强迫症与抑郁症的脑单光子发射计算机断层扫描对照研究

目的探讨强迫症、抑郁症局部脑血流量(rCBF)特点。方法应用单光子发射计算机断层扫描(SPECT)技术,对首发且未经治疗的39例强迫症患者、36例抑郁症患者和39名正常人于静息状态下行脑血流显像。以小脑皮质的放射性计数值为参考,对局部脑血流进行半定量分析。结果强迫症组两侧前额叶、前颞叶rCBF高于正常组(P<0.01);抑郁症组两侧前额叶、枕叶、扣带回及右前颞叶、右顶叶rCBF低于正常组(P<0.05);在两侧前额叶、前颞叶、顶叶、枕叶及右后额叶、扣带回,强迫症组rCBF高于抑郁症组(P<0.05)。结论强迫症组的前额叶及前颞叶呈高灌注改变,抑郁症组脑血流普遍低灌注,SPECT技术可望作为二者鉴别诊断的客观依据之一。     

强迫症患者局部脑血流灌注研究

目的　探讨强迫症(OCD)患者局部脑血流灌注(rCBF)特点及临床症状与rCBF的关系。方法　对2 8例符合国际疾病分类第1 0版(ICD 1 0 )强迫障碍诊断标准患者和1 5名正常人进行单光子发射计算机断层扫描(SPECT)脑显像分析。用耶鲁 布朗强迫评定量表(YBOCS)、Hamilton焦虑量表(HAMA)和Hamilton抑郁量表(HAMD)对患者临床症状进行评定。结果　OCD患者两侧丘脑、顶叶和基底神经节的平均放射性计数百分数(PMRC)显著高于正常组;右颞PMRC明显低于正常组;且正常组两侧颞叶和顶叶PMRC值差异非常显著。在强迫恐惧/洗涤、回避组,YBOCS强迫行为分量表评分与右基底PMRC显著正相关(r =0 .70 1 )。结论　OCD患者两侧丘脑、顶叶和基底神经节的血流灌注增加和功能亢进;右颞血流灌注减少和功能低下,两侧颞叶和顶叶血流灌注的不对称性与正常人显著不同,后者的不对称性非常显著;在强迫恐惧/洗涤、回避组,强迫行为与右基底节功能增强有关。     

皮质下缺血性血管性认知损害扩散张量成像研究

目的通过扩散张量成像(DTI)探讨皮质下缺血性血管性认知损害患者白质微结构变化及其与认知功能之间的相关性。方法采集49例皮质下缺血性脑血管病患者[轻度血管性痴呆(VaD)10例、非痴呆型血管性认知损害(VCIND)20例、认知功能正常19例]DTI数据并观察皮质下白质微结构改变,分析VaD组患者DTI参数与认知功能间的相关性。结果与对照组相比,VaD组内侧前额叶、前扣带回、胼胝体干、双侧顶叶、右侧颞叶、双侧眶额叶,以及VCIND组右侧额下回、右侧海马、双侧楔前叶FA值减低(均P=0.000);与VCIND组比较,VaD组内侧前额叶、前扣带回、胼胝体、双侧顶叶、右侧颞叶FA值减低(P=0.000)。与对照组相比,VaD组内侧前额叶、胼胝体、双侧顶叶、双侧颞叶、前扣带回,以及VCIND组双侧楔前叶、右侧海马MD值升高(均P=0.000);与VCIND组相比,VaD组右侧内侧前额叶、前扣带回、胼胝体干、双侧顶叶、双侧颞叶MD值升高(均P=0.000)。VaD组内侧前额叶FA值与数字连线测验A时呈显著负相关(r=-0.782,P=0.007),双侧额下回MD值与数字连线试验A时程呈显著正相关(r=0.877,P=0.001)。结论 DTI对皮质下缺血性认知损害患者白质微结构改变更敏感,能够反映患者认知功能早期异常改变;内侧前额叶白质微结构的改变是影响患者执行能力的重要因素。     

以强迫思维为主的强迫症患者脑灰质体积与静息态功能连接的改变北大核心CSCD

目的探讨以强迫思维为主的强迫症患者脑灰质体积与全脑静息态功能连接的改变。方法选取以强迫思维为主的强迫症患者20例（强迫思维组）,混合型强迫症患者20例（混合型组）,以及年龄、性别、受教育程度与患者相匹配的健康对照者20名（对照组）,分别进行头部磁共振扫描。采用基于体素的形态学分析方法检测受试者大脑灰质体积;将以强迫思维为主的强迫症患者异常灰质体积脑区作为种子点,进行全脑静息态功能连接分析;采用Spearman相关分析方法探讨以强迫思维为主的强迫症患者全脑功能连接与临床资料的相关关系。结果与对照组相比,强迫思维组右侧苍白球灰质体积减小（0.17±0.02与0.10±0.01）;右侧舌回（0.39±0.04与0.47±0.07）、右侧顶下小叶（0.22±0.02与0.30±0.05）灰质体积增加（t=-25.37、5.03、7.79,GRF校正,均P〈0.05）;混合型组左侧苍白球灰质体积减小,右侧舌回、左侧颞下回灰质体积增加（t=-24.87、6.17、11.37,GRF校正,均P〈0.05）。强迫思维组右侧苍白球内部,右侧苍白球与右侧小脑、左侧苍白球之间功能连接显著降低,与左侧辅助运动区的功能连接显著增强（t=-7.44, -4.03, -4.30, 3.93, GRF校正,P〈0.05）。强迫思维组右侧苍白球与右侧小脑之间的功能连接与病程存在正相关（r=0.488,P=0.029）。结论以强迫思维为主的强迫症患者脑灰质结构及静息态脑功能出现异常,其异常改变不仅局限于皮质-纹状体-丘脑-皮质环路,小脑可能也参与了强迫思维的发生。     

进行性核上性麻痹患者脑部葡萄糖代谢特征分析

目的：利用^18F-脱氧葡萄糖（^18F-FDG）正电子发射断层扫描成像（PET）分析进行性核上性麻痹（PSP）患者脑部葡萄糖代谢特征。方法：7例临床确诊的PSP患者（PSP组）和14例年龄匹配的健康对照者（对照组）行静息状态下^F—FDGPET脑成像,将两组的PET图像分别进行统计参数图（SPM）及尺度子轮廓模型／主要成分分析（SSM／PCA）研究,获得PSP患者脑部葡萄糖异常代谢图像并建立PSP脑代谢网络模式（PSPRP）。结果：SPM分析显示,与对照组比较,PSP组双侧内侧前额叶、腹外侧前额叶、尾状核、丘脑和中脑的葡萄糖代谢降低,双侧中央前回、顶上小叶、顶下小叶葡萄糖代谢增高。SSM／PCA分析显示PSPRP的特征表现为双侧内侧前额叶、腹外侧前额叶、尾状核、丘脑和中脑的葡萄糖代谢显著减低,而双侧顶叶代谢显著增高。PSP组的PSPRP表达值（1．711±1．218）明显高于对照组（0．043±O．496,t=-5．379,P=0．001）。结论：基于18F-FDGPET显像得到的脑部异常葡萄糖代谢特征可以有效鉴男IJPSP患者和健康对照者。     

全面性强直-阵挛发作间期脑血流量改变的磁共振动脉自旋标记研究

目的应用MRI脉冲式动脉自旋标记（PASL）技术,研究全面性强直．阵挛发作患者发作间期局部脑血流量改变,阐述全面性强直一阵挛发作可能的神经病理生理学机制。方法选择29例诊断明确、病程〉1年且发作〉3次的全面性强直一阵挛发作患者作为研究对象,以年龄、性别、利手性相匹配并例数相当的正常健康志愿者作为对照。通过siemens3．0TMRI扫描仪采集全脑PASL数据,通过两独立样本t检验比较全面性强直．阵挛发作患者发作间期相对正常人脑血流量改变的脑区。结果与对照组相比,全面性强直一阵孪发作患者发作间期脑血流量的改变以降低为主（P〈0．05）,主要包括双侧丘脑、脑干和小脑,以及右侧楔前叶部分皮质区域;而且发作间期双侧丘脑局部脑血流量改变与发作时间（r=-0．090,P=0．643）及发作频率（r=-0．115,P=0．551）无明显相关关系。结论全面性强直-阵挛发作患者在发作间期以丘脑、脑干和小脑等脑区血流灌注降低为主,支持特发性全面性癫癎的“中脑癫癎理论”。这些脑区可能与特发性全面性癫癎的病理生理学机制密切相关。     

血管性痴呆患者SPECT脑血流灌注显像特点

目的　探讨血管性痴呆 (VD)患者 SPECT局部脑血流灌注显像特点 ,为 VD的早期诊断和痴呆严重程度的评估寻找客观的生物学指标。方法　分别对 45例 VD、3 0例卒中无痴呆 (SWD)和 3 0例正常对照者 (NC)3组进行 SPECT局部脑血流灌注显像 ,半定量分析各脑区血流灌注情况。结果　 VD组额叶、顶叶、颞叶和基底节局部脑血流灌注比 SWD组减少 (P<0 .0 5 ) ;并以额叶、颞叶血流灌注的减少最为显著 (P<0 .0 1)。与 NC组相比 ,SWD组额叶、顶叶、颞叶和基底节局部脑血流灌注均减低 (P<0 .0 5 )。额叶、颞叶血流灌注减低与 MMSE评分间存在正相关关系 (r=0 .75 5 ,P<0 .0 1)。结论　 VD患者存在明显的脑血流灌注减低 ,以额叶、颞叶最为显著 ,且与MMSE评分间存在正相关 ,SPECT脑血流灌注显像有助于 VD的诊断和病情评估     

精神分裂症患者质子磁共振波谱变化特点及与疗效、认知功能的相关分析

目的探讨不同疗效的精神分裂症患者前额叶、丘脑神经生化代谢物质的变化特点,及神经生化代谢物质与疗效和事件相关电位P300的相关性。方法对经非典型抗精神病药物治疗8周的171例精神分裂症患者,治疗前后分别采用多体素1H-MRS检测前额叶和丘脑N-乙酰基天门冬氨酸(NAA)、胆碱复合物(Cho)与肌酸复合物(Cr),计算NAA/Cr值、Cho/Cr值;运用事件相关电位P300(P300)评估认知功能。运用阳性与阴性症状量表(PANSS)评定临床症状,以PANSS减分率评定疗效;根据PANSS减分率分为有效组(≥50%)、改善组(20%～49%)和无效组(<20%),比较不同疗效组上述脑代谢指标的变化。结果治疗后有效组(n=79)、改善组(n=71)和无效组(n=21)的左侧前额叶NAA/Cr变化值分别为(0.054±0.019)、(0.047±0.017)和(0.037±0.014),前者高于后两者,改善组高于无效组(P<0.05或P<0.01);有效组左、右侧丘脑NAA/Cr变化值均高于无效组(P均小于0.01)。左侧前额叶、左侧和右侧丘脑NAA/Cr变化值均与PANSS减分率呈正相关(r值分别为0.45、0.38、0.41,P均小于0.01)。左侧前额叶NAA/Cr变化值与靶刺激P2、P3潜伏期变化值成负相关(r值分别为-0.37,-0.33,P<0.01或P<0.05),与靶刺激P2、P3及非靶刺激P2波幅变化值成正相关(r值分别为0.42,0.38,0.36,P<0.01);左侧丘脑NAA/Cr变化值与靶刺激P2潜伏期变化值成负相关(r=-0.30,P<0.05),与靶刺激P2及非靶刺激P2波幅变化值成正相关(r值分别为0.40,0.35,P<0.01);右侧前额叶、右侧丘脑NAA/Cr变化值与靶刺激P2潜伏期变化值成负相关(r值分别为-0.33,-0.34,P<0.05),与波幅变化值成正相关(r值分别为0.34,0.32,P<0.05)。结论精神分裂症患者左侧前额叶和左侧丘脑NAA/Cr值变化与抗精神病药物疗效相关,与认知功能变化也存在相关性。     

血管性认知功能障碍脑血流灌注的临床研究

目的 探讨血管性认知功能障碍（vascular cognitive impairment,VCI）脑血流灌注的早期表现,分析局部脑血流量（regional cerebral blood flow,rCBF）的减低与认知受损领域的关系。方法 将入组患者按照认知受损程度分为：认知正常组、非痴呆血管性认知功能障碍（vascular cognitive impairment not dementia,VCIND）组及血管性痴呆（vascular dementia,VaD）组。分析比较三组患者不同区域rCBF的差异,及各区域rCBF与蒙特利尔认知评分（Montreal Cognitive Assessment,MoCA）相关性;分析比较血流灌注显像与形态学显像的差异;分析rCBF与各认知受损领域的关系。结果 三组患者左侧颞叶、左丘脑、左侧海马局部脑血流量差异有显著性（F=8.232、6.237、6.136;P=0.002、0.006、0.000）。左侧颞叶、丘脑及海马rCBF与MoCA评分具有相关性（P=0.011、0.023、0.029）且为正性相关（r=0.421、0.355、0.323）。SPECT检查下出现rCBF减低的平均区域数多于头部磁共振检查下出现梗死灶的平均区域数,但二者差异无显著性。左侧顶叶rCBF与计算力相关,且呈正相关性（Beta=0.445,P=0.020）;右侧海马、右侧颞叶与时间地点定向力相关,且为正相关（Beta=0.626、0.740;P=0.035、0.023）。结论 SPECT检查下显示rCBF的变化为VCI是以颞叶、海马、丘脑低血流代谢为主要表现提供了病理生理学依据。SPECT检查下显示rCBF的变化有早于脑组织结构检查下形态结构变化的趋势。     

运用磁共振动脉自旋标记技术鉴别轻度认知功能障碍和血管性轻度认知功能障碍

目的研究轻度认知功能障碍(MCI)和血管性轻度认知功能障碍(VaMCI)患者各认知功能脑区域脑血流量(CBF)的特点,为早期诊断提供科学依据。方法选择2016年1月-2018年1月昆明市延安医院神经内科门诊及住院部确诊的24例MCI患者(MCI组)和24例VaMCI(VaMCI组)患者及24名老年健康志愿者(正常对照组)作为研究对象,运用动脉自旋标记(ASL)技术采集3组受试者认知功能脑区域的CBF数据。结果与正常对照组相比,MCI组双侧额叶、双侧海马脑血流灌注增加,双侧颞叶、楔前叶等部位脑血流灌注降低(P 0. 05);与正常对照组相比,VaMCI组双侧额叶、双侧海马脑血流灌注增加,双侧楔前叶、角回等部位脑血流灌注降低(P 0. 05);与MCI组相比,VaMCI组左侧颞叶、双侧扣带回、左侧杏仁核脑血流灌注增加,右侧颞叶、右侧扣带回等部位脑血流灌注降低(P 0. 05)。结论 MCI患者和VaMCI患者认知功能脑区域脑血流灌注具有不同的特点,磁共振ASL技术能够为两者的鉴别提供影像学帮助。     

Functional brain imaging in obsessive-compulsive disorder secondary to neurological lesions

Obsessive-compulsive disorder (OCD) may result from a range of neurological lesions in frontal and basal ganglia areas. However, relatively few studies have explored functional brain imaging in acquired OCD. METHODS: Charts of patients presenting to our Neuropsychiatry Unit where obsessive-compulsive symptoms appeared secondary to neurological lesions were reviewed. Demographic information and clinical diagnoses were collated, and brain SPECT scans reviewed. Six patients with various neurological conditions presented with OCD. All demonstrated decreased blood flow in the temporal lobes as well as cortical perfusion abnormalities in the frontal lobes (focal areas of decreased perfusion in one patient, focal areas of increased perfusion in two, and a combination of focal increased and decreased frontal perfusion in three cases). Abnormal blood flow may be seen in a number of different brain regions in acquired OCD. It is unclear whether these changes reflect primary neurological lesions or secondary changes to compensate for such damage. However, increased frontal blood flow in OCD may be hypothesized to reflect a compensatory mechanism.     

Mapping of SPECT regional cerebral perfusion abnormalities in obsessive-compulsive disorder

Locations of cerebral perfusion abnormalities in obsessive-compulsive disorder (OCD) were mapped with single photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI). This report is a new, more thorough analysis of a previous study of these subjects that used region-of-interest methods. Ten obsessive-compulsive patients and seven age- and sex-matched control subjects were studied. Image sets were converted into stereotaxic space, normalized to each subject's mean cerebral value, then group averaged. Difference images were calculated and searched for regions with significant between-group cerebral perfusion differences. Obsessive-compulsive patients had significantly higher relative cerebral perfusion in medial-frontal and right frontal cortex and in cerebellum, and significantly reduced perfusion in right visual association cortex. Increased frontal Perfusion agrees with several prior reports. The caudate nucleus, which has been controversial in neuroimaging studies of OCD, did not display a difference between groups. The results of this study provide information about the locations and extents of cerebral perfusion abnormalities in OCD. Regional abnormalities were compared with those reported in prior functional neuroimaging studies. Issues related to OCD hyperfrontality and frontal lateralization of psychopathology are discussed. Normal caudate nucleus findings are considered in relation to prior functional imaging studies and hypotheses of OCD pathology. © 1994 Wiley-Liss, Inc.     

Tc-99m HMPAO brain perfusion SPECT in drug-free obsessive-compulsive patients without depression

The aim of this study was to confirm prior results of brain-imaging studies on obsessive-compulsive disorder (OCD) in a sample of Turkish patients, as a cross-cultural study. Tc-99m HMPAO brain perfusion SPECT imaging was performed in nine drug-free OCD patients without depression and six controls. The patients' Hamilton Depression Rating Scale scores were <16. The severity of obsessive-compulsive symptoms was rated with the Yale-Brown Obsessive-Compulsive Rating Scale (YBOCS). Quantitative evaluation of regional cerebral blood flow revealed that right thalamus, left frontotemporal cortex and bilateral orbitofrontal cortex showed significant hyperperfusion in patients with OCD compared with controls. YBOCS scores did not show any correlation with hyperperfusion in regional cerebral blood flow in these areas. Results of this cross-cultural study may support orbitofrontal and thalamic dysfunction in OCD in a sample of Turkish patients.     

Single photon emission computed tomography (SPECT) of anxiety disorders before and after treatment with citalopram

Background  

Several studies have now examined the effects of selective serotonin reuptake inhibitor (SSRI) treatment on brain function in a variety of anxiety disorders including obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (social phobia) (SAD). Regional changes in cerebral perfusion following SSRI treatment have been shown for all three disorders. The orbitofrontal cortex (OFC) (OCD), caudate (OCD), medial pre-frontal/cingulate (OCD, SAD, PTSD), temporal (OCD, SAD, PTSD) and, thalamic regions (OCD, SAD) are some of those implicated. Some data also suggests that higher perfusion pre-treatment in the anterior cingulate (PTSD), OFC, caudate (OCD) and antero-lateral temporal region (SAD) predicts subsequent treatment response. This paper further examines the notion of overlap in the neurocircuitry of treatment and indeed treatment response across anxiety disorders with SSRI treatment.     

Serotonin 2A receptor, serotonin transporter and dopamine transporter alterations in dogs with compulsive behaviour as a promising model for human obsessive-compulsive disorder

Neuro-imaging studies have shown altered, yet often inconsistent, serotonergic and dopaminergic neurotransmission in patients with obsessive-compulsive disorder (OCD). We investigated both serotonergic and dopaminergic neurotransmission in 9 drug-na?ve dogs with compulsive behaviour, as a potential model for human OCD. Single photon emission computed tomography was used with (123)I-R91150 and (123)I-FP-CIT, in combination with (99m)Tc-ECD brain perfusion co-registration, to measure the serotonin (5-HT) 2A receptor, dopamine transporter (DAT) and serotonin transporter (SERT) availability. Fifteen normally behaving dogs were used as reference group. Significantly lower 5-HT2A receptor radioligand availability in frontal and temporal cortices (bilateral) was observed. Further, in 78% of the compulsive dogs abnormal DAT ratios in left and right striatum were demonstrated. Interestingly, both increased and decreased DAT ratios were observed. Finally, significantly lower subcortical perfusion and (hypo)thalamic SERT availability were observed in the compulsive dogs. This study provides evidence for imbalanced serotonergic and dopaminergic pathways in the pathophysiology of compulsions in dogs. The similarities with the altered neurotransmission in human OCD provide construct validity for this non-induced, natural canine model, suggesting its usefulness for future investigations of the pathophysiology of human OCD as well as the effectiveness of psychopharmacological interventions.     

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

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.     

Regional cerebral blood flow and aberrant motor behaviour in Alzheimer's disease

Aberrant motor behaviour (AMB) in Alzheimer's disease shares behavioural correlates with obsessive compulsive disorder (OCD). We investigated whether AMB was also comparable in terms of metabolic activity in the orbitofrontal cortex (OFC), an area shown to be hyperactive in OCD. In this study 135 patients meeting research criteria for Alzheimer's disease were identified from a database of patients recruited as part of a phase II drug trial. These patients were assessed using the Neuropsychiatric Inventory, the Alzheimer's disease assessment scale, cognitive subscale and perfusion SPECT performed with ⁹⁹Tc^m hexamethylpropyleneamine oxime. Regions of interest were created for orbitofrontal cortices and basal ganglia. In 35 patients with AMB, adjusted tracer uptake was greater in the OFC. This reached statistical significance in right superior, left superior, right medial and left medial orbital gyri (p < 0.05). The association between AMB and hyperactivity in the OFC remained significant after adjusting for the presence of anxiety. These results parallel the OFC hypermetabolism consistently seen in OCD. One model of OCD, proposes that dysfunctional interactions between frontal regions, including the OFC, produce the characteristic symptoms of OCD. The behaviour is though to be brought about by a perceived incompleteness of performing a task and is caused by an error in normal reward signals initiated upon task completion. These finding indicate that AMB in Alzheimer's disease are brought about by the same mechanistic failure.     

Study of compulsive buying in patients presenting obsessive-compulsive disorder

OBJECTIVE: The authors assessed the prevalence of compulsive buying (CB) among patients presenting an obsessive-compulsive disorder (OCD). They compared the buying style of patients with and without CB. METHOD: One thousand five hundred consecutive patients were assessed by a general practitioner in Paris (France). Sixty patients presenting with OCD were included. Patients with CB associated with OCD (n = 14) were compared with those with "pure" OCD (n = 46). Sixty patients paired for sex and age and free from OCD, depression, and anxiety were also recruited among the clients of the same general practitioner. We compared 3 groups: controls, patients with OCD, and patients with OCD + CB. RESULTS: Prevalence of CB was 23% (14 cases) among patients with OCD and 6% (4 cases) in controls (chi(2)(1) = 5.3, P = .02). Patients presenting with OCD + CB had a higher number of Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition diagnostic criteria for OCD than patients with pure OCD (6.1 and 5.4, respectively, P = .001). Depression was more frequent in the OCD + CB group (78%) than in the OCD group (42%) and in controls (10%) (P = .02). Patients from the OCD + CB group had higher score at the CAGE questionnaire than those of the OCD group (2 vs 0.7, P = .003). Patients with OCD + CB considered 42% of their purchases as occasions not to be passed up compared with 15.4% in the OCD group and 8.6% in controls. OCD+CD patients used the items they bought after a longer delay than controls and patients with pure OCD (8.2 vs 3 and 3.1 days, respectively). CONCLUSION: Compulsive buying is more frequent in OCD than in controls. Patients presenting with OCD + CB show more depressive disorders and drink more alcohol. They are more highly implicated in the items they buy and they are more often disappointed by the items once they possess them.