White Matter Features Associated With Autistic Traits in Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders. Comorbid autism spectrum disorder (ASD) or autistic traits may impair treatment response in OCD. To identify possible neurostructural deficits underlying autistic traits, we performed white matter tractography on diffusion tensor images (DTI) and assessed autistic trait severity using the Autism-Spectrum Quotient (AQ) in 33 OCD patients. Correlations between AQ and the DTI parameters, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were examined in major white matter tracts that were suggested to be altered in previous OCD studies. We found a negative correlation between AQ and FA and positive correlations between AQ and MD, AD and RD in the left uncinate fasciculus using age, Beck Depression Inventory, Yale-Brown Obsessive-Compulsive Scale, intelligence quotient and medication as covariates. However, we could not detect the significant results between AQ and all DTI parameters when adding gender as a covariate. In addition, in the ASD comorbid group, FA in the left uncinate fasciculus was significantly lower than in the non-ASD comorbid group and MD and RD were significantly higher than in the non-ASD group. These results did not survive correction for multiple comparisons. In ASD, the socio-emotional dysfunction is suggested to be related to the alteration of white matter microstructure in uncinate fasciculus. Our results suggest that variations in white matter features of the left uncinate fasciculus might be partly explained by autistic traits encountered in OCD patients.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder with and without Autism Spectrum Disorder: Gray Matter Differences Associated with Poor Outcome.

Cognitive behavioral therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) and is also applicable to patients with both OCD and autism spectrum disorder (ASD). However, previous studies have reported that CBT for patients with both OCD and ASD might be less effective than for patients with OCD alone. In addition, there is no evidence as to why autistic traits might be risk factors. Therefore, we investigated whether comorbidity between ASD and OCD may significantly affect treatment outcome and discovered predictors of CBT outcomes using structural magnetic resonance imaging (MRI) data. A total of 39 patients, who were diagnosed with OCD, were enrolled in this study. Of these, except for 2 dropout cases, 15 patients were diagnosed with ASD, and 22 patients were diagnosed with OCD without ASD. Both groups took CBT for 11-20 sessions. First, to examine the effectiveness of CBT for OCD patients with and without ASD, we compared CBT outcomes between the two groups. Second, to investigate how the structural abnormality profile of the brain at pretreatment influenced CBT outcomes, we performed a structural MRI comparison focusing on the gray matter volume of the whole brain in both patients with only OCD, and those with both OCD and ASD. In order to discover neurostructural predictors of CBT outcomes besides autistic traits, we divided our samples again into two groups of those who did and those who did not remit after CBT, and repeated the analysis taking autistic traits into account. The results showed that OCD patients with ASD responded significantly less well to CBT. The OCD patients with ASD had much less gray matter volume in the left occipital lobe than OCD patients without ASD. The non-remission group had a significantly smaller volume of gray matter in the left dorsolateral prefrontal cortex (DLPFC) compared with the remission group, after having partialed out autistic traits. These results indicate that the abnormalities in DLPFC negatively affect the CBT outcome, regardless of the severity of the autistic traits.

Development and validation of the Japanese version of cognitive flexibility scale.

BACKGROUND: Various instruments have been developed to assess cognitive flexibility, which is an important construct in psychology. Among these, the self-report cognitive flexibility scale (CFS) is particularly popular for use with English speakers; however, there is not yet a Japanese version of this scale. This study reports on the development of a Japanese version of the cognitive flexibility scale (CFS-J), and the assessment of its internal consistency, test-retest reliability, and validities. METHODS: We used the standard translation-back-translation process to develop the Japanese wording of the items and tested these using a sample of 335 eligible participants who did not have a mental illness, were aged 18 years or older, and lived in the suburbs of Tokyo. Participants included office workers, public servants, and college students; 71.6 % were women and 64.8 % were students. The translated scale's internal consistency reliability was assessed by calculating Cronbach's alpha and McDonald's omega, and test-retest reliability was assessed with 107 eligible participants via intra-class correlation coefficient (ICC) and Spearman's correlation of coefficient. Exploratory factory analysis (EFA) and correlations with other scales were used to examine the factor-based and concurrent validities of the CFS-J. RESULTS: Results indicated that the CFS-J has good internal consistency (Cronbach's alpha = 0.847, McDonald's omega = 0.871) and acceptable test-retest reliability (Spearman's = 0.687, ICC = 0.689). EFA provided evidence that the CFS-J has a one-factor structure and factor loadings were generally appropriate. The total CFS-J score was significantly and positively correlated with the cognitive flexibility inventory-Japanese version and its two subscales, along with the cognitive control scale and the positive subscale of the short Japanese version of the automatic thought questionnaire-revised (ATQ-R); further, it had a significantly negative correlation with the negative subscale of the ATQ-R (ps < 0.001). This study developed a Japanese version of the cognitive flexibility scale and confirmed its reliability and validity among a sample of people with no current mental illness, who were living in the suburbs of Tokyo.

Transient contribution of left posterior parietal cortex to cognitive restructuring.

Cognitive restructuring is a fundamental method within cognitive behavioural therapy of changing dysfunctional beliefs into flexible beliefs and learning to react appropriately to the reality of an anxiety-causing situation. To clarify the neural mechanisms of cognitive restructuring, we designed a unique task that replicated psychotherapy during a brain scan. The brain activities of healthy male participants were analysed using functional magnetic resonance imaging. During the brain scan, participants underwent Socratic questioning aimed at cognitive restructuring regarding the necessity of handwashing after using the restroom. The behavioural result indicated that the Socratic questioning effectively decreased the participants' degree of belief (DOB) that they must wash their hands. Alterations in the DOB showed a positive correlation with activity in the left posterior parietal cortex (PPC) while the subject thought about and rated own belief. The involvement of the left PPC not only in planning and decision-making but also in conceptualization may play a pivotal role in cognitive restructuring.