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
6 resultados
Resultados de Busca
Agora exibindo 1 - 6 de 6
- 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 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 BeloconferenceObject 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. GedankeconferenceObject 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.- Can early improvement be an indicator of treatment response at twelve weeks in obsessive-compulsive disorder?(2012) COSTA, D.; DINIZ, J. B.; JOAQUIM, M.; BORCATO, S.; VALERIO, C.; MIGUEL, E. C.; SHAVITT, R. G.
- Randomized, Double-Blind, Placebo-Controlled Trial of N-Acetylcysteine Augmentation for Treatment-Resistant Obsessive-Compulsive Disorder(2017) COSTA, Daniel L. C.; DINIZ, Juliana B.; REQUENA, Guaraci; JOAQUIM, Marines A.; PITTENGER, Christopher; BLOCH, Michael H.; MIGUEL, Euripedes C.; SHAVITT, Roseli G.Objective: To evaluate the efficacy of serotonin reuptake inhibitor (SRI) augmentation with N-acetylcysteine (NAC), a glutamate modulator and antioxidant medication, for treatment-resistant obsessive-compulsive disorder (OCD). Methods: We conducted a randomized, double-blind, placebo-controlled, 16-week trial of NAC (3,000 mg daily) in adults (aged 18-65 years) with treatment-resistant OCD, established according to DSM-IV criteria. Forty subjects were recruited at an OCD-specialized outpatient clinic at a tertiary hospital (May 2012-October 2014). The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To evaluate the variables group, time, and interaction effects for Y-BOCS scores at all time points, we used nonparametric analysis of variance with repeated measures. Secondary outcomes were the severity scores for anxiety, depression, specific OCD symptom dimensions, and insight. Results: Both groups showed a significant reduction of baseline Y-BOCS scores at week 16: the NAC group had a reduction of 4.3 points (25.6 to 21.3), compared with 3.0 points (24.8 to 21.8) for the placebo group. However, there were no significant differences between groups (P =.92). Adding NAC was superior to placebo in reducing anxiety symptoms (P =.02), but not depression severity or specific OCD symptom dimensions. In general, NAC was well tolerated, despite abdominal pain being more frequently reported in the NAC group (n [%]: NAC = 9 [60.0], placebo = 2 [13.3]; P <.01). Conclusions: Our trial did not demonstrate a significant benefit of NAC in reducing OCD severity in treatmentresistant OCD adults. Secondary analysis suggested that NAC might have some benefit in reducing anxiety symptoms in treatment-resistant OCD patients. (C) Copyright 2017 Physicians Postgraduate Press, Inc.