ROSELI GEDANKE SHAVITT

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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

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Autor: BATISTUZZO, Marcelo C. ×

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  • article 81 Citação(ões) na Scopus
    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.
  • article 53 Citação(ões) na Scopus
    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.
  • conferenceObject
    Cortico-Basal Ganglia-Thalamo-Cortical Circuitry Structural Correlates of Treatment Response in Children with Obsessive-Compulsive Disorder
    (2016) VATTIMO, Edoardo F. Q.; BATISTUZZO, Marcelo C.; SATO, Joao R.; SA, Daniel G. F. de; SHAVITT, Roseli G.; MIGUEL, Euripedes C.; HOEXTER, Marcelo Q.
  • article 20 Citação(ões) na Scopus
    The Child Behavior Checklist-Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children
    (2017) SAAD, Laura O.; ROSARIO, Maria C. do; CESAR, Raony C.; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.; MANFRO, Gisele G.; SHAVITT, Roseli G.; LECKMAN, James F.; MIGUEL, Euripedes C.; ALVARENGA, Pedro G.
    Objective: The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ""at-risk for OCD'') using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD. Methods: Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales. Results: A total of 2512 (mean age: 8.86 +/- 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an ""at-risk for OCD'' subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%. Conclusions: The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The ""at-risk for OCD'' group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.
  • conferenceObject
    Influence of Treatment on Visual Information Planning and Nonverbal Memory Performance in Children and Adolescents with Obsessive Compulsive Disorder
    (2014) SHAVITT, Roseli G.; MARCO, Marina de; BATISTUZZO, Marcelo C.; OKI, Fabio H.; BERNARDES, Elisa; MONTI, Camilla; MORAIS, Ivanil; BORCATO, Sonia R.; FATORI, Daniel
  • 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.
  • conferenceObject
    Visuospatial Memory Improvement Secondary to Gamma Ventral Capsulotomy in Refractory Obsessive-compulsive Disorder Patients
    (2014) LOPES, Antonio C.; BATISTUZZO, Marcelo C.; TAUB, Anita; CANTERAS, Miguel M.; HOEXTER, Marcelo Q.; JOAQUIM, Marines A.; MATHIS, Maria E. de; SHAVITT, Roseli G.; GREENBERG, Benjamin D.; NOREN, Georg; MIGUEL, Euripedes C.
  • article 1 Citação(ões) na Scopus
    No evidence of attentional bias toward angry faces in patients with obsessive-compulsive disorder
    (2019) SKINAZI, Michele; MATHIS, Maria A. de; COHAB, Tatiana; SOUZA, Marina de Marco e; SHAVITT, Roseli G.; MIGUEL, Euripedes C.; HOEXTER, Marcelo Q.; BATISTUZZO, Marcelo C.
    Objective: Although attentional bias (AB) toward angry faces is well established in patients with anxiety disorders, it is still poorly studied in obsessive-compulsive disorder (OCD). We investigated whether OCD patients present AB toward angry faces, whether AB is related to symptom severity and whether AB scores are associated with specific OCD symptom dimensions. Methods: Forty-eight OCD patients were assessed in clinical evaluations, intelligence testing and a dot-probe AB paradigm that used neutral and angry faces as stimuli. Analyses were performed with a one-sample t-test, Pearson correlations and linear regression. Results: No evidence of AB was observed in OCD patients, nor was there any association between AB and symptom severity or dimension. Psychiatric comorbidity did not affect our results. Conclusion: In accordance with previous studies, we were unable to detect AB in OCD patients. To investigate whether OCD patients have different brain activation patterns from anxiety disorder patients, future studies using a transdiagnostic approach should evaluate AB in OCD and anxiety disorder patients as they perform AB tasks under functional neuroimaging protocols.
  • article 76 Citação(ões) na Scopus
    Evolution of gamma knife capsulotomy for intractable obsessive-compulsive disorder
    (2019) MIGUEL, Euripedes C.; LOPES, Antonio C.; MCLAUGHLIN, Nicole C. R.; NOREN, Georg; GENTIL, Andre F.; HAMANI, Clement; SHAVITT, Roseli G.; BATISTUZZO, Marcelo C.; VATTIMO, Edoardo F. Q.; CANTERAS, Miguel; SALLES, Antonio De; GORGULHO, Alessandra; SALVAJOLI, Joao Victor; FONOFF, Erich Talamoni; PADDICK, Ian; HOEXTER, Marcelo Q.; LINDQUIST, Christer; HABER, Suzanne N.; GREENBERG, Benjamin D.; SHETH, Sameer A.
    For more than half a century, stereotactic neurosurgical procedures have been available to treat patients with severe, debilitating symptoms of obsessive-compulsive disorder (OCD) that have proven refractory to extensive, appropriate pharmacological, and psychological treatment. Although reliable predictors of outcome remain elusive, the establishment of narrower selection criteria for neurosurgical candidacy, together with a better understanding of the functional neuroanatomy implicated in OCD, has resulted in improved clinical efficacy for an array of ablative and non-ablative intervention techniques targeting the cingulum, internal capsule, and other limbic regions. It was against this backdrop that gamma knife capsulotomy (GKC) for OCD was developed. In this paper, we review the history of this stereotactic radiosurgical procedure, from its inception to recent advances. We perform a systematic review of the existing literature and also provide a narrative account of the evolution of the procedure, detailing how the procedure has changed over time, and has been shaped by forces of evidence and innovation. As the procedure has evolved and adverse events have decreased considerably, favorable response rates have remained attainable for approximately one-half to two-thirds of individuals treated at experienced centers. A reduction in obsessive-compulsive symptom severity may result not only from direct modulation of OCD neural pathways but also from enhanced efficacy of pharmacological and psychological therapies working in a synergistic fashion with GKC. Possible complications include frontal lobe edema and even the rare formation of delayed radionecrotic cysts. These adverse events have become much less common with new radiation dose and targeting strategies. Detailed neuropsychological assessments from recent studies suggest that cognitive function is not impaired, and in some domains may even improve following treatment. We conclude this review with discussions covering topics essential for further progress of this therapy, including suggestions for future trial design given the unique features of GKC therapy, considerations for optimizing stereotactic targeting and dose planning using biophysical models, and the use of advanced imaging techniques to understand circuitry and predict response. GKC, and in particular its modern variant, gamma ventral capsulotomy, continues to be a reliable treatment option for selected cases of otherwise highly refractory OCD.