Main points. Neuropsychology. Neuropsychological methods OCD. The neuropsychology of obsessivecompulsive. Neuropsychology OCD

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Main points Neuropsychology The neuropsychology of obsessivecompulsive disorder () 215 Gyula Demeter gdemeter@cogsci.

Summary further directions Neuropsychology is an experimental field of psychology studies the structure and function

cognition are influenced by brain functioning Neuropsychological methods Observation of behavior Anamnesis and

scales) Brain mapping techniques (EEG, fmri, PET etc.

1 Main points Neuropsychology The neuropsychology of obsessivecompulsive disorder () 215 Gyula Demeter Neuropsychological models of Is there a specific cognitive deficit? Summary further directions Neuropsychology is an experimental field of psychology studies the structure and function of the brain as they relate to specific psychological processes and behaviors aims to understand how behavior and cognition are influenced by brain functioning Neuropsychological methods Observation of behavior Anamnesis and heteroanamesis (the case history of a patient) Neuropsychological testing Questionnaires (personality; clinical scales) Brain mapping techniques (EEG, fmri, PET etc.) Obsessive-Compulsive Disorder () is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions) Lifetime prevalence: 2-3% Comorbidity: depression, phobias, bulimia, anorexia, panic disorder, tic disorders

rituals Avoidance Checking, needing reassurance Counting, ordering, rearranging Perfectionism Praying, penance Saving, hoarding DSM V Obsessive-Compulsive and Related Disorders Body Dysmorphic

2 Typical Obsessions Contamination (with dirt, germs, chemicals etc.) Fear of harm to self or others Doubting Need for specific order, symmetry Just right feeling Moral, religious Disturbing Images (violent or sexual) Symptoms Typical Compulsions Washing, cleaning rituals Avoidance Checking, needing reassurance Counting, ordering, rearranging Perfectionism Praying, penance Saving, hoarding DSM V Obsessive-Compulsive and Related Disorders Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Substance/Medication-Induced Obsessive-Compulsive and Related Disorder and Obsessive-Compulsive and Related Disorder Due to Another Medical Condition Other Specified and Unspecified Obsessive-Compulsive and Related Disorders Cortical structures involved in the pathomechansim of Orbitofrontal cortex (OFC) Dorsolateral prefrontal cortex (DLPFC) Anterior cingular cortec (ACC) Nucleus caudatus Amygdala Thalamus (Szecsko, 1999; Kang, 24; Whiteside 24) Altered cognitive functions - Executive functions Neurocognitive deficits in A unitary account? Syndromic Behavior Obsessions Compulsions Inhibition Inhibitory Failures Failures in Cognitive Inhibitory Processes Failures in Behavioral Inhibitory Processes Decision making Cognitive Findings Planning Inability to inhibit prepotent responses Inability to setshift Memory deficits on tasks assisted by strategy use Memory Go/No-Go Tasks Ocumlomotor Tasks CANTAB 2D ID/ED OAT DAT WCST RCFT BVRT CANTAB SRM CANTAB SWM (Chamberlain, et al., 25)

Our main findings (executive functions, nonverbal memory, prospective memory and memory retrieval) Shifting and inhibition

, in prep) Altered prospective memory functions in overactivation hypothesis (Racsmány et al.

, 214) WCST- Results (N=3) Stroop Test (N=3) ** Perseverative error 3 Nonperseverative error 25 Mean-Errors 2 15 1 5 RT colour RT

KONTROLL Control 9 stimuli, RT measure, 3 category Control KONTROLL (Demeter et al., 213) (Demeter et al.

3 Our main findings (executive functions, nonverbal memory, prospective memory and memory retrieval) Shifting and inhibition components of the executive system is impaired in (Demeter et al. 28, 213) Impaired nonverbal memory functions in (Demeter et al., in prep) Altered prospective memory functions in overactivation hypothesis (Racsmány et al., 211) No RIF effect in - suppression of irrelevant, interfering memories during competitive recall is impaired in (Demeter et al., 214) WCST- Results (N=3) Stroop Test (N=3) ** Perseverative error 3 Nonperseverative error 25 Mean-Errors RT colour RT word Control KONTROLL RT interference Mean- Category achieved ** Mean RT(msec) ** KONTROLL Control 9 stimuli, RT measure, 3 category Control KONTROLL (Demeter et al., 213) (Demeter et al., 213) Nonverbal memory - Tasks (Examples) Corsi Block Tapping Task 7 Corsi Block Tapping Task Rey Complex Figure Task 6 * Corsi - Spatial memory span Healthy Control 1 Corsi (Demeter et al., 213)

, 28) The event based PM Task: Ongoing Task: press the key (left or right) in direction of black arrow PM Task: if colour bars are the same colour press the uparrow key The task was administered in 3

4 Examples (MM) Prospective Memory (PM) is a multiphase process Realizing delayed intentions (Ellis, 1996) Remembering to do something (Kliegel, et al., 28) Formation Retention Initiation Execution Time (Demeter et al., in prep) (Kliegel, et al., 22) Cortical structures and PM Br. 1 as al Marker (Burgess et al., 28) The event based PM Task: Ongoing Task: press the key (left or right) in direction of black arrow PM Task: if colour bars are the same colour press the uparrow key The task was administered in 3 conditions: Baseline condition no PM stimuli occurred and were no expectation that they would Expectation condition was told that PM stimuli might occur, but non actually did Execution condition was told that PM stimuli might occur, and they did Stimuli: Colours used: red, green, blue, orange, yellow Baseline, Expectation conditions: 6 items Results - RTs (ms) Mean reaction times (RTs) for the ongoing and PM tasks in the execution condition Mean reaction times (RTs) for the expectation and execution costs Execution condition 8 items, contained 2 PM stimuli pseudorandomly distributed through the trials The stimuli were subject paced: the onset of the next stimulus was cued by a response by the subject, and stimuli remained visible until that response (Demeter et al., 211)

Conclusions the group performed significantly slower than the control group in all experimental conditions: baseline, expectation and execution the group slowed down significantly more than the

forgetting (RIF) The Retrieval Practice Paradigm Selectively retrieving a target memory among related memories requires some degree of inhibitory control over interfering and competing memories, a

5 Conclusions the group performed significantly slower than the control group in all experimental conditions: baseline, expectation and execution the group slowed down significantly more than the control group both in the expectation and the execution conditions expectation and execution costs the group responded significantly slower on the PM task in the execution condition Retrieval induced forgetting (RIF) The Retrieval Practice Paradigm Selectively retrieving a target memory among related memories requires some degree of inhibitory control over interfering and competing memories, a process held to be supported by inhibitory mechanisms. 1. Study Phase 2. Selective Practice Phase sport-tennis sport-cycling sport-te.? 3. Delay Phase Resolving simple mathematical problems 4. Test Phase sport-t..? sport-c..? Evidence from behavioral studies suggests that such inhibitory control can lead to subsequent forgetting of the interfering information, a finding called retrieval-induced forgetting (Anderson & Spellman, 1995; Anderson, Bjork, & Bjork, 1994). animal-dog Typical mean recall rates (%) Rp+ Rp- Nrp animal-d..? Rp+ Practiced items from practiced categories Rp- Unpracticed items from practiced categories Nrp Items from unpracticed categories baseline (Anderson, Bjork & Bjork, 1994) Results RTs (ms) Conclusions Average recall RTs in the final test in the two groups retrieval of some memories led to enhancement in both groups (practice effects), but forgetting of related memories (RIF) occurred only among controls it seems that neither state- and trait anxiety nor working memory capacity influence RIF in (no significant correlation between STAI, n-back and RIF scores) we suggest that the lack of RIF effect in is due to the dysfunction of conflict detection or resolution processes (Demeter et al., 214)

6 Summary Specific neurocognitive pattern (?) Heterogeneity - identification of different subgroups, cognitive patterns Valid neuropsychological tasks + cognitive experimental psychological paradigms Biological markers (e.g.: Eye-tracking, Deep Brain Stimulation)

Biological Risk Factors

Biological Risk Factors Ms Angelina Crea Provisional Psychologist Academic Child Psychiatry Unit Royal Children s Hospital Professor Alasdair Vance Head Academic Child Psychiatry Department of Paediatrics