Visual Symptom Provocation in a Treatment-Naive Boy with Obsessive-Compulsive Disorder. A Single-Case Study with Functional Magnet Resonance Imaging

Visual Symptom Provocation in a Treatment-Naive Boy with Obsessive-Compulsive Disorder. A Single-Case Study with Functional Magnet Resonance Imaging Introduction: Neuroimaging research has played an important role in advancing pathophysiological models of obsessive-compulsive disorder (OCD). However, the majority of functional imaging studies in the past years have been limited to the adult population despite the fact that as many as 80% of all cases of OCD are believed to have their onset in childhood and adolescence. Treatment-naive children shortly after onset of the illness represent a unique group for studying the neurobiology of OCD because of the small number of confounding factors. Case Report: We used a functional magnet resonance imaging (fMRI) box-car paradigm with symptom provocation in a treatment-naive 12-year-old boy with OCD shortly after onset of the illness and in a control subject matched by age and IQ. Visual exposure to individual OCD symptom-related pictures represented the activation state, whereas neutral pictures were used for the control condition. Results: Increased neural activity was evident in the patient in the thalamus, in the orbitofrontal cortex, the anterior cingulate cortex and in the amygdala during the provocative compared to the control state, but no activation of the striatum was found. There was no increased activity in these regions in the control subject. Discussion and Conclusions: Visual stimulation proved adequate for the fMRI symptom-provocation paradigm. Future fMRI studies with treatment-naive patients with OCD might not only help to improve etiological models of OCD but also have the potential to predict treatment outcome.