The goal of a new $10 million grant awarded to scientists at the University of Rochester School of Medicine and Dentistry is to improve our understanding of the brain networks that play a central role in obsessive-compulsive disorder (OCD). Together with leading mental health researchers at four other institutions in the U.S., they will pinpoint specific abnormalities within the brain circuits that are associated with the disease and use this information to guide new treatment options for the three million-plus Americans who live with the disorder.
The five-year grant from the National Institute of Mental Health (NIMH) establishes a new Silvio O. Conte Center for Basic and Translational Mental Health Research at the University of Rochester. Conte Centers are designed to bring scientists with diverse but complimentary backgrounds together to improve the diagnosis and treatment of mental health disorders.
OCD is one of the leading mental health disorders, affecting two to three percent of the worldwide population, according to the World Health Organization. Suzanne N. Haber, Ph.D., leader of the research team, says the disease is characterized by intrusive, ruminating thoughts (obsessions), and impulses to carry out repetitive behaviors (compulsions), despite the awareness by most patients that these behaviors don’t make sense.
Imaging studies show that the brain regions and circuits disrupted in OCD are those involved in how we make decisions about situations that involve potential risk or reward. Haber’s laboratory focuses on the wiring of these circuits, which she likens to complex air traffic networks.
Haber’s team will map these networks, identifying hubs that bring together information from several brain regions that are involved in transmitting data about the internal and external environments. These hubs, which are key to making decisions about what actions to take, are thought to be disorganized in OCD. With her collaborators, she hopes to develop new treatment targets aimed at specific brain regions that they find are altered in the disease.
“What’s really exciting about this work is that what we learn can be applied to a wide range of psychiatric disorders, since some parts of this circuitry are also involved in depression, post-traumatic stress disorder and addiction” said Haber, professor in the Department of Pharmacology and Physiology at the School of Medicine and Dentistry.
Knowledge gained from anatomical and imaging studies in Haber’s and her collaborators’ labs will be used to guide and test the promise of different forms of non-invasive brain stimulation methods in OCD, including transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). These techniques use mild electrical currents or magnetic pulses applied to the scalp to stimulate nerve cells in particular regions of the brain: they appear to affect how targeted brain regions work, but more research is needed to understand their exact influence on the brain. Neither method requires surgery or the implantation of electrodes. TMS is already done as an outpatient procedure in a doctor’s office or clinic for depression, but not for OCD.
People with OCD are usually aware that the thoughts and behaviors it produces are not rational. Even though patients may struggle to control their symptoms, they are generally, with effort, able to work or go to school, maintain a household and socialize with family and friends. But for about 10 percent of OCD sufferers the impact on functioning and the normal activities of daily life is very high and quality of life is seriously impaired.
While the majority of patients can be helped with a combination of antidepressant medications and cognitive behavioral treatments, there continues to be a need for more effective treatments for those who fail to respond.
“The good news is that standard behavioral therapies and medications can help most patients with OCD,” noted Ben Greenberg, M.D., Ph.D., professor of Psychiatry and project leader at Butler Hospital and Brown Medical School. “The bad news is that many have an inadequate response to those treatments and are often left with substantial suffering and impairment. That is why we need new treatments that are suitable for wide clinical use in OCD.”
The research team hopes that pinpointing the circuit abnormalities in OCD will be a major step forward in developing individualized treatments for the disorder, as well as for related psychiatric conditions.
In addition to Haber and Greenberg, the other team leaders in the new Center include:
· Randy Buckner, Ph.D., professor of Psychology, Harvard University
· Mary Phillips, M.D., professor of Psychiatry, University of Pittsburgh
· Greg Quirk, Ph.D., professor of Psychiatry, University of Puerto Rico
· Steve Rasmussen, M.D., chair and professor of Psychiatry, Brown University
This is the second Conte Center grant that Haber has received from NIMH. The first grant funded research from 2009 to 2014 focused on the circuitry underlying the effects of a surgical treatment known as deep brain stimulation on OCD. The findings highlighted the mechanisms of brain stimulation for the disease and helped modify the target used with deep brain stimulation.
Conte Centers are named after a former congressman from Massachusetts who championed neuroscience research and the care of the severely mentally ill.