Changes in insular subregion functional connectivity and its correlation with cognitive flexibility in patients with first-episode and treatment-naïve obsessive-compulsive disorder

Psychiatry Res. 2026 Mar 27;361:117126. doi: 10.1016/j.psychres.2026.117126. Online ahead of print.

ABSTRACT

OBJECTIVES: The purpose of this study was to investigate the changes of functional connectivity (FC) and its relationship with cognitive flexibility in patients with first-episode, treatment-naïve obsessive-compulsive disorder (OCD), using bilateral insula as seed regions.

METHODS: 45 OCD patients and 40 healthy controls (HC) were recruited to undergo a clinical symptom assessment, the Wisconsin Card Sorting Test (WCST), and rs-fMRI scans. Six seed regions in the bilateral insula were selected for whole-brain FC analyses. A two-sample t-test was utilized to compare the differences in FC between two groups. SPSS software was used to analyze the relationship between the strength of FC in different brain regions and cognitive flexibility in the OCD group using Pearson correlation.

RESULTS: Compared with the HC, FC between the left ventral anterior insula and left ventrolateral nucleus of thalamus was reduced in the OCD(p < 0.001), FC between the left dorsal anterior insula and right posterior central gyrus was increased (p < 0.001), and FC between the right dorsal anterior insula and right posterior central/middle temporal gyrus was increased (p < 0.001). FC between right dorsal anterior insula and right posterior central gyrus was significantly negatively correlated with cognitive flexibility(uncorrected p < 0.05). FC between left ventral anterior insula and left ventrolateral thalamus was positively correlated with cognitive flexibility(uncorrected p < 0.05). Finally, the FC between right dorsal anterior insula and right middle temporal gyrus was negatively correlated with cognitive flexibility (uncorrected p < 0.05).

CONCLUSION: Patients with OCD exhibit abnormal FC network involving insula, which are associated with cognitive flexibility, supporting a functional mechanism of cognitive inflexibility in OCD.

PMID:41935505 | DOI:10.1016/j.psychres.2026.117126