Past research has found a high prevalence of neuropsychological deficits and neurological soft signs in patients with obsessive-compulsive disorder (OCD). A close relationship between OCD and depression has also been indicated in the literature. However, many aspects of this association remain unclear. In this study we compared neuropsychological functioning and neurological soft signs of 46 OCD patients who were off psychotropic medication (21 with significant depressive symptoms and 25 without) with 25 non-patient comparison subjects. The patients were matched to the comparison group with regard to age, sex, education, marital status and handedness. There were significant differences between OCD patients and the non-patient comparison group on neuropsychological functioning but not on neurological soft signs. As far as working memory concerns there was a significant difference between the OCD depressed and non-depressed groups. But we found no evidence that the neuropsychological functions such as cognitive flexibility, problem solving and spatial perception in OCD to be attributable to comorbid depression. The pattern of neuropsychological deficits in this sample of OCD patients is suggestive of orbito-frontal as well as dorsolateral prefrontal cortical dysfunction.
American Psychiatric Association, “Diagnostic and Statistical Manual of Mental Disorders,” 4th Edition, American Psychiatric Association, Washington DC, 1994.
ó. F. Goncalves, T. R. Marques, N. F. Lori, A. Sampaio and M. C. Branco, “Obsessive-Compulsive Disorder as a Visual Processing Impairment,” Medical Hypotheses, Vol. 74, No. 1, 2010, pp. 107-109. doi:10.1016/j.mehy.2009.07.048
D. J. Stein, “Obsessive-Compulsive Disorder,” The Lancet, Vol. 360, No. 9330, 2002, pp. 397-405. doi:10.1016/S0140-6736(02)09620-4
L. E. Baxter, “Position Emission Tomography Studies of Cerebral Glucose Metabolism in Obsessive-Compulsive Disorder,” Journal of Clinical Psychiatry, Vol. 55, Suppl. 10, 1994, pp. 54-59.
M. L. Bethier, “Cognitive Function in the Obsessive-Compulsive Disorder Associated with Cerebral Lesions,” Revista de Neurologia, Vol. 30, No. 8, 2000, pp. 762-772.
J. S. Choi, D. H. Kang, J. J. Kim, T. H. Ha, J. M. Lee, T. Youn, et al., “Left Anterior Subregion of Orbito-Frontal Cortex Volume Reduction and Inpaired Organizational Strategies in Obsessive-Compulsive Disorder,” Journal of Psychiatric Research, Vol. 38, No. 2, 2004, pp. 193-199. doi:10.1016/j.jpsychires.2003.08.001
J. S. Kwon, J. J. Kim, J. S. Lee, D. S. Lee, M. S. Kim, et al., “Neural Correlates of Clinical Symptoms and Cognitive Dysfunctions in Obsessive-Compulsive Disorder,” Psychiatry Research, Vol. 122, No. 1, 2003, pp. 37-47. doi:10.1016/S0925-4927(02)00104-X
S. L. Rauch, P. J. Whalen, D. Dougherty and M. A. Jenike, “Neurobiological Models of Obsessive-Compulsive Disorder,” In: M. A. Jenike, L. Baer, W. E. Minichello, Eds., Obsessive Compulsive Disorders: Practical Management, Mosby, St. Louis, 1998, pp. 222-253.
S. Saxena, A. Brody, K. M. Maidment, J. J. Dunkin, M. Colgan, S. Aborzian, M. E. Phelphs and L. R. Baxter, “Localized Orbitofrontal and Subcortical Metabolic Changes and Predictors of Response to Paroxetine Treatment in Obsessive-Compulsive Disorder,” Neuropsychopharmacol- ogy, Vol. 21, No. 6, 1998, pp. 683-693. doi:10.1016/S0893-133X(99)00082-2
C. R. Savage, “Neuropsychology of OCD,” In: M. A. Jenike, L. Baer and W. E. Minichello, Eds., Obsessive Compulsive Disorders: Practical Management, Mosby, St. Louis, 1998, pp. 255-275.
B. Cassey, R. Trainor, J. L. Prebdi, A. B. Schubert, L. E. Nystrom, J. N. Giedd, et al., “A Developmental Functional MRI Study of Prefrontal Activation during Performance of a Go-No-Go Task,” Journal of Cognitive Neuroscience, Vol. 9, No. 6, 1997, pp. 835-847. doi:10.1162/jocn.1997.9.6.835
J. V. Lucy, C. E. Burness and D. C. Costa, “Wisconsin Card Sorting Task (WCST) and Cerebral Blood Flow in Obsessive-Compulsive Disorder (OCD),” British Journal of Medical Psychology, Vol. 70, No. 4, 1997, pp. 403-411. doi:10.1111/j.2044-8341.1997.tb01916.x
S. V. Muller, S. Johannes, B. Wieringa, A. Weber, K. Muller-Vahl, M. Matzke, H. Kolbe, R. Dengler and T. F. Munte, “Disturbed Monitoring and Response Inhibition in Patients with Gilles de la Tourette Syndrome and Co-Morbid Obsessive Compulsive Disorder,” Behavioral Neurology, Vol. 14, No. 1-2, 2003, pp. 29-37.
D. R. Rosenberge and M. S. Keshavan, “Toward a Neurodevelopmental Model of Obsessive-Compulsive Disorder,” Biological Psychiatry, Vol. 43, No. 9, 1998, pp. 623- 640. doi:10.1016/S0006-3223(97)00443-5
K. Rubia, T. Russell, S. Overmeyer, M. J. Brammer, E. T. Bullmore, T. Sharma, et al., “Mapping Motor Inhibition: Conjunctive Brain Activations across Different Versions of Go-No-Go Tasks,” NeuroImage, Vol. 13, No. 2, 2001, pp. 250-261. doi:10.1006/nimg.2000.0685
M. B. Spitznagel and J. A. Suhr, “Executive Function Defi- cits Associated with Symptoms of Schizotypy and Obsessive-Compulsive Disorder,” Psychiatry Research, Vol. 110, No. 2, 2002, pp. 151-163. doi:10.1016/S0165-1781(02)00099-9
S. R. Chamberlain, A. D. Blackwell, N. A. Fineberg, T. W. Robbins and B. J. Sahakian, “The Neuropsychology of Obsessive Compulsive Disorder: The Importance of Failures in Cognitive and Behavioral Inhibition as Candidate Endophenotypic Markers,” Neuroscience and Biobehavioral Reviews, Vol. 29, No. 3, 2005, pp. 399-419. doi:10.1016/j.neubiorev.2004.11.006
P. Schilder, “The Organic Background of Obsessions and Compul-sions,” American Journal of Psychiatry, Vol. 94, No. 6, 1993, pp. 1397-1414.
L. V. Conde, M. J. J. de la Gandara, L. M. L. Blanco, R. P. Cerezo, R. M. Martinez and F. A. de Dios, “Minor Neurological Signs in Obsessive-Compulsive Disorders,” Acta Luso-Espanolas De Neurologia, Psychiatria Ciencias Afines, Vol. 18, 1990, pp. 143-164.
E. Hollander, C. M. De Caria, J. B. Saud, et al., “Neurological Soft Signs in OCD,” Archives General Psychiatry, Vol. 48, No. 3, 1991, pp. 278-279. doi:10.1001/archpsyc.1991.01810270090014
D. Neary, “Classification of the Dementias,” Reviews in Clinical Gerontology, Vol. 9, No. 1, 1999, pp. 55-64. doi:10.1017/S0959259899009156
R. Baldwin, S. Jeffries, A. Jackson and C. Sutcliffe, “Neu- rological Findings in Late Onset Depressive Disorder: Comparison of Individuals with and without Depression,” The British Journal of Psychiatry, Vol. 186, 2005, pp. 308-313. doi:10.1192/bjp.186.4.308
D. W. Black, R. Noyes, R. B. Goldstein and N. Blum, “A Family Study of Obsessive-Compulsive Disorder,” Archives General Psychiatry, Vol. 49, No. 5, 1992, pp. 362- 368. doi:10.1001/archpsyc.1992.01820050026004
S. E. Swedo and J. L. Rapoport, “Phenomenology and Differential Diagnosis of Obsessive-Compulsive Disorder in Children and Adolescents,” In: J. L., Rapoport, Ed., Obsessive-Compulsive Disorder in Children and Adolescents, American Psychiatric Press, Washington DC, 1989, pp. 13-23.
S. Andrés, T. Boget, L. Lázaro, R. Penadés, A. Morer, Salamero, M. and J. Castro-Fornieles, “Neuropsychological Performance in Children and Adolescents with Obsessive-Compulsive Disorder and Influence of Clinical Variables,” Biological Psychiatry, Vol. 61, No. 8, 2007, pp. 946-951. doi:10.1016/j.biopsych.2006.07.027
A. Aycicegi, W. M. Dinn, C. L. Harris and H. Erkmen, “Neuropsychological Function in Obsessive-Compulsive Disorder: Effects of Comorbid Conditions on Task Performance,” European Psychiatry, Vol. 18, No. 5, 2003, pp. 241-248. doi:10.1016/S0924-9338(03)00065-8
M. R. Basso, R. A. Bornstein, F. C. Carona and R. Morton, “Depression Accounts for Executive Function Deficits in Obsessive-compulsive Disorder,” Neuropsychiatry, Neuro-psychology and Behavioral Neurology, Vol. 14, No. 4, 2001, pp. 241-245.
S. Moritz, M. Kloss, H. Jahn, M. Schick and I. Hand, “Impact of Comorbid Depressive Symptoms on Nonverbal Memory and Visuospatial Performance in Obsessive-Compulsive Disorder,” Cognitive Neuropsychiatry, Vol. 8, No. 4, 2001, pp. 261-272. doi:10.1080/135468000344000020
J. K. Trivedi, M. Dhyani, D. Goel, S. Sharma, A. P. Singh, P. K. Sinha and R. Tendon, “Neurocognitive Dysfunction in Patients with Obsessive Compulsive Disorder,” African Journal of Psychiatry, Vol. 11, No. 3, 2008, pp. 204- 209.
J. K. Christensen and H. K. Maxwell, “Neuropsychological Performance in Obsessive-Compulsive Disorder,” Biological Psychiatry, Vol. 31, No. 1, 1992, pp. 4-18. doi:10.1016/0006-3223(92)90003-I
R. W. Buchanan and D. W. Heinrichs, “The Neurological Evaluation Scale (NES): A Structured Instrument for the Assessments of Neurological Signs in Schizophrenia,” Psychiatry Research, Vol. 27, No. 3, 1989, pp. 335-350. doi:10.1016/0165-1781(89)90148-0
C. M. Zielinski, M. A. Taylor, K. R. Juzwin, “Neuropsychological Deficits in Obsessive-Compulsive Disorder,” Neuropsychiatry, Neuropsychology and Behavioral Neurology, Vol. 4, No. 2, 1991, pp. 110-126.
M. N. Barahani, “Raven’s Progressive Matrices as Applied to Iranian Children,” Educational & Psychological Measures, Vol. 34, No. 4, 1974, pp. 443-478.
J. C. Raven, “Progressive Matrices: A Perceptual Test of Intelligence,” Lewis Raven, London, 1938.
R. C. Oldfield, “The Assessment and Analysis of Handedness: The Edinburgh Inventory,” Neuropsychologia, Vol. 9, No. 1, 1971, pp. 97-113. doi:10.1016/0028-3932(71)90067-4
A. T. Beck, R. A. Steer and G. K. Brown, “Manual for the Beck Depression Inventory-II,” Psychological Corporation, San An-tonio, 1996.
A. T. Beck, C. H. Ward, M. Mendel-sohn, J .E. Mock and J. K. Erbaugh, “An Inventory for Measuring Depression,” Arch. Gen. Psychiatry, Vol. 4, No. 6, 1961, pp. 561-571. doi:10.1001/archpsyc.1961.01710120031004
H. Ghassemzadeh, R. Mojtabai, N. Karamghadiri and N. Ebrahimkhani, “Psychometric Properties of a Persian- Language Version of the Beck Depression Inventory- Second Edition: BDI-II-Persian,” Depression and Anxiety, Vol. 21, No. 4, 2005, pp. 185-192. doi:10.1002/da.20070
R. Hodgson and S. Rachman, “Obsessive-Compulsive Com- plaints,” Behaviour Re-search and Therapy, Vol. 15, No. 5, 1977, pp. 389-395. doi:10.1016/0005-7967(77)90042-0
S. Rachman and R. J. Hodgson, “Obsession and Compulsions,” Prentice-Hall, Englewood Cliffs, 1980.
H. Ghassemzadeh, A. Khamseh and N. Ebrahimkhani, “Symptoms of OCD in a Sample of Iranian Patients,” International Journal of Social Psychiatry, Vol. 48, No. 1, 2002, pp. 20-28. doi:10.1177/002076402128783055
H. Ghassemzadeh, J. Bolhari, B. Birashk and M. Salavati, “Responsibility Attitude in a Sample of Iranian Obsessive-Compulsive Patients,” International Journal of So- cial Psychiatry, Vol. 51, No. 1, 2005a, pp. 13-22. doi:10.1177/0020764005053266
H. Ghassemzadeh, A. Khamseh and N. Ebrahimkhani, “Demographic Variables and Clinical Features of Obsessive- Compulsive Disorder in Iranian Patients (Second Report),” In: B. E. Ling, Ed., Obsessive-Compulsive Disorder Research, Nova Science Publishers, Inc., New York, 2005, pp. 243-271.
T. St. Clare, “Assessment Procedures,” In: R. G. Menzies, ans P. De Silva, Eds., Obsessive-Compulsive Disorder: Theory Research and Treatment, John Wiley, Chrichester, 2003, pp. 239-258.
R. Philpott, “Recent Advances in the Behavioral Measurement of Obsessional Illness, Difficulties to These and Other Instruments,” Scottish Medical Journal, Vol. 20, 1975, pp. 33-40.
J. Cottraux, M. Bouvard, M. Defayolle and P. Messy, “Validity and Factorial Structure of the Compulsive Activity Checklist,” Behavior Therapy, Vol. 19, No. 1, 1988, pp. 45-53. doi:10.1016/S0005-7894(88)80054-6
R. K. Heaton, “Wisconsin Card Sorting Test Manual,” Psychological Assessment Resources, Odessa, 1981.
N. Hymas, A. Lees, D. Bolton, K. Epps and D. Head, “The Neurology of Obsessional Slowness,” Brain, Vol. 114, No. 5, 1991, pp. 2203-2233. doi:10.1093/brain/114.5.2203
K. Lezak, “Neuropsychological Assessment,” University Press, Oxford, 1995.
T. Shallice, “Specific Impairments of Planning,” Philsophical Transactions of the Royal Society of London, 98, Vol. 98, No. 1089, 1982, pp. 199-209. doi:10.1098/rstb.1982.0082
H. A. Simon, “The Functional Equivalence of Problem Solving Skills,” Cognitive Psychology, Vol. 7, No. 2, 1975, pp. 268-288. doi:10.1016/0010-0285(75)90012-2
V. Goel and J. Grafman, “Are the Frontal Lobes Implicated in ‘Planning’ Functions? Interpreting data from the Tower of Hanoi,” Neuropsychologia, Vol. 33, No. 5, 1995, pp. 623-643. doi:10.1016/0028-3932(95)90866-P
B. R. Aronowitz, E. Hollander and C. De Caria, “Neuropsychology of Obsessive-Compulsive Disorder,” Neuropsychiatry, Neuropsychology and Behavioral Neurology, Vol. 7, No. 2, 1994, pp. 81-86.
S. Rasmussen and J. L. Eisen, “Phenomenology of OCD: Clinical Subtypes Heterogeneity, and Coexistence,” In: J. Zohar, T. Insel and S Rasmussen, Eds., The Psychobiology of Obsessive-Compulsive Disorder, Springer, New York, 1991, pp. 13-43.
D. Wechsler, “Wechsler Memory Scale,” Psychological Corporation, San Antonio, 1987.
M. N. Barahani, S. Nasirian and B. Yazdi, “Wechsler Memory Scale (A Form)-Persian,” Tehran Psychiatric Institute, Tehran, 1981.
B. M. Gu, J. Park, D. H. Kang, S. J. Lee, et al., “Neural Correlates of Cognitive Inflexibility during Task-Switching in Obsessive-Compulsive Dis-order,” Brain, Vol. 131, No. 1, 2008, pp. 155-164. doi:10.1093/brain/awm277
D. W. Evans, M. D. Lewis and E. Iobst, “The Role of the Orbito-Frontal Cortex in Normally Developing Compulsive-Like Behaviors and Obsessive-Compulsive Disorder,” Brain and Cognition, Vol. 55, No. 1, 2004, pp. 220- 234. doi:10.1016/S0278-2626(03)00274-4
H. A. Berlin, E. T. Rolls and U. Kischka, “Impulsivity, Time Perception, Emotion and Reinforcement in Patients with Orbito-Frontal Cortex Lesions,” Brain, Electronic Publication Ahead of Print, 2004.
S. Galderisi, A. Mucci, F. Catapano, A. C. Damato and M. Maj, “Neuropsychological Slowness in Obsessive-Compulsive Patients: Is It Confined to Tests Involving the fronto-Subcortical Systems?” The British Journal of Psychiatry, Vol. 167, 1995, pp. 394-398. doi:10.1192/bjp.167.3.394
D. Head, D. Bolton and N. Hymas, “Deficits in Cognitive Shifting Ability in Patients with Obsessive Compulsive Disorder,” Biological Psychiatry, Vol. 25, No. 7, 1989, pp. 929-937. doi:10.1016/0006-3223(89)90272-2
A. Okasha, M. Rafaat, N. Mahallawy, G. El Nahas, A. Seif El Dawla, M. Sayed and S. El Kholi, “Cognitive Dys- function in Obsessive-Compulsive Disorder,” Acta Psychiatria Scandinavia, Vol. 101, No. 4, 2000, pp. 281-285.
S. Saxena, A. Brody, K. M. Maidment, J. J. Dunkin, M. Colgan, S. Aborzian, M. E. Phelphs and L.R. Baxter, “Localized Orbitofrontal and Subcortical Metabolic Changes and Predictors of Response to Paroxetine Treatment in Obsessive-Compulsive Disorder,” Neuropsychopharmacology, Vol. 21, No. 6, 1999, pp. 683-693. doi:10.1016/S0893-133X(99)00082-2
B. Milner, “Effects of Different Brain Lesion on Card Sorting: The Role of Frontal Lobes,” Archives of Neurology, Vol. 9, No. 1, 1963, pp. 90-100. doi:10.1001/archneur.1963.00460070100010
J. D. Henry, “A Meta-Analytic Review of Wisconsin Card Sorting Test and Verbal Fluency Performance in Obsessive-Compulsive Disorder,” Cognitive Neuropsychiatry, Vol. 11, No. 2, 2006, pp. 156-176. doi:10.1080/13546800444000227
R. Purcell, P. Maruff, M. Kyrios and C. H. Pantelis, “Neuropsychological Deficits in Obsessive-Compulsive Disorder: A Comparison with Unipolar Depression, Panic Disorder and Normal Controls,” Archives of General Psychiatry, Vol. 55, No. 5, 1998, pp. 415-423. doi:10.1001/archpsyc.55.5.415
C. H?rting and H. J. Markowitsch, “Neuropsychologische Befunde der Zwangsst?rung,” Fortschritte der Neurologie und Psychiatrie, Vol. 65, 1997, pp. 509-515.
A. K. Kuelz, F. Hohagen and U. Voderholzer, “Neuropsychological Performance in Obsessive-Compulsive Disorder: A Critical Review,” Biological Psychology, Vol. 65, No. 3, 2004, pp. 185-236. doi:10.1016/j.biopsycho.2003.07.007
M. Jenike, “Theories of Etiology,” In: M. A. Jenike, L. Baer and W. E. Minichiello, Eds., Obsessive-Compulsive Disorder: Theory and Management, PSQ Inc., Litteton, 1986.
D. J. Stein, “Advances in the Neurobiology of Obsessive Compulsive Disorder,” Psychiatric Clinics of North Ame- rica, Vol. 23, No. 3, 2000, pp. 545-562. doi:10.1016/S0193-953X(05)70180-5
S. Moritz, M. Kloss, H. Jahn, M. Schick and I. Hand, “Impact of Comorbid Depressive Symptoms on Nonverbal Memory and visuospatial Performance in Obsessive- Compulsive Disorder,” Cognitive Neuropsychiatry, Vol. 8, No. 4, 2002, pp. 261-272. doi:10.1080/135468000344000020
S. Wilhem, R. J. McNally, L. Baer and I. Florin, “Auto- biographical Memory in Obsessive-Compulsive Disorder,” British Journal of Clinical Psychology, Vol. 36, No. 1, 1997, pp. 21-31. doi:10.1111/j.2044-8260.1997.tb01227.x
I. H. Got-lib, J. E. Roberts and I. E. Gilboa, “Cognitive Interference in Depression,” In: I.G., Sarason, Ed., Cognitive Interference: Theories, Methods, and Findings, Hill-sdale, Erl-baum 1996, pp. 347-377.
S. Moritz, M. Kloss, H. Hahn, M. Schick and I. Hand, “Impact of Comorbid De-pressive Symptoms on Nonverbal Memory and Visuos-patial Performance in Obsessive-Compulsive Disorder,” Cognitive Neuropsychiatry, Vol. 8, No. 4, 2003, pp. 261-272. doi:10.1080/135468000344000020
S. Moritz, D. Jacobsen, m. Kloss, S. Fricke, M. Rufer, I. Hand, “Examination of Emotional Stroop Interference in Obses-sive-Compulsive Disorder,” Behavioral Therapy, Vol. 42, No. 6, 2004, pp. 671-682. doi:10.1016/S0005-7967(03)00190-6
J. R. Wend-land, P. R. Moya, M. R. Kruse, et al., “A Novel, Putative Gain-of-Function Haplotype at SLC6A4 Associates with Obsessive-Compulsive Disorder,” Human Molecular Genetics, Vol. 17, No. 5, 2008, pp. 717-723. doi:10.1111/j.2044-8260.1997.tb01227.x
I. M. Blackburn, “Coping with Depression,” Chambers, Endinburn, 1987.