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
12 resultados
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- Toward a neurocircuit-based taxonomy to guide treatment of obsessive-compulsive disorder(2021) SHEPHARD, Elizabeth; STERN, Emily R.; HEUVEL, Odile A. van den; COSTA, Daniel L. C.; BATISTUZZO, Marcelo C.; GODOY, Priscilla B. G.; LOPES, Antonio C.; BRUNONI, Andre R.; HOEXTER, Marcelo Q.; SHAVITT, Roseli G.; REDDY, Y. C. Janardhan; LOCHNER, Christine; STEIN, Dan J.; SIMPSON, H. Blair; MIGUEL, Euripedes C.An important challenge in mental health research is to translate findings from cognitive neuroscience and neuroimaging research into effective treatments that target the neurobiological alterations involved in psychiatric symptoms. To address this challenge, in this review we propose a heuristic neurocircuit-based taxonomy to guide the treatment of obsessive-compulsive disorder (OCD). We do this by integrating information from several sources. First, we provide case vignettes in which patients with OCD describe their symptoms and discuss different clinical profiles in the phenotypic expression of the condition. Second, we link variations in these clinical profiles to underlying neurocircuit dysfunctions, drawing on findings from neuropsychological and neuroimaging studies in OCD. Third, we consider behavioral, pharmacological, and neuromodulatory treatments that could target those specific neurocircuit dysfunctions. Finally, we suggest methods of testing this neurocircuit-based taxonomy as well as important limitations to this approach that should be considered in future research.
- 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.
- 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.
- 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, JosephAim 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.
- 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, JosephAim: 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.
- 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 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.- Obsessive-compulsive disorder(2019) STEIN, Dan J.; COSTA, Daniel L. C.; LOCHNER, Christine; MIGUEL, Euripedes C.; REDDY, Y. C. Janardhan; SHAVITT, Roseli C.; HEUVEL, Odile A. van den; SIMPSON, H. BlairObsessive-compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the 'obsessive-compulsive and related disorders', a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive-behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
- The impact of comorbid body dysmorphic disorder on the response to sequential pharmacological trials for obsessive-compulsive disorder(2014) DINIZ, Juliana B.; COSTA, Daniel L. C.; CASSAB, Raony C. C.; PEREIRA, Carlos A. B.; MIGUEL, Euripedes C.; SHAVITT, Roseli G.Our aim was to investigate the impact of comorbid body dysmorphic disorder (BDD) on the response to sequential pharmacological trials in adult obsessive-compulsive disorder (OCD) patients. The sequential trial initially involved fluoxetine monotherapy followed by one of three randomized, add-on strategies: placebo, clomipramine or quetiapine. We included 138 patients in the initial phase of fluoxetine, up to 80 mg or the maximum tolerated dosage, for 12 weeks. We invited 70 non-responders to participate in the add-on trial; as 54 accepted, we allocated 18 to each treatment group and followed them for an additional 12 weeks. To evaluate the combined effects of sex, age, age at onset, initial severity, type of augmentation and BDD on the response to sequential treatments, we constructed a model using generalized estimating equations (GEE). Of the 39 patients who completed the study (OCD-BDD, n = 13; OCD-non-BDD, n = 26), the OCD-BDD patients were less likely to be classified as responders than the OCD-non-BDD patients (Pearson Chi-Square = 4.4; p = 0.036). In the GEE model, BDD was not significantly associated with a worse response to sequential treatments (z-robust = 1.77; p = 0.07). The predictive potential of BDD regarding sequential treatment strategies for OCD did not survive when the analyses were controlled for other clinical characteristics.
- 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.