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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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.- 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.
- Outlining new frontiers for the comprehension of obsessive-compulsive disorder: a review of its relationship with fear and anxiety(2012) DINIZ, Juliana Belo; MIGUEL, Euripedes Constantino; OLIVEIRA, Amanda Ribeiro de; REIMER, Adriano Edgar; BRANDAO, Marcus Lira; MATHIS, Maria Alice de; BATISTUZZO, Marcelo Camargo; COSTA, Daniel Lucas Conceicao; HOEXTER, Marcelo QueirozAnxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. Objectives: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. Results: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. Conclusion: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.
conferenceObject Is body dysmorphic disorder a predictive factor for poor response to sequential pharmacological treatment strategies in OCD patients?(2012) DINIZ, J. B.; COSTA, D. C.; PEREIRA, C. D. E. B.; MIGUEL, E. C.; SHAVITT, R. G.In obsessive-compuslive disorder (OCD), body dysmorphic disorder (BDD) is a common concurrent diagnosis that is associated with poorer insight of OCD symptoms, higher prevalence of hoarding symptoms and higher number of psychiatric comorbidities [1]. Although the combination of OCD and BDD has been shown to be associated with more severe features and worse prognosis, in one study that investigated the impact of BDD on OCD treatment response similar response patterns were observed in OCD patients with and without comorbid BDD [2]. Objectives: We aimed to investigate the impact of BDD on the treatment response to sequential pharmacological strategies in adult patients whose main diagnosis was OCD (DSM-IV-TR criteria). Methods: We conducted a post hoc analysis of the results of a sequential trial involving initial fluoxetine monotherapy followed by add-on treatment strategies with fluoxetine (up to 40mg) plus clomipramine (up to 75mg), quetiapine (up to 200mg) or fluoxetine (up to 80mg) plus placebo. The original clinical trial was better described elsewhere [3]. One hundred thirty-eight patients received fluoxetine up to the maximum tolerated dosage for 12 weeks. Seventy patients who were non-responders to fluoxetine monotherapy (less than a 35% reduction in initial Yale-Brown Obsessive Compulsive Scale (YBOCS) scores) were invited to participate in the add-on trial. Fifty-four patients (men=25, women=29; mean age=34, SD=11, range=18−64; mean age at onset=11, SD=5, range=5−27; mean initial YBOCS score=27, SD=5, range=13−38) accepted to participate and were followed for additional 12 weeks. Eighteen patients were allocated to each treatment group by a minimization procedure. At endpoint, patients were considered responders to augmentation treatment if they had an additional reduction of at least 25% of the YBOCS scores. Logistic regression was used having response status to add-on therapy as the dependent variable and age, gender, treatment group, age at OCD onset, comorbid tics and/or depression, maximum tolerated fluoxetine dosage, response to fluoxetine monotherapy, initial YBOCS severity and BDD status as covariates. Results: Thirty-nine patients (OCD with BDD, n=14; OCD without BDD, n=25) completed the study. OCD patients with BDD were more prone to be classified as non-responders (n=11; 84.6%) than OCD patients without BDD (n=13; 50%; Pearson Chi Square=3.9, p=0.049). Comorbid BDD was the only variable associated with non-response in the regression model (b=−3.3; p-value=0.044). Discussion: We found that BDD is a potential predictorofworsetreatmentresponsetosequentialOCDtreatment strategies irrespectively of the type of pharmacological intervention. These findings are coherent with the association of BDD with markers of higher severity in OCD patients but replication in future studies is still warranted. Limitations of this study include the small sample size, the short period of follow-up and high co-occurrenceofBDDandSocialPhobia.Inaddition,no conclusions could be drawn in regards to each individual add-on treatment strategy.- 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.
- BODY DYSMORPHIC DISORDER IN PATIENTS WITH OBSESSIVE-COMPULSIVE DISORDER: PREVALENCE AND CLINICAL CORRELATES(2012) COSTA, Daniel Lucas Conceicao; ASSUNCAO, Melissa Chagas; FERRAO, Ygor Arzeno; CONRADO, Luciana Archetti; GONZALEZ, Christina Hajaj; FONTENELLE, Leonardo Franklin; FOSSALUZA, Victor; MIGUEL, Euripedes Constantino; TORRES, Albina Rodrigues; SHAVITT, Roseli GedankeBackground The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessivecompulsive disorder (OCD) have been previously addressed in primarily relatively small samples. Methods We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. Results The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. Conclusions Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders. Depression and Anxiety 29: 966-975, 2012. (C) 2012 Wiley Periodicals, Inc.