EURIPEDES CONSTANTINO MIGUEL FILHO
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
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- Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder(2021) SHEPHARD, Elizabeth; STERN, Emily R.; HEUVEL, Odile A. van den; COSTA, Daniel L. C.; BATISTUZZO, Marcelo C.; GODOY, Priscilla B. G.; LOPES, Antonio C.; BRUNONI, Andre R.; HOEXTER, Marcelo Q.; SHAVITT, Roseli G.; REDDY, Y. C. Janardhan; LOCHNER, Christine; STEIN, Dan J.; SIMPSON, H. Blair; MIGUEL, Euripedes C.An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
- Can early improvement be an indicator of treatment response in obsessive-compulsive disorder? Implications for early-treatment decision-making(2013) COSTA, Daniel Lucas da Conceicao; SHAVITT, Roseli Gedanke; CESAR, Raony Cassab Castro; JOAQUIM, Marines Alves; BORCATO, Sonia; VALERIO, Carolina; MIGUEL, Euripedes Constantino; DINIZ, Juliana BeloIn major depression, early response to treatment has been strongly associated with final outcome. We aimed to investigate the ability of early improvement (4 weeks) to predict treatment response at 12 weeks in DSM-IV-defined obsessive-compulsive disorder (OCD) patients treated with serotonin reuptake inhibitors (SRI). We conducted an SRI practical trial with 128 subjects. Inclusion criteria: age range 18-65 years-old, baseline Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score > 16, and absence of previous adequate pharmacological treatment. Systematic assessments were performed at baseline, 4 and 12 weeks of treatment. Treatment response at 12 weeks was defined as a 35% or greater reduction in baseline Y-BOCS score. Stepwise logistic regression was used to test the relationship between early improvement and treatment response at 12 weeks, taking into account additional potential predictive factors. Different thresholds of early improvement were tested and their predictive power was calculated. Early improvement, defined as a 20% or greater reduction from baseline Y-BOCS score at 4 weeks, predicted response at 12 weeks with 75.6% sensitivity and 61.9% specificity. According to a logistic regression including demographic and clinical features as explaining variables, early improvement was the best predictor of treatment response (OR = 1.05, p < 0.0001). Only 19.8% of patients who did not improve at 4 weeks were responders after 12 weeks. In contrast, 55.3% of the individuals who showed early improvement were responders at 12 weeks (Pearson Chi-Square = 17.06, p < 0.001). Early improvement predicted OCD treatment response with relatively good sensitivity and specificity, such that its role in early decision-making warrants further investigation in wider samples. Trial registration: clinicaltrials.gov Identifier NCT00680602.
conferenceObject Fear Conditioning in Obsessive-compulsive Disorder Patients Treated with Sertraline: Preliminary Results(2015) DINIZ, Juliana B.; CAPPI, Carolina; COSTA, Daniel L. C.; REIMER, Adriano E.; OLIVEIRA, Amanda R. de; BRANDAO, Marcus L.; HOEXTER, Marcelo; MIGUEL, Euripedes C.; SHAVITT, Roseli G.- Toward identifying reproducible brain signatures of obsessive-compulsive profiles: rationale and methods for a new global initiative(2020) SIMPSON, Helen Blair; HEUVEL, Odile A. van den; MIGUEL, Euripedes C.; REDDY, Y. C. Janardhan; STEIN, Dan J.; LEWIS-FERNANDEZ, Roberto; SHAVITT, Roseli Gedanke; LOCHNER, Christine; POUWELS, Petra J. W.; NARAYANAWAMY, Janardhanan C.; VENKATASUBRAMANIAN, Ganesan; HEZEL, Dianne M.; VRIEND, Chris; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.; JOODE, Niels T. de; COSTA, Daniel Lucas; MATHIS, Maria Alice de; SHESHACHALA, Karthik; NARAYAN, Madhuri; BALKOM, Anton J. L. M. van; BATELAAN, Neeltje M.; VENKATARAM, Shivakumar; CHERIAN, Anish; MARINCOWITZ, Clara; PANNEKOEK, Nienke; STOVEZKY, Yael R.; MARE, Karen; LIU, Feng; OTADUY, Maria Concepcion Garcia; PASTORELLO, Bruno; RAO, Rashmi; KATECHIS, Martha; METER, Page Van; WALL, MelanieBackground Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. Methods We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. Discussion Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
conferenceObject Can early improvement be an indicator of treatment response at twelve weeks in obsessive-compulsive disorder? Implications for early-treatment decision-making(2013) COSTA, Daniel Lucas Conceicao; SHAVITT, Roseli Gedanke; CASSAB, Raony; JOAQUIM, Marines Alves; BORCATO, Sonia Regina; VALERIO, Carolina; MIGUEL, Euripedes Constantino; DINIZ, Juliana BelobookPart Comportamentos atípicos: automutilação, pica, tiques, obsessões, compulsões e somatização(2018) CASELLA, Caio Borba; GIUSTI, Jackeline Suzie; COSTA, Daniel Lucas da Conceição; MIGUEL, Euripedes ConstantinoconferenceObject Serotonin reuptake inhibitor augmentation with n-acetylcysteine in treatment resistant ocd: a double-blind randomized controlled trial(2015) COSTA, D. L. C.; DINIZ, J. B.; JOAQUIM, M.; ACCIARITO, A. C.; RODRIGUES, B.; ODA, E.; REQUENA, G.; MIGUEL, E. C.; SHAVITT, R. Gedanke- Phenomenology of OCD: Lessons from a large multicenter study and implications for ICD-11(2014) SHAVITT, Roseli G.; MATHIS, Maria Alice de; OKI, Fabio; FERRAO, Ygor A.; FONTENELLE, Leonardo F.; TORRES, Albina R.; DINIZ, Juliana B.; COSTA, Daniel L. C.; ROSARIO, Maria Conceicao do; HOEXTER, Marcelo Q.; MIGUEL, Euripedes C.; SIMPSON, H. BlairThis study aimed to investigate the phenomenology of obsessive compulsive disorder (OCD), addressing specific questions about the nature of obsessions and compulsions, and to contribute to the World Health Organization's (WHO) revision of OCD diagnostic guidelines. Data from 1001 patients from the Brazilian Research Consortium on Obsessive Compulsive Spectrum Disorders were used. Patients were evaluated by trained clinicians using validated instruments, including the Dimensional Yale Brown Obsessive Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, and the Brown Assessment of Beliefs Scale. The aims were to compare the types of sensory phenomena (SP, subjective experiences that precede or accompany compulsions) in OCD patients with and without tic disorders and to determine the frequency of mental compulsions, the co-occurrence of obsessions and compulsions, and the range of insight. SP were common in the whole sample, but patients with tic disorders were more likely to have physical sensations and urges only. Mental compulsions occurred in the majority of OCD patients. It was extremely rare for OCD patients to have obsessions without compulsions. A wide range of insight into OCD beliefs was observed, with a small subset presenting no insight. The data generated from this large sample will help practicing clinicians appreciate the full range of OCD symptoms and confirm prior studies in smaller samples the degree to which insight varies. These findings also support specific revisions to the WHO's diagnostic guidelines for OCD, such as describing sensory phenomena, mental compulsions and level of insight, so that the world-wide recognition of this disabling disorder is increased.
- When the past is present(2017) TORRES, Albina R.; COSTA, Daniel L. C.; MIGUEL, Euripedes C.
conferenceObject Fear conditioning and BDNF levels and genotype in obsessive-compulsive disorder patients pre and post treatment with sertraline: preliminary results(2015) DINIZ, J.; CAPPI, C.; COSTA, D.; REIMER, A.; OLIVEIRA, A. De; BRANDAO, M.; HOEXTER, M.; MIGUEL, E.; SHAVITT, R.