ROSA MAGALY CAMPELO BORBA DE MORAIS
Índice h a partir de 2011
6
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
12 resultados
Resultados de Busca
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- Long-term outcome of children and adolescents with obsessive-compulsive disorder: a 7-9-year follow-up of a randomized clinical trial(2020) FATORI, Daniel; POLANCZYK, Guilherme V.; MORAIS, Rosa Magaly Campelo Borba de; ASBAHR, Fernando R.Pediatric obsessive-compulsive disorder (OCD) is an impairing disorder frequently associated with long-term persistence. Long-term follow-up studies that investigated psychopathological trajectories after initial treatment are scarce. The present study is a 7-9-year follow-up of a randomized clinical trial (RCT) that tested the efficacy of group cognitive-behavioral therapy (CBT) and sertraline for children with OCD (n = 40), and aimed to describe long-term outcomes of pediatric OCD and identify predictors of these outcomes. Thirty-five participants who were included in the original study were recruited for follow-up evaluations. Participants underwent a comprehensive assessment of demographic and clinical characteristics comprised of the Structured Clinical Interview for DSM Disorders (SCID) and/or Kiddie-Schedule of Affective Disorders and Schizophrenia Present-Lifetime (K-SADS-PL), and the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Thirty-three participants had a complete psychiatric assessment at follow-up (mean age 21 years, SD 3.2; 65% male). At follow-up, 13 (39.4%) participants had an OCD diagnosis, 10 (30.3%) had a diagnosis of any mental disorder (excluding OCD), and 10 (30.3%) did not have any diagnosis of mental disorder. In total, 23 participants (69.7%) had at least one mental disorder (including OCD). Among those without OCD (n = 20), 60.6% had a mental disorder. The following characteristics at follow-up were associated with OCD diagnosis: YBOCS total score (p < 0.001), global functioning (p = 0.008), and presence of any anxiety disorder (p = 0.027). Being treated with GCBT or sertraline during the original RCT did not predict OCD at follow-up. New treatment strategies should consider the role of psychopathological trajectories using a dynamic approach to combine or change interventions to enhance prognosis.
bookPart Intervenção multidisciplinar em crianças e adolescentes com transtorno do espectro autista e deficiência intelectual(2016) BOARATI, Miguel Angelo; MORAIS, Rosa Magaly Campêlo Borba de; PORTOLESE, Joana; DREYER, Margareth Ramos Mari; SATO, Flávia M.; PANTANO, Telma- Comparison Among Clomipramine, Fluoxetine, and Placebo for the Treatment of Anxiety Disorders in Children and Adolescents(2013) COSTA, Carolina Zadrozny Gouvea da; MORAIS, Rosa Magaly Campelo Borba de; ZANETTA, Dirce Maria Trevisan; TURKIEWICZ, Gizela; NETO, Francisco Lotufo; MORIKAWA, Marcia; RODRIGUES, Camila Luisi; LABBADIA, Eunice Monteiro; ASBAHR, Fernando RamosObjective: The purpose of this study was to test the efficacy of clomipramine and fluoxetine, controlled by placebo, and compare their action in children and adolescents with anxiety disorders. Method: Thirty subjects (ages 7-17 years), who were diagnosed with generalized anxiety disorder and/or separation anxiety disorder and/or social phobia, were submitted to a 12 week double-blind, randomized, placebo-controlled trial of clomipramine and fluoxetine. The instruments included: the Schedule for Affective Disorders and Schizophrenia, the Multidimensional Anxiety Scale for Children, the Children's Depression Inventory, the Clinical Global Impressions, and the Children's Global Assessment Scale. Results: All groups (clomipramine [n=9], fluoxetine [n=10], placebo [n=11]) showed a significant improvement after 12 weeks of treatment. There were significant differences between the fluoxetine and placebo groups in some ratings of anxiety severity and impairment. No significant differences were observed between clomipramine and placebo groups or between fluoxetine and clomipramine groups. Conclusions: Treatment with placebo showed an unusual high response rate. Clomipramine showed similar efficacy compared with fluoxetine, although it was not superior to placebo.
- Bilateral Amygdala Radio-Frequency Ablation for Refractory Aggressive Behavior Alters Local Cortical Thickness to a Pattern Found in Non-refractory Patients(2021) GOUVEIA, Flavia Venetucci; GERMANN, Jurgen; DEVENYI, Gabriel A.; FONOFF, Erich T.; MORAIS, Rosa M. C. B.; BRENTANI, Helena; CHAKRAVARTY, M. Mallar; MARTINEZ, Raquel C. R.Aggressive behaviors comprise verbal and/or physical aggression directed toward oneself, others, or objects and are highly prevalent among psychiatric patients, especially patients diagnosed with autism spectrum disorder and severe intellectual disabilities. Some of these patients are considered refractory to treatment, and functional neurosurgery targeting the amygdala can result in widespread plastic brain changes that might reflect ceasing of some abnormal brain function, offering symptom alleviation. This study investigated cortical thickness changes in refractory aggressive behavior patients that were treated with bilateral amygdala ablation and compared to control patients presenting non-refractory aggressive behavior [three refractory and seven non-refractory patients, all males diagnosed with autism spectrum disorder (ASD) and intellectual disabilities]. The Overt Aggression Scale (OAS) was used to quantify behavior and magnetic resonance imaging was performed to investigate cortical thickness. Before surgery, both groups presented similar total OAS score, however refractory patients presented higher physical aggression against others. After surgery the refractory group showed 88% average reduction of aggressive behavior. Imaging analysis showed that while refractory patients present an overall reduction in cortical thickness compared to non-refractory patients across both timepoints, the local pattern of thickness difference found in areas of the neurocircuitry of aggressive behavior present before surgery is diminished and no longer detected after surgery. These results corroborate the hypotheses on induction of widespread neuronal plasticity following functional neurosurgical procedures resulting in modifications in brain morphology and improvement in behavior. Further studies are necessary to determine the underlying cause of these morphological changes and to better understand and improve treatment options.
bookPart Espectro autista(2018) STUMP, Gabriela Viegas; BIASãO, Mirian de Cesaro Revers; SATO, Fabio Pinato; MORAIS, Rosa Magaly Campelo Borba de; BRENTANI, Helena Paula- Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series(2021) GOUVEIA, Flavia Venetucci; GERMANN, Jurgen; MORAIS, Rosa de; FONOFF, Erich Talamoni; HAMANI, Clement; ALHO, Eduardo Joaquim; BRENTANI, Helena; MARTINS, Ana Paula; DEVENYI, Gabriel; PATEL, Raihaan; STEELE, Christopher; GRAMER, Robert; CHAKRAVARTY, Mallar; MARTINEZ, Raquel Chacon Ruiz
- Longitudinal Changes After Amygdala Surgery for Intractable Aggressive Behavior: Clinical, Imaging Genetics, and Deformation-Based Morphometry Study-A Case Series(2021) GOUVEIA, Flavia Venetucci; GERMANN, Jurgen; MORAIS, Rosa de; FONOFF, Erich Talamoni; HAMANI, Clement; ALHO, Eduardo Joaquim; BRENTANI, Helena; MARTINS, Ana Paula; DEVENYI, Gabriel; PATEL, Raihaan; STEELE, Christopher; GRAMER, Robert; CHAKRAVARTY, Mallar; MARTINEZ, Raquel Chacon RuizBACKGROUND: Intractable aggressive behavior (iAB) is a devastating behavioral disorder that may affect psychiatric patients. These patients have reduced quality of life, are more challenging to treat as they impose a high caregiver burden and require specialized care. Neuromodulatory interventions targeting the amygdala, a key hub in the circuitry of aggressive behavior (AB), may provide symptom alleviation. OBJECTIVE: To Report clinical and imaging findings from a case series of iAB patients treated with bilateral amygdala ablation. METHODS: This series included 4 cases (3 males, 19-32 years old) who underwent bilateral amygdala radiofrequency ablation for iAB hallmarked by life-threatening self-injury and social aggression. Pre- and postassessments involved full clinical, psychiatric, and neurosurgical evaluations, including scales quantifying AB, general agitation, quality of life, and magnetic resonance imaging (MRI). RESULTS: Postsurgery assessments revealed decreased aggression and agitation and improved quality of life. AB was correlated with testosterone levels and testosterone/cortisol ratio in males. No clinically significant side effects were observed. Imaging analyses showed preoperative amygdala volumes within normal populational range and confirmed lesion locations. The reductions in aggressive symptoms were accompanied by significant postsurgical volumetric reductions in brain areas classically associated with AB and increases in regions related to somatosensation. The local volumetric reductions are found in areas that in a normal brain show high expression levels of genes related to AB (eg, aminergic transmission) using gene expression data provided by the Allen brain atlas. CONCLUSION: These findings provide new insight into the whole brain neurocircuitry of aggression and suggest a role of altered somatosensation and possible novel neuromodulation targets.
- Amygdala and Hypothalamus: Historical Overview With Focus on Aggression(2019) GOUVEIA, Flavia Venetucci; HAMANI, Clement; FONOFF, Erich Talamoni; BRENTANI, Helena; ALHO, Eduardo Joaquim Lopes; MORAIS, Rosa Magaly Campelo Borba de; SOUZA, Aline Luz de; RIGONATTI, Sergio Paulo; MARTINEZ, Raquel C. R.Aggressiveness has a high prevalence in psychiatric patients and is a major health problem. Two brain areas involved in the neural network of aggressive behavior are the amygdala and the hypothalamus. While pharmacological treatments are effective in most patients, some do not properly respond to conventional therapies and are considered medically refractory. In this population, surgical procedures (ie, stereotactic lesions and deep brain stimulation) have been performed in an attempt to improve symptomatology and quality of life. Clinical results obtained after surgery are difficult to interpret, and the mechanisms responsible for postoperative reductions in aggressive behavior are unknown. We review the rationale and neurobiological characteristics that may help to explain why functional neurosurgery has been proposed to control aggressive behavior.
- Reduced Prefrontal Activation in Pediatric Patients With Obsessive-Compulsive Disorder During Verbal Episodic Memory Encoding(2015) BATISTUZZO, Marcelo Camargo; BALARDIN, Joana Bisol; MARTIN, Maria da Graca Morais; HOEXTER, Marcelo Queiroz; BERNARDES, Elisa Teixeira; BORCATO, Sonia; SOUZA, Marina de Marco e; QUERIDO, Cicero Nardini; MORAIS, Rosa Magaly; ALVARENGA, Pedro Gomes de; LOPES, Antonio Carlos; SHAVITT, Roseli Gedanke; SAVAGE, Cary R.; AMARO JR., Edson; MIGUEL, Euripedes C.; POLANCZYK, Guilherme V.; MIOTTO, Eliane C.Objective: Patients with obsessive-compulsive disorder (OCD) often present with deficits in episodic memory, and there is evidence that these difficulties may be secondary to executive dysfunction, that is, impaired selection and/or application of memory-encoding strategies (mediation hypothesis). Semantic clustering is an effective strategy to enhance encoding of verbal episodic memory (VEM) when word lists are semantically related. Self-initiated mobilization of this strategy has been associated with increased activity in the prefrontal cortex, particularly the orbitofrontal cortex, a key region in the pathophysiology of OCD. We therefore studied children and adolescents with OCD during uncued semantic, clustering strategy application in a VEM functional magnetic resonance imaging (fMRI)-encoding paradigm. Method: A total of 25 pediatric patients with OCD (aged 8.1-17.5 years) and 25 healthy controls (HC, aged 8.1-16.9) matched for age, gender, handedness, and IQ were evaluated using a block design VEM paradigm that manipulated semantically related and unrelated words. Results: The semantic clustering strategy score (SCS) predicted VEM performance in HC (p <.001, R-2 = 0.635), but not in patients (p =.099). Children with OCD also presented hypoactivation in the dorsomedial prefrontal cortex (cluster-corrected p <.001). Within-group analysis revealed a negative correlation between Yale-Brown Obsessive Compulsive Scale scores and activation of orbitofrontal cortex in the group with OCD. Finally, a positive correlation between age and SCS was found in HC (p = .001, r = 0.635), but not in patients with OCD (p = .936, r = 0.017). Conclusion: Children with OCD presented altered brain activation during the VEM paradigm and absence of expected correlation between SCS and age, and between SCS and total words recalled. These results suggest that different neural mechanisms underlie self-initiated semantic clustering in OCD.
- Oxytocin and Gynecomastia: Correlation or Causality?(2018) AMORIM, Leticia; GOUVEIA, Flavia V.; GERMANN, Jurgen; ZAMBORI, Debora; MORAIS, Rosa; SATO, Flavia M.; FONGARO, Camila; PORTOLESE, Joana; BRENTANI, Helena; MARTINEZ, RaquelOxytocin has been administered to patients with autism spectrum disorder (ASD) in order to improve social skills, communication, and manage repetitive behaviors in the context of research trials. The majority of the studies focus on acute administration; thus, the effectiveness and potential side effects of chronic administration remain unknown. The main goal of this case report is to highlight the importance of the safety parameters for the chronic use of intranasal oxytocin administration. In a single case conducted in our outpatient clinic, one adolescent (15 years old) received intranasal oxytocin (24 IU) twice per day, in accordance with the recommended doses for this age group that varies from 8 - 25 IU twice per day. After three weeks of treatment, the patient presented with gynecomastia. While it is not certain that the gynecomastia was oxytocin-induced, this case highlights the importance of developing optimal regimens for chronic oxytocin administration, with a particular focus on safety parameters.