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Inattention symptoms in early pregnancy predict parenting skills and infant maltreatment during the first year of life
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Oliveira, Jordana Verano de

; Fatori, Daniel

; Shephard, Elizabeth

; Xavier Neto, Mauro

; Matijasevich, Alicia

; Ferraro, Alexandre Archanjo

; Rohde, Luis Augusto

; Chiesa, Anna Maria

; Miguel, Euripedes Constantino

; Polanczyk, Guilherme V.

Brazilian Journal of Psychiatry

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aug 2022, Volume 44 N. 4 Pages 388 - 400

Abstract: En | Text: En | PDF: En

Objective: Maternal attention-deficit/hyperactivity disorder has not been investigated in relation to parenting skills in adolescent mothers. This study investigated whether maternal inattention and hyperactivity/impulsivity symptoms early in pregnancy predict poorer parenting skills and infant maltreatment during the first year of life in adolescent mothers living in adverse environmental conditions. Methods: The participants in this study were 80 adolescent mothers aged 14-19 years and their babies who were taking part in a randomized controlled trial on the effects of a home-visiting program on infant development. Symptoms of maternal attention-deficit/hyperactivity disorder were assessed in the first trimester of pregnancy. Parenting skills (maternal competence, attachment to the baby, home environment) and child maltreatment were assessed when the infants were aged 6 and 12 months. Multilevel linear regression models were constructed to test the extent to which prenatal maternal inattention and hyperactivity/impulsivity symptoms predicted these parenting variables during the first year of the infant’s life. Results: Prenatal inattention symptoms significantly predicted lower maternal competence and attachment, a poorer home environment, and greater maltreatment during the first year of life. Hyperactivity did not significantly predict parenting skills or maltreatment. Conclusions: Our findings suggest that inattention symptoms may interfere with parenting abilities in adolescent mothers and should be considered in early intervention programs.

https://doi.org/10.47626/1516-4446-2021-2045

Not only pharmacodynamic: the role of brain circuits in improving the treatment of suicidal thoughts and behaviors
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Damiano, Rodolfo Furlan

; Miguel, Euripedes Constantino

; Shephard, Elizabeth

Brazilian Journal of Psychiatry

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feb 2022, Volume 44 N. 1 Pages 113 - 113

Abstract: En | Text: En | PDF: En

https://doi.org/10.1590/1516-4446-2021-2257

COMVC-19, a Program to Protect Healthcare Workers’ Mental Health During the COVID-19 Pandemic, and the Second Wave of the Pandemic: A New Moment and the Impact of Previous Experiences
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Scarduelli, Fabio Cassiodoro Veiga

; Fukuti, Pedro

; Corchs, Felipe

; Miguel, Euripedes Constantino

; Humes, Eduardo de Castro

Clinics

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2021, Volume 76 elocation e3574

Abstract: En | Text: En | PDF: En

https://doi.org/10.6061/clinics/2021/e3574

COMVC-19: A Program to protect healthcare workers’ mental health during the COVID-19 Pandemic. What we have learned
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Fukuti, Pedro

; Uchôa, Caroline Louise Mesquita

; Mazzoco, Marina Flaborea

; Cruz, Isabella D'Andrea Garcia da

; Echegaray, Mariana V.F.

; Humes, Eduardo de Castro

; Silveira, Júlia Belizário

; Santi, Talita Di

; Miguel, Euripedes Constantino

; Corchs, Felipe

; Fatori, Daniel

; Campello, Guilherme

; Oliveira, Gabriel M. de

; Argolo, Felipe C.

; Ferreira, Felipe de M.

; Machado, Gustavo

; Argeu, Adriana

; Oliveira, Graça Maria Ramos de

; Serafim, Antônio de Pádua

; Siqueira, Luciana de Lima

; Rossi, Luciane de

; Rios, Izabel Cristina

; Oliveira, Talita Rodrigues de

; Antoniazzi, Leilane C. K.

; Gagliotti, Daniel Augusto Mori

; Abelama Neto, Emílio

; Oliveira Junior, Paulo Novais de

; Correia, Aline Villalobo

; Gonçalves, Luca Schilling

; Tortato, Liana Silva

; Busato, Wagner Machado Moraes

; Guimarães-Fernandes, Flávio

; Alves, Marcos

; Leite Netto, Oswaldo Ferreira

; Schoueri, Patrícia de Campos Lindenberg

; Roque, Márcio de Assis

; Merlin, Silvia Stahl

; Boer, Giovana Cardoso Machado

; Sallet, Paulo Clemente

; Malbergier, André

; Spedo, Mariana Abrahão

; Kamitsuji, Carla Satie

; Faria, Elizabeth de

; Moreira, Moacyr Vergara de Godoy

; Kaufman, Arthur

; Abdo, Carmita

; Scanavino, Marco de Tubino

; Lancman, Selma

; Tavares, Hermano

; Polanczyk, Guilherme

; Brunoni, André R.

; Forlenza, Orestes V.

; Barros-Filho, Tarcísio Eloy Pessoa de

Clinics

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2021, Volume 76 elocation e2631

Abstract: En | Text: En | PDF: En

OBJECTIVE: In 2020, the COVID-19 pandemic brought a work and stress overload to healthcare workers, increasing their vulnerability to mental health impairments. In response, the authors created the COMVC-19 program. The program offered preventive actions and mental health treatment for the 22,000 workers of The Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP). This paper aims to describe its implementation and share what we have learned from this experience. METHODS: Workers were able to easily access the program through a 24/7 hotline. Additionally, a mobile phone app that screened for signs and symptoms of emotional distress and offered psychoeducation and/or referral to treatment was made available. Data from both these sources as well as any subsequent psychiatric evaluations were collected. RESULTS: The first 20 weeks of our project revealed that most participants were female, and part of the nursing staff working directly with COVID-19 patients. The most frequently reported symptoms were: anxiety, depression and sleep disturbances. The most common diagnoses were Adjustment, Anxiety, and Mood disorders. CONCLUSIONS: Implementing a mental health program in a multimodal intervention was feasible in a major quaternary public hospital. Our data also suggests that preventive actions should primarily be aimed at anxiety and depression symptoms, with a particular focus on the nursing staff.

https://doi.org/10.6061/clinics/2021/e2631

Prevalência de problemas de saúde mental na infância na atenção primária
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Fatori, Daniel

; Brentani, Alexandra

; Grisi, Sandra Josefina Ferraz Ellero

; Miguel, Euripedes Constantino

; Graeff-Martins, Ana Soledade

Ciência & Saúde Coletiva

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sep 2018, Volume 23 N. 9 Pages 3013 - 3020

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

Resumo O presente estudo populacional de corte transversal teve como objetivo verificar a prevalência de problemas de saúde mental (PSM) e descrever o uso de serviços de saúde numa amostra de crianças atendidas em unidades de saúde (UBS) do município de São Paulo. Responsáveis de 825 crianças de 6-11 anos de idade foram entrevistados. PSM das crianças foram avaliados pelo “Strength and Difficulties Questionnaire” e uso de serviços por uma versão adaptada do “Client Service Receipt Inventory Children’s version”. A prevalência de PSM internalizantes e externalizantes foi de 30,7% e 18,3%, respectivamente. O pediatra foi o profissional de saúde mais consultado (56,7%), o psicólogo foi o profissional da saúde mental mais consultado (7,9%). Apenas 3 crianças estavam em tratamento medicamentoso para PSM. A alta prevalência de PSM em crianças atendidas na AP e o baixo número de atendimentos em serviços configuram um importante problema de saúde pública. Programas de capacitação para profissionais são importantes para aprimorar a identificação e o encaminhamento de casos de PSM.

Abstract The present population study aimed at identifying the prevalence of mental health problems (MHP) and describing health services use in a sample of children attending Primary Healthcare Units (PHU) in the city of Sao Paulo. Caregivers of 825 6-11 years old children were assessed. MHP were assessed with the Strength and Difficulties Questionnaire and health services use with an adapted version of the Client Receipt Inventory Children`s version. Prevalence of internalizing and externalizing MHP was 30.7% and 18.3%, respectively. Pediatricians were the most consulted health professional (56.7%) and psychologists the most consulted mental health professional (7.9%). Only 3 children were under medication treatment for MHP. The high prevalence of MHP among children in the primary care setting and the low rate of treatment constitute a public health problem. Training programs for health professionals are relevant to help identify and refer MHP cases.

https://doi.org/10.1590/1413-81232018239.25332016 3751 downloads

Prevalência de problemas de saúde mental na infância na atenção primária
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Fatori, Daniel

; Brentani, Alexandra

; Grisi, Sandra Josefina Ferraz Ellero

; Miguel, Euripedes Constantino

; Graeff-Martins, Ana Soledade

Ciência & Saúde Coletiva

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2018, Volume 23 N. 9 Pages 3013 - 3020

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1590/1413-81232018239.25332016 16 downloads

Attention deficit disorder/hyperactivity: a scientific overview
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Polanczyk, Guilherme V.

; Casella, Erasmo Barbante

; Miguel, Euripedes Constantino

; Reed, Umbertina Conti

Clinics

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oct 2012, Volume 67 N. 10 Pages 1125 - 1126

Abstract: En | Text: En | PDF: En

https://doi.org/10.6061/clinics/2012(10)01 2879 downloads

Outlining new frontiers for the comprehension of obsessive-compulsive disorder: a review of its relationship with fear and anxiety
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Diniz, Juliana Belo

; Miguel, Euripedes Constantino

; Oliveira, Amanda Ribeiro de

; Reimer, Adriano Edgar

; Brandão, Marcus Lira

; Mathis, Maria Alice de

; Batistuzzo, Marcelo Camargo

; Costa, Daniel Lucas Conceição

; Hoexter, Marcelo Queiroz

Brazilian Journal of Psychiatry

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jun 2012, Volume 34 Suppl. 1 Pages 81 - 91

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

A ansiedade é um componente importante da psicopatologia do transtorno obsessivo-compulsivo (TOC). Até o momento, a maioria das intervenções que provaram ser eficazes para o tratamento de TOC é semelhante àquelas desenvolvidas para outros transtornos de ansiedade. No entanto, estudos que investigaram a neurobiologia do TOC chegaram a conclusões que nem sempre são compatíveis com aquelas anteriormente associadas aos demais transtornos de ansiedade. OBJETIVOS: Neste artigo, revisamos o grau de sobreposição entre as características do TOC e a fenomenologia e fisiopatologia dos demais transtornos de ansiedade com o intuito de dar suporte ao racional que orienta a pesquisa nesse campo. RESULTADOS: Alguns dados sobre os neurocircuitos envolvidos na manifestação dos transtornos de ansiedade foram obtidos a partir do estudo de modelos animais de ansiedade, e da neuroimagem estrutural e funcional em humanos. Esses trabalhos sugerem que no TOC, além da disfunção das vias corticoestriatais, o funcionamento do circuito amigdalocortical, essencial para a apresentação da resposta de medo e processos de extinção dessa resposta, também pode estar prejudicado. CONCLUSÃO: É provável que a ansiedade seja uma dimensão relevante do TOC, com impacto em outras características desse transtorno. Consequentemente, estudos futuros podem se beneficiar da investigação dos fenômenos de medo e ansiedade e de suas relações com os tipos de obsessões e compulsões, idade de início do TOC, comorbidades e padrões de resposta ao tratamento.

Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. OBJECTIVES: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. RESULTS: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. CONCLUSION: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.

12413 downloads Cited 1 time in SciELO

Marcos Mercadante (1960-2011) and his legacy to Brazilian psychiatry
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Miguel, Euripedes Constantino

Brazilian Journal of Psychiatry

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sep 2011, Volume 33 N. 3 Pages 219 - 220

Abstract: En | Text: En | PDF: En

3906 downloads

10.

Instruction in developmental psychiatry: preliminary findings at the undergraduate level in Brazil
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Moraes, Erika Neves de Souza

; Scivoletto, Sandra

; Fossaluza, Vitor

; Vieira, Joaquim Edson

; Miguel, Euripedes Constantino

; Alvarenga, Pedro Gomes de

Brazilian Journal of Psychiatry

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sep 2011, Volume 33 N. 3 Pages 287 - 291

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

CONTEXTO: Apesar de vital para o reconhecimento precoce, tratamento e prevenção de transtornos mentais, a psiquiatria do desenvolvimento ainda não foi incorporada à grade curricular ou prática psiquiátrica no Brasil. OBJETIVO: Avaliar o impacto de um curso extracurricular em psiquiatria do desenvolvimento na graduação e a viabilidade de expansão de políticas de ensino em psiquiatria do desenvolvimento no Brasil. MÉTODO: Antes e após assistirem um curso de 12 horas durante 4 dias sobre fundamentos da psiquiatria do desenvolvimento, estudantes de graduação em saúde responderam um questionário composto por 12 questões de múltipla escolha randomizadas para avaliação de retenção do conhecimento e questões destinadas à avaliação de atitudes. A análise estatística incluiu testes não-paramétricos de variáveis categóricas ordinais. RESULTADOS: Em uma amostra final composta por 43 estudantes, verificou-se um desempenho significativamente superior no pós-teste (65.0% vs. 39.9%; p < 0.0001). Atitudes positivas em relação ao curso relacionaram-se a um melhor desempenho. Estudantes dos 3º e 4º anos de medicina apresentaram resultados superiores quando comparados aos do 1º e 2º anos de medicina e aos estudantes de outras áreas da saúde. Constatou-se melhor desempenho no sexo masculino. CONCLUSÃO: Este estudo encoraja políticas de ensino em psiquiatria do desenvolvimento que poderão ter implicações clínicas diretas.

BACKGROUND: Although knowledge on developmental psychiatry is fundamental for the early recognition, treatment, and prevention of mental disorders, this subject has not been incorporated into the medical curriculum or psychiatric practice in Brazil. OBJECTIVE: To evaluate the effect of a short course on developmental psychiatry for undergraduate students and to expand education policies concerning developmental psychiatry in Brazil. METHODS: Before and after attending an extracurricular 12-hour, 4-day course on the fundamentals of developmental psychiatry, undergraduate health sciences students were tested regarding their knowledge of the subject. The pre-test/post-test included 12 randomly selected multiple-choice questions designed to evaluate knowledge related to developmental psychiatry and was administered together with a questionnaire designed to evaluate students' attitudes. To compare performances between groups, nonparametric analyses of ordinal categorical data were employed. RESULTS: The final sample comprised 43 students. The mean post-test score was significantly higher than the mean pre-test score (65.0% vs 39.9%; p < 0.0001). We found that strongly positive attitudes correlated with better performance. The 3rd and 4th year medical students performed better than the 1st and 2nd year medical students and the non-medical students. Sex differences favoring males were also observed. CONCLUSION: Our findings encourage additional educational policies related to developmental psychiatry which may result in direct clinical implications.

2574 downloads

11.

Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder
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Diniz, Juliana Belo

; Malavazzi, Dante Marino

; Fossaluza, Victor

; Belotto-Silva, Cristina

; Borcato, Sonia

; Pimentel, Izabel

; Miguel, Euripedes Constantino

; Shavitt, Roseli Gedanke

Clinics

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2011, Volume 66 N. 3 Pages 387 - 393

Abstract: En | Text: En | PDF: En

INTRODUCTION: In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments. OBJECTIVE: This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients. METHODS: A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs) or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs) were compared with a paired sample of compliant patients (n = 41). Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chisquare and Mann-Whitney tests were used when indicated. Variables presenting a p value <0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable. RESULTS: Agoraphobia was only present in one (2.4%) patient who completed the twelve-week therapy, whereas it was present in six (15.0%) patients who dropped out (p = 0.044). Social phobia was present in eight (19.5%) patients who completed the twelve-week therapy and eighteen (45%) patients who dropped out (p = 0.014). Generalized anxiety disorder was present in eight (19.5%) patients who completed the twelve-week therapy and twenty (50%) dropouts (p = 0.004), and somatization disorder was not present in any of the patients who completed the twelveweek therapy; however, it was present in six (15%) dropouts (p = 0.010). According to the logistic regression model, treatment modality (p = 0.05), agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03) and the Beck Anxiety Inventory (p = 0.02) scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables. DISCUSSION AND CONCLUSION: Early treatment discontinuation is a common phenomenon in obsessive-compulsive disorder patients from our therapeutic setting. Psychiatric comorbidities were associated with discontinuation rates of specific treatments. Future studies might use this information to improve management for increased compliance and treatment effectiveness.

https://doi.org/10.1590/S1807-59322011000300004 2906 downloads

12.

Cerebral perfusion and automated individual analysis using SPECT among an obsessive-compulsive population
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Rocha, Euclides Timóteo da

; Buchpiguel, Carlos Alberto

; Miguel, Euripedes Constantino

; Peres, Stela Verzinhase

; Busatto Filho, Geraldo

Jornal Brasileiro de Psiquiatria

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2011, Volume 60 N. 1 Pages 1 - 6

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Avaliar uma amostra de pacientes com transtorno obsessivo-compulsivo (TOC), individualmente, empregando uma metodologia de quantificação automatizada para rastrear anormalidades de perfusão em exames de SPECT cerebral. MÉTODOS: Foi utilizado o Statistical Parametric Mapping (SPM) para comparar 26 imagens de SPECT cerebral de pacientes com TOC, individualmente, com um banco de 32 imagens de voluntários normais, usando o limiar estatístico de p < 0,05 (corrigido para comparações múltiplas ao nível do voxel individual ou clusters). Os mapas foram analisados procurando por regiões que apresentassem voxels acima desse limiar. RESULTADOS: Seis pacientes da amostra de 26 imagens com TOC mostraram anormalidades ao nível do cluster ou voxel, considerando os critérios descritos acima, os quais representaram 23,07%. Contudo, sete imagens do grupo de 32 voluntários normais também foram apontadas com anormalidades de perfusão, que representou 21,8% da amostra. CONCLUSÃO: O método de quantificação automatizada não foi considerado como uma ferramenta útil na prática clínica, como forma de análise complementar à inspeção visual.

OBJECTIVE: To make individual assessments using automated quantification methodology in order to screen for perfusion abnormalities in cerebral SPECT examinations among a sample of subjects with OCD. METHODS: Statistical parametric mapping (SPM) was used to compare 26 brain SPECT images from patients with OCD individually with an image bank of 32 normal subjects, using the statistical threshold of p < 0.05 (corrected for multiple comparisons at the level of individual voxels or clusters). The maps were analyzed, and regions presenting voxels that remained above this threshold were sought. RESULTS: Six patients from a sample of 26 OCD images showed abnormalities at cluster or voxel level, considering the criteria described above, which represented 23.07%. However, seven images from the normal group of 32 were also indicated as cases of perfusional abnormality, representing 21.8% of the sample. CONCLUSION: The automated quantification method was not considered to be a useful tool for clinical practice, for analyses complementary to visual inspection.

2399 downloads

13.

The drug-naïve OCD patients imaging genetics, cognitive and treatment response study: methods and sample description
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Hoexter, Marcelo Queiroz

; Shavitt, Roseli Gedanke

; D'Alcante, Carina Chaubet

; Cecconi, Janaina Philippi

; Diniz, Juliana Belo

; Belotto-Silva, Cristina

; Hounie, Ana Gabriela

; Borcato, Sonia

; Moraes, Ivanil

; Joaquim, Marines Alves

; Cappi, Carolina

; Sampaio, Aline Santos

; Mathis, Maria Alice de

; Batistuzzo, Marcelo Camargo

; Lopes, Antonio Carlos

; Rosa, Ana Carolina Ferreira

; Muniz, Renan Kawano

; Marques, Andrea Horvath

; Santos, Luciana Cristina

; Taub, Anita

; Duran, Fábio Luís de Souza

; Dougherty, Darin Dean

; Busatto, Geraldo Filho

; Bressan, Rodrigo Affonseca

; Miguel, Euripedes Constantino

Brazilian Journal of Psychiatry

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dec 2009, Volume 31 N. 4 Pages 349 - 353

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever um protocolo integrativo de investigação neurobiológica para melhor compreender as bases patofisiológicas do transtorno obsessivo-compulsivo e apresentar as características clínicas e demográficas da amostra. MÉTODO: Protocolo padronizado que combina diferentes modalidades de investigação (genética, neuropsicologia, ressonância magnética cerebral e imagem molecular do transportador de dopamina) obtidas antes e depois do tratamento em pacientes com transtorno obsessivo-compulsivo nunca expostos à medicação submetidos a um ensaio clínico comparando um inibidor seletivo da recaptação de serotonina (fluoxetina) e terapia cognitivo-comportamental em grupo. RESULTADOS: Cinquenta e dois pacientes com transtorno obsessivo-compulsivo entraram no ensaio clínico (27 no grupo fluoxetina e 25 no grupo de terapia). No início, foram realizadas 47 coletas de sangue para genética, 50 avaliações neuropsicológicas, 50 ressonâncias magnéticas cerebrais e 48 exames de tomografia computadorizada por emissão de fóton único (SPECT) com TRODAT-1. Depois de 12 semanas, 38 pacientes terminaram o protocolo (20 no grupo de fluoxetina e 18 no grupo de terapia). Trinta e oito reavaliações neuropsicológicas, 31 ressonâncias magnéticas de crânio e 34 exames de SPECT foram obtidos após o tratamento. Quarenta e um controles pareados foram submetidos ao mesmo protocolo inicial. CONCLUSÃO: Os dados genéticos, neuropsicológicos, volumétricos e moleculares do transportador de dopamina aliados à resposta a tratamento podem tanto gerar informações importantes a respeito da neurobiologia do transtorno obsessivo-compulsivo quanto ter uma aplicação clínica.

OBJECTIVE: To describe a protocol that was based on an integrative neurobiological model of scientific investigation to better understand the pathophysiology of obsessive-compulsive disorder and to present the clinical and demographic characteristics of the sample. METHOD: A standardized research protocol that combines different methods of investigation (genetics, neuropsychology, morphometric magnetic resonance imaging and molecular neuroimaging of the dopamine transporter) obtained before and after treatment of drug-naïve adult obsessive-compulsive disorder patients submitted to a sequentially allocated 12-week clinical trial with a selective serotonin reuptake inhibitor (fluoxetine) and group cognitive-behavioral therapy. RESULTS: Fifty-two treatment-naïve obsessive-compulsive disorder patients entered the clinical trial (27 received fluoxetine and 25 received group cognitive-behavioral therapy). At baseline, 47 blood samples for genetic studies, 50 neuropsychological evaluations, 50 morphometrical magnetic resonance images and 48 TRODAT-1 single-photon emission computed tomography (SPECT) exams were obtained. After 12 weeks, 38 patients completed the protocol (fluoxetine = 20 and GCBT = 18). Thirty-eight neuropsychological evaluations, 31 morphometrical magnetic resonance images and 34 TRODAT-1 SPECT exams were obtained post-treatment. Forty-one healthy controls matched for age, gender, socioeconomic status, level of education and laterality were submitted to the same research procedures at baseline. CONCLUSION: The comprehensive treatment response protocol applied in this project allowing integration on genetic, neuropsychological, morphometrical and molecular imaging of the dopamine transporter data in drug-naïve patients has the potential to generate important original information on the neurobiology of obsessive-compulsive disorder, and at the same time be clinically meaningful.

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14.

The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results
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Miguel, Euripedes Constantino

; Ferrão, Ygor Arzeno

; Rosário, Maria Conceição do

; Mathis, Maria Alice de

; Torres, Albina Rodrigues

; Fontenelle, Leonardo Franklin

; Hounie, Ana Gabriela

; Shavitt, Roseli Gedanke

; Cordioli, Aristides Volpato

; Gonzalez, Christina Hojaij

; Petribú, Kátia

; Diniz, Juliana Belo

; Malavazzi, Dante Marino

; Torresan, Ricardo C

; Raffin, Andréa Litvin

; Meyer, Elisabeth

; Braga, Daniela T

; Borcato, Sonia

; Valério, Carolina

; Gropo, Luciana N

; Prado, Helena da Silva

; Perin, Eduardo Alliende

; Santos, Sandro Iêgo

; Copque, Helen

; Borges, Manuela Corrêa

; Lopes, Angélica Prazeres

; Silva, Elenita D da

Brazilian Journal of Psychiatry

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sep 2008, Volume 30 N. 3 Pages 185 - 196

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Descrever o recrutamento de pacientes, instrumentos de avaliação, métodos para o desenvolvimento de estudos colaborativos multicêntricos e os resultados preliminares do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo, que inclui sete centros universitários. MÉTODO: Este estudo transversal incluiu entrevistas semi-estruturadas (dados sociodemográficos, histórico médico e psiquiátrico, curso da doença e diagnósticos psiquiátricos comórbidos) e instrumentos que avaliam os sintomas do transtorno obsessivo-compulsivo (Escala para Sintomas Obsessivo-Compulsivos de Yale-Brown e Escala Dimensional para Sintomas Obsessivo-Compulsivos de Yale-Brown), sintomas depressivos (Inventário de Depressão de Beck), sintomas ansiosos (Inventário de Ansiedade de Beck), fenômenos sensoriais (Escala de Fenômenos Sensoriais da Universidade de São Paulo), juízo crítico (Escala de Avaliação de Crenças de Brown), tiques (Escala de Gravidade Global de Tiques de Yale) e qualidade de vida (questionário genérico de avaliação de qualidade de vida, Medical Outcome Quality of Life Scale Short-form-36 e Escala de Avaliação Social). O treinamento dos avaliadores consistiu em assistir cinco entrevistas filmadas e entrevistar cinco pacientes junto com um pesquisador mais experiente, antes de entrevistar pacientes sozinhos. A confiabilidade entre todos os líderes de grupo para os instrumentos mais importantes (Structured Clinical Interview for DSM-IV, Dimensional Yale-Brown Obsessive-Compulsive Scale, Universidade de São Paulo Sensory Phenomena Scale ) foi medida após seis entrevistas completas. RESULTADOS: A confiabilidade entre avaliadores foi de 96%. Até março de 2008, 630 pacientes com transtorno obsessivo-compulsivo tinham sido sistematicamente avaliados. A média de idade (±SE) foi de 34,7 (±0,51), 56,3% eram do sexo feminino e 84,6% caucasianos. Os sintomas obsessivo-compulsivos mais prevalentes foram os de simetria e os de contaminação. As comorbidades psiquiátricas mais comuns foram depressão maior, ansiedade generalizada e transtorno de ansiedade social. O transtorno de controle de impulsos mais comum foi escoriação neurótica. CONCLUSÃO: Este consórcio de pesquisa, pioneiro no Brasil, permitiu delinear o perfil sociodemográfico, clínico e terapêutico do paciente com transtorno obsessivo-compulsivo em uma grande amostra clínica de pacientes. O Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo estabeleceu uma importante rede de colaboração de investigação clínica padronizada sobre o transtorno obsessivo-compulsivo e pode abrir o caminho para projetos semelhantes destinados a integrar outros grupos de pesquisa no Brasil e em todo o mundo.

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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15.

Personality traits and treatment outcome in obsessive-compulsive disorder
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Corchs, Felipe

; Corregiari, Fábio

; Ferrão, Ygor Arzeno

; Takakura, Tania

; Mathis, Maria Eugênia

; Lopes, Antonio Carlos

; Miguel, Euripedes Constantino

; Bernik, Márcio

Brazilian Journal of Psychiatry

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sep 2008, Volume 30 N. 3 Pages 246 - 250

Abstract: Pt En | Text: Pt En | PDF: Pt | PDF: En

OBJETIVO: Comorbidade com transtornos de personalidade tem sido extensamente descrita no transtorno obsessivo-compulsivo. Aproximadamente 40% dos pacientes com transtorno obsessivo-compulsivo não respondem a tratamentos de primeira linha. Não obstante, não existem estudos comparando diretamente traços de personalidade entre pacientes responsivos e refratários ao tratamento do transtorno obsessivo-compulsivo. Este estudo investiga diferenças nos traços da personalidade baseados no Inventário de Temperamento e Caráter de Cloninger (TCI) entre dois grupos de pacientes com transtorno obsessivo-compulsivo classificados segundo desfecho terapêutico: responsivos e refratários. MÉTODO: Quarenta e cinco pacientes refratários e 44 responsivos foram selecionados. Os indivíduos foram considerados responsivos se, após tratamento com terapêutica convencional, apresentaram diminuição de ao menos 40% no escore inicial da Yale-Brown Obsessive Compulsive Scale, foram classificados como "melhor" ou "muito melhor" na Clinical Global Impressions; e mantiveram melhora por pelo menos um ano. Os refratários eram os pacientes que não atingiram redução de ao menos 25% na Yale-Brown Obsessive Compulsive Scale e tiveram a melhoria menor que "mínima" na Clinical Global Impressions após o tratamento com ao menos três inibidores seletivos da recaptura de serotonina, incluindo clomipramina, e ao menos 20 horas da terapia cognitiva-comportamental. Os traços da personalidade foram avaliados através do Temperament and Character Inventory. RESULTADOS: Refratários pontuaram menos em autodirecionamento e tenderam a pontuar mais em persistência. CONCLUSÃO: Este estudo sugere que os traços de personalidade, especialmente autodirecionamento, estão associados com a resposta pobre do tratamento em pacientes com transtorno obsessivo-compulsivo.

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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