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
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bookPart 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- 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.
conferenceObject Efficacy and Safety of Transcranial Direct Current Stimulation as a Treatment for Obsessive-Compulsive Disorder: A Randomized, Sham-Controlled Trial(2020) SILVA, Renata; BRUNONI, Andre R.; GOERIGK, Stephan; BATISTUZZO, Marcelo; COSTA, Daniel; DINIZ, Juliana; PADBERG, Frank; D'URSO, Giordano; MIGUEL, Euripedes; SHAVITT, Roseli- Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research(2022) SHEPHARD, Elizabeth; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.; STERN, Emily R.; ZUCCOLO, Pedro F.; OGAWA, Carolina Y.; SILVA, Renata M.; BRUNONI, Andre R.; COSTA, Daniel L.; DORETTO, Victoria; SARAIVA, Leonardo; CAPPI, Carolina; SHAVITT, Roseli G.; SIMPSON, H. Blair; HEUVEL, Odile A. van den; MIGUEL, Euripedes C.Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.
- Efficacy and safety of transcranial direct current stimulation as an add-on treatment for obsessive-compulsive disorder: a randomized, sham-controlled trial(2021) SILVA, Renata de Melo Felipe da; BRUNONI, Andre R.; GOERIGK, Stephan; BATISTUZZO, Marcelo Camargo; COSTA, Daniel Lucas da Conceicao; DINIZ, Juliana Belo; PADBERG, Frank; D'URSO, Giordano; MIGUEL, Euripedes Constantino; SHAVITT, Roseli GedankeObsessive-compulsive disorder (OCD) is a frequent, disabling disorder with high rates of treatment resistance. Transcranial direct current stimulation (tDCS) is a safe, tolerable noninvasive neuromodulation therapy with scarce evidence for OCD. This double-blind, randomized, and sham-controlled study investigates the efficacy of tDCS as add-on treatment for treatment-resistant OCD (failure to respond to at least one previous pharmacological treatment). On 20 consecutive weekdays (4 weeks), 43 patients with treatment-resistant OCD underwent 30 min active or sham tDCS sessions, followed by a 8 week follow-up. The cathode was positioned over the supplementary motor area (SMA) and the anode over the left deltoid. The primary outcome was the change in baseline Y-BOCS score at week 12. Secondary outcomes were changes in mood and anxiety and the occurrence of adverse events. Response was evaluated considering percent decrease of baseline Y-BOCS scores and the Improvement subscale of the Clinical Global Impression (CGI-I) between baseline and week 12. Patients that received active tDCS achieved a significant reduction of OCD symptoms than sham, with mean (SD) Y-BOCS score changes of 6.68 (5.83) and 2.84 (6.3) points, respectively (Cohen's d: 0.62 (0.06-1.18), p = 0.03). We found no between-group differences in responders (four patients in the active tDCS and one in the sham group). Active tDCS of the SMA was not superior to sham in reducing symptoms of depression or anxiety. Patients in both groups reported mild adverse events. Our results suggest that cathodal tDCS over the SMA is an effective add-on strategy in treatment-resistant OCD.
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part I: pharmacological treatment(2023) OLIVEIRA, Marcos Vinicius Sousa de; BARROS, Pedro Macul Ferreira de; MATHIS, Maria Alice de; BOAVISTA, Rodrigo; CHACON, Priscila; ECHEVARRIA, Marco Antonio Nocito; FERRAO, Ygor Arzeno; VATTIMO, Edoardo Felippo de Queiroz; LOPES, Antonio Carlos; TORRES, Albina Rodrigues; DINIZ, Juliana Belo; FONTENELLE, Leonardo F.; ROSARIO, Maria Conceicao do; SHAVITT, Roseli Gedanke; MIGUEL, Euripedes Constantino; SILVA, Renata de Melo Felipe da; COSTA, Daniel Lucas da ConceiaoObjectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD).Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological interven-tion for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first -line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.
- Obsessive-compulsive disorder during the COVID-19 pandemic(2021) SILVA, Renata M.; SHAVITT, Roseli G.; COSTA, Daniel L.
- Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders guidelines for the treatment of adult obsessive-compulsive disorder. Part II: cognitive-behavioral therapy(2023) MATHIS, Maria Alice de; CHACON, Priscila; BOAVISTA, Rodrigo; OLIVEIRA, Marcos Vinicius Sousa de; BARROS, Pedro Macul Ferreira de; ECHEVARRIA, Marco Antonio Nocito; FERRAO, Ygor Arzeno; VATTIMO, Edoardo Filippo de Queiroz; LOPES, Antonio Carlos; TORRES, Albina Rodrigues; DINIZ, Juliana Belo; FONTENELLE, Leonardo; ROSARIO, Maria Conceicao do; SHAVITT, Roseli Gedanke; SILVA, Renata de Melo Felipe da; CONSTANTINO, Euripedes; COSTA, Daniel Lucas da ConceicaoObjectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD).Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association.Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD.Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.