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Bortoncello CF, Cardoso NDO, Xavier SRM, Ferrão YA. Effectiveness of online group cognitive-behavior therapy for adolescents with obsessive-compulsive disorder: a pilot study. Braz J Psychiatry 2024. [PMID: 38573616 DOI: 10.47626/1516-4446-2023-3376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/18/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE This study aims to evaluate the effectiveness of online group cognitive-behavioral therapy (GCBT) guided by the CAMALEO TOC manual in treating of adolescents with obsessive compulsive disorder (OCD). METHOD A quasi-experimental study with a single group pre-posttest intervention. Over 12 weeks 11 adolescents aged 11 to 17 years with OCD received weekly online sessions of GCBT based on CAMALEO TOC manual. The Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms severity, the Family accommodation scale for obsessive-compulsive disorder interviewer-rated for family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale for anxiety, and the Multidimensional Student Life Satisfaction Scale to assess life satisfaction. RESULTS OCD symptoms decreased significantly (d = -1.55). A strong effect size (d = -1.03) was also found for family accommodation. No significant difference in OCD symptoms and family accommodation scores were found when controlling for differences between being in psychotherapeutic treatment, medication use, or psychiatric comorbidities. There was also no evidence that the intervention was effective in reducing symptoms of depression, anxiety or improving quality of life. CONCLUSION We demonstrate the feasibility of a short-term online GCBT as an effective treatment for adolescents with OCD.
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Affiliation(s)
- Cristiane Flores Bortoncello
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Nicolas de Oliveira Cardoso
- Department of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | | | - Ygor Arzeno Ferrão
- Department of Clinical Medicine, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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de Mathis MA, Chacon P, Boavista R, de Oliveira MVS, de Barros PMF, Echevarria MAN, Ferrão YA, Vattimo EFDQ, Lopes AC, Torres AR, Diniz JB, Fontenelle L, do Rosário MC, Shavitt RG, da Silva RDMF, Miguel EC, Costa DLDC. Brazilian research consortium on obsessive-compulsive spectrum disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: Cognitive-Behavior Therapy treatment. Braz J Psychiatry 2023; 45. [PMID: 37718254 PMCID: PMC10894635 DOI: 10.47626/1516-4446-2023-3081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/22/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To summarize the evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). METHODS A systematic review of the literature on CBT interventions for the treatment of adult OCD, comprising behavior therapy and exposure and response prevention (ERP) was done. The objective of this study is to present updated clinical guidelines to clinicians, providing comprehensive details regarding the necessary procedures to be incorporated into the CBT protocol. We searched the literature published from 2013-2020 in five databases (PubMed, Cochrane, Embase, Psycinfo and Lilacs), considering: study design, primary outcome measures, type of publication and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). RESULTS We examined 44 new studies used to update the APA guidelines from 2013. High-quality evidence supports CBT including ERP techniques as the first-line CBT treatment for OCD. In addition, protocols for internet-delivered CBT have also demonstrated their efficacy for the treatment of adults with OCD. CONCLUSION CBT based on ERP is a widely used treatment according to high-quality scientific evidence to treat adults with OCD.
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Affiliation(s)
- Maria Alice de Mathis
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
| | - Priscila Chacon
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Rodrigo Boavista
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marcos Vinícius Sousa de Oliveira
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Pedro Macul Ferreira de Barros
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Marco Antonio Nocito Echevarria
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Ygor Arzeno Ferrão
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
- Departamento de Neurociências Clínicas, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
| | - Edoardo Filippo de Queiroz Vattimo
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Antônio Carlos Lopes
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Albina Rodrigues Torres
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina – Câmpus de Botucatu, Universidade Estadual Paulista Júlio de Mesquita Filho, Botucatu, SP, Brazil
| | - Juliana Belo Diniz
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
| | - Leonardo Fontenelle
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, RJ, Brazil
- Department of Psychiatry, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Maria Conceição do Rosário
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
- Unidade de Psiquiatria da Infância e Adolescência, Departamento de Psiquiatria, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Roseli Gedanke Shavitt
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
| | - Renata de Melo Felipe da Silva
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eurípedes Constantino Miguel
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
| | - Daniel Lucas da Conceição Costa
- Departamento de Psiquiatria, Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
- Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, São Paulo, SP, Brazil
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de Oliveira MVS, de Barros PMF, de Mathis MA, Boavista R, Chacon P, Echevarria MAN, Ferrão YA, Vattimo EFDQ, Lopes AC, Torres AR, Diniz JB, Fontenelle LF, do Rosário MC, Shavitt RG, Miguel EC, da Silva RDMF, Costa DLDC. Brazilian Psychiatric Association guidelines for the treatment of adult obsessive-compulsive disorder. Part I: Pharmacological treatment. Braz J Psychiatry 2023; 45:146-161. [PMID: 36749887 PMCID: PMC10154009 DOI: 10.47626/1516-4446-2022-2891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/05/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To summarize the evidence-based pharmacological treatments and guide clinical interventions for adult patients with obsessive-compulsive disorder (OCD). METHODS The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs) - and augmentation strategies with clomipramine, antipsychotics and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the ACC/AHA. RESULTS We examined 57 new studies to update the 2013 APA guidelines. Highquality evidence supports SSRIs as first-line pharmacological treatments for OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. CONCLUSION SSRIs in the highest recommended or tolerable doses for 8-12 weeks remain the first-line treatment for adult OCD. Best augmentation strategies for SSRIresistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful have also been detailed.
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Affiliation(s)
- Marcos Vinícius Sousa de Oliveira
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Pedro Macul Ferreira de Barros
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Alice de Mathis
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC)
| | - Rodrigo Boavista
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Priscila Chacon
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Marco Antonio Nocito Echevarria
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC). Department of Clinical Neurosciences, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Edoardo Felippo de Queiroz Vattimo
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Antônio Carlos Lopes
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Albina Rodrigues Torres
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC). Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Juliana Belo Diniz
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC)
| | - Leonardo F Fontenelle
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC). Department of Psychiatry and Legal Medicine, Federal University of Rio de Janeiro. D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil. Department of Psychiatry, School of Clinical Sciences, Monash University, VIC, Australia
| | - Maria Conceição do Rosário
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC). Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Roseli Gedanke Shavitt
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC)
| | - Eurípedes Constantino Miguel
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC)
| | - Renata de Melo Felipe da Silva
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Daniel Lucas da Conceição Costa
- Department and Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil. Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC)
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Bettess Z, Albertella L, Destree L, Rosário MC, Ferrão YA, Miguel EC, Fontenelle LF. Clinical characteristics of transformation obsessions in obsessive-compulsive disorder: A psychopathological study. Aust N Z J Psychiatry 2023; 57:130-139. [PMID: 35303769 DOI: 10.1177/00048674221084241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO. METHODS In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes. RESULTS Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms. CONCLUSIONS These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.
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Affiliation(s)
- Zoe Bettess
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Lucy Albertella
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Louise Destree
- Brain & Mental Health Research Hub (BrainPark), Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC, Australia
| | - Maria C Rosário
- Child and Adolescent Psychiatry Unit, Department of Psychiatry at the Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ygor Arzeno Ferrão
- Department of Clinical Medicine (Clinical Neurosciences), Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Euripedes C Miguel
- Obsessive-Compulsive Spectrum Disorders Program (PROTOC), Department and Institute of Psychiatry, University of São Paulo (USP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,D'Or Institute for Research and Education, Rio de Janeiro, Brazil
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Costa DLDC, de Campos AP, Pereira CADB, Torres AR, Dos Santos AC, Requena G, Ferrão YA, do Rosário MC, Miguel EC, Simpson HB, Shavitt RG, Diniz JB. Latency to treatment seeking in patients with obsessive-compulsive disorder: Results from a large multicenter clinical sample. Psychiatry Res 2022; 312:114567. [PMID: 35490573 DOI: 10.1016/j.psychres.2022.114567] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 01/06/2023]
Abstract
This study aimed to identify the factors associated with a delay in treatment-seeking among patients with obsessive-compulsive disorder (OCD), a disabling neuropsychiatric disorder. To achieve this purpose, we conducted a cross-sectional study examining latency to treatment (LTT) and its associated correlates in 863 patients with OCD. We defined LTT as the time lag between the awareness of discomfort and/or impairment caused by symptoms and the beginning of OCD-specific treatment. To determine the socio-demographic and clinical characteristics associated with LTT, we built an interval-censored survival model to simultaneously assess the relationship between all variables, representing the best fit to our data format. The results of our study showed that approximately one-third of OCD patients sought treatment within two years of symptom awareness, one-third between two and nine years, and one-third after ten or more years. Median LTT was 4.0 years (mean = 7.96, SD = 9.54). Longer LTT was associated with older age, early onset of OCD symptoms, presence of contamination/cleaning symptoms and full-time employment. Shorter LTT was associated with the presence of aggression symptoms and comorbidity with hypochondriasis. The results of our study confirm the understanding that LTT in OCD is influenced by several interdependent variables - some of which are modifiable. Strategies for reducing LTT should focus on older patients, who work in a full-time job, and on individuals with early onset of OCD and contamination/cleaning symptoms.
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Affiliation(s)
- Daniel Lucas da Conceição Costa
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | | | - Carlos Alberto de Bragança Pereira
- Institute of Applied Mathematics (INMA), Federal University of Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brazil; Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil
| | - Albina R Torres
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Deparment of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil
| | - Allan Christiano Dos Santos
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Guaraci Requena
- Institute of Mathematics and Statistics, University of Sao Paulo, Sao Paulo, Brazil; Institute of Exact Sciences, Federal University of Viçosa, Florestal, Minas Gerais, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Clinical Medical Department, Federal University of Health Sciences of Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil; Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil
| | - Eurípedes Constantino Miguel
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | - Helen Blair Simpson
- Department of Psychiatry, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Roseli Gedanke Shavitt
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
| | - Juliana Belo Diniz
- Institute of Psychiatry, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil; Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (CTOC), Brazil
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Ferrão YA, Radins RB, Ferrão JVB. Psychopathological intersection of OCD and PTSD: scoping review of similitudes and differences. Trends Psychiatry Psychother 2022. [PMID: 35244353 DOI: 10.47626/2237-6089-2021-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 02/16/2022] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Although Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder have distinct diagnostic criteria, some psychopathological phenomena seem to be shared, what may lead to misdiagnosis and to wrong therapeutical decisions. This scoping review explores the psychopathological similitudes and differences of both disorders. METHODS It followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and included articles published in Portuguese, English or Spanish in the last 50 years in the PubMed database. Case-reports were excluded. RESULTS Fifty-three studies with different designs were included (30(56.5%) were cross-sectional; 8 (15.1%) were case control; 1 (1.9%) was cohort; 3 (5.7%) were clinical trials; 9 (17.0%) were reviews/systematic reviews; and 2 (3.8%) were meta-analysis.). The main described interfaced psychopathological aspects by the included studies were flashbacks x obsessions; avoidant behavior; depressive, anxious, and somatic symptoms; sexuality, sleep, and appetite; psychiatric comorbidities; and suicidality. The intersection of clinical features seems to be on the extrinsic psychopathological dimension. CONCLUSIONS The psychopathological symptoms core (intrinsic characteristics) is distinctly different, since flashbacks and obsessions are consequences of predominant diverse defective mental function: the former from memory, the last from thought. In the same way, the avoidant behaviors are derived from different purposes and inner necessities.
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Affiliation(s)
- Ygor Arzeno Ferrão
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil. Obsessive-compulsive disorder Research Consortium of Rio Grande do Sul, Porto Alegre, Brazil. Health Sciences Post-Graduation Program (UFCSPA), Porto Alegre, Brazil
| | - Rodrigo Bolsson Radins
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil. Health Sciences Post-Graduation Program (UFCSPA), Porto Alegre, Brazil
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Agne NA, Tisott CG, Ballester P, Passos IC, Ferrão YA. Predictors of suicide attempt in patients with obsessive-compulsive disorder: an exploratory study with machine learning analysis. Psychol Med 2022; 52:715-725. [PMID: 32669156 DOI: 10.1017/s0033291720002329] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) are at increased risk for suicide attempt (SA) compared to the general population. However, the significant risk factors for SA in this population remains unclear - whether these factors are associated with the disorder itself or related to extrinsic factors, such as comorbidities and sociodemographic variables. This study aimed to identify predictors of SA in OCD patients using a machine learning algorithm. METHODS A total of 959 outpatients with OCD were included. An elastic net model was performed to recognize the predictors of SA among OCD patients, using clinical and sociodemographic variables. RESULTS The prevalence of SA in our sample was 10.8%. Relevant predictors of SA founded by the elastic net algorithm were the following: previous suicide planning, previous suicide thoughts, lifetime depressive episode, and intermittent explosive disorder. Our elastic net model had a good performance and found an area under the curve of 0.95. CONCLUSIONS This is the first study to evaluate risk factors for SA among OCD patients using machine learning algorithms. Our results demonstrate an accurate risk algorithm can be created using clinical and sociodemographic variables. All aspects of suicidal phenomena need to be carefully investigated by clinicians in every evaluation of OCD patients. Particular attention should be given to comorbidity with depressive symptoms.
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Affiliation(s)
- Neusa Aita Agne
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Caroline Gewehr Tisott
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
| | - Pedro Ballester
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Ives Cavalcante Passos
- Laboratory of Molecular Psychiatry, Centro de Pesquisa Experimental (CPE) and Centro de Pesquisa Clínica (CPC), Hospital de Clínicas de Porto Alegre (HCPA), Instituto Nacional de Ciência e Tecnologia Translacional em Medicina (INCT-TM), Porto Alegre (RS), Brazil
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, School of Medicine, Graduate Program in Psychiatry and Behavioral Sciences, Porto Alegre, Brazil
| | - Ygor Arzeno Ferrão
- Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC), Porto Alegre, Brazil
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Andreotti ET, Ipuchima JR, Pivetta MVL, Arieta AG, Cazella SC, Herbert JS, Cardoso NDO, Machado WDL, Ferrão YA. Detect-S: an mHealth application to assist health professionals to identify suicide risk in hospitalized patients. Trends Psychiatry Psychother 2021; 43:200-206. [PMID: 34852186 PMCID: PMC8638715 DOI: 10.47626/2237-6089-2020-0079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 01/28/2021] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Suicide is a serious public health problem that affects the whole world. This study describes development of the prototype for an mHealth application (app) intended to assist healthcare professionals to identify suicide risk in hospitalized patients and reports on testing of the app by some of these professionals, conducted to confirm its functionality. METHOD This is applied exploratory research into use of Information Technology within the healthcare field, based on application prototyping for mobile devices. The research was conducted at the Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) from 2017 to 2019. Six healthcare professionals, one data scientist, and three undergraduate students in Biomedical Informatics took part in the study. All research participants signed the free and informed consent form. RESULTS The main findings show that the development team created a prototype named Detect-S, which became a cross-platform application (iOS and Android) offering 16 functions. CONCLUSION It can be concluded that Detect-S has the potential to be a positive technological instrument that can be tested in a hospital setting to assist healthcare professionals to identify and manage patients with at risk of suicide.
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Affiliation(s)
| | | | | | - Angel Gabriel Arieta
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Silvio César Cazella
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Juliana Silva Herbert
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | | | | | - Ygor Arzeno Ferrão
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
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Andreotti ET, Ipuchima JR, Cazella SC, Beria P, Bortoncello CF, Silveira RC, Ferrão YA. Instruments to assess suicide risk: a systematic review. Trends Psychiatry Psychother 2021; 42:276-281. [PMID: 32997043 PMCID: PMC7879069 DOI: 10.1590/2237-6089-2019-0092] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/30/2020] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Suicide is an issue of great severity in public health worldwide. This study aimed to investigate which instruments are most frequently used by healthcare professionals to assess suicide risk and how accessible such instruments are, as well as to determine the scope of suicide phenomena. METHOD A systematic review was performed using the following Boolean searches: "scale AND suicide," "evaluation AND suicide," "questionnaire AND suicide." The articles retrieved were read and selected by two independent researchers - any discrepancies were addressed by a third researcher. RESULTS From a total number of 206 articles, 20 instruments were identified as being currently used to assess suicide risk. The two most common were the Beck Scale for Suicide Ideation (BSI) and The Columbia - Suicide Severity Rating Scale (C-SSRS). CONCLUSION Even though the two scales (BSI and C-SSRS) are the most frequently mentioned and used by healthcare professionals to assess suicide risk, both instruments present breaches in their structure and there is not yet a single instrument considered to be the gold standard. As a future perspective, there is the urgency of developing a new tool that can widely and completely assess all psychopathological aspects of suicidality.
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Affiliation(s)
- Ezequiel T Andreotti
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre , RS , Brazil
| | - Jaqueline R Ipuchima
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre , RS , Brazil
| | - Silvio César Cazella
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre , RS , Brazil
| | - Pedro Beria
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre , RS , Brazil
| | | | | | - Ygor Arzeno Ferrão
- Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre , RS , Brazil
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Kracker Imthon A, Antônio Caldart C, do Rosário MC, Fontenelle LF, Constantino Miguel E, Arzeno Ferrão Y. Stressful Life Events and the Clinical Expression of Obsessive-Compulsive Disorder (OCD): An Exploratory Study. J Clin Med 2020; 9:E3371. [PMID: 33096706 PMCID: PMC7590000 DOI: 10.3390/jcm9103371] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In obsessive-compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) in terms of the sociodemographics of patients and the clinical characteristics of OCD. METHODS This was a cross-sectional study involving 1001 patients with OCD. Data concerning SLEs were collected via the Yale OCD Natural History Questionnaire, while for OCD symptoms, the Dimensional Yale-Brown Obsessive-Compulsive Scale was used. RESULTS Of the 1001 OCD patients, 605 (60.5%) reported experiencing at least one SLE in their lifetime. Self-declared nonwhite skin color (odds ratio (OR) = 1.51), the presence of a sensory phenomenon (OR = 1.47), and comorbidity with post-traumatic stress disorder (PTSD) (OR = 2.38) were some of the logistic regression variables related to the reported SLEs with relevant statistical significance and risk (i.e., OR) values. CONCLUSIONS Our results indicate that SLEs may make Brazilian OCD patients vulnerable to the onset or exacerbation of obsessive-compulsive symptoms. The positive association of the occurrence of SLEs and sensory phenomena in this population could corroborate that environmental influences impact the neurobiology associated with OCD, and likely with other psychiatric disorders as well.
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Affiliation(s)
- André Kracker Imthon
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - César Antônio Caldart
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
| | - Maria Conceição do Rosário
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Child and Adolescent Psychiatry Unit (UPIA) at the Department of Psychiatry, Federal University of São Paulo, São Paulo 04017-030, Brazil
| | - Leonardo F. Fontenelle
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Turner Institute for Brain and Mental Health, Monash University, Clayton VIC 3800, Australia
- D’Or Institute for Research and Education (IDOR) and Institute of Psychiatry (IPUB), Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
| | - Euripedes Constantino Miguel
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
- Department of Psychiatry, São Paulo University Medical School, São Paulo 05403-903, Brazil
| | - Ygor Arzeno Ferrão
- Psychiatric Service, President Vargas Hospital, Porto Alegre 90035-074, Brazil; (C.A.C.); (Y.A.F.)
- Department of Internal Medicine-Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90050-170, Brazil
- The Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders, São Paulo 05403-903, Brazil; (M.C.d.R.); (L.F.F.); (E.C.M.)
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Dias de Castro Bins H, Dotta Panichi RM, Vernet Taborda JG, Arzeno Ferrão Y. Childhood trauma, psychiatric disorders, and criminality in women: Associations with serum levels of brain-derived neurotrophic factor. Int J Law Psychiatry 2020; 71:101574. [PMID: 32768114 DOI: 10.1016/j.ijlp.2020.101574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/06/2020] [Indexed: 06/11/2023]
Abstract
Psychiatric disorders and childhood trauma are highly prevalent in female inmates. Brain-derived neurotrophic factor (BDNF) plays a number of roles in neuronal survival, structure, and function. Data in the literature suggest that it is a neurobiological substrate that moderates the impact of childhood adversities on the late expression of psychiatric disorders. The aim of this study was to determine whether five childhood trauma subtypes-physical abuse, sexual abuse, emotional abuse, physical neglect, and emotional neglect-are associated with adult psychiatric disorders, BDNF levels, and criminality among incarcerated women. This was a cross-sectional study involving a consecutive sample of 110 women, divided into three groups of women (forensic - mentally ill who committed crimes, clinical psychiatric inpatients and healthy controls). The Childhood Trauma Questionnaire and the Mini-International Neuropsychiatric Interview-Plus were applied in the whole sample, and BDNF levels were measured in a sub-sample of 54 women. The rates of mental illness and childhood trauma were high in the forensic group. Emotional abuse was higher in the clinical and forensic groups than in the healthy control group. Lower BDNF levels were associated with emotional abuse in the forensic group as well as with sexual abuse in the healthy control group. After multinomial logistic regression, lower levels of BDNF, higher levels of emotional abuse and the presence of familial offense were considered factors related to clinical psychiatric group. The results of this study underscore the idea that BDNF may be an important factor related to the development of diseases and criminality in women who are victims of childhood trauma, becoming a possible biological marker.
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Affiliation(s)
- Helena Dias de Castro Bins
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil.
| | - Renata Maria Dotta Panichi
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
| | - José Geraldo Vernet Taborda
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
| | - Ygor Arzeno Ferrão
- Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre (Federal University of Health Sciences of Porto Alegre), Porto Alegre, Brazil
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de Avila RCS, do Nascimento LG, Porto RLDM, Fontenelle L, Filho ECM, Brakoulias V, Ferrão YA. Level of Insight in Patients With Obsessive-Compulsive Disorder: An Exploratory Comparative Study Between Patients With "Good Insight" and "Poor Insight". Front Psychiatry 2019; 10:413. [PMID: 31333508 PMCID: PMC6619338 DOI: 10.3389/fpsyt.2019.00413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/24/2019] [Indexed: 12/17/2022] Open
Abstract
Introduction: Insight may be defined as the ability to perceive and evaluate external reality and to separate it from its subjective aspects. It also refers to the ability to self-assess difficulties and personal qualities. Insight may be a predictor of success in the treatment of obsessive-compulsive disorder (OCD), so that individuals with poor insight tend to become refractory to treatment. The objective of this study is to investigate factors associated with poor insight in individuals with OCD. Methods: This cross-sectional exploratory study used the Brown Belief Assessment Scale as a parameter for the creation of the comparison groups: individuals who obtained null scores (zero) composed the group with preserved or good insight (n = 148), and those with scores above the 75% percentile composed the group with poor insight (n = 124); those with intermediate scores were excluded. Sociodemographic characteristics and clinical and psychopathological aspects, intrinsic and extrinsic to the typical symptoms of OCD, were compared in a univariate analysis. A logistic regression was used to determine which factors associated with critical judgment remained significant. Results: Individuals in the poor insight group differed from those with good insight in regard to: more prevalent use of neuroleptics (p = 0.05); higher untreated time interval (p < 0.001); higher total Yale-Brown obsessive-compulsive scale score and the obsessions and compulsions factors (all factors with p < 0.001); higher dimensional Yale-Brown obsessive-compulsive scale total and dimensional scores (p from 0.04 to 0.001); higher prevalence of contamination/cleaning (p = 0.006) and hoarding (p < 0.001) symptoms dimensions; more prevalent sensory phenomena (p = 0.023); higher levels of depression (p = 0.007); and more prevalent comorbidity with bipolar affective disorder (p = 0.05) and post-traumatic stress disorder (PTSD) (p = 0.04). After analyzing the logistic regression, we conclude that the most important factors associated with poor insight are: the presence of any sensory phenomena (OR: 2.24), use of neuroleptics (OR: 1.66), and hoarding symptoms (OR: 1.15). Conclusion: The variability of insight in patients with OCD seems to be an important psychopathological characteristic in the differentiation of possible subtypes of OCD, since the poor insight is associated with sensory phenomena and greater use of neuroleptics, which makes it possible to conjecture the role of dopaminergic neurocircuits in the neurobiology of this disorder. In addition, there is also an association with the symptoms of hoarding content, admittedly one of the symptomatic contents with less response to conventional OCD treatments. Studies based on neurobiological aspects such as neuroimaging and neuropsychology may help to elucidate more consistently the role of insight in patients with OCD and the repercussions concerning available treatments.
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Affiliation(s)
- Richard Chuquel Silveira de Avila
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Laura Gratsch do Nascimento
- Departamento de Psicologia, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Rafaella Landell de Moura Porto
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Leonardo Fontenelle
- Departamento de Psiquiatria, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Vlasios Brakoulias
- School of Medicine of Western Sydney University, University of Sydney, Sydney, NSW, Australia
| | - Ygor Arzeno Ferrão
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Ferreira MAT, Almeida Júnior IGD, Kuratani DK, Rosa RFM, Gonzales JFDO, Telles LEDB, Ferrão YA, Zen PRG. WAGRO syndrome: a rare genetic condition associated with aniridia and additional
ophthalmologic abnormalities. Arq Bras Oftalmol 2019; 82:336-338. [DOI: 10.5935/0004-2749.20190065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 12/29/2018] [Indexed: 11/20/2022] Open
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Ferrão YA, da Silva RDMF. Repetitive transcranial magnetic stimulation for the treatment of major depression during pregnancy. ACTA ACUST UNITED AC 2018; 40:227-228. [PMID: 29846468 PMCID: PMC6900775 DOI: 10.1590/1516-4446-2017-2522] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Accepted: 12/17/2017] [Indexed: 02/08/2023]
Affiliation(s)
- Ygor Arzeno Ferrão
- Departamento de Psiquiatria, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS, Brazil
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Felipe RDM, Ferrão YA. Transcranial magnetic stimulation for treatment of major depression during pregnancy: a review. Trends Psychiatry Psychother 2017; 38:190-197. [PMID: 28076639 DOI: 10.1590/2237-6089-2015-0076] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/16/2016] [Indexed: 02/26/2023]
Abstract
Introduction: Pregnancy is characterized by a high prevalence of mental disorders. Depression is the most common of these disorders and it is a risk factor for negative maternal and child development outcomes. Psychotherapy and pharmacotherapy are conventional and well-established therapeutic options, but some clients fail to respond and the safety of using some pharmacological agents during pregnancy is unclear. Some neuromodulation techniques, such as repetitive transcranial magnetic stimulation (rTMS), have been studied in depressed pregnant women. Objective: To evaluate the safety and efficacy of rTMS for major depression in pregnant women. Methods: The LILACS and PubMed databases were reviewed using the search terms depression, pregnancy and magnetic stimulation. Texts including primary data, published in Portuguese, Spanish, or English, between 1995 and 2014, that evaluated depressed pregnant women and used rTMS as the intervention were selected. Papers lacking sufficient data were excluded. Twenty-two texts were initially identified; after applying the inclusion criteria, 12 were selected and analyzed. Results: The studies reviewed reported satisfactory responses to rTMS in acute depressive episodes, as measured using depressive symptom scales. Remission of symptoms was achieved in many cases. The procedure was well tolerated and there were no reports of damage/complications to unborn children. Conclusion: The data available at this time support the efficacy and tolerability of rTMS for depression in pregnant women. Controlled studies should corroborate this conclusion. This review only included studies in three languages and the resulting sample size was not large enough to conduct a meta-analysis.
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Affiliation(s)
- Renata de Melo Felipe
- Programa de Residência Médica em Psiquiatria, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, RS, Brazil
| | - Ygor Arzeno Ferrão
- Departamento de Medicina Interna - Psiquiatria, UFCSPA, Porto Alegre, RS, Brazil
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Carvalho F, Weires K, Ebling M, Padilha MDSR, Ferrão YA, Vercelino R. Effects of acupuncture on the symptoms of anxiety and depression caused by premenstrual dysphoric disorder. Acupunct Med 2013; 31:358-63. [PMID: 24029029 DOI: 10.1136/acupmed-2013-010394] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The objective of this investigation was to evaluate the effects of acupuncture and sham acupuncture on the symptoms of anxiety and depression brought on by premenstrual dysphoric disorder (PMDD). METHODS In a single-blind randomised clinical trial, 30 volunteers with PMDD were assigned alternately to group 1 (acupuncture) or group 2 (sham acupuncture), and completed an evaluation of symptoms of anxiety and depression using the Hamilton Anxiety (HAM-A) and Hamilton Depression (HAM-D) Rating Scales. The procedure was performed twice a week for two menstrual cycles, for a total of 16 attendances for each participant. RESULTS Before the intervention the mean HAM-A and HAM-D scores did not differ between groups. Following the intervention symptoms of anxiety and depression were reduced in both groups; however, the improvement was significant in group 1 compared to group 2, as shown by a mean reduction in HAM-A scores of 58.9% in group 1 and 21.2% in group 2 (p<0.001). The reduction in the mean HAM-D scores was 52.0% in group 1 and 19.6% in group 2, resulting in a significant difference (p=0.012). CONCLUSIONS The results suggest that acupuncture could be another treatment option for PMDD patients.
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Moreira L, Bins H, Toressan R, Ferro C, Harttmann T, Petribú K, Juruena MF, do Rosário MC, Ferrão YA. An exploratory dimensional approach to premenstrual manifestation of obsessive-compulsive disorder symptoms: a multicentre study. J Psychosom Res 2013; 74:313-9. [PMID: 23497833 DOI: 10.1016/j.jpsychores.2012.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Revised: 12/01/2012] [Accepted: 12/03/2012] [Indexed: 02/08/2023]
Abstract
OBJECTIVE In women with obsessive-compulsive disorder (OCD), symptom severity appears to fluctuate over the course of the menstrual cycle. The objective of this paper was to compare female OCD patients with and without premenstrual worsening of obsessive-compulsive symptoms (OCS), in terms of the clinical characteristics of OCD. METHODS This was a cross-sectional study involving 455 women with OCD, of whom 226 (49.7%) had experienced premenstrual OCS worsening and 229 (50.3%) had not (PMOCS-worse and PMOCS-same groups, respectively). Data were collected with the original and dimensional versions of the Yale-Brown obsessive-compulsive scale, as well as with the Beck Depression Inventory (BDI) and Beck anxiety inventory (BAI). RESULTS We found significant differences between the PMOCS-same and PMOCS-worse groups, the latter showing a higher frequency of suicidal ideation (P<.001), suicide attempts (P=.027), current use of selective serotonin reuptake inhibitors (P=.022), lifetime use of mood stabilisers (P=.015), and sexual/religious obsessions (P<.001; OR=1.90), as well as higher scores on the BDI (P<.001) and BAI (P<.001). CONCLUSION Underscoring the fact that OCD is a heterogeneous disorder, there appears to be a subgroup of female OCD patients in whom the premenstrual period is associated with a higher frequency of sexual/religious obsessions, depression, anxiety, and suicidality. This might be attributable to hormonal fluctuations. Further studies are warranted in order to investigate this hypothesis by evaluating such patients at different phases of the menstrual cycle, as well as measuring hormonal levels.
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Affiliation(s)
- Luciana Moreira
- The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, São Paulo, Brazil
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Franz AP, Paim M, Araújo RMD, Rosa VDO, Barbosa ÍM, Blaya C, Ferrão YA. Treating refractory obsessive-compulsive disorder: what to do when conventional treatment fails? Trends Psychiatry Psychother 2013; 35:24-35. [DOI: 10.1590/s2237-60892013000100004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic and impairing condition. A very small percentage of patients become asymptomatic after treatment. The purpose of this paper was to review the alternative therapies available for OCD when conventional treatment fails. Data were extracted from controlled clinical studies (evidence-based medicine) published on the MEDLINE and Science Citation Index/Web of Science databases between 1975 and 2012. Findings are discussed and suggest that clinicians dealing with refractory OCD patients should: 1) review intrinsic phenomenological aspects of OCD, which could lead to different interpretations and treatment choices; 2) review extrinsic phenomenological aspects of OCD, especially family accommodation, which may be a risk factor for non-response; 3) consider non-conventional pharmacological approaches; 4) consider non-conventional psychotherapeutic approaches; and 5) consider neurobiological approaches.
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Affiliation(s)
| | - Mariana Paim
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | | | | | - Carolina Blaya
- Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
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Assunção MC, Costa DLDC, de Mathis MA, Shavitt RG, Ferrão YA, do Rosário MC, Miguel EC, Torres AR. Social phobia in obsessive-compulsive disorder: prevalence and correlates. J Affect Disord 2012; 143:138-47. [PMID: 22858214 DOI: 10.1016/j.jad.2012.05.044] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Accepted: 05/05/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP. METHOD A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV Axis I Disorders. Univariate analyses were followed by logistic regression. RESULTS Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder. LIMITATIONS The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error). CONCLUSION SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.
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Affiliation(s)
- Melissa Chagas Assunção
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ. Estadual Paulista, SP, Brazil.
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Conceição Costa DL, Chagas Assunção M, Arzeno Ferrão Y, Archetti Conrado L, Hajaj Gonzalez C, Franklin Fontenelle L, Fossaluza V, Constantino Miguel E, Rodrigues Torres A, Gedanke Shavitt R. Body dysmorphic disorder in patients with obsessive-compulsive disorder: prevalence and clinical correlates. Depress Anxiety 2012; 29:966-75. [PMID: 22815241 DOI: 10.1002/da.21980] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/30/2012] [Accepted: 06/15/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessive-compulsive disorder (OCD) have been previously addressed in primarily relatively small samples. METHODS We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. RESULTS The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. CONCLUSIONS Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders.
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Affiliation(s)
- Daniel Lucas Conceição Costa
- Projeto Transtornos do Espectro Obsessivo-Compulsivo (PROTOC, Obsessive-Compulsive Spectrum Disorders Project), Department and Institute of Psychiatry, School of Medicine, Universidade de São Paulo (USP), São Paulo, Brazil.
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Lovato L, Ferrão YA, Stein DJ, Shavitt RG, Fontenelle LF, Vivan A, Miguel EC, Cordioli AV. Skin picking and trichotillomania in adults with obsessive-compulsive disorder. Compr Psychiatry 2012; 53:562-8. [PMID: 22014580 DOI: 10.1016/j.comppsych.2011.06.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/18/2011] [Indexed: 02/03/2023] Open
Abstract
The objective of this study was to compare patients with obsessive-compulsive disorder (OCD) associated with pathologic skin picking (PSP) and/or trichotillomania, and patients with OCD without such comorbidities, for demographic and clinical characteristics. We assessed 901 individuals with a primary diagnosis of OCD, using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I disorders. Diagnoses of PSP and trichotillomania were made in 16.3% and 4.9% of the sample, respectively. After the logistic regression analysis, the following factors retained an association with OCD-PSP/trichotillomania: younger (odds ratio [OR] = 0.979; P = .047), younger at the onset of compulsive symptoms (OR = 0.941; P = .007), woman (OR = 2.538; P < .001), with a higher level of education (OR = 1.055; P = .025), and with comorbid body dysmorphic disorder (OR = 2.363; P = .004). These findings support the idea that OCD accompanied by PSP/trichotillomania characterizes a specific subgroup.
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Affiliation(s)
- Lucas Lovato
- Department of Psychiatry, Federal University of Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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Ferrão YA, Shavitt RG, Prado H, Fontenelle LF, Malavazzi DM, de Mathis MA, Hounie AG, Miguel EC, do Rosário MC. Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: an exploratory study of 1001 patients. Psychiatry Res 2012; 197:253-8. [PMID: 22361443 DOI: 10.1016/j.psychres.2011.09.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2011] [Revised: 07/20/2011] [Accepted: 09/20/2011] [Indexed: 11/29/2022]
Abstract
A substantial number of patients with obsessive-compulsive disorder (OCD) report compulsions that are preceded not by obsessions but by subjective experiences known as sensory phenomena. This study aimed to investigate the frequency, severity, and age at onset of sensory phenomena in OCD, as well as to compare OCD patients with and without sensory phenomena in terms of clinical characteristics. We assessed 1,001 consecutive OCD patients, using instruments designed to evaluate the frequency/severity of OC symptoms, tics, anxiety, depression, level of insight and presence/severity of sensory phenomena. All together, 651 (65.0%) subjects reported at least one type of sensory phenomena preceding the repetitive behaviors. Considering the sensory phenomena subtypes, 371 (57.0%) patients had musculoskeletal sensations, 519 (79.7%) had externally triggered "just-right" perceptions, 176 (27.0%) presented internally triggered "just right," 144 (22.1%) had an "energy release," and 240 (36.9%) patients had an "urge only" phenomenon. Sensory phenomena were described as being as more severe than were obsessions by 102(15.7%) patients. Logistic regression analysis showed that the following characteristics were associated with the presence of sensory phenomena: higher frequency and greater severity of the symmetry/ordering/arranging and contamination/washing symptom dimensions; comorbid Tourette syndrome, and a family history of tic disorders. These data suggest that sensory phenomena constitute a poorly understood psychopathological aspect of OCD that merits further investigation.
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Affiliation(s)
- Ygor Arzeno Ferrão
- Department of Psychiatry, Federal University School of Health Sciences, Porto Alegre, Brazil.
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Borges CP, Meyer E, Ferrão YA, Souza FP, Sousa MB, Cordioli AV. Cognitive-behavioral group therapy versus sertraline for obsessive-compulsive disorder: five-year follow-up. Psychother Psychosom 2011; 80:249-50. [PMID: 21540627 DOI: 10.1159/000322028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 10/06/2010] [Indexed: 11/19/2022]
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Jakubovski E, Pittenger C, Torres AR, Fontenelle LF, do Rosario MC, Ferrão YA, de Mathis MA, Miguel EC, Bloch MH. Dimensional correlates of poor insight in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:1677-81. [PMID: 21640153 PMCID: PMC4048951 DOI: 10.1016/j.pnpbp.2011.05.012] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 04/30/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Cross-sectional studies have associated poor insight in patients with obsessive-compulsive disorder (OCD) with increased OCD symptom severity, earlier age of onset, comorbid depression, and treatment response. The goal of this current study was to examine the relationship between dimensions of OCD symptomatology and insight in a large clinical cohort of Brazilian patients with OCD. We hypothesized that poor insight would be associated with total symptom severity as well as with hoarding symptoms severity, specifically. METHODS 824 outpatients underwent a detailed clinical assessment for OCD, including the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS), the Brown Assessment of Beliefs Scale (BABS), a socio-demographic questionnaire, and the Structured Clinical Interview for axis I DSM-IV disorders (SCID-P). Tobit regression models were used to examine the association between level of insight and clinical variables of interest. RESULTS Increased severity of current and worst-ever hoarding symptoms and higher rate of unemployment were associated with poor insight in OCD after controlling for current OCD severity, age and gender. Poor insight was also correlated with increased severity of current OCD symptoms. CONCLUSION Hoarding and overall OCD severity were significantly but weakly associated with level of insight in OCD patients. Further studies should examine insight as a moderator and mediator of treatment response in OCD in both behavioral therapy and pharmacological trials. Behavioral techniques aimed at enhancing insight may be potentially beneficial in OCD, especially among patients with hoarding.
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Affiliation(s)
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
,Yale Child Study Center, Yale University School of Medicine, New Haven, CT
| | | | | | | | - Ygor Arzeno Ferrão
- Departmente of Psychiatry, Universidade Federal de Ciências da Saúde de Porto Alegre
| | | | | | - Michael H. Bloch
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
,Yale Child Study Center, Yale University School of Medicine, New Haven, CT
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Phillips KA, Stein DJ, Rauch SL, Hollander E, Fallon BA, Barsky A, Fineberg N, Mataix-Cols D, Ferrão YA, Saxena S, Wilhelm S, Kelly MM, Clark LA, Pinto A, Bienvenu OJ, Farrow J, Leckman J. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010; 27:528-55. [PMID: 20533367 PMCID: PMC3985410 DOI: 10.1002/da.20705] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The obsessive-compulsive (OC) spectrum has been discussed in the literature for two decades. Proponents of this concept propose that certain disorders characterized by repetitive thoughts and/or behaviors are related to obsessive-compulsive disorder (OCD), and suggest that such disorders be grouped together in the same category (i.e. grouping, or "chapter") in DSM. This article addresses this topic and presents options and preliminary recommendations to be considered for DSM-V. The article builds upon and extends prior reviews of this topic that were prepared for and discussed at a DSM-V Research Planning Conference on Obsessive-Compulsive Spectrum Disorders held in 2006. Our preliminary recommendation is that an OC-spectrum grouping of disorders be included in DSM-V. Furthermore, we preliminarily recommend that consideration be given to including this group of disorders within a larger supraordinate category of "Anxiety and Obsessive-Compulsive Spectrum Disorders." These preliminary recommendations must be evaluated in light of recommendations for, and constraints upon, the overall structure of DSM-V.
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Lopes AC, Greenberg BD, Norén G, Canteras MM, Busatto GF, de Mathis ME, Taub A, D'Alcante CC, Hoexter MQ, Gouvea FS, Cecconi JP, Gentil AF, Ferrão YA, Fuentes D, de Castro CC, Leite CC, Salvajoli JV, Duran FLS, Rasmussen S, Miguel EC. Treatment of resistant obsessive-compulsive disorder with ventral capsular/ventral striatal gamma capsulotomy: a pilot prospective study. J Neuropsychiatry Clin Neurosci 2010; 21:381-92. [PMID: 19996246 DOI: 10.1176/jnp.2009.21.4.381] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A subgroup of obsessive-compulsive disorder (OCD) patients remains refractory to conventional treatments. For them, a new stereotactic radiosurgery has been recently developed: the ventral capsular/ventral striatal (VC/VS) gamma capsulotomy. The authors aim to report efficacy and adverse events of VC/VS gamma capsulotomy. Five refractory OCD patients were selected. The authors assessed OCD, anxiety and depressive symptoms, and side effects pre- and postoperatively. Three patients (60%) met response criteria 48 months after surgery. Adverse effects were episodic and transient. Ventral capsular/ventral striatal gamma capsulotomy holds therapeutic promise, with few adverse effects.
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Affiliation(s)
- Antonio Carlos Lopes
- Obsessive Compulsive Spectrum Disorders Program (PROTOC), Department of Psychiatry, University of São Paulo School of Medicine, R. Dr. Ovídio Pires de Campos, 785, 3 degrees andar, sala 9, São Paulo, SP 01060-970, Brazil.
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Abstract
OBJETIVO: O transtorno obsessivo-compulsivo (TOC) causa importante impacto sobre a dinâmica familiar. Frequentemente, ocorrem modificações na rotina da família, a qual acaba se adaptando aos sintomas e às exigências do paciente, fenômeno denominado acomodação familiar. Portadores de TOC podem sentir-se, ainda, alvo de críticas por parte de pessoas de seu convívio. Alguns estudos associam pior prognóstico a maiores Índices de Acomodação Familiar e criticismo percebido. Este artigo tem como objetivo verificar possíveis associações entre tipos de sintomas predominantes (dimensões) determinados pela escala DYBOCS, em relação ao funcionamento familiar e percepção crítica dos pacientes. MÉTODO: Quarenta e nove pacientes e seus familiares foram avaliados por meio da aplicação de escalas para medição dos índices de criticismo percebido (Perceived Criticism Scale) e acomodação familiar (Family Accommodation Scale), além de escalas para medir a intensidade dos sintomas obsessivo-compulsivos (Dimensional Yale-Brown Obsessive-Compulsive Scale, Yale-Brown Obsessive-Compulsive Scale), depressivos e ansiosos (Hamilton and Beck depression and anxiety inventories). Compararam-se os resultados aos índices obtidos pela DYBOCS e a outras variáveis clínicas relacionadas ao TOC. RESULTADOS: Encontraram-se correlações estatísticas entre gravidade das dimensões agressividade e contaminação, com maior acomodação familiar. Foi verificado também maior criticismo por parte dos pacientes portadores de colecionismo. CONCLUSÃO: Diferentes subtipos de TOC exercem diferentes padrões de influência no contexto familiar. Mais estudos com esse enfoque são necessários para melhor orientação comportamental a pacientes e familiares.
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Affiliation(s)
- Ygor Arzeno Ferrão
- Universidade Federal de Ciências da Saúde de Porto Alegre; IPA; Hospital Materno Infantil Presidente Vargas; Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo
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Corchs F, Corregiari F, Ferrão YA, Takakura T, Mathis ME, Lopes AC, Miguel EC, Bernik M. Personality traits and treatment outcome in obsessive-compulsive disorder. Braz J Psychiatry 2009; 30:246-50. [PMID: 18833426 DOI: 10.1590/s1516-44462008000300012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 06/14/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Comorbidity with personality disorders in obsessive-compulsive patients has been widely reported. About 40% of obsessive-compulsive patients do not respond to first line treatments. Nevertheless, there are no direct comparisons of personality traits between treatment-responsive and non-responsive patients. This study investigates differences in personality traits based on Cloninger's Temperament and Character Inventory scores between two groups of obsessive-compulsive patients classified according to treatment outcome: responders and non-responders. METHOD Forty-four responsive and forty-five non-responsive obsessive-compulsive patients were selected. Subjects were considered treatment-responsive (responder group) if, after having received treatment with any conventional therapy, they had presented at least a 40% decrease in the initial Yale-Brown Obsessive Compulsive Scale score, had rated "better" or "much better" on the Clinical Global Impressions scale; and had maintained improvement for at least one year. Non-responders were patients who did not achieve at least a 25% reduction in Yale-Brown Obsessive Compulsive Scale scores and had less than minimal improvement on the Clinical Global Impressions scale after having received treatment with at least three selective serotonin reuptake inhibitors (including clomipramine), and at least 20 hours of cognitive behavioral therapy. Personality traits were assessed using Temperament and Character Inventory. RESULTS Non-responders scored lower in self-directedness and showed a trend to score higher in persistence than responders did. CONCLUSION This study suggests that personality traits, especially self-directedness, are associated with poor treatment response in obsessive-compulsive patients.
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Affiliation(s)
- Felipe Corchs
- Department and Institute of Psychiatry, Medical School, Universidade de São Paulo, SP, Brazil
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Torresan RC, Ramos-Cerqueira ATDA, de Mathis MA, Diniz JB, Ferrão YA, Miguel EC, Torres AR. Sex differences in the phenotypic expression of obsessive-compulsive disorder: an exploratory study from Brazil. Compr Psychiatry 2009; 50:63-9. [PMID: 19059516 DOI: 10.1016/j.comppsych.2008.05.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/15/2008] [Accepted: 05/29/2008] [Indexed: 10/21/2022] Open
Abstract
Previous studies have shown differences in clinical features of obsessive-compulsive disorder (OCD) between men and women, including mean age at onset of obsessive-compulsive symptoms (OCS), types of OCS, comorbid disorders, course, and prognosis. The aim of this study was to compare male and female Brazilian patients with OCD on several demographic and clinical characteristics. Three hundred thirty outpatients with OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], criteria) who sought treatment at 3 Brazilian public universities and at 2 private practice clinics in the city of São Paulo were evaluated. The assessment instruments used were the Yale-Brown Obsessive-Compulsive Scale to evaluate OCD severity and symptoms, the Beck Depression and Anxiety Inventories, the Yale Global Tic Severity Scale, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders to assess psychiatric comorbidity. Fifty-five percent of the patients (n = 182) were men who were significantly more likely than women to be single and to present sexual, religious, and symmetry obsessions and mental rituals. They also presented earlier onset of OCS and earlier symptom interference in functioning, and significantly more comorbid tic disorders and posttraumatic stress disorder. Women, besides showing significantly higher mean scores in the Beck Depression and Anxiety Inventories, were more likely to present comorbid simple phobias, eating disorders in general and anorexia in particular, impulse control disorders in general, and compulsive buying and skin picking in particular. No significant differences were observed between sexes concerning family history of OCS or OCD, and global symptoms severity, either in obsession or compulsive subscale. The present study confirms the presence of sex-related differences described in other countries and cultures. The fact that the OCS start earlier and probably have a worse impact in men can eventually lead to more specific and efficacious treatment approaches for these patients.
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Affiliation(s)
- Ricardo Cezar Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil.
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Miguel EC, Ferrão YA, Rosário MCD, Mathis MAD, Torres AR, Fontenelle LF, Hounie AG, Shavitt RG, Cordioli AV, Gonzalez CH, Petribú K, Diniz JB, Malavazzi DM, Torresan RC, Raffin AL, Meyer E, Braga DT, Borcato S, Valério C, Gropo LN, Prado HDS, Perin EA, Santos SI, Copque H, Borges MC, Lopes AP, Silva EDD. The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results. Rev Bras Psiquiatr 2008; 30:185-96. [DOI: 10.1590/s1516-44462008000300003] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2008] [Accepted: 08/05/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE: To describe the recruitment of patients, assessment instruments, implementation, methods and preliminary results of The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, which includes seven university sites. METHOD: This cross-sectional study included a comprehensive clinical assessment including semi-structured interviews (sociodemographic data, medical and psychiatric history, disease course and comorbid psychiatric diagnoses), and instruments to assess obsessive-compulsive (Yale-Brown Obsessive-Compulsive Scale and Dimensional Yale-Brown Obsessive-Compulsive Scale), depressive (Beck Depression Inventory) and anxious (Beck Anxiety Inventory) symptoms, sensory phenomena (Universidade de São Paulo Sensory Phenomena Scale), insight (Brown Assessment Beliefs Scale), tics (Yale Global Tics Severity Scale) and quality of life (Medical Outcome Quality of Life Scale Short-form-36 and Social Assessment Scale). The raters' training consisted of watching at least five videotaped interviews and interviewing five patients with an expert researcher before interviewing patients alone. The reliability between all leaders for the most important instruments (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale) was measured after six complete interviews. RESULTS: Inter-rater reliability was 96%. By March 2008, 630 obsessive-compulsive disorder patients had been systematically evaluated. Mean age (±SE) was 34.7 (±0.51), 56.3% were female, and 84.6% Caucasian. The most prevalent obsessive compulsive symptom dimensions were symmetry and contamination. The most common comorbidities were major depression, generalized anxiety and social anxiety disorder. The most common DSM-IV impulsive control disorder was skin picking. CONCLUSION: The sample was composed mainly by Caucasian individuals, unmarried, with some kind of occupational activity, mean age of 35 years, onset of obsessive-compulsive symptoms at 13 years of age, mild to moderate severity, mostly of symmetry, contamination/cleaning and comorbidity with depressive disorders. The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders has established an important network for standardized collaborative clinical research in obsessive-compulsive disorder and may pave the way to similar projects aimed at integrating other research groups in Brazil and throughout the world.
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Ferrão YA, Diniz JB, Lopes AC, Shavitt RG, Greenberg B, Miguel E. [Resistance and refractoriness in obsessive-compulsive disorder]. ACTA ACUST UNITED AC 2008; 29 Suppl 2:S66-76. [PMID: 18172943 DOI: 10.1590/s1516-44462006005000059] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE AND METHOD Despite the existence of effective therapeutic alternatives for obsessive-compulsive disorder, a significant number of patients does not achieve or does not maintain remission after adequate treatment. The relief of these patients' suffering with the available treatments is a clinical challenge related to many unanswered questions. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness, to describe the intrinsic and extrinsic factors of obsessive-compulsive disorder's phenomenology that might influence treatment response to conventional treatment, and to present a fluxogram of therapeutic alternatives for resistant or refractory obsessive compulsive disorder patients. CONCLUSION The literature evinces that intrinsic and/or extrinsic phenomenological aspects of obsessive-compulsive disorder may collaborate to the fact that, at least 30% of obsessive-compulsive disorder patients do not respond to conventional treatment. Several therapeutic or augmentation alternatives, psychopharmacological, biological or even psychotherapeutical exist, but more studies are necessary to evince the correct way to symptom remission.
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Affiliation(s)
- Ygor Arzeno Ferrão
- Consórcio Brasileiro de Pesquisa em Transtorno Obsessivo-Compulsivo, Brazil.
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de Mathis MA, do Rosario MC, Diniz JB, Torres AR, Shavitt RG, Ferrão YA, Fossaluza V, de Bragança Pereira CA, Miguel EC. Obsessive–Compulsive Disorder: Influence of Age at Onset on Comorbidity Patterns. Eur Psychiatry 2008; 23:187-94. [DOI: 10.1016/j.eurpsy.2008.01.002] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/29/2022] Open
Abstract
AbstractPurpose.This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset.Methods.Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis.Results.Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse–control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse–control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample.Conclusions.Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value.
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Raffin AL, Ferrão YA, Souza FPD, Cordioli AV. Fatores preditores de resultados no tratamento do transtorno obsessivo-compulsivo com as terapias comportamental e cognitivo-comportamental: uma revisão sistemática. ACTA ACUST UNITED AC 2008. [DOI: 10.1590/s0101-81082008000200006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: As terapias comportamental e cognitivo-comportamental reduzem os sintomas do transtorno obsessivo-compulsivo em mais de 70% dos pacientes. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer fatores associados a esses desfechos poderia auxiliar numa melhor indicação do tratamento, incrementando sua eficácia. MÉTODO: Foram revisados trabalhos que investigaram fatores preditivos de resultados nos tratamentos do transtorno obsessivo-compulsivo, nas fontes PubMed, PsycINFO e LILACS. Termos utilizados na busca: predictive factors OR prediction AND obsessive-compulsive disorder AND exposure response prevention OR ritual prevention OR behav* therapy OR cognitive behav* therapy, resultando em 104 artigos. As referências dos artigos foram analisadas, possibilitando maior número de trabalhos revisados. Excluíram-se artigos que utilizaram apenas farmacoterapia e aqueles que não abordavam o tema, resultando em 29 artigos. DISCUSSÃO: As variáveis demográficas parecem exercer papel indireto, destacando-se sexo masculino e ausência de companheiro(a) como fatores de pior prognóstico. Maior gravidade e início precoce dos sintomas indicariam piores resultados. O transtorno esquizotípico comórbido é potencialmente negativo. Sintomas relacionados ao colecionismo e com conteúdo sexual/religioso indicam pior prognóstico. Maior nível de insight, motivação e colaboração com o tratamento são características favoráveis. Maior intensidade da melhora e a remissão completa são preditores para a não-recaída. CONCLUSÃO: A identificação de fatores preditores de resultados está longe de ser esclarecida. É possível que múltiplos fatores, cujas associações são complexas, atuem em conjunto. Os resultados podem depender de fatores não-específicos, ainda não abordados pelos estudos. A heterogeneidade do transtorno obsessivo-compulsivo e das pesquisas e o uso associado de medicamentos dificultam o estabelecimento de conclusões mais definidas.
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Ferrão YA, Fontenelle LF. [Discussing resistant and refractory cases in psychiatry]. Braz J Psychiatry 2007; 29 Suppl 2:S39-S40. [PMID: 18157432 DOI: 10.1590/s1516-44462007000600001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Arzeno Ferrão Y, Almeida VP, Bedin NR, Rosa R, D'Arrigo Busnello E. Impulsivity and compulsivity in patients with trichotillomania or skin picking compared with patients with obsessive-compulsive disorder. Compr Psychiatry 2006; 47:282-8. [PMID: 16769303 DOI: 10.1016/j.comppsych.2005.11.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2004] [Revised: 03/22/2005] [Accepted: 11/10/2005] [Indexed: 10/24/2022] Open
Abstract
To compare impulsivity and compulsivity, we performed a case control study comparing a group of 20 patients with obsessive-compulsive disorder with a group of 20 patients with skin picking and/or trichotillomania (SP/T). The instruments used were Structured Clinical Interview for DSM-IV Axis I Diagnosis, Yale-Brown Obsessive-Compulsive Scale, Schalling Impulsivity Scale, and Hamilton Anxiety and Depression Inventories. A Multidimensional Impulsive-Compulsive Spectrum Assessment Instrument was designed for this particular study. The Yale-Brown Obsessive-Compulsive Scale scores were significantly higher in patients with obsessive-compulsive disorder, compared with patients with SP/T (F = 90.29; P < .001). The Hamilton Inventories and Schalling Impulsivity Scale revealed no significant intergroup differences. The Multidimensional Impulsive-Compulsive Spectrum Assessment Instrument allowed us to find 6 statistically significant differences between groups: the ability or inability to delay an impulse, quick response or action planning, feelings of pleasure or guilt during or after an act, ritualization, and whether the patient believes he/she has losses or benefits if prevented from acting. In conclusion, SP/T should deserve further attention about their classification in future versions of diagnostic manuals because, as in International Classification of Diseases, Tenth Revision, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition includes these disorders in the same chapter as pathological gambling, kleptomania, pyromania and others. Despite their resemblance to compulsions, their classification under the Obsessive-Compulsive Spectrum needs particular phenomenological and neurobiologic investigation.
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Affiliation(s)
- Ygor Arzeno Ferrão
- Universidade Federal do Rio Grande do Sul; Hospital Psiquiátrico São Pedro, Centro Universitário Metodista IPA, Rua Padre Chagas, 185/403 Porto Alegre, 90570-080 Brazil.
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Fontenelle LF, do Rosário-Campos MC, Mendlowicz MV, Ferrão YA, Versiani M, Miguel EC. Treatment-response by age at onset in obsessive-compulsive disorder. J Affect Disord 2004; 83:283-4. [PMID: 15555726 DOI: 10.1016/j.jad.2004.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2004] [Accepted: 07/01/2004] [Indexed: 10/26/2022]
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Ferrão YA, Scheidt B. Basal ganglia hemorrhagic ablation causing temporary suppression of trichotillomania symptoms. Braz J Psychiatry 2003; 25:262-3, author reply 263. [PMID: 15330004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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Abstract
INTRODUÇÃO: Dermatotilexomania pode ser classificada, segundo o DSM-IV, dentro do capítulo de transtornos de controle de impulsos não classificados em outro lugar. Autores têm incluído o distúrbio dentro do espectro obsessivo-compulsivo. O objetivo deste trabalho é identificar a prevalência de dermatotilexomania em estudantes de medicina de uma faculdade de Porto Alegre (RS). MATERIAL E MÉTODO: Os autores realizaram um levantamento das características clínicas e demográficas dessa população. Um questionário adaptado foi aplicado a 144 estudantes de medicina. RESULTADOS: Destes, 89 (61,8%) já haviam causado ou agravado lesões à pele no passado ou ainda o fazem; 12 (8,3%) responderam que lesionam mais a pele do que a maioria das pessoas e 1 (0,7%) classificou sua dermatotilexomania como extrema. Mais da metade dos estudantes (n=80, 55,6%) consideraram o ato como um mau hábito. CONCLUSÕES: O estudo sugere que a o ato de causar ou agravar lesões à pele parece ser comum entre jovens, mas não necessariamente deve ser considerado como patológico. Para os casos mais graves, entretanto, a condição poderia ser classificada como um transtorno: dermatotilexomania.
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