Brain Regional alpha-[C-11]Methyl-L-Tryptophan Trapping in Medication-Free Patients With Obsessive-Compulsive Disorder

作者：Berney Alexandre; Leyton Marco; Gravel Paul; Sibon Igor; Sookman Debbie; Rosa Neto Pedro; Diksic Mirko; Nakai Akio; Pinard Gilbert; Todorov Christo; Okazawa Hidehiko; Blier Pierre; Nordahl Thomas Edward; Benkelfat Chawki^*

来源：Archives of General Psychiatry, 2011, 68(7): 732-741.

DOI：10.1001/archgenpsychiatry.2011.16

Context: The hypothesis of a serotonin (5-hydroxytryptamine [5-HT]) dysfunction in obsessive-compulsive disorder (OCD) stems largely from the clinical efficacy of 5-HT reuptake inhibitors. Serotonergic abnormalities in the unmedicated symptomatic state, however, remain to be fully characterized.
Objective: To investigate brain regional 5-HT synthesis, as indexed by positron emission tomography and the alpha-[C-11]methyl-L-tryptophan trapping constant (K*), in treatment-free adults meeting criteria for OCD.
Design: Between-group comparison.
Setting: Department of Psychiatry and Montreal Neurological Institute, McGill University, and Department of Psychology, McGill University Health Centre, Quebec, Canada.
Participants: Twenty-one medication-free patients with OCD (15 men with a mean [SD] age of 33.2 [9.3] years and 6 women with a mean [SD] age of 35.8 [7.1] years) and 21 healthy controls matched for age and sex (15 men with a mean [SD] age of 32.9 [10.1] years and 6 women with a mean [SD] age of 36.5.5 [8.6] years).
Main Outcome Measure: The alpha-[C-11]methyl-L-tryptophan brain trapping constant K*, which was analyzed with Statistical Parametric Mapping (SPM8) and with proportional normalization (extent threshold of 100 voxels with a peak threshold of P <= .005).
Results: Compared with healthy controls, the patients with OCD exhibited significantly greater alpha-[C-11]methyl-L-tryptophan trapping in the right hippocampus and left temporal gyrus (Brodmann area 20). In the larger subsample of all men, these same differences were also evident, as well as higher K* values in the caudate nucleus. Individual differences in symptom severity correlated positively with K* values sampled from the caudate and temporal lobe of the patients with OCD, respectively. There were no regions where the patients exhibited abnormally low K* values. Volumetric analyses found no morphometric alterations that would account for the group differenees.
Conclusion: The results support previous reports of greater striatal and temporal lobe activity in patients with OCD than in healthy controls and suggest that these disturbances include a serotonergic component. Previously reported glucose metabolic disturbances in OCD involving the orbitofrontal and cingulate cortices, in comparison, might reflect postsynaptic changes in the serotonergic system.

• 出版日期2011-7