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Tijdschrift voor Psychiatrie 54 (2012) 1, 39 - 49

Review article

The decision-making process in obsessive compulsive disorder

C.L.A. Vandenbroucke, L. Gabriëls

background The extremely intrusive and repetitive nature of the symptoms of patients with obsessive-compulsive disorder (ocd) is suggestive of abnormalities in the decision-making process. This could explain why such patients realise how exaggerated and unreasonable their symptoms are, but time after time they become entrapped by them.
aim To review the available research results relating to the underlying mechanisms of decision making and to link these to the characteristics of ocd.
method We studied the literature on the decision-making process in ocd with the help of PubMed.
results There is a correlation between abnormalities in the decision-making process and dysfunction in the prefrontal cortex, more specifically in the orbitofrontal cortex (ofc) and the anterior cingulate cortex (acc). The activity in these areas in the course of functional imaging is different in ocd patients and in healthy persons. Evaluation of abnormal decision-making in ocd patients performed with the help of the Iowa Gambling Task (igt) is a possible predictor of the prognosis for pharmacological treatment.
conclusion The concept of ‘ocd as an abnormality in the decision-making process’ generates new hypotheses concerning the etiology and pathophysiology of ocd. Abnormal decision-making may be an endophenotype, which could have important implications for treatment.

keywords decision-making, obsessive compulsive disorder, orbitofrontal cortex