{
  "abstract": "Psychiatric states manifest over multiple timescales, from transient fluctuations in disorder-related distress to long-term variations in disease severity, yet whether these expressions share common neural representations remains unknown. We addressed this question in obsessive-compulsive disorder (OCD) by comparing neural activity associated with momentary distress evoked by triggers versus that associated with clinically assessed chronic symptom severity. We analyzed intracranial recordings from the ventral capsule and orbitofrontal cortex spanning more than 4595 patient-days in 8 individuals undergoing deep brain stimulation therapy (NCT03457675, NCT04281134, NCT04806516), together with quantitative facial- and speech-derived behavioral measures. Neural signatures of OCD severity were dissociable from and stronger than signatures of momentary distress, indicating distinct underlying brain states. Integrating behavioral data into a predictive computational model improved neural decoding performance of both momentary distress and OCD severity. These findings show that acute manifestations of psychiatric illness are not simply short-timescale readouts of the same neural states that encode longer-term clinical burden. Instead, transient distress and longitudinal disease severity are represented by dissociable neural processes. This distinction has important implications for how psychiatric biomarkers and adaptive neuromodulation strategies should be designed.",
  "abstract_shown": true,
  "affiliations": [
    "Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 21,
  "authors": [
    {
      "name": "T. Merk"
    },
    {
      "name": "G. Bezold"
    },
    {
      "name": "R. Hingorani"
    },
    {
      "name": "A. D. Wiese"
    },
    {
      "name": "B. Robinson"
    },
    {
      "name": "H. Yi"
    },
    {
      "name": "J. Altman"
    },
    {
      "name": "S. V. Rajesh"
    },
    {
      "name": "V. E. Gobo"
    },
    {
      "name": "M. Ochoa"
    },
    {
      "name": "T. Hamre"
    },
    {
      "name": "V. Belavadi"
    },
    {
      "name": "C. P. S. Romain"
    },
    {
      "name": "M. Avendano-Ortega"
    },
    {
      "name": "S. Soubra"
    },
    {
      "name": "G. Reyes"
    },
    {
      "name": "T. M. Fraczek"
    },
    {
      "name": "E. A. Storch"
    },
    {
      "name": "W. K. Goodman"
    },
    {
      "name": "S. A. Sheth"
    },
    {
      "affs": [
        0
      ],
      "name": "N. R. Provenza"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/dm796h9c9evza.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.07.30.26359255",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.07.30.26359255v2.full",
  "id": "dm796h9c9evza",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.07.30.26359255v2",
  "language": null,
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "neurology"
    ],
    [
      "openalex",
      "3203|Obsessive-Compulsive Spectrum Disorders"
    ]
  ],
  "openalex": "W7172307297",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.07.30.26359255v2.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-07-30",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/dm796h9c9evza.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:51Z",
      "native_id": "10.64898/2026.07.30.26359255",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.07.30.26359255v2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:neurology",
      "subfield": "neurology"
    }
  ],
  "title": "Distinct neural representations encode psychiatric states across timescales",
  "title_text": "Distinct neural representations encode psychiatric states across timescales",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:51Z",
  "url": "https://research.draconitic.com/paper/dm796h9c9evza",
  "venue": "medRxiv",
  "versions": []
}