comparison groups from other psychiatry disorders within and outside the OCRD and anxiety spectra.</p>

<p>From: <a href="https://www.ncbi.nlm.nih.gov/pubmed/15276956">Obsessive-compulsive disorder after traumatic brain injury. - PubMed - NCBI</a></p>

<p>Traumatic brain injury ( TBI) neuropsychiatric sequelae are a significant cause of morbidity in TBI victims. Among the recognized sequelae are anxiety, obsessions, compulsions and obsessive-compulsive disorder (OCD). This review addresses the emergence of OCD and OCD symptoms after TBI with an emphasis on neural circuits that underlie OCD symptom expression that may be affected by the injury. Current studies suggest that post-TBI emergent psychopathology, including OCD, is influenced by underlying sub-clinical diathesis, brain injury lesions sites, environmental stressors and the rehabilitation process. Pre-morbid status can be obtained by structured psychiatric interviews, and TBI brain lesions can be defined with advanced neuroimaging techniques. This information along with the management of family and environmental stressors and the enhanced clinical identification of symptoms of anxiety and OCD can be used in the rehabilitation process to improve prognosis after TBI.</p>

<p>From: <a href="https://www.ncbi.nlm.nih.gov/pubmed/11234906">Obsessivecompulsive disorder and traumatic brain injury: behavioral, cognitive, and neuroimaging findings. - PubMed - NCBI</a></p>

<h4>OBJECTIVE:</h4>

<p>The goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disorder (OCD) after suffering a traumatic brain injury (TBI).</p>

<h4>BACKGROUND:</h4>

<p>Because OCD is a rare sequelae of TBI, the phenomenology of obsessions and compulsions, the comorbid psychiatric disorders, the performance on cognitive tests, and the neural correlates have not been well characterized.</p>

<h4>METHODS:</h4>

<p>Ten adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were studied using structured psychiatric rating scales (i.e., Yale-Brown Obsessive Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI).</p>

<h4>RESULTS:</h4>

<p>Global severity of OCD ranged from moderate to severe, and all patients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sexual obsessions as well as cleaning/washing, checking, and repeating compulsions. Unusual features such as obsessional slowness (3 cases) and compulsive exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests of general intelligence, attention, learning, memory, word-retrieval, and executive functions; these cognitive deficits were more pervasive among patients displaying obsessional slowness. All OCD patients with mild TBI had normal MRI scans, whereas focal contusions in the frontotemporal cortices, subcortical structures (caudate nucleus), or both were found in OCD patients with moderate and severe TBI.</p>

<h4>CONCLUSIONS:</h4>

<p>Posttraumatic OCD has a relatively specific pattern of symptoms even in patients with mild TBI and is associated with a variety of other psychiatric disorders, particularly non-OCD anxiety. The patterns of cognitive deficits and MRI findings suggest dysfunction of frontal-subcortical circuits.</p>

<p>From: Obsessive-Compulsive Disorder following Brain Injury: A Review <a href="http://journals.sagepub.com/doi/abs/10.2190/XENN-NNWT-7N2K-R26A?journalCode=ijpb">SAGE Journals: Your gateway to world-class journal research</a></p>

<p>This article reviews obsessive-compulsive disorder (OCD) following acquired brain injury. OCD type symptomatology without any other cognitive, behavioral, or emotional problems following a brain injury appears to be rare. However, the first onset of obsessions and compulsions following a brain injury has been described, but cognitive impairments can potentially color the presentation.</p>

<h2 class="sectionHeading">Method:</h2>

</div>

<p>This article reviews obsessive-compulsive disorder (OCD) after brain injury, including traumatic brain injury, cerebrovascular accidents, brain tumors and brain infections. Overlapping symtomatology between OCD and brain injury is discussed.</p>

<h2 class="sectionHeading">Results:</h2>

</div>

<p>Findings regarding the neuro-imaging of OCD after brain injury are reviewed and integrated with neuropsychological data from studies with idiopathic OCD.</p>

<h2 class="sectionHeading">Conclusion:</h2>

<p>There appears to be some convergance between findings from studies of the neuropsychology of idiopathic OCD and neuro-imaging of OCD following brain injury.</p>

</div>

<p>Find article on grasping and replay correlates tbi cfs</p>