Objectives: Animal hoarding is a special manifestation of hoarding disorder, characterized by the accumulation of animals and failure to provide them with minimal care. The main objective of this systematic review is to evaluate the characteristics of animal hoarding, focusing on the profile of affected individuals and the features of accumulation behavior. Methods: A systematic search of the literature was conducted in the electronic databases MEDLINE, Scopus, and LILACS until October 2022. We included case series (n ≥ 10) and cross-sectional studies assessing animal hoarding. Results: A total of 374 studies were initially retrieved. Most studies were classified as having poor quality and significant risk of bias. A total of 538 individuals with animal hoarding were evaluated. These individuals were predominantly middle-aged, unmarried women who lived alone in urban areas. Most of their residences had unsanitary conditions. Recidivism rates varied from 13-41%. Cats and dogs were the main hoarded species, mostly acquired through unplanned breeding, and disease, injury, behavioral problems, and a lack of hygiene were characreristic of their condition. Animal carcasses were found in up to 60% of the properties. Conclusion: Animal hoarding is a complex condition that requires urgent attention. More research is necessary to develop effective strategies that can save community resources, improve animal and human welfare, and prevent recidivism.

Objectives: To summarize evidence-based pharmacological treatments and provide guidance on 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 American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of 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. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.

Despite the long-held view that hoarding is a symptom of both obsessive-compulsive disorder and obsessive-compulsive personality disorder, increased evidence has emerged during the last 20 years suggesting that hoarding represents a distinct form of psychopathology. This study reflects the discussions on the nosological status of hoarding carried out by the WHO ICD-11 Working Group on the Classification of Obsessive-Compulsive and Related Disorders. The distinctiveness of hoarding is based on its having core symptoms that differ from those of other disorders, as well as distinctive neurobiological correlates and treatment responses. Furthermore, data showing the clinical utility, global applicability, and appropriateness of the concept of hoarding disorder outside specialty mental health settings suggest that this condition should be included in ICD-11. Finally, given the focus of ICD-11 on primary care and public health, the Working Group suggests that poor insight and severe domestic squalor may be considered as specifiers for hoarding disorder in ICD-11.

CONTEXTO: Enrubescimento, tremores e transpiração excessiva são fenômenos frequentemente observados na fobia social. OBJETIVOS: Descrever a resposta de um paciente com o tipo generalizado de fobia social e hiperidrose à terapia cognitivo-comportamental aliada à toxina botulínica. MÉTODO: Relato de caso único. RESULTADOS: O Sr. A, 20 anos, estudante universitário, procurou tratamento por apresentar sintomas compatíveis com os diagnósticos de fobia social e depressão. O Sr. A também apresentava diagnóstico de hiperidrose palmar, plantar e axilar. Tanto a fobia social quanto a hiperidrose tiveram seu início no começo da adolescência, com a primeira se iniciando quatro anos antes da segunda. A terapia cognitivo-comportamental levou à remissão da depressão, mas o tratamento efetivo da fobia social apenas foi possível após a terapia com a toxina botulínica. CONCLUSÃO: A toxina botulínica, um tratamento que bloqueia fenômenos autonômicos periféricos, também pode proporcionar alívio dos sintomas em pacientes com fobia social.

BACKGROUND: Blushing, trembling, and sweating are frequently seen in social phobia. OBJECTIVES: In this study, we aimed at describing the response of a patient with a generalized type of social phobia and hyperhydrosis to cognitive-behavioral therapy augmented by botulinum toxin. METHOD: Single case report. RESULTS: Mr. A, a 20 year-old university student, sought treatment in our unit for social phobia with comorbid depression. Mr. A also exhibited a diagnosis of palmar, plantar, and axilar hyperidrosis. He described that exposure to feared situations always lead to aggravation of sweating and other symptoms of heightened physiological arousal. Both social phobia and hyperhydrosis had their onset in early adolescence, with the former beginning four years before the latter. Cognitive-behavioral therapy led to aliviation of depression but effective treatment of social phobia was only possible after therapy with botulinum toxin. DISCUSSION: Botulinum toxin, a treatment that blocks peripheral autonomic symptoms, might also lead to improvement of social phobia.

CONTEXTO: Avaliações tradicionais de sintomas obsessivo-compulsivos, baseadas na introspecção, estão sujeitas a diversas variáveis, como os níveis de insight apresentados pelo paciente. OBJETIVOS: Neste estudo, nosso objetivo foi o de avaliar a consistência interna e as correlações clínicas de um teste que busca identificar a existência de um viés cognitivo implícito em pacientes com transtorno obsessivo-compulsivo (TOC). MÉTODOS: Quarenta pacientes com TOC realizaram o teste de associação implícita para o TOC (TAI-TOC) e responderam a três instrumentos de autoavaliação [Inventário de Ansiedade de Beck (BAI), Inventário de Depressão de Beck (BDI), Inventário de Obsessões e Compulsões - Revisado (OCI-R)]. RESULTADOS: O valor do alfa de Cronbach com itens de treino foi de 0,83 e sem o treino foi de 0,79. Não foram observadas correlações significativas entre os escores gerados pelo TAI-TOC e os instrumentos de autoavaliação, i.e., BDI, BAI e diferentes dimensões do OCI-R. CONCLUSÃO: Nossos achados apontam para uma elevada consistência interna do TAI-TOC. A ausência de correlações entre o TAI-TOC e diferentes dimensões do OCI-R sugere que medidas implícitas e explícitas de sintomas obsessivo-compulsivos podem formar constructos independentes. Estudos futuros, com maior número de pacientes, são necessários para confirmar essa hipótese.

BACKGROUND: Traditional assessments of obsessive-compulsive symptoms, based on patients' introspection, are subject to several factors, including the levels of insight presented by them. OBJECTIVES: In this study, our goal was to assess the internal consistency and clinical correlations of a test that seeks to identify the existence of an implicit cognitive bias in patients with obsessive-compulsive disorder (OCD). METHODS: 40 patients with OCD performed the implicit association test for OCD (IAT-OCD) and answered three instruments of self-assessment [Beck Anxiety Inventory (BAI), Inventory, Beck Depression Inventory (BDI), Obsessive-Compulsive Inventory-Revised (OCI-R)]. RESULTS: Cronbach's alpha with IAT-OCD training items was 0.83 and without them 0.79. There were no significant correlations between the IAT-OCD scores and the instruments of self-assessment, e.g., BDI, BAI and different dimensions of the OCI-R. DISCUSSION: Our findings are consistent with a high internal consistency of the IAT-OCD. The absence of correlations between the IAT-OCD and different dimensions of the OCI-R suggests that implicit and explicit measures of obsessive-compulsive symptoms may be independent constructs. Future studies, with greater number of patients, are needed to confirm this hypothesis.

OBJETIVO: Atualizar os clínicos sobre a existência de um possível subtipo do transtorno obsessivo-compulsivo caracterizado por pouco insight. MÉTODO: Revisão opinativa baseada em estudos indexados na base de dados PubMed e PsychINFO, identificados por meio dos unitermos "obsessive-compulsive disorder" e "insight" ou "ego-dystonic" e publicados entre 1966 e outubro de 2009. Os resultados foram examinados de acordo com a estratégia utilizada para abordar o insight, i.e. categórica vs. dimensional. RESULTADOS: Análise dos estudos nos permitiu identificar pontos que colocam em dúvida a existência de um subtipo do transtorno obsessivo-compulsivo bem delimitado caracterizado por pouco insight. Estes pontos incluem 1) prevalência extremamente variável do transtorno obsessivo-compulsivo com insight reduzido encontrada em estudos categóricos, 2) homogeneidade dos achados fenotípicos (i.e. maior gravidade) associados a baixo insight em estudos categóricos e dimensionais e 3) ausência de estudos que investigam "zonas de raridade" entre as formas de transtorno obsessivo-compulsivo com pouco e bom insight. CONCLUSÃO: Embora uma abordagem categórica do insight no transtorno obsessivo-compulsivo seja importante em ambientes clínicos, uma vez que neles existem demandas prementes para tomada de decisões, a abordagem dimensional do insight parece refletir de forma mais fidedigna o fenômeno apresentado pelos pacientes em tela.

OBJECTIVE: To update clinicians regarding the existence of a putative subtype of obsessive-compulsive disorder based on poor insight. METHOD: Opinionative review based on studies indexed in the PubMed and PsychINFO databases, identified by means of the keywords "obsessive-compulsive disorder" AND "insight" OR "ego-syntonic", and published between 1966 and October 2009. The results were analyzed according to the approach adopted, i.e. a categorical or dimensional view of insight in obsessive-compulsive disorder. RESULTS: The review of recent studies led us to identify some issues that cast doubts over the existence of a clear-cut poor insight subtype of obsessive-compulsive disorder. These issues include 1) an extremely variable prevalence of poor insight obsessive-compulsive disorder in categorical studies, 2) a significant degree of homogeneity in the phenotypical findings (i.e. greater severity) associated with lower levels of insight in obsessive-compulsive disorder in both categorical and dimensional studies and, 3) a lack of studies investigating zones of rarity between poor and good insight obsessive-compulsive disorder. CONCLUSION: Although a categorical approach to the insight issue in obsessive-compulsive disorder is still important in clinical settings, where decision-making is often a critical issue, a dimensional approach seems to reflect levels of impairment in these patients more reliably.

CONTEXTO: A inexistência de uma medida implícita para sintomas do transtorno obsessivo-compulsivo (TOC) limita a avaliação às escalas e aos inventários tradicionais. OBJETIVOS: O objetivo foi construir um instrumento de avaliação de sintomas obsessivo-compulsivos que independa da autoavaliação pelo examinando [por exemplo, o Teste de Associação Implícita para transtorno obsessivo-compulsivo (TAI-TOC)]. MÉTODOS: A fim de construir o TAI-TOC, foram consultados (1) estudos anteriores que utilizaram o TAI para avaliação de outros sintomas psiquiátricos, (2) psiquiatras e psicólogos com experiência na avaliação e tratamento de pacientes com TOC e (3) os próprios pacientes com TOC. RESULTADOS: Estímulos verbais e visuais foram selecionados para cada dimensão dos sintomas obsessivo-compulsivos (contaminação e lavagem, obsessões de checagem, simetria e colecionismo). Um software projetado para mensurar o tempo de reação em milissegundos (um programa para associação implícita) foi desenvolvido. Uma versão final do TAI-TOC foi obtida. CONCLUSÕES: O TAI-TOC expande o arsenal existente para avaliação dos sintomas obsessivo-compulsivos, especialmente naqueles indivíduos que informam mal sobre seus sintomas.

BACKGROUND: The lack of an implicit measure for the obsessive-compulsive disorder symptoms limits its assessment to the traditional scales and inventories. OBJECTIVES: The aim is the construction of an instrument for the evaluation of obsessive-compulsive symptoms that is independent from examinee's self-evaluation [i.e. the Implicit Association Test for obsessive-compulsive disorder (IAT-OCD)]. METHODS: In order to build the IAT-OCD, we consulted (1) previous studies that employed the IAT for the evaluation of other psychiatric symptoms; (2) expert psychiatrists and psychologists with experience in the assessment and treatment of patients with OCD; and (3) patients with OCD themselves. RESULTS: Specific verbal and visual stimuli were selected for each obsessive-compulsive symptom dimensions (contamination-washing, obsessions-checking, symmetry and hoarding). A software designed to measure reaction time in miliseconds (a proxy for implicit association) was developed. A final version of the IAT-OCD was then obtained. DISCUSSION: The IAT-OCD expands the existing armamentarium to evaluate obsessive-compulsive symptoms, especially among those individuals who report badly about their symptoms.