Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder

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.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Gray Matter Volumes in Obsessive-Compulsive Disorder Before and After Fluoxetine or Cognitive-Behavior Therapy: A Randomized Clinical Trial

Serotonin reuptake inhibitors and cognitive-behavior therapy (CBT) are considered first-line treatments for obsessive-compulsive disorder (OCD). However, little is known about their modulatory effects on regional brain morphology in OCD patients. We sought to document structural brain abnormalities in treatment-naive OCD patients and to determine the effects of pharmacological and cognitive-behavioral treatments on regional brain volumes. Treatment-naive patients with OCD (n = 38) underwent structural magnetic resonance imaging scan before and after a 12-week randomized clinical trial with either fluoxetine or group CBT. Matched-healthy controls (n = 36) were also scanned at baseline. Voxel-based morphometry was used to compare regional gray matter (GM) volumes of regions of interest (ROIs) placed in the orbitofrontal, anterior cingulate and temporolimbic cortices, striatum, and thalamus. Treatment-naive OCD patients presented smaller GM volume in the left putamen, bilateral medial orbitofrontal, and left anterior cingulate cortices than did controls (p<0.05, corrected for multiple comparisons). After treatment with either fluoxetine or CBT (n = 26), GM volume abnormalities in the left putamen were no longer detectable relative to controls. ROI-based within-group comparisons revealed that GM volume in the left putamen significantly increased (p<0.012) in fluoxetine-treated patients (n = 13), whereas no significant GM volume changes were observed in CBT-treated patients (n = 13). This study supports the involvement of orbitofronto/cingulo-striatal loops in the pathophysiology of OCD and suggests that fluoxetine and CBT may have distinct neurobiological mechanisms of action. Neuropsychopharmacology (2012) 37, 734-745; doi: 10.1038/npp.2011.250; published online 26 October 2011Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)MedtronicEli LillyMcNeilCyberonicsNIMHNARSADTSAOCFTufts UniversityMGH Psychiatry AcademyBrainCellsSystems Research and Applications CorporationBoston UniversityCatalan Agency for Health Technology Assessment and ResearchNational Association of Social Workers MassachusettsMassachusetts Medical SocietyNIDAGerman Research Foundation/Federal Ministry for Education and ResearchOxford University PressNIHNIAAHRQJanssen PharmaceuticalsForest Research InstituteShire DevelopmentNorthstarJanssenAstraZenecaLundbeckSolvayUniv São Paulo, Sch Med, Dept Psychiat, São Paulo, BrazilUniv São Paulo, Sch Med, Inst Psychiat, São Paulo, BrazilUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilHarvard Univ, Massachusetts Gen Hosp, Sch Med, Dept Psychiat, Boston, MA USAUniversidade Federal de São Paulo UNIFESP, Dept Psychiat, Interdisciplinary Lab Clin Neurosci LiNC, São Paulo, BrazilFAPESP: 2005/55628-8FAPESP: 06/61459-7FAPESP: 06/50273-0FAPESP: 2008/10257-0FAPESP: 06/58286-3FAPESP: 2005/04206-6CAPES: 4375/08-4Web of Scienc

Photovoice como estratégia de intervenção socioeducativa com crianças, jovens e pessoas idosas: perspetivas de futuros Educadores Sociais

O photovoice é uma metodologia de investigação-ação participativa que permite a partilha de conceções e experiências vividas através de fotografias com o propósito de melhorar aspetos das comunidades em que é desenvolvido. O seu uso tem sido privilegiado em comunidades marginalizadas ou em desvantagem. É uma das metodologias apresentadas na formação de Educadores Sociais da Escola Superior de Educação de Viseu, dada a sua difusão quer como ferramenta de intervenção quer como instrumento de investigação. Durante a formação destes profissionais, é importante criar situações e usar metodologias em que os estudantes possam considerar a sua própria atuação e refletir criticamente sobre crenças fundamentais relacionadas com a realidade e com os contextos de intervenção. Várias experiências internacionais e nacionais têm revelado vantagens importantes da utilização pedagógica do photovoice no ensino superior. Este estudo procurou caraterizar as perspetivas de estudantes do 3.º ano da licenciatura no final do seu curso sobre a metodologia enquanto estratégia de intervenção socioeducativa, no que diz respeito à experiência de utilização da metodologia num trabalho realizado no âmbito das unidades curriculares de Intervenção socioeducativa com crianças e jovens e Intervenção socioeducativa com pessoas idosas, e às possibilidades de utilização da metodologia no futuro profissional. Ambos os conjuntos de dados foram sujeitos a uma análise de conteúdo que demonstrou que os participantes consideram vantagens significativas na utilização da metodologia quer como estratégia formativa quer como estratégia de intervenção profissional.info:eu-repo/semantics/publishedVersio

Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy

Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, 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. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD

Predictive factors or treatment response in patients with obsessive-compulsive disorder

O objetivo deste estudo foi estudar fatores preditivos de respostas ao tratamento farmacológico do Transtorno Obsessivo-Compulsivo (TOC). Os fatores investigados foram a idade de início dos sintomas, gênero, presença de transtornos de tiques, presença de comordidades psiquiátricas, e experiências subjetivas associadas aos comportamentos repetitivos. Houve interesse particular nos fatores associados aos dois subtipos de TOC melhor caracterizados até o momento, que são o TOC associado a tiques e o TOC de início precoce. Todos receberam tratamento exclusivo com clomipramina por 14 semanas com dose máxima de 250mg/dia. Concluiu-se que a presença de fenômenos sensoriais precedendo ou acompanhando os comportamentos repetitivos e estar casado ou cohabitando foram fatores preditivos de boa resposta ao tratamento do TOC com clomipramina no curto prazo.This study investigated predictive factors of treatment response in Obsessive Compulsive Disorder (OCD). Forty-one adults with OCD received exclusively clomipramine for 14 weeks. OCD symptoms and phenomenology of compulsions were assessed by the Yale-Brown Obsessive Compulsive Scale (YBOCS) and the USP-Harvard Repetitive Behaviors Interview, respectively. Response, in terms of percent decrease of the initial YBOCS score, was rated blind to the investigated factors. By the end of a linear regression model, the presence of sensory phenomena preceding the compulsions and being married/cohabiting were associated with a greater response to clomipramin