Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis

Preethi Premkumar; Dominic Fannon; Adegboyega Sapara; Emmanuelle R Peters; Anantha P Anilkumar; Andrew Simmons; Elizabeth Kuipers; Veena Kumari

doi:10.1016/j.pscychresns.2015.01.013

Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis

Psychiatry Res. 2015 Mar 30;231(3):298-307. doi: 10.1016/j.pscychresns.2015.01.013. Epub 2015 Jan 19.

Authors

Preethi Premkumar¹, Dominic Fannon², Adegboyega Sapara², Emmanuelle R Peters³, Anantha P Anilkumar⁴, Andrew Simmons⁵, Elizabeth Kuipers³, Veena Kumari³

Affiliations

¹ Division of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK. Electronic address: [email protected].
² Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK.
³ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK.
⁴ South London and Maudsley NHS Foundation Trust, London, UK.
⁵ NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK; Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, UK.

Abstract

Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region׳s role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry, emotional decision-making and CBTp responsiveness. Emotional decision-making was measured by the Iowa Gambling task (IGT). Thirty patients received CBTp+standard care (CBTp+SC; 25 completers) for 6-8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging. Patients׳ symptoms were assessed before and after therapy. Pre-therapy OFC GMV was measured using a region-of-interest approach, and IGT performance was measured as overall learning, attention to reward, memory for past outcomes and choice consistency. Both these measures, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC׳s function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness.

Keywords: Asymmetry; Prefrontal cortex; Schizophrenia.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Cognitive Behavioral Therapy / methods*
Decision Making / physiology*
Emotions / physiology*
Female
Humans
Magnetic Resonance Imaging / methods
Male
Middle Aged
Prefrontal Cortex / anatomy & histology*
Psychotic Disorders / physiopathology
Psychotic Disorders / therapy*
Schizophrenia / physiopathology
Schizophrenia / therapy*
Treatment Outcome
Young Adult

Grants and funding

067427/z/02/z/Wellcome Trust/United Kingdom