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OCD IMAGING KEEPS FINDING THE SAME LOOP OF REGIONS
Researchers Have Scanned The Brains Of People With OCD
What They Found Was A Loop Of Connected Regions
The Loop Runs From The Cortex To Deeper Structures And Back
Differences Show Up Along It Only When Groups Are Compared
Treatment Studies Scanned Those Same Regions Afterwards
Their Measurements Did Not All Move The Same Way
This Part Covers The Loop And What Treatment Changes
THIS NEWSLETTER IS FOR INFORMATIONAL PURPOSES ONLY. NOTHING IN THIS CONTENT CONSTITUTES MEDICAL, PSYCHOLOGICAL, OR PROFESSIONAL ADVICE. ALWAYS CONSULT A QUALIFIED HEALTHCARE PROFESSIONAL BEFORE MAKING ANY HEALTH RELATED DECISIONS.
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OKAY BACK FROM THE SCANNER 🧠
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THE LOOP OCD MODELS DESCRIBE 🔄
Researchers Describe Cortico Striato Thalamo Cortical Circuits
That Name Lists The Stops In Order
Cortex Comes First In The Sequence
Striatum Receives The Signal Next
Thalamus Takes It From There
Cortex Appears Again At The End Of The Name
Those Circuits Go By The Shorthand CSTC
These Circuits Are Described As Parallel And Partly Segregated
Parallel Means Several Of Them Run At Once
Partly Segregated Means They Overlap Without Merging
Sensorimotor Processes Involve These Circuits
Cognitive Processes Involve Them As Well
Affective And Motivational Processes Complete The List
Four Kinds Of Processing Therefore Share One Anatomy
A Fault In One Part Could Show Up In Several Of Them
That Breadth Is Why The Model Explains So Much At Once
It Is Also Why The Model Is Hard To Falsify
Naming A Circuit Is Not The Same As Proving Causation
The Loop Is Where The Findings Cluster
Clustering Is A Weaker Claim Than Explanation
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WHERE THE DIFFERENCES SHOW UP 🔬
Symptom Provocation Studies Scan People While Symptoms Rise
Those Studies Find Increased Activation In Several Places
Ventral Frontostriatal And Temporal Regions Are Two Of Them
The Hippocampus Is Part Of That Temporal Grouping
Emotional Processing Tasks Produced A Separate List
The Bilateral Amygdala Appears In That One
Beside It Comes The Right Putamen
Orbitofrontal Cortex Extends Into The Anterior Cingulate There
A Later Analysis Found Overactivation Of Other Networks
Salience And Arousal And Habitual Responding Are What They Serve
The Anterior Cingulate Serves Them Along With Others
Insula Appears Alongside It
The Head Of The Caudate Nucleus Is Named Too
Putamen Completes That Grouping
Structural Studies Measure Volume Rather Than Activity
Smaller Dorsomedial Prefrontal Volumes Appear In Patients
Medial Orbitofrontal And Insular Opercular Volumes Are Smaller As Well
Bilateral Lenticular Nuclei Show Increased Volume Instead
Larger Putamen And Cerebellum Volumes Appear In The Same Literature
That Putamen Finding Was Most Pronounced In Older Patients
Unmedicated Children Showed A Larger Thalamus Than Controls
Direction Of Difference Is Not Consistent Across Structures
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WHAT TREATMENT MOVES 🧲
Behavioral Studies Test The Same Circuits A Different Way
Patients Show Increased Habit Formation Compared With Healthy Controls
Hyperactivation Of The Caudate Nucleus Is Associated With That
Increased Habitual Responding Appears Alongside Affective Processing
Impaired Cognitive Control Appears In The Same Description
A Habit Repeats Regardless Of The Goal Behind It
Compulsion Fits That Description Better Than Deliberate Choice Does
Researchers Then Test Whether Any Of This Shifts
One Systematic Review Examined 64 Studies From 1990 To 2020
Each Compared Pretreatment And Post Treatment Imaging In Patients
Medications And Cognitive Behavioral Therapy Both Appear In That Set
Stereotactic Lesions And Deep Brain Stimulation Appear Too
Transcranial Magnetic Stimulation Rounds Out The Modalities
Decreases In Metabolism And Perfusion Are The Most Notable Result
Those Decreases Show Up In The Caudate
Anterior Cingulate Metabolism Falls As Well
Thalamus And Regions Of Prefrontal Cortex Complete The Set
The Authors Add A Warning To Their Own Finding
OCD Is An Especially Heterogeneous Disorder In Their Words
The Caudate Shows Clinically Relevant Activity In Both Directions
They Argue For Tuning The CSTC Circuit Not Raising Or Lowering It
