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
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bookPart Exposição ao calor(2013) LOPES, Antonio Carlos; GRAFF, Sergio- 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 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.conferenceObject Pretreatment Orbitofrontal Thickness as a Measure to Classify OCD Patients in Responders and Non-Responders(2013) HOEXTER, Marcelo Q.; LOPES, Antonio C.; SHAVITT, Roseli G.; BATISTUZZO, Marcelo C.; DOUGHERTY, Darin D.; DINIZ, Juliana B.; DURAN, Fabio F. S.; BUSATTO, Geraldo F.; BRESSAN, Rodrigo A.; SATO, Joao R.; MIGUEL, Euripedes C.bookPart Exposição ao frio(2013) LOPES, Antonio Carlos; GRAFF, Sergio