Imagine there’s dirt on your floor. You clean it up. You move on. Easy! Unless you have obsessive-compulsive disorder (OCD), a disorder marked by intrusive, uncontrollable, repetitive thoughts or actions.
Columbia neurosurgeon Dr. Sameer Sheth is at the forefront of research on how OCD and other psychiatric and behavior disorders work in the brain, and how to treat them when behavioral therapy and medication fail.
For many years, neurosurgeons have worked to discover which areas of the brain should be targeted to treat these disorders. But in a recent Grand Rounds talk here at Columbia Dr. Sheth explained that psychiatric disorders are not a problem of just one region of the brain but of a network of processes.
Going back to the example of a dirty floor, Dr. Sheth described how the brain normally functions in such a situation: If there’s dirt on the floor, one part of the brain senses that information and passes it on. Another part evaluates the information, makes the decision that we don’t want dirt on the floor and directs other parts of the brain to clean it up.
Once the dirt is gone the network stops alerting us to the need to clean and everything goes back to normal. This process of taking in information from the world around us, making decisions about it and directing the body to react is called the cognitive control process.
In someone with OCD this process breaks down. Once the floor is cleaned, the cognitive control network fails to stop sending out the “dirt” alarm. The OCD sufferer keeps needing to clean, over and over, even when the dirt itself is long gone.
Dr. Sheth said this kind of dysfunction in the cognitive control process is behind many psychiatric and behavioral disorders, not just OCD, and that the key to better treatment outcomes will depend on understanding the way behaviors function as a network of processes.
He said that in the future, close ties between neurosurgery, psychiatry, neuroscience and engineering will be critical to understanding the brain as a whole and bringing greater relief to patients.
Image credit: John Abbott
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