Obsessive-compulsive disorder and traumatic brain injury: Behavioral, cognitive, and neuroimaging findings

Objective: The goal of this study was to evaluate behavior and cognition in a consecutive series of patients who developed obsessive-compulsive disord er (OCD) after suffering a traumatic brain injury (TBI). Background: Becaus e OCD is a rare sequelae of TBI, the phenomenology of obsessions and compul sions, the comorbid psychiatric disorders, the performance on cognitive tes ts, and the neural correlates have not been well characterized. Methods: Te n adult patients who met DSM-IV diagnostic criteria for OCD after suffering either mild (6 cases), moderate (2 cases), or severe (2 cases) TBI were st udied using structured psychiatric rating scales (i.e., Yale-Brown Obsessiv e Compulsive Scale), cognitive tests, and magnetic resonance imaging (MRI). Results: Global severity of OCD ranged from moderate to severe, and all pa tients had multiple obsessions and compulsions. There was a high frequency of aggressive, contamination, need for symmetry/exactness, somatic, and sex ual obsessions as well as cleaning/washing, checking, and repeating compuls ions. Unusual features such as obsessional slowness (3 cases) and compulsiv e exercising (3 cases) were also documented. Comorbid psychiatric diagnoses were common and included posttraumatic stress disorder, anxiety with panic attacks, depression, and intermittent explosive disorder. Compared with 10 age-matched normal controls, the OCD group had poor performance on tests o f general intelligence, attention, learning, memory, word-retrieval, and ex ecutive functions; these cognitive deficits were more pervasive among patie nts displaying obsessional slowness. All OCD patients with mild TBI had nor mal MRI scans, whereas focal contusions in the frontotemporal cortices, sub cortical structures (caudate nucleus), or both were found in OCD patients w ith moderate and severe TBI. Conclusions: Posttraumatic OCD has a relativel y specific pattern of symptoms even in patients with mild TBI and is associ ated with a variety of other psychiatric disorders, particularly non-OCD an xiety. The patterns of cognitive deficits and MRI findings suggest dysfunct ion of frontal-subcortical circuits.