About

Nicole McLaughlin is an Associate Professor of Psychiatry and Human Behavior at Brown University. Her research concentrates on investigating changes in clinical outcomes, neuroimaging, and cognitive functioning following neurocircuitry-based interventions. Her background includes a PhD from Suffolk University, a master's degree from the same institution, and a bachelor's degree from Boston University. She completed a neuropsychology fellowship at Butler Hospital, focusing on neuropsychology, and has been involved in various research projects, including her role as a Co-Investigator at the Conte Center for OCD Research. Her primary research interests involve exploring the neurobiological and cognitive effects of neurosurgical and neurostimulation treatments for obsessive-compulsive disorder (OCD), including deep brain stimulation and gamma knife capsulotomy. She has contributed to understanding clinical, neuroimaging, and cognitive changes after these interventions, as well as examining related neuropsychiatric symptoms and treatment outcomes. Her work has been recognized through multiple awards and her involvement in NIH-funded projects, emphasizing her focus on advancing neuropsychiatric treatment strategies.

Research topics

• Medicine
• Psychiatry
• Psychotherapist
• Psychology
• Internal medicine
• Neuroscience
• Genetics
• Radiology
• Surgery
• Clinical psychology
• Biology

Selected publications

• Comparison of neuropsychological side effects between contemporary radiofrequency ablative neurosurgery for psychiatric disorders and conventional neurosurgical procedures: systematic review and meta-analysis

  Journal of Neurology Neurosurgery & Psychiatry · 2026-04-07

  articleOpen access

  BACKGROUND: Psychiatric disorders are increasingly contributing to global disability. Despite advances in conservative management, the prevalence of treatment-resistant cases remains high. Meanwhile, neurosurgery for psychiatric disorders (NPD) remains underused, largely due to strict regulations and historical concerns, particularly those related to neuropsychological side effects (NPSE). OBJECTIVE: To address this issue, we conducted a systematic review with meta-analysis to compare NPSE associated with radiofrequency ablative NPD to those observed in neuro-oncological, neurovascular and epilepsy surgeries. METHODS: PubMed, Embase and LILACS databases were searched in April 2024 for articles published in English/Spanish from 1990 to 2022, following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS: A total of 48 articles with 2678 participants were included. The frequency of transient and permanent NPSE in the NPD group ranged from 0.94% to 11.50% and 0.94% to 2.03%, respectively, comparable to the other surgical groups (epilepsy: 0.31-11.70%; vascular: 0.52-22.90%; oncology: 0.94-17.60% for transient NPSE; epilepsy: 0.31-12%; vascular: 0.40-1.96% and oncology: 0.84-1.48% for permanent NPSE). Regarding permanent NPSE, arguably the most critical consideration, the NPD group showed better outcomes in memory, language and social cognition than the epilepsy group, but worse outcomes in executive and perceptual-motor functions. Compared with the vascular group, the NPD group had better executive function but worse complex attention. Finally, the NPD group had fewer permanent deficits than the oncology group in executive function, complex attention and perceptual-motor domains, although language performance was lower. CONCLUSIONS: Contemporary NPD apparently carries a similar risk of NPSE as other conventional neurosurgical procedures, challenging misconceptions and this unjustified barrier to its broader use.

  PublisherOA PDFDOI

• Femoroacetabular impingement

  The Bone & Joint Journal · 2026-01-01

  article1st authorCorresponding

  Aims Hip arthroscopy is the treatment of choice for patients with femoroacetabular impingement (FAI), and it has been shown that outcomes are dependent upon symptom duration. However, the relationship between symptom duration and intra-articular injury pattern at time of arthroscopy has not previously been studied. Methods A retrospective review was conducted of all patients undergoing hip arthroscopy for FAI between January 2017 and December 2023, who were identified from the institutional database of Queen Elizabeth University Hospital, Glasgow, a tertiary referral, university-affiliated hospital. Times from referral and review to surgery, patient demographics, and intraoperative findings (Beck and University College London Hospitals (UCLH) classifications) were assessed. Multivariate and univariate linear regression analyses were performed to determine if there was a correlation between severity of cartilage injury and waiting time or patient demographics. Results A total of 307 patients were eligible for inclusion. The mean age was 34 years (SD 9.2) and mean BMI 26.6 kg/m 2 (SD 4.5). Time from surgeon review to surgery, patient age, and α angle independently influence the severity of cartilage damage. All cartilage damage scores were significantly correlated to waiting times in males (Beck ( r = 0.325; p < 0.001), UCLH ( r = 0.248; p = 0.006), UCLH size of lesion ( r = 0.197; p = 0.044)). Beck (2.88 vs 2.56; p = 0.027) and UCLH (2.50 vs 2.23; p = 0.038) scores were significantly higher in patients waiting > two years from referral to surgery compared to those who waited < two years. This was more apparent when male patients were analyzed separately (Beck (3.51 vs 2.66; p < 0.001) and UCLH (3.03 vs 2.29; p = 0.001)). Male patients waiting > six months from review to surgery also had significantly worse Beck scores than those waiting < six months (2.98 vs 2.33; p = 0.028). Conclusion Increasing waiting times are resulting in increased severity of intra-articular damage in patients undergoing hip arthroscopy for FAI. For the first time, longer waiting times have been correlated with worse cartilage injuries, independent of the size of the cam lesion, particularly in male patients. Cite this article: Bone Joint J 2026;108-B(1):39–45.

  PublisherDOI

• EP6.45 Femoroacetabular Impingement: Increased waiting times lead to articular destruction in young adults

  Journal of Hip Preservation Surgery · 2025-03-01

  articleOpen access1st authorCorresponding

  Abstract Background: Femoroacetabular impingement (FAI) is a common cause of hip pain. Hip arthroscopy is the treatment of choice for patients with FAI and has been shown to have improved outcomes when performed within six months of onset of symptoms. Since the Covid-19 pandemic, NHS waiting times for all surgery have increased. The severity of cartilage injury identified at hip arthroscopy has not previously been compared to duration of symptoms. Methods: A retrospective review of all patients undergoing hip arthroscopy for FAI at the Queen Elizabeth University Hospital (QEUH), Glasgow for three years before and after the Covid 19 pandemic was performed. Times from referral and review to surgery, patient demographics and intra-operative findings in the form of the Beck and UCLH classifications were assessed. Classification scores were confirmed by a review of retained intra-operative images by a fellowship trained hip arthroscopy surgeon. Results: 194 patients between January 2017 and December 2019 (pre-Covid) and 113 patients between January 2021 and December 2023 (post-Covid) underwent hip arthroscopy. Beck classification was significantly higher post-Covid compared to pre-Covid (mean 2.99 v 2.49, p=0.0005) as was UCLH classification (mean 2.57 v 2.18, p=0.003) and the extent of cartilage damage as measured by UCLH score (p=0.030). Time from referral to surgeon review (261 v146 days, p<0.0001) and the waiting time from review to surgery (849 days v 422 days, p<0.0001) were significantly higher post-Covid compared to pre-Covid. Multiple linear regression analysis comparing the effect of waiting times, BMI and age found time from surgeon review to surgery to independently influence the extent of cartilage damage (p=0.042). Conclusion: These findings demonstrate that longer waiting times following the Covid-19 pandemic are resulting in increased severity of intra-articular damage in patients undergoing hip arthroscopy for FAI. Waiting time to surgery was independently correlated with an increased extent of intra-articular damage.

  PublisherDOI

• Cognitive sequences in obsessive-compulsive disorder are supported by frontal cortex ramping activity

  Imaging Neuroscience · 2025-12-10

  articleOpen access

  Completing sequences is a routine part of daily life. Many are abstract, defined by a rule governing the order rather than the identity of individual steps (e.g., getting dressed). In obsessive-compulsive disorder (OCD), excessive ritualistic behaviors suggest a disruption in abstract sequence completion. Executing abstract sequences requires at least two levels in a hierarchy of cognitive control: abstract sequential control (tracking steps) and task switching (shifting between tasks). While task switching has been studied in OCD, little is known in a sequential context. Understanding both hierarchical control types is key to uncovering how abstract sequences with nested task switches are processed in OCD. Previous studies showed that the rostrolateral prefrontal cortex (RLPFC) supports abstract sequence monitoring in healthy individuals with an increase in activity across each sequence, a dynamic known as "ramping". Ramping outside the RLPFC is potentially indicative of other sequence-related processes such as progress toward a goal and increasing working memory load. Therefore, we hypothesized that abstract sequential control deficits would correspond to altered ramping dynamics in RLPFC and other cortical regions. Second, we predicted task switching deficits in OCD, coupled with altered activity in cortical regions canonically implicated in task level control. We found partial support for both hypotheses. Abstract sequential control did not show behavioral differences in OCD but did show increased overall ramping in the anterior cingulate cortex (ACC) and superior frontal sulcus (SFS) and ramping differences in additional, novel cortical regions according to abstract sequence complexity. In contrast, behavioral differences were observed for task switching in OCD without neural differences between the groups. Together, these results suggest a group of areas support sequential control differentially in OCD than in healthy controls, despite behavioral similarity, and that this observation is likely not the result of neural deficits in task switching. These findings, thus, provide insight into OCD during complex behaviors more similar to daily life where sequence and task level control are intertwined and may inform future potential treatment.

  PublisherOA PDFDOI

• Gauging Public Perception of Neurosurgery for Obsessive-Compulsive Disorder:A Qualitative and Descriptive Analysis of Online Forums (Preprint)

  2025-03-27

  preprintOpen accessSenior author

  <sec> <title>BACKGROUND</title> Psychiatric neurosurgery, including deep brain stimulation (DBS) and neuroablative procedures, has shown significant promise in treating severe, intractable Obsessive-Compulsive Disorder (OCD). The emergence of innovative neurostimulation techniques and neuroablation targets has catalyzed discussions in mainstream media. Online chat forums such as Reddit and Quora serve as particularly valuable resources for gauging public perception of medical interventions and technologies, making them crucial for researchers and clinicians in understanding how these procedures are viewed by the public. </sec> <sec> <title>OBJECTIVE</title> This study aims to evaluate public perceptions of psychiatric neurosurgery for OCD, as expressed in online chat forums, and to identify prevalent discussion topics and misinformation. </sec> <sec> <title>METHODS</title> We conducted a qualitative thematic analysis of 254 online posts discussing psychiatric neurosurgery for OCD, posted between 2008 and 2020 on popular forums. Three independent reviewers coded the posts, determining key discussion topics, characteristics, and misinformation. The data were analyzed using Applied Thematic Analysis (ATA) to identify structural and interpretive components and statistical analyses to quantify post characteristics. </sec> <sec> <title>RESULTS</title> There has been a burgeoning interest in psychiatric neurosurgery for OCD on these forums since 2008, with analyzed posts amassing over 25,000 cumulative online views. Thematic analysis identified three primary discussion topics: the efficacy of neurosurgical procedures, the existence of these procedures as treatment options, and their associated risks and benefits. Notably, statistical analysis found that 30.6% of posts contained misinformation, with a significantly higher rate of inaccuracies in posts expressing negative views of surgery compared to those expressing neutral or positive views (p=0.0079). Posts often began with users seeking information or sharing personal experiences, highlighting a gap between public perception and clinical evidence. </sec> <sec> <title>CONCLUSIONS</title> Our findings reveal significant interest and engagement in online discussions about psychiatric neurosurgery for OCD, accompanied by substantial misinformation. These insights underscore the need for targeted educational interventions to bridge the gap between public perception and clinical evidence. Addressing misinformation and enhancing public understanding could improve patient outcomes and referral patterns for those considering psychiatric neurosurgery. This study provides valuable data for clinicians aiming to better comprehend and navigate public concerns and misconceptions in this rapidly evolving field. </sec>

  PublisherOA PDFDOI

• Cost-effectiveness analysis of deep brain stimulation versus treatment as usual for treatment-resistant obsessive-compulsive disorder

  Journal of neurosurgery · 2025-01-03 · 7 citations

  article

  OBJECTIVE: Deep brain stimulation (DBS) is an effective neurosurgical option for patients with treatment-resistant obsessive-compulsive disorder (OCD). Despite being more costly than neuroablative procedures of comparable efficacy, DBS has gained popularity over the years for its reversibility and adjustability. Although the cost-effectiveness of DBS has been investigated extensively in movement disorders, few economic analyses of DBS for psychiatric disorders exist. In this study, the authors present the first cost-effectiveness analysis of DBS for treatment-resistant OCD in the United States. METHODS: The authors developed four decision analytical models to compare the cost-effectiveness of DBS with treatment as usual (TAU) for OCD, varying either the device type (i.e., nonrechargeable or rechargeable) or the time horizon (i.e., 3 or 5 years) in each model. Treatment response and complication rates were based on a literature review. Published algorithms were used to convert Yale-Brown Obsessive Compulsive Scale scores into utility scores reflecting improvements in quality of life. Costs were approached from the healthcare sector perspective and were drawn primarily from Medicare facility and physician reimbursement rates. For each model, a Monte Carlo simulation (n = 100,000) and probabilistic sensitivity analysis were performed to estimate the incremental cost-effectiveness ratio (ICER) in US dollars per quality-adjusted life year (QALY). RESULTS: Data from 249 and 265 treatment-resistant OCD patients from the published literature who received DBS and had sufficient follow-up in 3- and 5-year models, respectively, were included. When conventional US willingness-to-pay (WTP) thresholds were used, nonrechargeable DBS models were less cost-effective (3-year ICER: $108,431/QALY; 5-year ICER: $203,202/QALY) and rechargeable DBS models were more cost-effective (3-year ICER: $49,363/QALY; 5-year ICER: $41,495/QALY) than TAU. At a WTP threshold of $100,000/QALY, rechargeable DBS devices were moderately more cost-effective than TAU at 3 and 5 years in 100% of iterations. At a WTP threshold of $50,000/QALY, rechargeable DBS devices were definitively more cost-effective than TAU at 3 and 5 years in 54% and 89% of iterations, respectively. When using WHO WTP conventions, 3- and 5-year nonrechargeable models were cost-effective in 100% and 84% of iterations, and 3- and 5-year rechargeable models were highly cost-effective in 99% and 100% of iterations, respectively. CONCLUSIONS: Rechargeable DBS models were cost-effective for treatment-resistant OCD compared with TAU. Nonrechargeable DBS models may be cost-effective, especially with improvement in battery longevity and changes in accepted WTP thresholds.

  PublisherDOI

• Genome-wide analyses identify 30 loci associated with obsessive–compulsive disorder

  Nature Genetics · 2025-05-13 · 41 citations

  reviewOpen access

  Abstract Obsessive–compulsive disorder (OCD) affects ~1% of children and adults and is partly caused by genetic factors. We conducted a genome-wide association study (GWAS) meta-analysis combining 53,660 OCD cases and 2,044,417 controls and identified 30 independent genome-wide significant loci. Gene-based approaches identified 249 potential effector genes for OCD, with 25 of these classified as the most likely causal candidates, including WDR6 , DALRD3 and CTNND1 and multiple genes in the major histocompatibility complex (MHC) region. We estimated that ~11,500 genetic variants explained 90% of OCD genetic heritability. OCD genetic risk was associated with excitatory neurons in the hippocampus and the cortex, along with D 1 and D 2 type dopamine receptor-containing medium spiny neurons. OCD genetic risk was shared with 65 of 112 additional phenotypes, including all the psychiatric disorders we examined. In particular, OCD shared genetic risk with anxiety, depression, anorexia nervosa and Tourette syndrome and was negatively associated with inflammatory bowel diseases, educational attainment and body mass index.

  PublisherOA PDFDOI

• Moving beyond symptom subtypes: testing a common dimension of lifetime OCD symptoms

  CNS Spectrums · 2025-01-01

  articleOpen access

  INTRODUCTION: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by recurrent intrusive thoughts and ritualized behaviors, often aimed at reducing distress. OCD is heterogeneous in its presentation and many patients with OCD experience a variety of different symptoms throughout their course of illness. Efforts to understand symptom domains in OCD have typically identified three to five symptom domains, such as the domains of doubt/checking, contamination, superstitions/rituals, symmetry/hoarding, and taboo thoughts. Recent studies in the genetics of OCD have suggested a common OCD dimension may provide additional information above and beyond the previously identified symptom domains. Thus, we sought to test a hierarchical model of lifetime OCD symptoms and evaluate the utility of the inclusion of a common OCD dimension. METHODS: Participants included 999 individuals participating in the OCD Collaborative Genetics Study (OCGS) and an additional 2363 individuals participating in the OCD Genetic Association Study (OCGAS). We evaluated unidimensional, 5-factor, and hierarchical models of lifetime OCD symptom presentation using confirmatory factor analysis. RESULTS: Results suggested that the hierarchical model best fit the data. Further evaluation of these models using a Bayesian testlet response model showed that lifetime presence of specific OCD symptoms was differentially associated with lifetime OCD severity. Moreover, symptoms associated with greater lifetime severity were generally reported less frequently than symptoms present at lower levels of lifetime severity. Implications of these findings and future directions are discussed.

  PublisherOA PDFDOI

• The NExT trial: Protocol for a two-phase randomized controlled trial testing transcranial magnetic stimulation to augment exposure therapy for youth with OCD

  Trials · 2024-12-18 · 3 citations

  articleOpen access

  BACKGROUND: Exposure with Response Prevention (ERP) is a first-line treatment for OCD, but even when combined with first-line medications it is insufficiently effective for approximately half of patients. Compulsivity in OCD is thought to arise from an imbalance of two distinct neural circuits associated with specific subregions of striatum. Targeted modulation of these circuits via key cortical nodes (dorsolateral prefrontal cortex [dlPFC] or presupplementary motor area [pSMA]) has the potential to improve ERP efficacy by decreasing compulsions during therapy. METHODS: The NExT (Neuromodulation + Exposure Therapy) trial is a two-phase, multisite early-stage randomized controlled trial designed to examine whether TMS augmentation of ERP alters activity in dlPFC and/or pSMA-associated circuitry and reduces compulsions during therapy in youth with OCD age 12-21 years. Phase 1 (N = 60) will compare two different active TMS regimens with sham: A. continuous theta burst stimulation (cTBS) to pSMA vs. B. intermittent theta burst stimulation (iTBS) to dlPFC. A priori "Go/No-Go" criteria will inform a decision to proceed to Phase 2 and the choice of TMS regimen. Phase 2 (N = 60) will compare the selected TMS regimen vs. sham in a new sample. DISCUSSION: This trial is the first to test TMS augmentation of ERP in youth with OCD. Results will inform the potential of TMS to enhance ERP efficacy and enhance knowledge about mechanisms of change. TRIAL REGISTRATION: ClinicalTrials.gov NCT05931913. Registered prospectively on July 5, 2023.

  PublisherOA PDFDOI

• Cognitive sequences in obsessive-compulsive disorder are supported by frontal cortex ramping activity

  bioRxiv (Cold Spring Harbor Laboratory) · 2024-07-29 · 4 citations

  preprintOpen access

  Abstract Completing sequences is a routine part of daily life. Many are abstract, defined by a rule governing the order rather than the identity of individual steps (e.g., getting dressed). In obsessive-compulsive disorder (OCD), excessive ritualistic behaviors suggest a disruption in abstract sequence completion. Executing abstract sequences requires at least two levels in a hierarchy of cognitive control: abstract sequential control (tracking steps) and task switching (shifting between tasks). While task switching has been studied in OCD, little is known in a sequential context. Understanding both hierarchical control types is key to uncovering how abstract sequences with nested task switches are processed in OCD. Previous studies showed that the rostrolateral prefrontal cortex (RLPFC) supports abstract sequence monitoring in healthy individuals with an increase in activity across each sequence, a dynamic known as “ramping”. Ramping outside the RLPFC is potentially indicative of other sequence-related processes such as progress towards a goal and increasing working memory load. Therefore, we hypothesized that abstract sequential control deficits would correspond to altered ramping dynamics in RLPFC and other cortical regions. Second, we predicted task switching deficits in OCD, coupled with altered activity in cortical regions canonically implicated in task level control. We found partial support for both hypotheses. Abstract sequential control did not show behavioral differences in OCD but did show increased overall ramping in the anterior cingulate cortex (ACC) and superior frontal sulcus (SFS) and ramping differences in additional, novel cortical regions according to abstract sequence complexity. In contrast, behavioral differences were observed for task switching in OCD without neural differences between the groups. Together, these results suggest a group of areas support sequential control differentially in OCD than in healthy controls, despite behavioral similarity, and that this observation is likely not the result of neural deficits in task switching. These findings thus provide insight into OCD during complex behaviors more similar to daily life where sequence and task level control are intertwined and may inform future potential treatment.

  PublisherOA PDFDOI

Recent grants

• Neuroanatomical Changes After Ventral Capsulotomy for Intractable OCD: A Translat

  NIH · $740k · 2013–2018

• Neuroimaging and Neuromodulation Core

  NIH · $22.5M · 2019–2026

Frequent coauthors

• Keith A. Johnson

  Massachusetts General Hospital

  729 shared

• D. Cheng

  567 shared

• Joseph C. Wu

  486 shared

• Carl K. Hoh

  University of California, San Diego

  405 shared

• Monte S. Buchsbaum

  University of California, Irvine

  405 shared

• Marcelo F. Di Carli

  Harvard University

  405 shared

• Steven E. Arnold

  Harvard University

  324 shared

• Carolyn C. Meltzer

  University of Southern California

  324 shared

Labs

• McLaughlin LabPI

Awards & honors

• Sponsored as a neuropsychological fellow at the Vivian Smith…
• National Psychologist Trainee Register Scholarship, sponsore…
• Anxiety Disorders Association of America Career Development…
• Suffolk University Young Alumna Award (2010)
• National Institutes of Health Loan Repayment Program (2012-2…