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
14 resultados
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- 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.
- 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 Transtorno obsessivo-compulsivo e transtornos relacionados(2014) COSTA, Daniel Lucas da Conceição; DINIZ, Juliana Belo; MATHIS, Alice de; HOEXTER, Marcelo Queiroz; SHAVITT, Roseli GedankebookPart Transtorno obsessivo-compulsivo(2021) COSTA, Daniel Lucas da Conceição; GUIMARãES, Carolina; CARNAVALE, Cristiane de Fátima; RUIZ, Deise Palermo Puertas; VATTIMO, Edoardo Filippo de Queiroz; PIMENTEL, Jamila Aparecida Rocha; CARVALHO, Luan; MATHIS, Maria Alice de; ROSáRIO, Maria Conceição do; MAZIERO, Maria Paulo; ALVARENGA, Pedro Gomes de; CHACON, Priscila; SILVA, Renata de Melo Felipe da; BOAVISTA, Rodrigo; TANAMATIS, Tais; SHAVITT, Roseli Gedanke- Considering the Complexity of Treatment Response in Psychiatric Clinical Trials(2016) DINIZ, Juliana Belo; SHAVITT, Roseli Gedanke; MIGUEL, Euripedes Constantino; COSTA, Daniel L. C.
- Management of Patients With Obsessive-Compulsive Disorder: Focus on Pharmacotherapy(2022) MAZIERO, Maria Paula; MACAYA, Daniela; SHAVITT, Roseli Gedanke; DINIZ, Juliana Belo; MIGUEL, Euripedes C.; SILVA, Renata Melo Felipe da; COSTA, Daniel Lucas da ConceicaoThe use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of obsessive-compulsive disorder (OCD) has dramatically changed clinical practice. Indeed, SSRIs are currently considered the first-line pharmacological therapy for OCD. However, randomized controlled trials (RCTs) have demonstrated a limited efficacy of SSRI treatment in OCD, with nearly half of patients experiencing an unsatisfactory outcome. Critically, nonresponse to treatment of OCD is associated with significant morbidity and social disability. In this study, we conducted a narrative review of the literature to describe and reinforce the basic rationale for pharmacological treatment of OCD. Our primary aim is to discuss the most common clinical issues that arise during the treatment of patients with OCD-details that have not been fully covered within the reports of RCTs. To this end, based on the knowledge of clinicians experienced in OCD treatment, here we provide the best evidence regarding pharmacotherapy for OCD and the management of potential clinical situations that may arise therein. The topics explored in this article include the first- and secondline pharmacological treatments for OCD, concepts of response and remission, pharmacological strategies for SSRI-resistant OCD, and management of adverse events.
bookPart Transtorno obsessivo-compulsivo e transtomos relacionados(2018) COSTA, Daniel Lucas da Conceição; DINIZ, Juliana Belo; MATHIS, Maria Alice De; HOEXTER, Marcelo Queiroz; SHAVITT, Roseli GedankebookPart Tratamento do transtorno obsessivo-compulsivo(2021) COSTA, Daniel Lucas da Conceição; SANTOS, Allan Cristiano dos; GUIMARãES, Carolina; GOBO, Denise Matheus; MORAIS, Ivanil; AZEVEDO, Marina Kairalla Garcia de; ALVARENGA, Pedro Gomes de; CHACON, Priscila; BOAVISTA, Rodrigo; BORCATO, Sonia; SHAVITT, Roseli Gedanke- Social phobia in obsessive-compulsive disorder: Prevalence and correlates(2012) ASSUNCAO, Melissa Chagas; COSTA, Daniel Lucas da Conceicao; MATHIS, Maria Alice de; SHAVITT, Roseli Gedanke; FERRAO, Ygor Arzeno; ROSARIO, Maria Conceicao do; MIGUEL, Euripedes Constantino; TORRES, Albina RodriguesBackground: Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP. 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 Axis I Disorders. Univariate analyses were followed by logistic regression. Results: Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder. Limitations: The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error). Conclusion: SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.