Understanding the OCD Brain: Inside a Patient's Head

In this video, David Adam, a patient with Obsessive Compulsive Disorder (OCD), visits the University of Cambridge to learn more about his condition. He volunteers for a cognitive test and brain scan to understand how his brain functions in relation to OCD. The video also discusses the importance of animal research in understanding OCD and the need for better treatments.

My name is David Adam, and I have Obsessive Compulsive Disorder, or OCD. I want to learn more about my condition, so I've come to the University of Cambridge to see how some of the top scientists in the field are studying this disorder. I've observed how they use animals to understand what's going on in the brain. But since OCD is a human condition, I'm curious about how this research relates to the human brain. Today, I'm meeting Dr. Anamika Apergis-Hout, who uses cognitive tasks very similar to those we've just seen carried out on animals, but with human volunteers. Today, I'm the volunteer. Ultimately, scientists need to compare what they've learned from animals with what is happening in the human brain. Cognitive tests can tell us a great deal about the OCD brain, but to see which areas of my brain are involved in my OCD, Anamika is going to conduct a similar test, while imaging my brain in a brain scanner 60,000 times the strength of the Earth's magnetic field. "So David," she says, "you're about to go into the scanner, where you'll just be laying down and watching a screen. You'll see two angry male faces. Your job is to figure out after which face you might be getting a shock. At the same time, we will be recording your skin conductance, where we can see tiny changes in your sweat, to see when you might be expecting a shock. You also have a shock electrode on your other wrist, through which you'll be getting those little shocks." After the scan, she asks, "David, what did you notice about when you were getting shocks?" I reply, "At the beginning, I definitely felt that I was getting shocks from the green faces. And then I got a bit confused, because the red faces seemed to join in." Dr. Apergis-Hout explains, "That's very interesting, because that's what we overall find in OCD patients. Initially, they realize they're getting shocks to the green face, and that the other one is safe, as we see by their skin conductance responses. But in the middle, when unexpectedly, now the red face is giving shocks, and now the green one has become safe, there's no difference between their skin conductance responses in this part. And what we see from the OCD patients, in their brain, is that they have a region here, in the medial front part of the brain, that is hyperactive, throughout differentiating these two respond to faces. So, in the healthy controls, we see that this region actually signals when a stimulus is safe, but it doesn't seem to do this for the OCD patients." I ask, "Why bring the animals into it?" She explains, "With humans, we can see correlations between brain regions, and what happens when they do a certain task. But we can't see things on the neuronal level, and we also can't manipulate the brain, so we can't stimulate a certain region, or maybe even ablate a certain region, take it out. We can't put drugs in, to see what happens if the levels of certain neurotransmitters change. So, in an animal, we can model, we can do a lot more, that we're not able to do in humans, on that much more specific level." I've seen some of the research now at the university, and I came in interested and a little skeptical about the animal research. But what is most striking for me now are those images of my own brain, seeing those on the computer screen. It's quite humbling, and it's also quite emotional for me, because of course that's where it all began. I think we like to think of the brain as being uniquely human, and of course it is, but also seeing it in that way, cut away, made me realize that I'm an animal, and my brain is a part of my body in the way that the other organs are. When the other organs go wrong, we try and treat them, and so it is with the brain. But we're probably not as advanced with some of those treatments, and certainly not with OCD. It's worth remembering that the treatments for OCD are better than they used to be, and they help people, certainly. They certainly help me, but they don't help everybody, and they're not particularly good for some people. So we need to keep trying to find better treatments. And I think if I'm honest, I think some of the research that I've seen probably won't lead to any breakthrough, certainly in time to help me, but hopefully in time to help the next generation. And if we want to try and develop better treatments and new treatments, then I think we do need to treat the brain like any other part of the body, and we do need to experiment with it, and we do need to find out what goes wrong. I guess we can't do that work with humans, so I think we have to do some of that with animals, just to maybe not to develop new treatments immediately, as some people might talk about, but mainly just to give us the knowledge to try and improve and develop new treatments in the future. Because I think sadly, as far as my generation goes and me, it's probably too late. We have to make do with the rather crude tools and treatments that we have now, but hopefully for the next generation, it's not too late.