DANIEL LUCAS DA CONCEICAO COSTA

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

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  • article 26 Citação(ões) na Scopus
    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 Belo
    In 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.
  • article 8 Citação(ões) na Scopus
    Latency to treatment seeking in patients with obsessive-compulsive disorder: Results from a large multicenter clinical sample
    (2022) CONCEICA, Daniel Lucas da; CAMPOS, Adriano Polpo de; PEREIRA, Carlos Alberto de Braganca; TORRES, Albina R.; SANTOS, Allan Christiano dos; REQUENA, Guaraci; FERRA, Ygor Arzeno
    This study aimed to identify the factors associated with a delay in treatment-seeking among patients with obsessive-compulsive disorder (OCD), a disabling neuropsychiatric disorder. To achieve this purpose, we conducted a cross-sectional study examining latency to treatment (LTT) and its associated correlates in 863 patients with OCD. We defined LTT as the time lag between the awareness of discomfort and/or impairment caused by symptoms and the beginning of OCD-specific treatment. To determine the socio-demographic and clinical characteristics associated with LTT, we built an interval-censored survival model to simultaneously assess the relationship between all variables, representing the best fit to our data format. The results of our study showed that approximately one-third of OCD patients sought treatment within two years of symptom awareness, onethird between two and nine years, and one-third after ten or more years. Median LTT was 4.0 years (mean = 7.96, SD = 9.54). Longer LTT was associated with older age, early onset of OCD symptoms, presence of contamination/cleaning symptoms and full-time employment. Shorter LTT was associated with the presence of aggression symptoms and comorbidity with hypochondriasis. The results of our study confirm the understanding that LTT in OCD is influenced by several interdependent variables - some of which are modifiable. Strategies for reducing LTT should focus on older patients, who work in a full-time job, and on individuals with early onset of OCD and contamination/cleaning symptoms.
  • article 11 Citação(ões) na Scopus
    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, Melanie
    Background 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.
  • article 45 Citação(ões) na Scopus
    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. Blair
    This 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.
  • article 4 Citação(ões) na Scopus
    Dissecting the Yale-Brown Obsessive-Compulsive Scale severity scale to understand the routes for symptomatic improvement in obsessive-compulsive disorder
    (2017) COSTA, Daniel L. da Conceicao; BARBOSA, Veronica S.; REQUENA, Guaraci; SHAVITT, Roseli G.; PEREIRA, Carlos A. de Braganca; DINIZ, Juliana B.
    We aimed to investigate which items of the Yale-Brown Obsessive-Compulsive Severity Scale best discriminate the reduction in total scores in obsessive-compulsive disorder patients after 4 and 12 weeks of pharmacological treatment. Data from 112 obsessive-compulsive disorder patients who received fluoxetine (<= 80 mg/day) for 12 weeks were included. Improvement indices were built for each Yale-Brown Obsessive-Compulsive Severity Scale item at two timeframes: from baseline to week 4 and from baseline to week 12. Indices for each item were correlated with the total scores for obsessions and compulsions and then ranked by correlation coefficient. A correlation coefficient. >= 0.7 was used to identify items that contributed significantly to reducing obsessive-compulsive disorder severity. At week 4, the distress items reached the threshold of 0.7 for improvement on the obsession and compulsion subscales although, contrary to our expectations, there was greater improvement in the control items than in the distress items. At week 12, there was greater improvement in the time, interference, and control items than in the distress items. The use of fluoxetine led first to reductions in distress and increases in control over symptoms before affecting the time spent on, and interference from, obsessions and compulsions. Resistance did not correlate with overall improvement. Understanding the pathway of improvement with pharmacological treatment in obsessive-compulsive disorder may provide clues about how to optimize the effects of medication.
  • article 9 Citação(ões) na Scopus
    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.
  • article 23 Citação(ões) na Scopus
    World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part I: Anxiety disorders
    (2023) BANDELOW, Borwin; ALLGULANDER, Christer; BALDWIN, David S.; COSTA, Daniel Lucas da Conceicao; DENYS, Damiaan; DILBAZ, Nesrin; DOMSCHKE, Katharina; ERIKSSON, Elias; FINEBERG, Naomi A.; HATTENSCHWILER, Josef; HOLLANDER, Eric; KAIYA, Hisanobu; KARAVAEVA, Tatiana; KASPER, Siegfried; KATZMAN, Martin; KIM, Yong-Ku; INOUE, Takeshi; LIM, Leslie; MASDRAKIS, Vasilios; MENCHON, Jose M.; MIGUEL, Euripedes C.; MOLLER, Hans-Jurgen; NARDI, Antonio E.; PALLANTI, Stefano; PERNA, Giampaolo; RUJESCU, Dan; STARCEVIC, Vladan; STEIN, Dan J.; TSAI, Shih-Jen; AMERINGEN, Michael Van; VASILEVA, Anna; WANG, Zhen; ZOHAR, Joseph
    Aim This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. Result This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. Conclusion It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.
  • article 20 Citação(ões) na Scopus
    World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders - Version 3. Part II: OCD and PTSD
    (2023) BANDELOW, Borwin; ALLGULANDER, Christer; BALDWIN, David S.; COSTA, Daniel Lucas da Conceicao; DENYS, Damiaan; DILBAZ, Nesrin; DOMSCHKE, Katharina; HOLLANDER, Eric; KASPER, Siegfried; MOELLER, Hans-Juergen; ERIKSSON, Elias; FINEBERG, Naomi A.; HAETTENSCHWILER, Josef; KAIYA, Hisanobu; KARAVAEVA, Tatiana; KATZMAN, Martin A.; KIM, Yong-Ku; INOUE, Takeshi; LIM, Leslie; MASDRAKIS, Vasilios; MENCHON, Jose M.; MIGUEL, Euripedes C.; NARDI, Antonio E.; PALLANTI, Stefano; PERNA, Giampaolo; RUJESCU, Dan; STARCEVIC, Vladan; STEIN, Dan J.; TSAI, Shih-Jen; AMERINGEN, Michael Van; VASILEVA, Anna; WANG, Zhen; ZOHAR, Joseph
    Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders which was published in 2002 and revised in 2008. Method: A consensus panel of 34 international experts representing 22 countries developed recommendations based on efficacy and acceptability of the treatments. In this version, not only medications but also psychotherapies and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medication treatments. Result: The present paper (Part II) contains recommendations based on published randomised controlled trials (RCTs) for the treatment of OCD (n = 291) and PTSD (n = 234) in children, adolescents, and adults. The accompanying paper (Part I) contains the recommendations for the treatment of anxiety disorders. For OCD, first-line treatments are selective serotonin reuptake inhibitors (SSRIs) and cognitive behavioural therapy (CBT). Internet-CBT was also superior to active controls. Several second-line medications are available, including clomipramine. For treatment-resistant cases, several options are available, including augmentation of SSRI treatment with antipsychotics and other drugs. Other non-pharmacological treatments, including repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS) and others were also evaluated. For PTSD, SSRIs and the SNRI venlafaxine are first-line treatments. CBT is the psychotherapy modality with the best body of evidence. For treatment-unresponsive patients, augmentation of SSRI treatment with antipsychotics may be an option. Conclusion: OCD and PTSD can be effectively treated with CBT and medications.
  • article 0 Citação(ões) na Scopus
    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 Conceicao
    The 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.
  • article 12 Citação(ões) na Scopus
    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.