Veale, David Mikael William de Coverly; (1995) Cognitive deficits in obsessive compulsive disorder in tests which are sensitive to frontal lobe dysfunction. Doctoral thesis (M.D), UCL (University College London).

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Abstract

Forty patients with obsessive compulsive disorder (OCD) were compared to matched healthy controls on neuropsychological tests which are sensitive to frontal lobe dysfunction. On a computerised version of the Tower of London task of planning, OCD patients were no different to healthy controls in the accuracy of their solutions. There was no difference between the groups in the time spent thinking prior to making the first move or in the time spent thinking after the first move when "perfect move" solutions were considered. However, when the patients made a mistake, they spent more time than the controls generating alternative solutions or checking that the next move would be correct. The results suggest that OCD patients have a selective deficit in planning of generating alternative strategies when they make a mistake. In a separate attentional set-shifting task, OCD patients showed a continuous increase in terms of the number who failed at each stage of the task, including the crucial extra- dimensional set shifting stage. This suggests that OCD patients show deficits in both acquiring and maintaining cognitive sets. A sub-group of OCD patients who fail at or before the extra-dimensional shift stage also performed poorly on the Tower of London task. They are less accurate when solving problems and have a similar pattern of deficits to some neurosurgical patients with frontal lobe excisions. Both studies support the evidence of frontal-striatal dysfunction in OCD and the pattern of results is compared to that found in other known fronto-striatal disorders. The results are discussed in terms of a functional absence of a Supervisory Attentional System (Norman and Shallice, 1980).

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