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
13 resultados
Resultados de Busca
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- 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 Psychiatric Comorbidity in Patients with Ocd: Implications for Treatment Response After One Year Follow-Up(2012) SENCO, Natasha M.; FOSSALUZA, Victor; VALERIO, Carolina; DINIZ, Juliana B.; MIGUEL, Euripedes C.; SHAVITT, Roselli G.Background: The present study aimed to investigate, prospectively, clinical and socio-demographic features that may influence response to OCD treatment in the long term. Methods: One hundred ninety-seven subjects, who received randomized treatment with group cognitive behavioral therapy (GCBT) or a selective serotonin reuptake inhibitor (SSRI) for the first 12 weeks have been studied. Non-responders to the initial treatment had their treatment tailored to individual conditions, according to international guidelines for the treatment of OCD. Treatment response, measured initially and after three, six and twelve months, was considered as a categorical [35% or greater reduction in baseline YBOCS scores plus a CGI-Improvement rating of better(2) or much better(1)] and as a continuous variable (percent reduction in baseline YBOCS scores). Results: After one year follow-up, better treatment response were associated with absence of psychiatric comorbidity (p= 0,0002) and, in particular, absence of a mood disorder (p=0,0004). Poorer outcome was associated to higher scores on Beck Depression Inventory (p=0,0012), number of psychiatric comorbidities (p=0,0015) and presence of obsessive thoughts of diverse content (p= 0,0117). Age at onset, male gender and family history of OCD were not associated with treatment response in this sample, and there was no influence of initial treatment modality on the long-term outcome. Conclusions: In this study, comorbidity number showed correlation with poorer treatment response. Additional studies will be necessary to enlighten if there is an early set point to determine treatment success or failure.- Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: A practical clinical trial(2012) BELOTTO-SILVA, Cristina; DINIZ, Juliana Belo; MALAVAZZI, Dante Marino; VALERIO, Carolina; FOSSALUZA, Victor; BORCATO, Sonia; SEIXAS, Andre A.; MORELLI, Dawn; MIGUEL, Euripedes Constantino; SHAVITT, Roseli GedankeClinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores >= 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n = 70) or fluoxetine (n = 88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p = 0.875). Patients presented a mean of 2.7 psychiatric comorbidities. and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p = 0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p = 0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.
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 symptom dimensions correlate to specific gray matter volumes in treatment-naive patients(2012) ALVARENGA, Pedro G.; ROSARIO, Maria C. do; BATISTUZZO, Marcelo C.; DINIZ, Juliana B.; SHAVITT, Roseli G.; DURAN, Fabio L. S.; DOUGHERTY, Darin D.; BRESSAN, Rodrigo A.; MIGUEL, Euripedes C.; HOEXTER, Marcelo Q.Background: Clinical and sociodemographic findings have supported that OCD is heterogeneous and composed of multiple potentially overlapping and stable symptom dimensions. Previous neuroimaging investigations have correlated different patterns of OCD dimension scores and gray matter (GM) volumes. Despite their relevant contribution, some methodological limitations, such as patient's previous medication intake, may have contributed to inconsistent findings. Method: Voxel-based morphometry was used to investigate correlations between regional GM volumes and symptom dimensions severity scores in a sample of 38 treatment-naive OCD patients. Several standardized instruments were applied, including an interview exclusively developed for assessing symptom dimensions severity (DY-BOCS). Results: Scores on the ""aggression"" dimension were positively correlated with GM volumes in lateral parietal cortex in both hemispheres and negatively correlated with bilateral insula, left putamen and left inferior OFC. Scores on the ""sexual/religious"" dimension were positively correlated with GM volumes within the right middle lateral OFC and right DLPFC and negatively correlated with bilateral ACC. Scores on the ""hoarding"" dimension were positively correlated with GM volumes in the left superior lateral OFC and negatively correlated in the right parahippocampal gyrus. No significant correlations between GM volumes and the ""contamination"" or ""symmetry"" dimensions were found. Conclusions: Building upon preexisting findings, our data with treatment-naive OCD patients have demonstrated distinct GM substrates implicated in both cognitive and emotion processing across different OCS dimensions.
- 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.
- Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder(2012) D'ALCANTE, Carina C.; DINIZ, Juliana B.; FOSSALUZA, Victor; BATISTUZZO, Marcelo C.; LOPES, Antonio C.; SHAVITT, Roseli G.; DECKERSBACH, Thilo; MALLOY-DINIZ, Leandro; MIGUEL, Euripedes C.; HOEXTER, Marcelo Q.Objective: To identify neuropsychological predictors of treatment response to cognitive-behavioral therapy (CBT) and fluoxetine in treatment-naive adults with obsessive-compulsive disorder (OCD). Method: Thirty-eight adult outpatients with OCD underwent neuropsychological assessment, including tasks of intellectual function, executive functioning and visual and verbal memory, before randomization to a 12-week clinical trial of either CBT or fluoxetine. Neuropsychological measures were used to identify predictors of treatment response in OCD. Results: Neuropsychological measures that predicted a better treatment response to either CBT or fluoxetine were higher verbal IQ (Wechsler Abbreviated Scale of Intelligence) (p = 0.008); higher verbal memory on the California Verbal Learning Test (p = 0.710); shorter time to complete part D (Dots) (p<0.001), longer time to complete part W (Words) (p = 0.025) and less errors on part C (Colors) (p<0.001) in the Victoria Stroop Test (VST). Fewer perseverations on the California Verbal Learning Test, a measure of mental flexibility, predicted better response to CBT, but worse response to fluoxetine (p = 0.002). Conclusion: In general, OCD patients with better cognitive and executive abilities at baseline were more prone to respond to either CBT or fluoxetine. Our finding that neuropsychological measures of mental flexibility predicted response to treatment in opposite directions for CBT and fluoxetine suggests that OCD patients with different neuropsychological profiles may respond preferentially to one type of treatment versus the other. Further studies with larger samples of OCD patients are necessary to investigate the heuristic value of such findings in a clinical context.
conferenceObject PSP-Richardson's syndrome (PSP-RS) phenotypes with severe eyelid retraction, foot dystonia, sialorrhea and cervicalgia due to retrocollis treated with botulinum toxin type A. Report of two cases(2012) COSTA, M. do D. L. da; CALDAS, F. B. S.; SARMENTO, L. M. C.; MOREIRA, A. X.; SEGUNDO, L. V. Gomes; LAURENTINO, S. G.; DINIZ, J. M.; BEZERRA, A. L. T.; PEIXOTO, R. L.; PAZ, D. A.; PAZ, D. A.; BARBOSA, E. R.- 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.
- Clinical correlates of social adjustment in patients with obsessive-compulsive disorder(2012) ROSA, Ana Carolina; DINIZ, Juliana Belo; FOSSALUZA, Victor; TORRES, Albina Rodrigues; FONTENELLE, Leonardo Franklin; MATHIS, Alice Simoes De; ROSARIO, Maria da Conceicao; MIGUEL, Euripedes Constantino; SHAVITT, Roseli GedankeBackground: Patients with obsessive-compulsive disorder (OCD) frequently show poor social adjustment, which has been associated with OCD severity. Little is known about the effects that age at symptom onset, specific OCD symptoms, and psychiatric comorbidities have on social adjustment. The objective of this study was to investigate the clinical correlates of social functioning in OCD patients. Methods: Cross-sectional study involving 815 adults with a primary DSM-IV diagnosis of OCD participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Patients were assessed with the Social Adjustment Scale, the Medical Outcomes Study 36-item Short-Form Health Survey, the Yale-Brown Obsessive-Compulsive Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Clinical correlates of social adjustment were assessed with generalized linear models with gamma distribution. Results: Poor overall social functioning was associated with greater OCD severity (p = 0.02); hoarding symptoms (p = 0.004); sexual/religious obsessions (p = 0.005); current major depressive disorder (p = 0.004); current post-traumatic stress disorder (p = 0.002); and current eating disorders (p = 0.02). Poor social adjustment was also associated with impaired quality of life. Conclusions: Patients with OCD have poor social functioning in domains related to personal relationships and professional performance. Hoarding symptoms and sexual/religious obsessions seem to have the strongest negative effects on social functioning. Early age at OCD symptom onset seems to be associated with professional and academic underachievement and impairment within the family unit, whereas current psychiatric comorbidity worsen overall social functioning. In comparison with quality of life, social adjustment measures seem to provide a more comprehensive overview of the OCD-related burden.