Executive function and nonverbal memory in obsessive-compulsive disorder

It has been suggested that memory impairments found in obsessive-compulsive disorder (OCD) are mediated by organizational problems in encoding that are caused by primary executive dysfunction. Performance on different nonverbal memory and executive skills was tested in 68 subjects (35 non-depressed OCD sufferers and 33 healthy controls). Multiple regression models were performed to analyze the role of different cognitive variables, especially organizational encoding strategies in nonverbal memory. OCD patients performed significantly worse than controls in immediate nonverbal memory [Rey-Osterrieth Complex Figure Test (RCFT)] and on all the executive functions such as interference control (Stroop test), mental set shifting (Trail-Making Test), and organizational strategies (copy organization). As no differences were found in the memory of faces, where organizational strategies are minimal, it is possible to speculate that immediate nonverbal memory problems in OCD appear only when organizational strategies mediate the recalling process. Thus, memory deficits appear to have less to do with memory, per se, and more to do with the degree of organization necessary to effectively complete the task. Statistical analyses of mediation models showed the highest explanatory power for the organizational approach and demonstrated the mediation effect of organizational strategies in nonverbal impairment.     

The involvement of distinct neural systems in patients with obsessive-compulsive disorder with autogenous and reactive obsessions

Besiroglu L, Sozen M, Ozbebit Ö, Avcu S, Selvi Y, Bora A, Atli A, Unal O, Bulut MD. The involvement of distinct neural systems in patients with obsessive–compulsive disorder (OCD) with autogenous and reactive obsessions. Objective: To investigate the regional metabolite abnormalities and changes after treatment in patients with OCD with autogenous and reactive obsessions. Method: We assessed right anterior cingulate cortex (ACC) and amygdala–hippocampal region (Am + Hpp) N‐acetyl‐aspartate (NAA), choline (Cho) and creatine (Cr) concentrations and NAA/Cr and Cho/Cr ratios using single‐voxel proton magnetic resonance spectroscopy in 15 patients with autogenous obsessions (OCD‐A), 15 patients with reactive obsessions (OCD‐R) and 15 healthy controls (HC). Measurements were repeated after 16 weeks of fluoxetine treatment. Results: Baseline ACC NAA/Cr ratios of both OCD groups were significantly lower than HC. OCD‐A group had significantly lower baseline NAA/Cr ratios in the Am + Hpp than other groups. These differences were more likely to be explained by higher Cr levels in ACC. We found no significant differences and changes for Cho levels and Cho/Cr ratios between groups and within groups. Significant increase in NAA/Cr ratios of OCD‐A group found in the Am + Hpp was more likely to be explained by increased NAA levels. No significant changes were found in ACC NAA/Cr ratios. Conclusion: While disturbed energy metabolism in ACC might reflect a common pathology in patients with OCD regardless of symptom dimension, alterations in mesiotemporal lobe are more likely for autogenous obsessions.     

Short-term verbal memory deficits in patients with obsessive-compulsive disorder

Recent neuropsychological studies have found deficits in the verbal memory of patients with obsessive-compulsive disorder. Difficulties in using organizational strategies were presumed to be the cause. Preceding studies did not look closely at their ability of feature detection of stimuli. Efficiency in feature detection is crucial to use the attributes or feature of stimuli as a clue in memory tasks. We examined verbal memory deficit and the ability of feature detection in Japanese patients with obsessive-compulsive disorder. We administered Iddon et al.'s verbal strategy task to 16 patients with obsessive-compulsive disorder and 16 healthy controls. The feature of Iddon et al.'s task was to include a phase that showed subjects the semantic structure of the task and timed each subject's analysis of the organization. Patients with obsessive-compulsive disorder were slower to classify stimuli words into semantic categories than were healthy controls. They recalled and recognized significantly fewer words than did healthy controls. In recall tasks, they used less organizational strategy than did healthy controls. Patients with obsessive-compulsive disorder were slower to analyze features of stimuli words than were healthy controls. This slowness possibly contributes to impaired memory performances that patients showed during the encoding process, since the efficient use of organizational strategies in limited time is difficult for them.     

Towards a post-traumatic subtype of obsessive-compulsive disorder

We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.     

Metacognition and episodic memory in obsessive-compulsive disorder

Memory deficits in patients with obsessive-compulsive disorder (OCD) have been frequently reported but are not sufficiently accounted for by cognitive models of OCD. The aim of the study was to identify cognitive mechanisms that might be able to explain memory deficits in OCD. We hypothesized that a self-conscious meta-cognitive style might be responsible for reduced memory performance in OCD.Episodic verbal memory performance was assessed in 23 participants with OCD (DSM-IV criteria) and 22 matched controls. Cognitive self-consciousness was assessed with a self-report measure derived from the Meta-Cognitions Questionnaire (MCQ). Compared to controls, OCD participants showed reduced immediate and delayed recall of complex verbal material and increased self-reported levels of cognitive self-consciousness. Multiple regression analyses indicated that group differences in story recall were significantly mediated by self-reported trait cognitive self-consciousness. Results point to the deteriorating effects of a thought-focused cognitive style on effortful encoding processes in OCD.     

Nonverbal memory dysfunction in obsessive-compulsive disorder patients with checking compulsions

Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder; nonetheless, most of the previous neuropsychological studies for assessing the involvement of memory dysfunction grouped together patients with different symptoms, thereby potentially accounting for the inconsistencies of results. The goals of this study were to compare the memory dysfunction of two main subtypes of OCD and to identify the type of memory dysfunction that is associated with the checking symptoms in OCD patients. The sample population comprised the cleaning-type OCD group (N=23), checking-type OCD group (N=24), and a control group of healthy volunteers (N=20). All the OCD patients were selected from the outpatient clinic. All the subjects underwent the Rey-Osterreith Complex Figure Test (RCFT) for the assessment of nonverbal memory function, the Hopkins Verbal Learning Test (HVLT) for verbal memory function, the Wechsler Adult Intelligence Scale-Revised (WAIS-R), and the Wisconsin Card Sorting Test (WCST). The immediate and delayed memory scores of RCFT were significantly lower in the checking-type OCD group; there were no significant differences in HVLT scores amongst the three groups. Our results indicate that the checking-type compulsion of OCD patients is associated with nonverbal memory deficits and not with verbal memory deficits.     

Longitudinal assessment of symptom and subtype categories in obsessive-compulsive disorder

Although it has been postulated that symptom subtypes are potential predictors of treatment response, few data exist on the longitudinal course of symptom and subtype categories in obsessive-compulsive disorder (OCD). Putative subtypes of OCD have gradually gained more recognition, but as yet there is no generally accepted subtype discrimination. Subtypes, it has been suggested, could perhaps be discriminated based on autogenous versus reactive obsessions stemming from different cognitive processes. In this study, our aim was to assess whether symptom and subtype categories change over time. Using the Yale-Brown Obsessive Compulsive Symptom Checklist (Y-BOCS-SC), we assessed 109 patients who met DSM-IV criteria for OCD to establish baseline values, then reassessed 91 (83%) of the initial group after 36+/-8.2 months. Upon reassessment, we found significant changes from baseline within aggressive, contamination, religious, symmetry and miscellaneous obsessions and within checking, washing, repeating, counting and ordering compulsion categories. Sexual, hoarding, and somatic obsessions, and hoarding and miscellaneous compulsions, did not change significantly. In accordance with the relevant literature, we also assigned patients to one of three subtypes--autogenous, reactive, or mixed groups. Though some changes in subtype categories were found, no subtype shifts (e.g., autogenous to reactive or reactive to autogenous) were observed during the course of the study. Significantly more patients in the autogenous group did not meet OCD criteria at follow-up than did patients in the other groups. Our results suggest that the discrimination between these two types of obsession might be highly valid, because autogenous and reactive obsessions are quite different, both in the development and maintenance of their cognitive mechanisms, and in their outcome.     

Procedural and declarative memory in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) has been associated with frontostriatal abnormality. This has led to the hypothesis that the disorder is characterized by abnormality of procedural memory. However, evidence for either procedural or declarative memory disturbance has been mixed, and few studies have directly assessed both of these forms of memory in the same patient group. In the present study, we assessed encoding and retrieval in declarative memory using the Rey Auditory Verbal Learning Test (RAVLT), and procedural memory using the Pursuit Rotor Task, in 27 adults with OCD and 29 matched healthy controls. Groups did not differ with respect to salient demographic characteristics or memory on the RAVLT. In contrast, patients with OCD performed significantly better than controls during the early, but not later trial blocks of the Pursuit Rotor Task. This pattern of results indicates intact encoding and retrieval in declarative memory, but abnormally enhanced procedural memory during the early course of learning in OCD. These findings may be consistent with striatal overactivation observed in neuroimaging studies of OCD, as well as the prominent role of the striatum during early stages of procedural memory.     

Executive functions in borderline personality disorder

Different domains of executive function such as working memory and response inhibition were investigated together with elementary cognitive processes in borderline personality disorder (BPD). Patients with BPD (N=28) were compared to nonpatient controls (NP, N=28) on eight tasks (e.g. n-back, Go/NoGo, CPT-AX). In order to separate impairments in different cognitive domains and to assess the influence of more elementary cognitive processes on executive functioning, tasks were embedded in a reaction-time-decomposition approach. BPD patients solved tasks with accuracies comparable to those of nonpatients. The only exception was the n-back task, for which working memory is required: here, error rates were higher and increased more prominently in BPD patients depending on working memory load. In most tasks, movement times were shorter for BPD patients than for nonpatients, while the quality of task-solving was comparable. The faster processing in the BPD group was observable starting with the simplest task, i.e. a simple reaction-time task. These findings suggest that domains of executive functioning are differentially affected in BPD. In contrast to load-dependent deficits in working memory, response inhibition processes were unimpaired. Faster action-related processes could be observed in BPD patients in a variety of tasks; however, these did not influence executive functioning.     

Impairment of incidental memory for frequency in patients with obsessive-compulsive disorder.

The aim of our study was to investigate whether patients with obsessive-compulsive disorder (OCD) have impaired incidental memory for frequency. Fifty-four subjects (27 OCD patients and 27 matched control subjects) performed a task assessing estimation of occurrence of previously heard words. Performance on this task was compared with other intentional verbal memory tasks (recognition, recall and learning of common words). We also correlated memory for frequency with frontal lobe tests (Wisconsin Card Sorting Test, Trail Making Tests A and B, and verbal fluency). Performance on incidental learning of frequency was significantly worse in the OCD group than in control subjects. Other verbal memory measures did not show significant differences. Performance in the frequency task correlated with verbal fluency. Although intentional verbal memories are normal in OCD patients, incidental memory for frequency is impaired, suggesting that prefrontal systems are involved in OCD.     

Episodic memory impairment in bipolar disorder and obsessive-compulsive disorder: the role of memory strategies

BACKGROUND: There is evidence that individuals with bipolar disorder exhibit neuropsychological impairments not only during mood episodes but also when they are euthymic. One of the most consistently reported cognitive problems in euthymic individuals with bipolar disorder is an impairment in verbal episodic memory. Verbal learning and memory depend on individuals' ability to organize verbal information appropriately during learning. The purpose of the present study was (i) to determine whether episodic memory impairment in euthymic individuals with bipolar disorder is mediated by impairments in organization of verbal information during learning and (ii) to compare the characteristics of memory impairment in bipolar disorder with that previously found in obsessive-compulsive disorder (OCD). METHODS: Study participants were 30 individuals with DSM-IV bipolar I disorder (BP-I), 30 individuals with DSM-IV OCD and 30 normal control participants matched for age, gender and education. Participants completed the California Verbal Learning Test (CVLT), a well-established measure of verbal learning and memory that enables assessment of verbal organization strategies during learning. RESULTS: Compared with control subjects, both BP-I and OCD participants showed impaired performance in long-delayed free recall and verbal organization strategies during learning. BP-I participants showed greater long-delay free recall difficulties but not greater verbal organization difficulties during learning than OCD participants. For OCD participants, the long-delay recall impairment was mediated by difficulties using verbal organizational strategies during learning. In contrast, the group difference in long-delayed free recall between BP-I and control participants remained significant even when semantic clustering was introduced as a mediator. This indicated that BP-I participants' long-delayed free recall difficulties were mediated to a lesser extent by difficulties using verbal organizational strategies than for OCD participants. CONCLUSIONS: Verbal episodic memory problems in individuals with bipolar I disorder and OCD are mediated to different degrees by difficulties using semantic clustering encoding strategies compared with control participants.     

Executive hypercontrol in obsessive-compulsive disorder: electrophysiological and neuropsychological indices.

OBJECTIVE: Neuropsychological, brain imaging and electrophysiological research have consistently shown a dysfunction of fronto-striato-thalamic pathways in subjects with obsessive-compulsive disorder (OCD). The functional meaning of the observed dysfunction in the pathogenesis of OCD is still debated. In the present study the hypothesis that it might be related to a hyperactive executive control is explored by means of neuropsychological and electrophysiological measures. METHODS: Multilead quantitative EEG (QEEG) characteristics and neuropsychological performance on tests exploring executive functions, attention, short-term memory and the ability to learn supraspan recurring sequences were investigated in 32 drug-free patients with DSM-IV OCD. Multilead QEEG characteristics were also investigated in 32 healthy controls, matched with patients for age, gender and handedness. RESULTS: A decrease of the slow alpha-band power in OCD as compared to healthy subjects was observed. A significant negative correlation between the slow alpha-band power and the time to complete a neuropsychological test exploring executive functions was found: the more reduced the slow alpha-band power, the slower the performance on this test. CONCLUSIONS: The topographic distribution of the observed QEEG abnormalities, as well as their correlations with neuropsychological indices, suggest an increased activation of frontal networks in OC patients. SIGNIFICANCE: Study findings support the presence of a hyperactivity of attention/executive control mechanisms in obsessive-compulsive patients.     

强迫症患者前瞻记忆缺损性质及内表型

目的 考察强迫症患者前瞻记忆功能缺损情况以及强迫症患者未患病一级亲属的前瞻记忆功能,验证前瞻记忆作为强迫症内表型的潜在可能.方法 选择年龄、受教育程度、性别、智商、婚姻状况相匹配的健康对照组、强迫症患者和强迫症患者一级亲属各25例,进行多试次设计的标准化前瞻记忆任务,将被试的正确反应率作为前瞻记忆功能的指标.结果 强迫...     

Executive function deficits associated with symptoms of schizotypy and obsessive-compulsive disorder

Research suggests that executive dysfunction is seen both in disorders of the schizophrenia constellation and in obsessive-compulsive disorder (OCD), but that the patterns of executive deficits may differ. While disorders of the schizophrenia spectrum reflect impairment of functions such as integration of cognitive activities, a tendency to perseverate, and a failure to notice details (e.g. impairment associated with the dorsolateral prefrontal cortex), OCD may involve problems of impulse control and regulation of behavior, and an inability to maintain cognitive set (e.g. impairment associated with the orbitofrontal cortex). The present study examined differences between high-scorers on a measure of schizotypy, high-scorers on a measure of OCD, high-scorers on both schizotypy and OCD and a control group in performance on executive function tests. As expected, the OCD group demonstrated relative deficits on measures thought to reflect orbitofrontal functioning. However, contrary to expectations, the schizotypal group did not demonstrate deficits on neuropsychological tests thought to reflect dorsolateral prefrontal cortex functioning, and the combined group showed no executive impairment.     

强迫症患者工作记忆认知操作功能缺损与完美主义的相关性研究

目的 探讨强迫症患者认知操作功能缺损与完美主义之间的关系。方法 采用方便抽 样法,随机选取 2022 年 1 月— 2023 年 1 月在首都医科大学附属北京朝阳医院临床心理科门诊就诊的 69 例强迫症患者为研究组,同期在北京市朝阳区向社会面招募 74 名健康者为对照组。采用 Frost 多维 完美主义量表中文版（FMPS-C）和工作记忆认知操作任务分别测量两组受试者的完美主义水平以及认 知操作功能,并采用皮尔逊积差相关法分析两者之间的相关性。结果 最终纳入研究组 65 例、对照组 69 名。研究组患者的 FMPS-C 总分、非适应性维度得分高于对照组,适应性维度得分低于对照组,差异 均有统计学意义（均P＜ 0.01）。提示条件为“相反”时,两组受试者对中性、积极、消极 3 种词语的反应 时比较,差异有统计学意义（F=8.943,P＜ 0.01）。两两比较结果显示,研究组患者在 3 种词语刺激下的 反应时均高于对照组,差异均有统计学意义（均P＜ 0.05）。提示条件为“相反”时,研究组消极词语的 反应时长于积极与中性词语反应时（均P＜ 0.05）。两组受试者 3 种词语刺激下的转换消耗值比较,差异 有统计学意义（F=24.378,P＜ 0.001）。两两比较结果显示,研究组患者在中性、积极、消极 3 种词语刺激 下的转换消耗值高于对照组,差异均有统计学意义（均P＜ 0.05）。研究组患者在消极词语刺激下的转换 消耗值高于中性和积极词语刺激的转换消耗值,差异均有统计学意义（均P＜ 0.01）。在中性词语的刺激 条件下,研究组患者的转换消耗值与非适应性维度得分呈正相关（r=0.18,P＜ 0.05）;在消极词语的刺激 条件下,研究组患者的转换消耗值与 FMPS-C 得分、非适应性维度得分呈正相关（r=0.23、0.24;P＜ 0.05）。 结论 强迫症患者存在认知操作功能受损,在处理消极刺激时的受损程度更高,且这种认知操作困难 与非适应性完美主义呈正相关。     

Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients

概述

精神病共病极为常见，其部分原因是DSM 诊 断系统症状分组重叠。其中双相障碍 (bipolar disorder, BD) 和强迫症 (obsessive compulsive disorder, OCD) 的共 同出现是最常见的共病之一。然而，我们尚未解决有 关该病症的关键疾病分类问题，即它们两个不同的疾 病还是其中一个病症中的另一种亚型。为了解决这个 悬而未决的问题，我们更新了最近的系统综述，即搜 索电子数据库MEDLINE、Embase 和PsycINFO 专门研 究BD 与OCD 共病患者的遗传性。我们一共纳入了8 篇相关论文，其中大部分研究的发现是，相较于非BD 与OCD 共病的患者，共病患者更可能有心境障碍的家 族史而不太可能有强迫症的家族病史。这些结果支持 大多数BD 与OCD 共病的案例实际上BD 患者。如果这 一结论能在更大的、更集中的研究中得到证实，将具 有重要的疾病分类和临床意义。

中文全文

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Implicit and explicit memory in patients with obsessive-compulsive disorder: an event-related potential study

The implicit and explicit memory in patients with obsessive-compulsive disorder (OCD) was investigated using the event-related potential (ERP). For the assessment of implicit memory, a lexical decision task was administered. Among a total of 320 words and 140 non-words, 200 words were repeated, while the remaining 120 words and the 140 non-words were not repeated. For explicit memory, a continuous recognition task was administered, in which 280 words were repeated and 100 were not repeated. On the recognition task, both the controls and OCD patients showed more positivity to the old words than to the new words during the 200-600 ms period post-stimulus. Both groups showed faster response time to the old words than to the new words. On the lexical decision task, the controls showed the old/new effect during the 200-500 ms period post-stimulus, while the OCD patients did not. However, OCD patient showed faster response time to the old words than to the new words, although OCD patients showed prolonged response times to the old words compared to the controls. These results indicate that OCD patients have preserved explicit and implicit memory. The absence of old/new effect on ERP in OCD patients was discussed in terms of dysfunction of frontostriatal system, which plays an important role in both OCD and implicit memory.     

Executive and verbal working memory dysfunction in first-degree relatives of patients with bipolar disorder

The authors aimed to investigate cognitive performance of first-degree relatives of probands with bipolar disorder (BD). They hypothesized that the relatives of BD patients would have impaired performance on cognitive tests of frontal-executive functions. A neuropsychological battery was administered to 34 first-degree relatives of BD probands and 25 control subjects. Relatives showed significant impairment in verbal working memory and executive function. Verbal memory and psychomotor performances of relatives were not different from control subjects. One particular component of executive function, cognitive flexibility, was associated with family history of mood episodes with psychotic features. Verbal working memory and executive function deficits may be useful endophenotypic markers of genetic vulnerability to BD.     

Bradykinesia in patients with obsessive-compulsive disorder

ObjectiveTo investigate the frequency of bradykinesia in patients with obsessive-compulsive disorder (OCD) and to see whether patients with OCD who also have bradykinesia display distinctive neuropsychological and neuropsychiatric features.MethodsWe studied 23 antipsychotic-free patients with OCD and 13 healthy controls. Bradykinesia was assessed with section III of the Unified Parkinson Disease Rating Scale. The Wechsler Adult Intelligent Scales-Revised (WAIS-R) was used to assess the Full Scale IQ and to measure visuospatial, visuoconstructional ability and psychomotor speed/mental slowness.ResultsOf the 23 patients with OCD studied, 8 (34%) had mild symptoms of bradykinesia. No relationship was found between bradykinesia and the sociodemographic variables assessed but this motor symptom was significantly associated with the severity of compulsions. Patients with bradykinesia differed from those without: they had a higher frequency of repeating compulsions, and lower IQ scores, performance scores, and WAIS-R subtest scores for similarities and picture completion. No significant differences were found between patients without bradykinesia and healthy controls in any test.ConclusionsClinical assessment of motor symptoms in adult patients with OCD often discloses mild bradykinesia sometimes associated with repeating compulsions and poor WAIS-R performance scores.     

Executive functions in adolescents with schizotypal personality disorder

Adolescents meeting diagnostic criteria for schizotypal personality disorder (SPD) are presumed to be at risk for developing schizophrenia in adulthood, making them an important group for exploring the developmental trajectory of the disease. Deficits in executive functioning have been documented in schizophrenia patients and adults with SPD. The present study examined executive functions in adolescents with SPD. It was predicted that the SPD group would score below comparison groups (normals and adolescents with other disorders) on measures of executive function, and that those with greater 'negative' signs of SPD would show more pronounced performance deficits. Analyses revealed that the performance of the SPD subjects was impaired relative to the other groups on the modified Wisconsin Card Sorting Test (MCST), but not on the Tower of London or the Controlled Oral Word Association Test. Consistent with prediction, regression analyses indicated that MCST deficits were associated with greater negative signs of SPD, but not positive signs.