ANTONIO CARLOS LOPES
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
LIM/23 - Laboratório de Psicopatologia e Terapêutica Psiquiátrica, Hospital das Clínicas, Faculdade de Medicina
22 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 22
- 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.- 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 Decrease in Thalamic Volumes of Refractory Patients with Obsessive-Compulsive Disorder who Were Submitted to Gamma Ventral Capsulotomy(2015) COSTA, Douglas; BATISTUZZO, Marcelo; DURAN, Fabio; GREENBERG, Benjamin; CANTERAS, Miguel; SHAVITT, Roseli; GENTIL, Andre; MIGUEL, Euripedes; LOPES, Antonio; HOEXTER, MarceloconferenceObject Myo-Inositol Reduction in Medial Prefrontal Cortex of Obsessive Compulsive Disorder: A Proton Magnetic Resonance Spectroscopy Study(2015) BATISTUZZO, Marcelo; HOEXTER, Marcelo; COSTA, Fabiana; SHAVITT, Roseli; LOPES, Antonio; CAPPI, Carolina; MATHIS, Alice De; NATASHA, Senc O.; HENNING, Anke; PASTORELLO, Bruno; LEITE, Claudia; MIGUEL, Euripedes; OTADUY, Maria- 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.
- 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.
- Obsessive-Compulsive Personality Symptoms Predict Poorer Response to Gamma Ventral Capsulotomy for Intractable OCD(2020) COPETTI, Maria Eugenia; LOPES, Antonio C.; REQUENA, Guaraci; JOHNSON, Isaac N. S.; GREENBERG, Benjamin D.; NOREN, Georg; MCLAUGHLIN, Nicole C. R.; SHAVITT, Roseli G.; MIGUEL, Euripedes C.; BATISTUZZO, Marcelo C.; HOEXTER, Marcelo Q.Gamma ventral capsulotomy (GVC) is a radiosurgical procedure which aims to create lesions in the ventral part of the anterior limb of the internal capsule (ALIC). It has been used as a treatment option for patients with intractable obsessive-compulsive disorder (OCD) who do not respond to several first-line treatments attempts. However, changes in personality disorder symptoms after GVC have not been investigated. The aims of this study are to investigate changes in personality disorder symptoms after GVC and to search for baseline personality disorder symptoms that may predict clinical response to GVC. Fourteen treatment-intractable OCD patients who underwent GVC completed the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) at baseline and one year after the procedure. Wilcoxon signed-rank test was performed to investigate personality disorder symptom changes before and after surgery. Linear regression models were utilized to predict treatment response, using baseline personality disorder symptoms as independent variables. We did not observe any quantitative changes in personality disorder symptoms after GVC, compared with baseline. Higher severity of obsessive-compulsive personality disorder symptoms at baseline was correlated with worse treatment response after GVC for OCD (beta = -0.085, t-value = -2.52, p-value = 0.027). These findings advocate for the safety of the GVC procedure in this specific population of intractable OCD patients, in terms of personality disorder symptom changes. They also highlight the importance of taking into account the severity of obsessive-compulsive personality disorder symptoms when GVC is indicated for intractable OCD patients.
- Personality measures after gamma ventral capsulotomy in intractable OCD(2018) PAIVA, Raquel R.; BATISTUZZO, Marcelo C.; MCLAUGHLIN, Nicole C.; CANTERAS, Miguel M.; MATHIS, Maria E. de; REQUENA, Guaraci; SHAVITT, Roseli G.; GREENBERG, Benjamin D.; NOREN, Georg; RASMUSSEN, Steven A.; TAVARES, Hermano; MIGUEL, Euripedes C.; LOPES, Antonio C.; HOEXTER, Marcelo Q.Background: Neurosurgeries such as gamma ventral capsulotomy (GVC) are an option for otherwise intractable obsessive-compulsive disorder (OCD) patients. In general, clinical and neuropsychological status both improve after GVC. However, its consequences on personality traits are not well-studied. The objective of this study was to investigate personality changes after one year of GVC in intractable OCD patients. Methods: The personality assessment was conducted using the Revised NEO Personality Inventory (NEO PI-R) and Cloninger's Temperament and Character Inventory (TCI) in 14 intractable OCD patients before and one year after GVC. Comparisons of personality features between treatment responders (n = 5) and non-responders (n = 9) were performed. Multiple linear regression was also used for predicting changes in clinical and global functioning variables. Results: Overall, no deleterious effect was found in personality after GVC. Responders had a reduction in neuroticism (p = 0.043) and an increase in extraversion (p = 0.043). No significant changes were observed in nonresponders. Increases in novelty seeking and self-directedness, and decreases in persistence and cooperativiness predicted OCD symptom improvement. Similary, improvement in functioning was also predicted by hgher novelty seeking and self-directedness after GVC, whereas better functioning was also associated with lower reward dependence and cooperativeness after surgery. Conclusions: The pattern of changes in personality traits after GVC was generally towards that observed in nonclinical population, and does not raise safety concerns.
conferenceObject Gamma Ventral Capsulotomy for Obsessive Compulsive Disorder: A Placebo-Controlled, Double-Blind Clinical Trial(2013) LOPES, Antonio C.; BATISTUZZO, Marcelo C.; CANTERAS, Miguel M.; JOAQUIM, Marines A.; MATHIS, Maria E. de; HOEXTER, Marcelo Q.; GREENBERG, Benjamin D.; NOREN, Georg; RASMUSSEN, Steven A.; SHAVITT, Roseli G.; MIGUEL, Euripedes C.Background: Gamma ventral capsulotomy (GVC) is a radiosurgical technique employed for refractory Obsessive Compulsive Disorder (OCD). However, placebo-controlled, double-blind clinical trials (PC-DBCT) of ablative surgeries for psychiatric disorders were never conducted. We recently completed a PC-DBCT with GVC for treatment refractory OCD patients. Methods: Sixteen refractory DSM-IV OCD patients were randomly assigned to an active radiosurgery treatment group (ATa, 8 patients ) or to a“sham” treatment group (ST, 8 patients). Unblinding was provided 12 months after randomization only. By this time, 4 of the 8 ST patients (the ATb group) received a true procedure. Periodical pre and post-operative follow-up assessments were provided, including psychopathological, global status, neuropsychological and personality scales, and neuroimaging assessments. Results: Three of 8 (37.5%) ATa patients responded to treatment, 12 months after surgery. However, no ST group patients responded. One of the ATb patients became a responder at post-GVC month 6. Fifty-months after surgery, 62.5% of ATa patients were responders. Groups were statistically different as to changes in scores of the Yale-Brown Obsessive Compulsive Scale (YBOCS, p=0.046), the total Dimensional YBOCS (DYBOCS, p=0.016) and the impairment scores of the DYBOCS (p=0.021). Manic episodes, delirium, episodic headaches, paraesthesias, nausea were few times observed. One patient presented a cyst and transient cognitive changes. When compared to ST group, ATa group patients showed a significant improvement on various visuospatial memory tests domains (p=0.008). No patients maintained any long-term significant adverse neuropsychological effects or personality changes. Conclusions: Preliminary findings suggest that GVC for OCD is efficacious, with few adverse effects.
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