EURIPEDES CONSTANTINO MIGUEL FILHO

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Departamento de Psiquiatria, Faculdade de Medicina - Docente
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder

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  • article 143 Citação(ões) na Scopus
    Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: An exploratory study of 1001 patients
    (2012) FERRAO, Ygor Arzeno; SHAVITT, Roseli Gedanke; PRADO, Helena; FONTENELLE, Leonardo F.; MALAVAZZI, Dante Marino; MATHIS, Maria Alice de; HOUNIE, Ana Gabriela; MIGUEL, Euripedes Constantino; ROSARIO, Maria Conceicao do
    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.
  • article 24 Citação(ões) na Scopus
    Association study between functional polymorphisms in the TNF-alpha gene and obsessive-compulsive disorder
    (2012) CAPPI, Carolina; MUNIZ, Renan Kawano; SAMPAIO, Aline Santos; CORDEIRO, Quirino; BRENTANI, Helena; PALACIOS, Selma A.; MARQUES, Andrea H.; VALLADA, Homero; MIGUEL, Euripedes Constantino; GUILHERME, Luiza; HOUNIE, Ana Gabriela
    Obsessive-compulsive disorder (OCD) is a prevalent psychiatric disorder of unknown etiology. However, there is some evidence that the immune system may play an important role in its pathogenesis. In the present study, two polymorphisms (rs1800795 and rs361525) in the promoter region of the cytokine tumor necrosis factor-alpha (TNFA) gene were genotyped in 183 OCD patients and in 249 healthy controls. The statistical tests were performed using the PLINK (R) software. We found that the A allele of the TNFA rs361525 polymorphism was significantly associated with OCD subjects, according to the allelic x association test (p=0.007). The presence of genetic markers, such as inflammatory cytokines genes linked to OCD, may represent additional evidence supporting the rote of the immune system in its pathogenesis.
  • article 4 Citação(ões) na Scopus
    Does anti-obsessional pharmacotherapy treat so-called comorbid depressive and anxiety states?
    (2012) VALERIO, Carolina; DINIZ, Juliana Belo; FOSSALUZA, Victor; MATHIS, Maria Alice de; BELOTTO-SILVA, Cristina; JOAQUIM, Marines Alves; MIGUEL FILHO, Euripedes Constantino; SHAVITT, Roseli Gedanke
    Background: Obsessive-compulsive disorder (OCD) is a chronic condition that normally presents high rates of psychiatric comorbidity. Depression, tic disorders and other anxiety disorders are among the most common comorbidities in OCD adult patients. There is evidence that the higher the number of psychiatric comorbidities, the worse the OCD treatment response. However, little is known about the impact of OCD treatment on the outcome of the psychiatric comorbidities usually present in OCD patients. The aim of this study was to investigate the impact of exclusive, conventional treatments for OCD on the outcome of additional psychiatric disorders of OCD patients, detected at baseline. Methods: Seventy-six patients with primary OCD admitted to the treatment protocols of the Obsessive-Compulsive Spectrum Disorders Program between July 2007 and December 2009 were evaluated at pre-treatment and after 12 months. Data were analyzed to verify possible associations between,OCD treatment response and the outcome of psychiatric comorbidities. Results: Results showed a significant association between OCD treatment response and improvement of major depression and dysthymia (p-value = 0.002), other anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, panic disorder, agoraphobia and anxiety disorder not otherwise specified) (p-value = 0.054) and tic disorders (p-value = 0.043). Limitations: This is an open, non-blinded study, without rating scales for comorbid conditions. Further research is necessary focusing on the possible mechanisms by which OCD treatment could improve these specific disorders. Conclusions: Our results suggest that certain comorbid disorders may benefit from OCD-targeted treatment.
  • conferenceObject
    Psychiatric Comorbidity in Patients with Ocd: Implications for Treatment Response After One Year Follow-Up
    (2012) SENCO, Natasha M.; FOSSALUZA, Victor; VALERIO, Carolina; DINIZ, Juliana B.; MIGUEL, Euripedes C.; SHAVITT, Roselli G.
    Background: The present study aimed to investigate, prospectively, clinical and socio-demographic features that may influence response to OCD treatment in the long term. Methods: One hundred ninety-seven subjects, who received randomized treatment with group cognitive behavioral therapy (GCBT) or a selective serotonin reuptake inhibitor (SSRI) for the first 12 weeks have been studied. Non-responders to the initial treatment had their treatment tailored to individual conditions, according to international guidelines for the treatment of OCD. Treatment response, measured initially and after three, six and twelve months, was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a CGI-Improvement rating of better(2) or much better(1)] and as a continuous variable (percent reduction in baseline YBOCS scores). Results: After one year follow-up, better treatment response were associated with absence of psychiatric comorbidity (p= 0,0002) and, in particular, absence of a mood disorder (p=0,0004). Poorer outcome was associated to higher scores on Beck Depression Inventory (p=0,0012), number of psychiatric comorbidities (p=0,0015) and presence of obsessive thoughts of diverse content (p= 0,0117). Age at onset, male gender and family history of OCD were not associated with treatment response in this sample, and there was no influence of initial treatment modality on the long-term outcome. Conclusions: In this study, comorbidity number showed correlation with poorer treatment response. Additional studies will be necessary to enlighten if there is an early set point to determine treatment success or failure.
  • article 7 Citação(ões) na Scopus
    Attention deficit disorder/hyperactivity: a scientific overview
    (2012) POLANCZYK, Guilherme V.; CASELLA, Erasmo Barbante; MIGUEL, Euripedes Constantino; REED, Umbertina Conti
  • article 59 Citação(ões) na Scopus
    Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: A practical clinical trial
    (2012) BELOTTO-SILVA, Cristina; DINIZ, Juliana Belo; MALAVAZZI, Dante Marino; VALERIO, Carolina; FOSSALUZA, Victor; BORCATO, Sonia; SEIXAS, Andre A.; MORELLI, Dawn; MIGUEL, Euripedes Constantino; SHAVITT, Roseli Gedanke
    Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores >= 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n = 70) or fluoxetine (n = 88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p = 0.875). Patients presented a mean of 2.7 psychiatric comorbidities. and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p = 0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p = 0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.
  • article 84 Citação(ões) na Scopus
    Towards a post-traumatic subtype of obsessive-compulsive disorder
    (2012) FONTENELLE, Leonardo F.; COCCHI, Luca; HARRISON, Ben J.; SHAVITT, Roseli G.; ROSARIO, Maria Conceicao do; FERRAO, Ygor A.; MATHIS, Maria Alice de; CORDIOLI, Aristides V.; YUECEL, Murat; PANTELIS, Christos; MARI, Jair de Jesus; MIGUEL, Euripedes C.; TORRES, Albina R.
    We evaluated whether traumatic events are associated with a distinctive pattern of socio-demographic and clinical features of obsessive-compulsive disorder (OCD). We compared socio-demographic and clinical features of 106 patients developing OCD after post-traumatic stress disorder (PTSD; termed post-traumatic OCD), 41 patients developing OCD before PTSD (pre-traumatic OCD), and 810 OCD patients without any history of PTSD (non-traumatic OCD) using multinomial logistic regression analysis. A later age at onset of OCD, self-mutilation disorder, history of suicide plans, panic disorder with agoraphobia, and compulsive buying disorder were independently related to post-traumatic OCD. In contrast, earlier age at OCD onset, alcohol-related disorders, contamination-washing symptoms, and self-mutilation disorder were all independently associated with pre-traumatic OCD. In addition, patients with post-traumatic OCD without a previous history of obsessive-compulsive symptoms (OCS) showed lower educational levels, greater rates of contamination-washing symptoms, and more severe miscellaneous symptoms as compared to post-traumatic OCD patients with a history of OCS.
  • article 48 Citação(ões) na Scopus
    Skin picking and trichotillomania in adults with obsessive-compulsive disorder
    (2012) LOVATO, Lucas; FERRAO, Ygor Arzeno; STEIN, Dan J.; SHAVITT, Roseli G.; FONTENELLEE, Leonardo F.; VIVANA, Analise; MIGUEL, Euripedes Constantino; CORDIOLI, Aristides Volpato
    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.
  • conferenceObject
    Can Early Improvement be an Indicator of Treatment Response at Twelve Weeks in Obsessive Compulsive Disorder? Implications for Early-Treatment Decision-Making
    (2012) COSTA, Daniel L. C.; DINIZ, Juliana B.; JOAQUIM, Marines; BORCATO, Sonia R.; VALERIO, Carolina; MIGUEL, Euripedes C.; SHAVITT, Roseli G.
    Background: Delayed onset of response to serotonin reuptake inhibitors represents a challenge in obsessive-compulsive disorder (OCD) treatment. In depression, absence of improvement in the first weeks has been raised as a motive to switch antidepressants before full non-response is observed. We aimed to investigate if early improvement is a predictor of OCD outcome after 12 weeks. Methods: Participants (n=150) were admitted to a specialized OCD outpatient program. Inclusion criteria: age 18-65, DSM-IV diagnosis of OCD, minimum baseline Yale-Brown Obsessive Compulsive Scale(Y-BOCS) score of 16, absence of previous pharmacological treatment for OCD. Fluoxetine was used up to 80mg/day. Systematic assessments were taken at baseline, weeks 4 and 12. Non-improvement at 4-weeks was defined as no reduction of baseline Y-BOCS scores. Response at 12 weeks was defined as 35% or greater decrease in baseline Y-BOC score. Spearman correlation, linear regression and chi-square test were performed to test the relationship between improvement at 4-weeks and the 12-weeks outcome. Results: Mean Y-BOCS scores(SD) at baseline, 4 and 12 weeks were, respectively: 27.3(5.4), 22.8(6.9) and 20.8(8.3). Correlation coefficient for 4-weeks improvement and 12-weeks outcome was 0.43(p=0.01). Linear regression analysis showed no-effect of the covariates on 12-weeks outcome and confirmed the relationship between improvement at 4-weeks and outcome at 12 weeks (β coef= 0.44, p< 0.01). Only five (11.9%) non-responders at 4-weeks were responders at 12-weeks (Pearson Chi-Square= 9.1, p= 0.003). Conclusions: Early improvement predicted 12-weeks outcome of OCD, which may have a role in early decision-making in OCD treatment.
  • article 60 Citação(ões) na Scopus
    Clinical features of tic-related obsessive-compulsive disorder: results from a large multicenter study
    (2012) ALVARENGA, Pedro Gomes de; MATHIS, Maria Alice de; ALVES, Anna Claudia Dominguez; ROSARIO, Maria Conceicao do; FOSSALUZA, Victor; HOUNIE, Ana Gabriela; MIGUEL, Euripedes Constantino; TORRES, Albina Rodrigues
    Objective. To evaluate the clinical features of obsessive-compulsive disorder (OCD) patients with comorbid tic disorders (TD) in a large, multicenter, clinical sample. Method. A cross-sectional study was conducted that included 813 consecutive OCD outpatients from the Brazilian OCD Research Consortium and used several instruments of assessment, including the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale Global Tic Severity Scale (YGTSS), the USP Sensory Phenomena Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Results. The sample mean current age was 34.9 years old (SE 0.54), and the mean age at obsessive-compulsive symptoms (OCS) onset was 12.8 years old (SE 0.27). Sensory phenomena were reported by 585 individuals (72% of the sample). The general lifetime prevalence of TD was 29.0% (n=236), with 8.9% (n=72) presenting Tourette syndrome, 17.3% (n=5141) chronic motor tic disorder, and 2.8% (n=523) chronic vocal tic disorder. The mean tic severity score, according to the YGTSS, was 27.2 (SE 1.4) in the OCD1TD group. Compared to OCD patients without comorbid TD, those with TD (OCD1TD group, n=236) were more likely to be males (49.2% vs. 38.5%, p<005) and to present sensory phenomena and comorbidity with anxiety disorders in general: separation anxiety disorder, social phobia, specific phobia, generalized anxiety disorder, post-traumatic stress disorder, attention-deficit hyperactivity disorder, impulse control disorders in general, and skin picking. Also, the ""aggressive,"" ""sexual/religious,"" and ""hoarding"" symptom dimensions were more severe in the OCD+TD group. Conclusion. Tic-related OCD may constitute a particular subgroup of the disorder with specific phenotypical characteristics, but its neurobiological underpinnings remain to be fully disentangled.