JULIANA BELO DINIZ
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 Associations Between Medial Prefrontal Cerebral Metabolic Features and Clinical Characteristics in Obsessive-compulsive Disorder(2016) BATISTUZZO, Marcelo C.; HOEXTER, Marcelo; COSTA, Fabiana; SHAVITT, Roseli; LOPES, Antonio C.; CAPPI, Carolina; VATTIMO, Edoardo; MATHIS, Alice de; DINIZ, Juliana B.; HENNING, Anke; PASTORELLO, Bruno; MIGUEL, Euripedes C.; OTADUY, Maria C.- 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 Fear Conditioning in Obsessive-compulsive Disorder Patients Treated with Sertraline: Preliminary Results(2015) DINIZ, Juliana B.; CAPPI, Carolina; COSTA, Daniel L. C.; REIMER, Adriano E.; OLIVEIRA, Amanda R. de; BRANDAO, Marcus L.; HOEXTER, Marcelo; MIGUEL, Euripedes C.; SHAVITT, Roseli G.- Comparative Prevalence, Correlates of Impairment, and Service Utilization for Eating Disorders Across US Ethnic Groups: Implications for Reducing Ethnic Disparities in Health Care Access for Eating Disorders(2011) MARQUES, Luana; ALEGRIA, Margarita; BECKER, Anne E.; CHEN, Chih-nan; FANG, Angela; CHOSAK, Anne; DINIZ, Juliana BeloObjective: The study compared the prevalence, correlates of functional impairment, and service utilization for eating disorders across Latinos, Asians, and African Americans living in the United States to non-Latino Whites. Method: Pooled data from the NIMH Collaborative Psychiatric Epidemiological Studies (CPES; NIMH, 2007) were used. Results: The prevalence of anorexia nervosa (AN) and binge-eating disorder (BED) were similar across all groups examined, but bulimia nervosa (BN) was more prevalent among Latinos and African Americans than non-Latino Whites. Despite similar prevalence of BED among ethnic groups examined, lifetime prevalence of any binge eating (ABE) was greater among each of the ethnic minority groups in comparison to non-Latino Whites. Lifetime prevalence of mental health service utilization was lower among ethnic minority groups studied than for non-Latino Whites for respondents with a lifetime history of any eating disorder. Discussion: These findings suggest the need for clinician training and health policy interventions to achieve optimal and equitable care for eating disorders across all ethnic groups in the United States. (C) 2010 by Wiley Periodicals, Inc.
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 Belo- Risk factors for early treatment discontinuation in patients with obsessive-compulsive disorder(2011) DINIZ, Juliana Belo; MALAVAZZI, Dante Marino; FOSSALUZA, Victor; BELOTTO-SILVA, Cristina; BORCATO, Sonia; PIMENTEL, Izabel; MIGUEL, Euripedes Constantino; SHAVITT, Roseli GedankeINTRODUCTION: In obsessive-compulsive disorder, early treatment discontinuation can hamper the effectiveness of first-line treatments. OBJECTIVE: This study aimed to investigate the clinical correlates of early treatment discontinuation among obsessive-compulsive disorder patients. METHODS: A group of patients who stopped taking selective serotonin reuptake inhibitors (SSRIs) or stopped participating in cognitive behavioral therapy before completion of the first twelve weeks (total n = 41; n = 16 for cognitive behavioral therapy and n = 25 for SSRIs) were compared with a paired sample of compliant patients (n = 41). Demographic and clinical characteristics were obtained at baseline using structured clinical interviews. Chi-square and Mann-Whitney tests were used when indicated. Variables presenting a p value < 0.15 for the difference between groups were selected for inclusion in a logistic regression analysis that used an interaction model with treatment dropout as the response variable. RESULTS: Agoraphobia was only present in one (2.4%) patient who completed the twelve-week therapy, whereas it was present in six (15.0%) patients who dropped out (p = 0.044). Social phobia was present in eight (19.5%) patients who completed the twelve-week therapy and eighteen (45%) patients who dropped out (p = 0.014). Generalized anxiety disorder was present in eight (19.5%) patients who completed the twelve-week therapy and twenty (50%) dropouts (p = 0.004), and somatization disorder was not present in any of the patients who completed the twelve-week therapy; however, it was present in six (15%) dropouts (p = 0.010). According to the logistic regression model, treatment modality (p = 0.05), agoraphobia, the Brown Assessment of Beliefs Scale scores (p = 0.03) and the Beck Anxiety Inventory (p = 0.02) scores were significantly associated with the probability of treatment discontinuation irrespective of interactions with other variables. DISCUSSION AND CONCLUSION: Early treatment discontinuation is a common phenomenon in obsessive-compulsive disorder patients from our therapeutic setting. Psychiatric comorbidities were associated with discontinuation rates of specific treatments. Future studies might use this information to improve management for increased compliance and treatment effectiveness.
- Epigenetic evidence for involvement of the oxytocin receptor gene in obsessive-compulsive disorder(2016) CAPPI, Carolina; DINIZ, Juliana Belo; REQUENA, Guaraci L.; LOURENCO, Tiaya; LISBOA, Bianca Cristina Garcia; BATISTUZZO, Marcelo Camargo; MARQUES, Andrea H.; HOEXTER, Marcelo Q.; PEREIRA, Carlos A.; MIGUEL, Euripedes Constantino; BRENTANI, HelenaBackground: Obsessive-compulsive disorder (OCD) is a chronic neurodevelopmental disorder that affects up to 3% of the general population. Although epigenetic mechanisms play a role in neurodevelopment disorders, epigenetic pathways associated with OCD have rarely been investigated. Oxytocin is a neuropeptide involved in neurobehavioral functions. Oxytocin has been shown to be associated with the regulation of complex socio-cognitive processes such as attachment, social exploration, and social recognition, as well as anxiety and other stress-related behaviors. Oxytocin has also been linked to the pathophysiology of OCD, albeit inconsistently. The aim of this study was to investigate methylation in two targets sequences located in the exon III of the oxytocin receptor gene (OXTR), in OCD patients and healthy controls. We used bisulfite sequencing to quantify DNA methylation in peripheral blood samples collected from 42 OCD patients and 31 healthy controls. Results: We found that the level of methylation of the cytosine-phosphate-guanine sites in two targets sequences analyzed was greater in the OCD patients than in the controls. The higher methylation in the OCD patients correlated with OCD severity. We measured DNA methylation in the peripheral blood, which prevented us from drawing any conclusions about processes in the central nervous system. Conclusion: To our knowledge, this is the first study investigating DNA methylation of the OXTR in OCD. Further studies are needed to evaluate the roles that DNA methylation and oxytocin play in OCD.
- Differential prefrontal gray matter correlates of treatment response to fluoxetine or cognitive-behavioral therapy in obsessive-compulsive disorder(2013) HOEXTER, Marcelo Q.; DOUGHERTY, Darin D.; SHAVITT, Roseli G.; D'ALCANTE, Carina C.; DURAN, Fabio L. S.; LOPES, Antonio C.; DINIZ, Juliana B.; BATISTUZZO, Marcelo C.; EVANS, Karleyton C.; BRESSAN, Rodrigo A.; BUSATTO, Geraldo F.; MIGUEL, Euripedes C.Nearly one-third of patients with obsessive-compulsive disorder (OCD) fail to respond to adequate therapeutic approaches such as serotonin reuptake inhibitors and/or cognitive-behavioral therapy (CBT). This study investigated structural magnetic resonance imaging (MRI) correlates as potential pre-treatment brain markers to predict treatment response in treatment-naive OCD patients randomized between trials of fluoxetine or CBI Treatment-naive OCD patients underwent structural MRI scans before randomization to a 12-week clinical trial of either fluoxetine or group-based CBT. Voxel-based morphometry was used to identify correlations between pretreatment regional gray matter volume and changes in symptom severity on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Brain regional correlations of treatment response differed between treatment groups. Notably, symptom improvement in the fluoxetine treatment group (n=14) was significantly correlated with smaller pretreatment gray matter volume within the right middle lateral orbitofrontal cortex (OFC), whereas symptom improvement in the CBT treatment group (n=15) was significantly correlated with larger pretreatment gray matter volume within the right medial prefrontal cortex (mPFC). No significant a priori regional correlations of treatment response were identified as common between the two treatment groups when considering the entire sample (n=29). These findings suggest that pretreatment gray matter volumes of distinct brain regions within the lateral OFC and mPFC were differentially correlated to treatment response to fluoxetine versus CBT in OCD patients. This study further implicates the mPFC in the fear/anxiety extinction process and stresses the importance of lateral portions of the OFC in mediating fluoxetine's effectiveness in OCD. Clinical registration information: http://clinicaltrials.gov-NCT00680602.
- Does anti-obsessional pharmacotherapy treat so-called comorbid depressive and anxiety states?(2012) VALERIO, Carolina; DINIZ, Juliana Belo; FOSSALUZA, Victor; MATHIS, Maria Alice de; BELOTTO-SILVA, Cristina; JOAQUIM, Marines Alves; MIGUEL FILHO, Euripedes Constantino; SHAVITT, Roseli GedankeBackground: Obsessive-compulsive disorder (OCD) is a chronic condition that normally presents high rates of psychiatric comorbidity. Depression, tic disorders and other anxiety disorders are among the most common comorbidities in OCD adult patients. There is evidence that the higher the number of psychiatric comorbidities, the worse the OCD treatment response. However, little is known about the impact of OCD treatment on the outcome of the psychiatric comorbidities usually present in OCD patients. The aim of this study was to investigate the impact of exclusive, conventional treatments for OCD on the outcome of additional psychiatric disorders of OCD patients, detected at baseline. Methods: Seventy-six patients with primary OCD admitted to the treatment protocols of the Obsessive-Compulsive Spectrum Disorders Program between July 2007 and December 2009 were evaluated at pre-treatment and after 12 months. Data were analyzed to verify possible associations between,OCD treatment response and the outcome of psychiatric comorbidities. Results: Results showed a significant association between OCD treatment response and improvement of major depression and dysthymia (p-value = 0.002), other anxiety disorders (generalized anxiety disorder, social phobia, specific phobia, posttraumatic stress disorder, panic disorder, agoraphobia and anxiety disorder not otherwise specified) (p-value = 0.054) and tic disorders (p-value = 0.043). Limitations: This is an open, non-blinded study, without rating scales for comorbid conditions. Further research is necessary focusing on the possible mechanisms by which OCD treatment could improve these specific disorders. Conclusions: Our results suggest that certain comorbid disorders may benefit from OCD-targeted treatment.
conferenceObject Does Inflammation Play a Role in Obsessive-Compulsive Disorder?(2013) SILVERMAN, Marni; CASSAB, Raony; MUNIZ, Renan; SHAVITT, Roseli G.; TOLEDO, Maria Cecilia; CAPPI, Carolina; THAYER, Julian; MATHIS, Maria Alice de; DINIZ, Juliana B.; HOEXTER, Marcelo Q.; D'ALCANTE, Carina C.; BORCATO, Sonia; HOUNIE, Ana G.; WHITFIELD, Jessie; BELYAVSKAYA, Elena; STERNBERG, Esther; MIGUEL, Euripedes; MARQUES, Andrea H.