An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive–compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
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We are very grateful to the patients who shared experiences of their symptoms and agreed for these to be included in this article. This work was supported by a postdoctoral fellowship awarded to ES from the São Paulo Research Foundation (18/22396-7) and research grants from the São Paulo Research Foundation (2014/50917-0) and CNPq (465550/2014-2) awarded to ECM as part of the National Institute of Developmental Psychiatry for Children and Adolescents (INDP).
Conflict of interest
RGS has received consulting honoraria from Lundbeck and a travel grant from LIBBS. ARB has received funding from the São Paulo Research Foundation (2017/50223-6, 2018/10861-7), the Brazilian National Council of Scientific Development productivity support (PQ-1B), and the University of São Paulo Medical School productivity support (PIPA-A), and is the Chief Medical Advisor of Flow Neuroscience (Malmö, Sweden) and has a small equity in this company. JR Y.C. has received support from the various Government of India funding agencies for research on OCD, including the Department of Biotechnology (DBT), Department of Science and Technology (DST), and the Indian Council of Medical Research (ICMR); he is also currently involved in an NIMH multicenter international study on OCD. DJS has received research grants and/or consultancy honoraria from Lundbeck and Servier. HBS has received research funds for a multisite industry-sponsored clinical trial from Biohaven Inc., royalties from Cambridge University Press and UpToDate Inc., and a stipend from the American Medical Association for serving as an Associate Editor for JAMA Psychiatry. The other authors declare that they have no conflict of interest.
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Shephard, E., Stern, E.R., van den Heuvel, O.A. et al. Toward a neurocircuit-based taxonomy to guide treatment of obsessive–compulsive disorder. Mol Psychiatry 26, 4583–4604 (2021). https://doi.org/10.1038/s41380-020-01007-8
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