Investigation of the effects of reactive and NON-reactive obsession TYPES on cognitive functions in patients with obsessive compulsive disorder

Aim: Studies on cognitive dysfunction in patients with Obsessive Compulsive Disorder (OCD) have found inconsistent results. The aim of this study is to determine whether obsession types cause differences on cognitive functions in patients with adult OCD. It is thought that our study may be useful in the interpretation of cognitive functions showing inconsistent results in patients with OCD and in studies on predicting the clinical course of patients with different types of obsessions and on individually tailored treatment selection. Materials and Methods: 38 patients with pure reactive obsession type, 41 patients with non-reactive obsession type who were diagnosed with OCD according to DSM-5 diagnostic criteria and 40 healthy volunteers were included in the study. Our research is an observational case-control study. Sociodemographic data form prepared by the researcher, Yale-Brown Obsession Compulsion Scale (YBOCS), Hamilton Anxiety Scale (HARS) and Hamilton Depression Scale (HDRS) were applied. All participants were asked to fill the Wender-Utah Scale (WUDO), Adult Attention Deficit Hyperactivity Rating Scale (ASRS), and Barratt Impulsivity Scale-11 (BDI-11) self-report scales. Then, the Cambridge Neurophysiological Assessment Test Battery (CANTAB) was administered to all participants by the researcher. Paired Associate Learning Test (PAL), Cambridge Gambling Tasks (CGT), Intra-Extra Dimensional Set Shift (IED), Stop Signal Test (SST) in CANTAB were used. Results: It was determined that the age at diagnosis was lower and benzodiazepine use was higher in the non-reactive type OCD group. The HDRS score was higher in the non-reactive type OCD group. When the effects of age, education year, and HDRS total score were removed, it was determined that the quality of decision-making deteriorated significantly in the pure reactive type OCD group compared to the non-reactive type OCD group. Pure reactive type OCD patients performed worse than the control group in terms of risk taking and high bet ratio. It was determined that as the HARS and HDRS scores decreased, the quality of decision-making increased, and the decision-making time and risk adjustment improved. Factors such as age, years of education, and education years of mother were found to be associated with decision-making quality, decision-making time, and risky decision-making. While years of education, education years of parents, age, age of symptom onset, age at diagnosis were effective on visuospatial functions, the severity of the disease did not. As the HARS and HDRS scores increased, it was observed that the performance in set-shifting worsened. It was determined that there was deterioration in response inhibition in the non-reactive type OCD group compared to the pure reactive type OCD group and the control group. It was determined that low education years, maternal education years, advanced age and disease severity negatively affected response inhibition. It was determined that IED- EDS errors, PAL- total attemps, PAL- Mean Errors to Success and SST- missed trials could predict the diagnosis of OCD. It was determined that IED- completed stages and SST- missed trials were significant in predicting the diagnosis of reactive obsession type OCD. Conclusion: In our study, it was determined that patients with different types of obsessions showed differences in terms of clinical features and cognitive functions. It was determined that response inhibition in the non-reactive type OCD group and decision making were impaired in the pure reactive type OCD group. We think that this may be useful in the evaluation of patients and in the choice of treatment. In order to support our findings, it may be recommended to carry out studies with large sample sizes and patients who receive treatments that will affect cognitive functions at a similar rate. Keywords: Obsessive compulsive disorder, Reactive obsession, Autogenous obsession, Decision making, Set-shifting, Visuospatial functions, Response inhibition.