DANIEL LUCAS DA CONCEICAO COSTA
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
17 resultados
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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.
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.- 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.
- Considering the Complexity of Treatment Response in Psychiatric Clinical Trials(2016) DINIZ, Juliana Belo; SHAVITT, Roseli Gedanke; MIGUEL, Euripedes Constantino; COSTA, Daniel L. C.
- Is it time to change the gold standard of obsessive-compulsive disorder severity assessment? Factor structure of the Yale-Brown Obsessive-Compulsive Scale(2020) FATORI, Daniel; COSTA, Daniel L. C.; ASBAHR, Fernando R.; FERRAO, Ygor A.; ROSARIO, Maria Conceicao; MIGUEL, Euripedes C.; SHAVITT, Roseli G.; BATISTUZZO, Marcelo C.Objectives: The Yale-Brown Obsessive-Compulsive Scale has been considered the gold standard scale to assess obsessive-compulsive disorder severity. Previous studies using exploratory factor analysis and confirmatory factor analysis with this scale showed mixed findings in terms of factor structure and fit of models. Therefore, we used confirmatory factor analysis to compare different Yale-Brown Obsessive-Compulsive Scale models in a large sample aiming to identify the best model fit. Methods: We assessed adult obsessive-compulsive disorder patients (n = 955) using three measures: Yale-Brown Obsessive-Compulsive Scale severity ratings, the Dimensional Yale-Brown Obsessive-Compulsive Scale and the clinical global impression scale. We tested all factor structures reported by previous studies to investigate which model best fitted the data: one-factor, two-factor, three-factor and their equivalent high-order solutions. We also investigated Yale-Brown Obsessive-Compulsive Scale items correlations with scores from the other measures of obsessive-compulsive disorder severity. Results: Confirmatory factor analysis models presented mediocre to fair goodness-of-fit indexes. Severity items related to resistance to obsessions and compulsions presented low factor loadings. The model with the best fit indexes was a high-order model without obsessive-compulsive disorder resistance items. These items also presented small correlations with other obsessive-compulsive disorder severity measures. Conclusion: The obsessive-compulsive disorder field needs to discuss further improvements in the Yale-Brown Obsessive-Compulsive Scale and/or continue to search for better measures of obsessive-compulsive disorder severity.
- Panic Disorder and Agoraphobia in OCD patients: Clinical profile and possible treatment implications(2014) TORRES, Albina R.; FERRAO, Ygor. A.; SHAVITT, Roseli G.; DINIZ, Juliana B.; COSTA, Daniel L. C.; ROSARIO, Maria Conceicao do; MIGUEL, Euripedes C.; FONTENELLE, Leonardo F.Objective: Panic Disorder (PD) and agoraphobia (AG) are frequently comorbid with obsessive compulsive disorder (OCD), but the correlates of these comorbidities in OCD are fairly unknown. The study aims were to: 1) estimate the prevalence of PD with or without AG (PD), AG without panic (AG) and PD and/or AG (PD/AG) in a large clinical sample of OCD patients and 2) compare the characteristics of individuals with and without these comorbid conditions. Method: A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale Brown Obsessive Compulsive Scale and the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. Bivariate analyses were followed by logistic regression models. Results: The lifetime prevalence of PD was 15.3% (N = 153), of AG 4.9% (N = 49), and of PD/AG 20.2% (N = 202). After logistic regression, hypochondriasis and specific phobia were common correlates of the three study groups. PD comorbidity was also associated with higher levels of anxiety, having children, major depression, bipolar I, generalized anxiety and posttraumatic stress disorders. Other independent correlates of AG were: dysthymia, bipolar 11 disorder, social phobia, impulsive compulsive internet use, bulimia nervosa and binge eating disorder. Patients with PD/AG were also more likely to be married and to present high anxiety, separation anxiety disorder, major depression, impulsive compulsive internet use, generalized anxiety, posttraumatic stress and binge eating disorders. Conclusions: Some distinct correlates were obtained for PD and AG in OCD patients, indicating the need for more specific and tailored treatment strategies for individuals with each of these clinical profiles.
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.- Obsessive-compulsive disorder(2019) STEIN, Dan J.; COSTA, Daniel L. C.; LOCHNER, Christine; MIGUEL, Euripedes C.; REDDY, Y. C. Janardhan; SHAVITT, Roseli C.; HEUVEL, Odile A. van den; SIMPSON, H. BlairObsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
- Expanding the heuristic neurocircuit-based taxonomy to guide treatment for OCD: reply to the commentary ""Probing the genetic and molecular correlates of connectome alterations in obsessive-compulsive disorder""(2022) 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.