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Multimodal Performance Monitoring in Patients With Obsessive-Compulsive Disorder

      What is it about the brains of patients with obsessive-compulsive disorder (OCD) that compels them to engage to a disabling degree in behaviors that they cognitively know to be unnecessary, such as washing and checking repeatedly? In this issue of Biological Psychiatry, Grützmann et al. (
      • Grützmann R.
      • Endrass T.
      • Kaufmann C.
      • Allen E.
      • Eichele T.
      • Kathmann N.
      Presupplementary motor area contributes to altered error monitoring in obsessive-compulsive disorder.
      ) probe the brains of patients with OCD in a multimodal brain mapping study that uses concurrent functional magnetic resonance imaging (fMRI) and electroencephalography (EEG)—the first ever to be applied to OCD. Appropriate for a disorder that compels repeated performance of irrational actions, they use these two modalities to evaluate performance monitoring, which refers to processes that monitor actions and make adjustments when errors occur (i.e., mismatches between intended and perceived actions). In 1987, Pitman first suggested that patients with OCD may generate larger mismatch (i.e., error) signals, leading to repeated behaviors (i.e., compulsions) in the attempt to reduce the error signal (
      • Pitman R.K.
      A cybernetic model of obsessive-compulsive psychopathology.
      ). In 2000, Gehring et al. provided the first evidence in support of this theory when they found that patients with OCD had exaggerated error-related negativity (ERN)—a negative amplitude event-related potential (ERP) that occurs in the EEG 50 to 100 ms after an erroneous response (
      • Gehring W.J.
      • Himle J.
      • Nisenson L.G.
      Action-monitoring dysfunction in obsessive-compulsive disorder.
      ). Multiple studies have replicated this finding in patients with OCD and their relatives, suggesting that a hyperactive ERN may be an endophenotype for the disorder (
      • Endrass T.
      • Ullsperger M.
      Specificity of performance monitoring changes in obsessive-compulsive disorder.
      ). The ERN findings are particularly intriguing because they occur in tasks that do not elicit OCD symptoms, possibly reflecting aspects of brain function that contribute to symptom generation.
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      Linked Article

      • Presupplementary Motor Area Contributes to Altered Error Monitoring in Obsessive-Compulsive Disorder
        Biological PsychiatryVol. 80Issue 7
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          Hyperactive performance monitoring, as measured by the error-related negativity (ERN) in the event-related potential, is a reliable finding in obsessive-compulsive disorder (OCD) research and may be an endophenotype of the disorder. Imaging studies revealed inconsistent results as to which brain regions are involved in altered performance monitoring in OCD. We investigated performance monitoring in OCD with simultaneous recording of electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) signals to determine the neural source of the enhanced ERN.
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