September 1992

Caudate Glucose Metabolic Rate Changes With Both Drug and Behavior Therapy for Obsessive-Compulsive Disorder

Author Affiliations

From the Departments of Psychiatry (Drs Baxter, Schwartz, Bergman, Szuba, Guze, Ferng, and Munford), Radiological Sciences (Drs Baxter, Guze, Mazziotta, and Phelps, Ms Alazraki, and Mr Selin), and Neurology (Dr Mazziotta and Ms Alazraki) and the Laboratory of Nuclear Medicine (Drs Baxter, Guze, Mazziotta, and Phelps, Ms Alazraki, and Mr Selin), UCLA School of Medicine. Dr Bergman is now at the University of Washington School of Medicine, Seattle; Ms Alazraki is now at Emory University School of Medicine, Atlanta, Ga; and Dr Ferng is now at National Defense Medical Center, Taipei, Republic of China.

Arch Gen Psychiatry. 1992;49(9):681-689. doi:10.1001/archpsyc.1992.01820090009002

• We used positron emission tomography to investigate local cerebral metabolic rates for glucose (LCMRG1c) in patients with obsessive-compulsive disorder before and after treatment with either fluoxetine hydrochloride or behavior therapy. After treatment, LCMRG1c in the head of the right caudate nucleus, divided by that in the ipsilateral hemisphere (Cd/hem), was decreased significantly compared with pretreatment values in responders to both drug and behavior therapy. These decreases in responders were also significantly greater than right Cd/hem changes in nonresponders and normal controls, in both of whom values did not change from baseline. Percentage change in obsessivecompulsive disorder symptom ratings correlated significantly with the percent of right Cd/hem change with drug therapy and there was a trend to significance for this same correlation with behavior therapy. By lumping all responders to either treatment, right orbital cortex/hem was significantly correlated with ipsilateral Cd/hem and thalamus/ hem before treatment but not after, and the differences before and after treatment were significant. A similar pattern was noted in the left hemisphere. A brain circuit involving these brain regions may mediate obsessivecompulsive disorder symptoms.