Overlapping Neural Circuits in Pediatric OCD
Study Details
Study Description
Brief Summary
The purpose of this study is to examine the brain functioning of children and adolescent with OCD before and after treatment with Exposure and Response Prevention (EXRP) therapy.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
The capacity to coordinate thoughts and actions to execute goal-directed behaviors (cognitive control) and the capacity to anticipate, respond to, and learn from reward (reward processing) are key processes for human behavior. Dysfunction in these processes has been hypothesized to contribute to repetitive thoughts and behaviors in many disorders, including obsessive-compulsive disorder (OCD), Tourette Syndrome (TS), and eating disorders. The investigators will use multimodal imaging to investigate neural circuits that support cognitive control and reward processing, using pediatric OCD as a model system. The short-term goal is to clarify how circuit-based abnormalities contribute to repetitive thoughts/behaviors; these data will inform future trans-diagnostic studies. The long-term goal is to identify control and reward circuit-abnormalities as targets for new trans-diagnostic treatments.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: OCD Participants will have a current diagnosis of OCD. |
Behavioral: Exposure & Response Prevention (EX/RP) and when indicated medication treatment
Cognitive Behavioral Therapy (CBT) for OCD involves gradually exposing patients to anxiety provoking stimuli while having patients refrain from engaging in compulsive rituals and/or avoidance behaviors. There are three major components of CBT treatment for OCD, specifically: (1) exposure to anxiety provoking stimuli, (2) response prevention, and (3) cognitive techniques intended to decrease anxiety during the exposure and response prevention processes.
|
Outcome Measures
Primary Outcome Measures
- Change from baseline in brain activation (fMRI) after therapy [Baseline & approximately 16-20 weeks later]
The goal of this study is to use multimodal MRI to assess the functioning and structure of overlapping frontostriatal circuits in a large sample of unmedicated children and adolescents diagnosed with OCD before and after CBT. The brain activity of children and adolescents diagnosed with OCD will be compared to age matched healthy controls during performance of the simon task and our virtual reality (VR)-based assessment of multiple learning and memory systems. In addition, functional connectivity within frontostriatal circuits in children and adolescents with OCD will be compared to age matched healthy control children and adolescents.
- Change from baseline in fractional anisotropy (Diffusion tensor imaging) after therapy [Baseline & approximately 16-20 weeks later]
Anatomical and Diffusion Tensor Imaging (DTI) data will be collected so that we can begin to identify any structural and organizational abnormalities in these neural systems in children and adolescents with OCD compared to healthy control participants.
Secondary Outcome Measures
- Probabilistic Go/No-go reinforcement learning task [Baseline & approximately 16-20 weeks later]
Participants will be presented with one of 5 images on each trial and must learn to press (i.e., 'Go') or not to press (i.e., 'No-Go') a button for each image.
- Continuous Performance Task [Baseline & approximately 16-20 weeks later]
The Continuous Performance Task (CPT)is a standardized measure of sustained attention and impulsivity.
- Stroop Word-Color Interference [Baseline & approximately 16-20 weeks later]
This is a classic task of cognitive interference that is comprised of 3 subtasks.
Eligibility Criteria
Criteria
Patient Inclusion Criteria:
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Participants must be 5-17 at the time of consent
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Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) Diagnosis of OCD as the principal problem
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Not on psychotropic medication and not receiving current psychotherapy for OCD
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Written informed assent by the participants (8 and older) and consent by the parent
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Participants and a parent/guardian must be able to read and understand English
Patient Exclusion Criteria:
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DSM-IV current diagnosis of major depressive disorder, attention-deficit hyperactivity disorder, Tourette's/Tic Disorder, or substance/alcohol abuse
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DSM-IV lifetime diagnosis of psychotic disorder, bipolar disorder, eating disorder, pervasive developmental disorder, or substance/alcohol abuse
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Active suicidal ideation
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Females who are pregnant or nursing
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Major medical or neurological problems
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Presence of metallic device or dental braces
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IQ<80
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A current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS)
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Individuals who are currently receiving CBT, other forms of psychotherapy, or psychotropic medications
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Individuals who have received a full course of CBT in the past
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A positive pregnancy test
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Positive urine screen for illicit drugs
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Inability of participant or parent/guardian to read or understand English
Healthy Control Inclusion Criteria:
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Participants must be 5-17 at the time of consent
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Written informed assent by the participants (8 and older) and consent by the parent
-
Participants and a parent/guardian must be able to read and understand English
Healthy Control Exclusion Criteria:
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Any current or lifetime psychiatric diagnosis
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Active suicidal ideation
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Females who are pregnant or nursing
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Major medical or neurological problems
-
Presence of metallic device or dental braces
-
IQ<80
-
A current or past diagnosis of pediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS)
-
A positive pregnancy test
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Positive urine screen for illicit drugs
-
Inability of participant or parent/guardian to read or understand English
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | NY State Psychiatric Institute | New York | New York | United States | 10032 |
Sponsors and Collaborators
- New York State Psychiatric Institute
- National Institute of Mental Health (NIMH)
Investigators
- Principal Investigator: Rachel Marsh, Ph.D., New York Psychiatric Institute
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 7006
- R21MH101441