To identify neurochemical factors measured pre-treatment that may predict cognitive behavioural treatment (CBT) outcome, aiming at understanding possible causes of poor CBT response. 1H magnetic resonance spectroscopy was used before treatment with CBT in treatment naïve 11–18 year-old patients with moderate–severe OCD. Diagnoses and assessment of OCD severity were based on semi-structured interviews. Linear mixed effects models were used to analyse the association between metabolite level and treatment outcome. Worse CBT outcome was associated with higher concentration of glutamine and glutamate combined (Glx) in middle cingulate cortex (MCC) (F = + 3.35, p = 0.004) and of N-acetylaspartate and N-acetylaspartylglutamate combined (tNAA) (F = + 2.59, p = 0.019). Also, we noted a tendency towards higher thalamic Glx concentration (F = + 1.91, p = 0.077) to be associated with worse CBT outcome. In general, the findings of the current pilot study are compatible with the hypothesis of an overweight of excitatory to inhibitory factors in brain circuits driving goal-directed behaviours (GDB). Higher MCC Glx and tNAA may be involved in the selection of GDB. A more detailed understanding of how these brain areas function in health and illness is needed.

确定治疗前测量的可预测认知行为治疗 (CBT) 结果的神经化学因素，旨在了解 CBT 反应不佳的可能原因。在接受 CBT 治疗的 11-18 岁中度至重度强迫症患者中使用 1H 磁共振波谱。强迫症严重程度的诊断和评估基于半结构化访谈。线性混合效应模型用于分析代谢物水平与治疗结果之间的关联。更糟糕的 CBT 结果与中扣带皮层 (MCC) 中较高浓度的谷氨酰胺和谷氨酸盐 (Glx) 相关 ( F  = + 3.35, p  = 0.004) 以及N-乙酰天冬氨酸和N-乙酰天冬氨酰谷氨酸盐 (tNAA) ( F  = + 2.59, p  = 0.019)。此外，我们注意到较高的丘脑 Glx 浓度（F  = + 1.91，p  = 0.077）与较差的 CBT 结果相关。总体而言，当前试点研究的结果与驱动目标导向行为 (GDB) 的大脑回路中兴奋性因素和抑制性因素过多的假设一致。较高的 MCC Glx 和 tNAA 可能参与 GDB 的选择。需要更详细地了解这些大脑区域在健康和疾病中的功能。