Executive Functions and Insight in OCD: A Comparative Study

OKB'de Yönetici İşlevler ve İçgörü: Karşılaştırmalı Bir Çalışma

Nearly 25% to 30% of the patients with Obsessive Compulsive Disorder (OCD) do not respond to treatment. Cognitive-behavioral therapy fails in 20% of the cases, while selective serotonin reuptake inhibitors (SSRIs) fail in 40%. These patients have a long-term disorder and a bad prognosis.

These low rates of success can be explained with three factors: Comorbidity, intensity of the symptoms, and insight. Insight was found as a potential explanation after the pieces of research made to understand this therapeutic resistance. Of the OCD patients, nearly 15-36% have poor insights. This situation makes insight one of the most promising topics of future research in OCD. Thus, it is important to characterize OCD patients having poor insight.

Poor insight has been associated with a number of different factors: lower educational levels, earlier ages of onset, a long duration of disorder, chronic development, and OCD history in the family are the most emphasized factors. Furthermore, it is associated with more severe symptoms and a bigger psychiatric comorbidity.

Executive Functions

Executive functions are supported by a neural network that involves the frontal lobes’ regions. Executive function, as per the definition of the International Neuropsychological Society, is the whole series of functions or cognitive skills, which are required for executing complex behaviors for a specific purpose, and which determine our capacity of adaptability to different requests and environmental changes. Executive functions include a great variety of cognitive processes, such as strategic working memory, cognitive flexibility, cognitive control of the behavior, planning and problem-solving: attention, ability to predict, creating objectives, putting activities in order, self-regulation and initiative, abstraction, etc.

There are few studies that focus on the neuropsychological and cognitive characteristics of OCD patients. In order to help fill this gap, OCD patients with good insight and poor insight were divided into two groups, and scales were used to understand whether the two groups had a different neuropsychological profile (the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS); the Brown Assessment of Beliefs Scale (BABS); Rey’s Figure Test; the California Verbal Learning Test (CVLT); the Toulouse-Piéron Test; the Wisconsin Card Sorting Test (WCST); the Trail Making Test (TMT). The results obtained were compared to those of a matched control group.

The statistical analysis with a significance level of 95% revealed differences in the executive functions test, particularly in the WCST and trail making test (TMT). OCD patients with poor insight scored lower points in the trail making test (TMT) and Auditory-Verbal Learning Test, compared to the group with better insight.

Even though the worse performance of the patients with poor insight has not been categorically explained yet, three reasons were put forward regarding their worse performances in terms of certain cognitive deficiencies: 1) The conflicts between their belief systems and external stimulants may prevent the stimulus-response inhibition function. 2) Memory disorders may prevent them from fixing their belief systems adequately; 3) Verbal fluency disorders may make it difficult to have access to previous memories.

These differences put emphasize on the fact that the neuropsychological profile of the patients with poor insight is different from the patients with good insight, and on the role of the administrative functions in insight.

– Manarte, L., Andrade, A. R., do Rosário, L., Sampaio, D., Figueira, M. L., Morgado, P., & Sahakian, B. J. (2021). Executive functions and insight in OCD: a comparative study. BMC psychiatry, 21(1), 1-11.