Showing papers by "Michelle Rozenman published in 2012"
TL;DR: The rationale for focusing on this "internalizing cluster" of anxiety, depression, and somatic complaints, clinical theory on transdiagnostic processes uniting these problems, and description of core treatment techniques for this group are presented.
80 citations
TL;DR: Comparing objectively measurable regional MRSI metabolites may indicate pediatric OCD and predict its response to CBT, and Interpretations are offered in terms of the Glutamatergic Hypothesis of Pediatric OCD.
Abstract: Background The brain mechanisms of cognitive–behavioral therapy (CBT), a highly effective treatment for pediatric obsessive–compulsive disorder (OCD), are unknown. Neuroimaging in adult OCD indicates that CBT is associated with metabolic changes in striatum, thalamus, and anterior cingulate cortex. We therefore probed putative metabolic effects of CBT on these brain structures in pediatric OCD using proton magnetic resonance spectroscopic imaging ( 1 H MRSI). Method Five unmedicated OCD patients (4 ♀, 13.5 ± 2.8) and 9 healthy controls (7 ♀, 13.0 ± 2.5) underwent MRSI (1.5 T, repetition-time/echo-time = 1500/30 ms) of bilateral putamen, thalamus and pregenual anterior cingulate cortex (pACC). Patients were rescanned after 12 weeks of exposure-based CBT. The Children's Yale–Brown Obsessive–Compulsive Scale (CY-BOCS) of OCD symptoms was administered before and after CBT. Results Four of 5 patients responded to CBT (mean 32.8% CY-BOCS reduction). Multiple metabolite effects emerged. Pre-CBT, N -acetyl-aspartate + N -acetyl-aspartyl-glutamate (tNAA) in left pregenual anterior cingulate cortex (pACC) was 55.5% higher in patients than controls. Post-CBT, tNAA (15.0%) and Cr (23.9%) in left pACC decreased and choline compounds (Cho) in right thalamus increased (10.6%) in all 5 patients. In left thalamus, lower pre-CBT tNAA, glutamate + glutamine (Glx), and myo -inositol (mI) predicted greater post-CBT drop in CY-BOCS ( r = 0.98) and CY-BOCS decrease correlated with increased Cho. Conclusions Interpretations are offered in terms of the Glutamatergic Hypothesis of Pediatric OCD. Similar to 18 FDG-PET in adults, objectively measurable regional MRSI metabolites may indicate pediatric OCD and predict its response to CBT.
30 citations