ROSELI GEDANKE SHAVITT
Projetos de Pesquisa
Unidades Organizacionais
Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina - Líder
147 resultados
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conferenceObject Attentional Bias to Symmetry and Cleaning Features in Obsessive-Compulsive Disorder: A Pilot Study(2015) MATHIS, Maria Alice De; SALUM, Giovanni; MORAES, Ivanil; BATISTUZZO, Marcelo; MARCO, Marina De; TOLEDO, Maria Cecilia; REQUENA, Guaraci; ABEND, Rany; BAR-HAIM, Yair; MIGUEL, Euripedes; SHAVITT, Roseli- Obsessive-compulsive symptoms are associated with psychiatric comorbidities, behavioral and clinical problems: a population-based study of Brazilian school children(2016) ALVARENGA, Pedro G.; ROSARIO, Maria C. do; CESAR, Raony C.; MANFRO, Gisele G.; MORIYAMA, Tais S.; BLOCH, Michael H.; SHAVITT, Roseli G.; HOEXTER, Marcelo Q.; COUGHLIN, Catherine G.; LECKMAN, James F.; MIGUEL, Euripedes C.Pediatric-onset obsessive-compulsive disorder (OCD) is underdiagnosed, and many affected children are untreated. The present study seeks to evaluate the presence and the clinical impact of OCD and obsessive-compulsive symptoms (OCS) in a large sample of school-age children. In Phase I, we performed an initial screening using the Family History Screen (FHS). In Phase II, we identified an ""at-risk"" sample, as well as a randomly selected group of children. A total of 2,512 children (6-12 years old) were assessed using the FHS, the Development and Well-Being Assessment (DAWBA), the Strengths and Difficulties Questionnaire (SDQ), and the Child Behavior Checklist (CBCL). Data analyses included descriptive and multivariate analytical techniques. 2,512 children (mean age: 8.86 +/- A 1.84 years; 55.0 % male) were categorized into one of the three diagnostic groups: OCD (n = 77), OCS (n = 488), and unaffected controls (n = 1,947). There were no significant socio-demographic differences (age, gender, socioeconomic status) across groups. The OCS group resembled the OCD on overall impairment, including school problems and delinquent behaviors. However, the OCD group did have significantly higher rates of several comorbid psychiatric disorders, including separation anxiety, generalized anxiety, and major depressive disorder, than OCS or unaffected controls. Moreover, the OCD group also scored higher than the SDQ, as well as on each of CBCL items rated by the parent. Our findings suggest that there is a psychopathological continuum between OCS and OCD in school-aged children. The presence of OCS is associated with functional impairment, which needs further investigation in longitudinal studies.
- 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.
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.- Defining clinical severity in adults with obsessive-compulsive disorder(2015) STORCH, Eric A.; NADAI, Alessandro S. De; ROSARIO, Maria Conceicao do; SHAVITT, Roseli G.; TORRES, Albina R.; FERRAO, Ygor A.; MIGUEL, Euripedes C.; LEWIN, Adam B.; FONTENELLE, Leonardo F.Objective: The Yale Brown Obsessive Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive compulsive symptoms. Treatment determinations are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive compulsive symptom severity. Method: Nine hundred fifty-four adult patients with obsessive compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions Severity scale (CGI-Severity). Results: Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R-2 = .48). Y-BOCS scores of 0-13 corresponded with 'mild symptoms' (CGI-Severity = 0-2), 14-25 with 'moderate symptoms' (CGI-Severity = 3), 26-34 with 'moderate-severe symptoms' (CGI-Severity = 4) and 35-40 with 'severe symptoms' (CGI-Severity = 5-6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive compulsive symptoms than males (d = .34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. Conclusions: These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
- Sensory phenomena associated with repetitive behaviors in obsessive-compulsive disorder: An exploratory study of 1001 patients(2012) FERRAO, Ygor Arzeno; SHAVITT, Roseli Gedanke; PRADO, Helena; FONTENELLE, Leonardo F.; MALAVAZZI, Dante Marino; MATHIS, Maria Alice de; HOUNIE, Ana Gabriela; MIGUEL, Euripedes Constantino; ROSARIO, Maria Conceicao doA substantial number of patients with obsessive-compulsive disorder (OCD) report compulsions that are preceded not by obsessions but by subjective experiences known as sensory phenomena. This study aimed to investigate the frequency, severity, and age at onset of sensory phenomena in OCD, as well as to compare OCD patients with and without sensory phenomena in terms of clinical characteristics. We assessed 1,001 consecutive OCD patients, using instruments designed to evaluate the frequency/severity of OC symptoms, tics, anxiety, depression, level of insight and presence/severity of sensory phenomena. All together, 651 (65.0%) subjects reported at least one type of sensory phenomena preceding the repetitive behaviors. Considering the sensory phenomena subtypes, 371 (57.0%) patients had musculoskeletal sensations, 519 (79.7%) had externally triggered ""just-right"" perceptions, 176 (27.0%) presented internally triggered ""just right,"" 144 (22.1%) had an ""energy release,"" and 240 (36.9%) patients had an ""urge only"" phenomenon. Sensory phenomena were described as being as more severe than were obsessions by 102(15.7%) patients. Logistic regression analysis showed that the following characteristics were associated with the presence of sensory phenomena: higher frequency and greater severity of the symmetry/ordering/arranging and contamination/washing symptom dimensions; comorbid Tourette syndrome, and a family history of tic disorders. These data suggest that sensory phenomena constitute a poorly understood psychopathological aspect of OCD that merits further investigation.
- 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.
- Comorbidity, age of onset and suicidality in obsessive-Compulsive disorder (OCD): An international collaboration(2017) BRAKOULIAS, V.; STARCEVIC, V.; BELLOCH, A.; BROWN, C.; FERRAO, Y. A.; FONTENELLE, L. F.; LOCHNER, C.; MARAZZITI, D.; MATSUNAGA, H.; MIGUEL, E. C.; REDDY, Y. C. J.; ROSARIO, M. C. do; SHAVITT, R. G.; SUNDAR, A. Shyam; STEIN, D. J.; TORRES, A. R.; VISWASAM, K.Objectives: To collate data from multiple obsessive-compulsive disorder (OCD) treatment centers across seven countries and five continents, and to report findings in relation to OCD comorbidity, age of onset of OCD and comorbid disorders, and suicidality, in a large clinical and ethnically diverse sample, with the aim of investigating cultural variation and the utility of the psychiatric diagnostic classification of obsessive-compulsive and related disorders. Methods: Researchers in the field of OCD were invited to contribute summary statistics on current and lifetime psychiatric comorbidity, age of onset of OCD and comorbid disorders and suicidality in their patients with OCD. Results: Data from 3711 adult patients with primary OCD came from Brazil (n = 955), India (n = 802), Italy (n = 750), South Africa (n = 565), Japan (n = 322), Australia (n = 219), and Spain (n = 98). The most common current comorbid disorders were major depressive disorder (28.4%; n = 1055), obsessive-compulsive personality disorder (24.5%, n = 478), generalized anxiety disorder (19.3%, n = 716), specific phobia (19.2%, n = 714) and social phobia (18.5%, n = 686). Major depression was also the most commonly co-occurring lifetime diagnosis, with a rate of 50.5% (n = 1874). OCD generally had an age of onset in late adolescence (mean = 17.9 years, SD = 1.9). Social phobia, specific phobia and body dysmorphic disorder also had an early age of onset. Co-occurring major depressive disorder, generalized anxiety disorder and psychotic disorders tended to have a later age of onset than OCD. Suicidal ideation within the last month was reported by 6.4% (n = 200) of patients with OCD and 9.0% (n = 314) reported a lifetime history of suicide attempt. Conclusions: In this large cross-continental study, comorbidity in OCD was common. The high rates of comorbid major depression and anxiety disorders emphasize the need for clinicians to assess and monitor for these disorders. Earlier ages of onset of OCD, specific phobia and social phobia may indicate some relatedness between these disorders, but this requires further study. Although there do not appear to be significant cultural variations in rates or patterns of comorbidity and suicidality, further research using similar recruitment strategies and controlling for demographic and clinical variables may help to determine whether any sociocultural factors protect against suicidal ideation or psychiatric comorbidity in patients with OCD.
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.- Intelligence quotient (IQ) in pediatric patients with obsessive-compulsive disorder(2020) BATISTUZZO, Marcelo Camargo; SOUZA, Marina de Marco e; BERNARDES, Elisa Teixeira; REQUENA, Guaraci; MIGUEL, Euripedes Constantino; SHAVITT, Roseli GedankeObjective: The aim of the present study was to examine the intellectual quotient (IQ) in a large sample of youth with obsessive-compulsive disorder (OCD) and to compare them with typically developing individuals (TDI), adding to the scarce literature focusing on the intelligence evaluation of this population. Method: The IQ of 82 children and adolescents with OCD and 82 TDI, matched by age, sex, handedness and education, was assessed by the Wechsler Abbreviated Scale of Intelligence (WASI, Brazilian-version). Statistics were performed with independent t-test, correlations and ANCOVA (controlling for motor and processing speed and comorbidities), corrected using the Benjamini-Hochberg multiple comparisons correction. Results: No between-group differences were found on the full-scale IQ (FSIQ, p-value = 0.545) or verbal IQ (VIQ; p-value = 0.423). In contrast, a significant difference was found in the performance IQ (PIQ; p-value = 0.045, Cohen's d = 0.379) and IQ discrepancy, i.e. the difference between VIQ and PIQ (p-value = 0.012, Cohen's d = 0.494). Analyses of the PIQ subtest scores revealed impaired performance in the Block Design test among OCD patients (p-value = 0.012, Cohen's d = 0.273), that remained after correcting for motor and processing speed and comorbidity status. Conclusion: In our sample of pediatric patients with OCD, the FSIQ, VIQ and PIQ were within the average range (90-110), and we did not find between-group differences in the FSIQ or VIQ, indicating that youth with OCD do not present major deficits in intellectual efficiency. Nevertheless, replicating an extensive adult literature, we found lower PIQ scores in youth patients, that were not better explained by motor and processing speed or comorbidity status.