Neurobiologische Korrelate der Zwangsstörungen - Aktuelle Befunde zur funktionellen Bildgebung

Zusammenfassung

Die vorliegende Übersichtsarbeit konzentriert sich auf Befunde aus dem Bereich der funktionellen Bildgebung. Nach einigen grundlegenden Informationen über Phänomenologie, Epidemiologie und Therapieansätze werden die wesentlichen Hirnareale vorgestellt, die mit Zwangsstörungen in Zusammenhang gebracht werden. Hierbei stehen Dysfunktionen im Bereich neuronaler Regelkreise im Vordergrund, welche von verschiedenen Kortexarealen über Striatum und Thalamus wieder zurück zum Kortex verlaufen. In verschiedenen, mit Verfahren der funktionellen Bildgebung durchgeführten Studien wurde allerdings deutlich, dass ein über den präfrontalen Kortex, Striatum und Thalamus hinausgehendes Netzwerk von Hirnarealen involviert sein dürfte, z. B. inferiore parietale Regionen, Bereiche des zingulären Kortex, Amygdala, Insel, Zerebellum. Vorschläge für eine Subklassifikation der Zwangsstörungen weisen darauf hin, dass an den verschiedenen Unterformen (Waschzwänge mit Kontaminationsangst, Kontrollzwänge mit aggressiven, sexuellen oder religiösen Zwangsgedanken, Symmetrie- und Ordnungszwänge, Hort- und Sammelzwänge) jeweils unterschiedliche, sich aber überschneidende Hirnareale beteiligt sind. Die geläufigsten methodischen Zugänge bei der neurofunktionellen Untersuchung arbeiten mit Symptomprovokation und mit Paradigmen zur Erfassung von Handlungsüberwachung und Fehlerkontrolle, da in diesen Funktionen zwangsspezifische Defizite vermutet werden. Darstellungen zur psychotherapeutisch induzierten Veränderung von Hirnaktivierungsmustern bei Zwangsstörungen runden das Bild ab.

Abstract

The following review is focusing on results of functional neuroimaging. After some introductory remarks on the phenomenology, epidemiology, and psychotherapy approaches of obsessive-compulsive disorders (OCD) the most important OCD-related brain regions are presented. Obviously, not only the prominent cortico-striato-thalamo-cortical feedback loops are involved, as functional brain imaging studies tell us, but also other regions as the inferior parietal lobe, the anterior and posterior cingulate gyrus, insula, amygdala, cerebellum, and others. Subclassifications using factor-analysis methods support the hypothesis, that most important subtypes („washing/contamination fear”, „obsessions/checking”, „symmetry/ordering”, „hoarding”) involve different, but partially overlapping brain areas. Stimulation paradigms in fMRI-research are commonly based on symptom provocation by visual or tactile stimuli, or on action-monitoring and error-monitoring tasks. Deficits in action-monitoring and planning are discussed to be one of the basic dysfunctions of OCD. Finally, results of psychotherapeutic induced variations of brain activations in OCD are presented.

Key words

obsessive-compulsive disorder - functional neuroimaging - fMRI - psychotherapy

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1 Wir verwenden hier aufgrund der Heterogenität der Subtypen den Plural, vgl. unten Punkt 3.

2 Abkürzungen: rCBF: regionaler zerebraler Blutfluss; OFC: orbitofrontaler Kortex; PFC: präfrontaler Kortex; AC bzw. ACC: anteriores Zingulum bzw. anteriorer zingulärer Kortex; HC: Healthy controls, d. h. gesunde Vergleichspersonen.