Predicting treatment outcome in obsessive-compulsive disorder using neuroimaging biomarkers.

Obsessive-compulsive disorder (OCD) is a severely debilitating psychiatric disorder that is characterized by repetitive behaviour such as washing or cleaning, which may take up the entire day. First-line treatment for OCD consists of pharmacological treatment with selective serotonin reuptake inhibitors (SSRIs) or psychological treatment with cognitive-behavioral therapy (CBT) (van Balkom et al. 2013). Both these treatments are effective, but 40-60% of patients do not benefit sufficiently (Pallanti et al. 2002; Eddy et al. 2004). We recently found that machine learning analysis of resting-state functional MRI obtained prior to treatment can reliably predict treatment outcome in depression (van Waarde et al. 2015).
Here, we aim to apply these methods to OCD to develop a treatment selection biomarker that enables the allocation of patients to the treatment with the largest chance of success. In addition, we aim to determine the common and specific neural mechanisms underlying treatment efficacy. The analysis of CBT and SSRI-related changes at the level of brain areas and circuits will provide more perspective on the pathophysiology of OCD and the response to different treatments. Patients in the first cohort are randomized to SSRI or CBT to develop and validate a treatment selection fMRI biomarker for allocating OCD patients and to determine the divergent longitudinal effects on brain measures of treatment in patients with OCD. In the second cohort, patients will be allocated to SSRI or CBT based on fMRI biomarkers identified in the first cohort.

We recently found that machine learning analysis of resting-state functional MRI obtained prior to treatment can reliably predict treatment outcome in depression (van Waarde et al. 2015). Here, we aim to apply these methods to OCD to develop a treatment selection biomarker that enables the allocation of patients to the treatment with the largest chance of success. In addition, we aim to determine the common and specific neural mechanisms underlying treatment efficacy.

Before treatment and 16 weeks after treatment.

The subjects will be randomized to pharmacological treatment or cognitive behavioral therapy (CBT).