Mental health of Brazilian university students during the Covid-19 / Saúde mental dos estudantes universitários brasileiros durante a pandemia de Covid-19 / Salud mental de estudiantes universitarios brasileños durante la pandemia Covid-19

This study aimed to investigate the effects of positive and negative affects, anxiety, and obsessive and compulsive thoughts and behaviors on Brazilian university students during the Covid-19 pandemic. Participated in this study 492 students, aged 18 years or over, from all regions of the country. The survey was conducted between April and May 2020, using self-report instruments applied in the online format. The results indicated that 37% (N=182) of the students had a high level of anxiety and 46.1% (N=227) moderate levels for obsessive and compulsive thoughts and behaviors. In addition, it was found that positive affects were negatively correlated with anxiety, as well as with obsessive and compulsive thoughts and behaviors, while negative affects were positively correlated with independent variables. It is concluded that the mental health of university students must be monitored during pandemics.

Este estudo teve como objetivo investigar os efeitos dos afetos positivos e negativos, da ansiedade e dos pensamentos e comportamentos obsessivos e compulsivos nos estudantes universitários brasileiros durante a pandemia da Covid-19. Participaram deste estudo 492 estudantes de todas as regiões do país e com idades a partir de 18 anos. A pesquisa foi realizada entre os meses de abril e maio de 2020, por meio de instrumentos de autorrelatos aplicados no formato on-line. Os resultados indicaram que 37% (N = 182) dos estudantes apresentaram alto nível de ansiedade e 46,1% (N = 227) níveis moderados para os pensamentos e comportamentos obsessivos e compulsivos. Além disso, verificou-se que os afetos positivos se relacionaram negativamente à ansiedade, assim como se relacionaram negativamente aos pensamentos e comportamentos obsessivos e compulsivos, enquanto os afetos negativos se relacionaram positivamente às variáveis independentes. Conclui-se que a saúde mental dos estudantes universitários deve ser monitorada durante pandemias.

Este estudio tuvo como objetivo investigar los efectos de los afectos positivos y negativos, la ansiedad y los pensamientos y comportamientos obsesivos y compulsivos en estudiantes universitarios brasileños durante la pandemia de Covid-19. En este estudio participaron 492 estudiantes de todas las regiones del país y mayores de 18 años. La encuesta se realizó entre los meses de abril y mayo de 2020, utilizando instrumentos se autoinforme aplicados en formato online. Los resultados indicaron que el 37% (N = 182) de los estudiantes tenían niveles altos de ansiedad y el 46,1% (N = 227) niveles moderados de pensamientos y comportamientos obsesivos y compulsivos. Además, se encontró que los afectos positivos se correlacionaron negativamente con la ansiedad, así como el pensamiento y el comportamiento obsesivo y compulsivo se correlacionaron negativamente, mientras que los afectos negativos se correlacionaron positivamente con variables independientes. Se concluye que la salud mental de los estudiantes universitarios debe ser monitoreada durante las pandemias.

Clinical characteristics of the obsessive-compulsive disorder patients with hoarding symptoms / 上海交通大学学报（医学版）

Objective • To explore the clinical characteristics of the obsessive-compulsive disorder (OCD) patients with hoarding symptoms and analyze the risk factors related to hoarding symptoms. Methods • A total of 247 OCD patients and 137 healthy controls (HC) were enrolled. The OCD patients were divided into hoarding group and non-hoarding group according to hoarding symptoms. Yale-Brown Obsessive-Compulsive Scale, Hamilton Depression Scale, Hamilton Anxiety Scale, Neuroticism Extraversion Openness Five-Factor Inventory and Obsessive Belief Questionnaire-44 were used to measure the severity of OCD, levels of depression and anxiety, personality characteristics and obsessive-compulsive beliefs of the three groups. The differences among the groups were compared, and Logistic regression was used to analyze the related factors of hoarding symptoms. Results • Regardless of hoarding symptoms, the scores of depression, anxiety, neuroticism and obsessive beliefs in the patients with OCD were significantly higher than those in the healthy controls (all P=0.000). Compared with OCD/non-hoarding group, OCD/hoarding group had a significantly lower level of extroversion (P=0.000), a significantly higher level of perfectionism/certainty (P=0.037), and higher scores in indecisiveness (P=0.003), pathological responsibility (P=0.006) and pathological slowness (P=0.000). There was statistical significance in age (OR=0.94), extraversion score (OR=0.89) and pathological retardation score (OR=2.50) in Logistic regression model (all P<0.05). Conclusion • The risk of hoarding symptoms in the OCD patients decreases with the increase of age and extroversion level, and increases with the increase of pathological retardation level.

Methodological strategies for functional analysis and evaluation of obsessive-compulsive behavior / Estratégias metodológicas para avaliação e análise funcional do comportamento obsessivo-compulsivo / Estrategias metodológicas para evaluación y análisis funcional de la conducta obsesiva-compulsiva

The study aimed to identify the controlling variables of obsessive-compulsive behaviors of an adult participant, based on three evaluation strategies. For the first one, Indirect Functional Assessment, the researchers recovered records of therapy sessions attended by the participant, in which conditions favorable to obsessive-compulsive behaviors were described. For the second one, Descriptive Functional Assessment, the researchers observed the participant's behavior during sessions in which they presented tasks previously mentioned as triggering of the problem behavior. For the third one, Brief Functional Analysis - Single Function Test, the researchers manipulated a demand condition and a control condition, aiming to examine the functional hypothesis that the problem behavior would be maintained by escape/avoidance of tasks. Although dissonant, the results allowed the researchers to discard the negative reinforcement hypothesis. The pertinence of the adoption of different evaluation strategies for clinical practice and the frailties of interventions guided only by verbal reports are discussed.

O estudo teve por objetivo identificar variáveis controladoras de comportamentos obsessivo-compulsivos de um participante adulto, com base em três estratégias de avaliação. Na primeira, Avaliação Funcional Indireta, recuperaram-se registros de sessões de terapia frequentadas pelo participante, em que foram descritas condições favorecedoras dos comportamentos obsessivo-compulsivos. Na segunda, Avaliação Funcional Descritiva, observou-se o comportamento do participante em sessões nas quais se dispunham tarefas antes indicadas como desencadeantes do comportamento-problema. Na terceira, Análise Funcional Breve - Teste de Função Única, foram manipuladas condições de demanda e controle, a fim de examinar a hipótese funcional de que o comportamento-problema seria mantido por fuga/ esquiva de tarefas. Embora divergentes, os resultados das avalições permitiram descartar a hipótese de que o comportamento-alvo seria mantido pela retirada da tarefa. Discutem-se a pertinência da adoção de diferentes estratégias de avaliação no trabalho clínico e a fragilidade de intervenções unicamente orientadas por relatos verbais.

El estudio objetivó identificar variables controladoras de la conducta obsesiva-compulsiva de un participante adulto, basando-se en tres estrategias de evaluación. Por la primera, Evaluación Funcional Indirecta, fueran recuperados registros de sesiones de terapia frecuentadas por el participante, en que se describieron condiciones favorecedoras de los comportamientos obsesivo-compulsivos. Por la segunda, Evaluación Funcional Descriptiva, fue observada la conducta del participante en sesiones en las cuales se disponían tareas indicadas como desencadenantes de la conducta-problema. Por la tercera, Análisis Funcional - Prueba de Función Única, fueran manipuladas condiciones de demanda e control, objetivando examinar la hipótesis funcional de que la conducta problema sería mantenida por fuga/evasión de tareas. Aunque divergentes, los resultados permitirán descartar a la hipótesis de que la conducta objetivo sería mantenida por reforzamiento negativo. Se discute la pertinencia de la adopción de diferentes estrategias de evaluación del trabajo clínico, y debilidades de intervenciones únicamente orientadas por relatos verbales.

Quality of Life and Suicidality in Obsessive Compulsive Disorder as Evaluated by WHO BREF

Obsessive Compulsive Disorder (OCD) is a chronic, distressing, anxiety disorder associated with significant functional impairment. Patient with OCD often suffer from one or more co-morbid disorders. Major depression has been the most common co-morbid syndrome. OCD in association with comorbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness and past history of suicide attempts have been associated with worsening levels of suicidality. As per data Thirty-six percent of the patients of OCD report lifetime suicidal thoughts and 11% have a history of attempted suicide. There is a reasonable probability that the patient of OCD has suicidal thoughts, plans or a suicidal attempt in the past. Methods: This study was conducted on 50 patients diagnosed with OCD as per ICD 10 criteria, both outpatient & indoor, from department of psychiatry, Teerthanker Mahaveer Medical College & Hospital, Moradabad, Uttar Pradesh, India. A socio-demographic proforma, Hamilton Depression rating scale, Yale Brown Obsessive Compulsive Scale and WHOQOL-BREF-Hindi version were administered. Results: The majority of the patients suffering from OCD were below 40 years of age. The prevalence of OCD was maximum in housewives and they mostly belonged to 25-34 years age group. All the patients who had current suicidal ideation showed low scores on all the domains of Quality of life. Also, the patients who had attempted suicide in the past showed same low scores on all domains of Quality of life and both results were statistically significant. Conclusion: Hence the assessment of Quality of life in OCD patient is a strong predictor of suicidality in these patients

Oficina de comunicación a distancia del Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ­ más de 20 años construyendo telemedicina / Outreach Communication Office of Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ­ more than 20 years building telemedicine

Introducción: El Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" ha sido pionero en la atención de la salud de la población infantil del país y de Latinoamérica. El 53% de los pacientes que concurren al hospital viven más allá del área metropolitana de Buenos Aires. En agosto de 1997, se creó la Oficina de Comunicación a Distancia como una herramienta para sostener la continuidad asistencial de los pacientes de áreas remotas; su apertura significó el embrión del primer programa de telemedicina del país. Objetivos: Promover la construcción de redes integradas de servicios de salud. Impulsar nuevos procesos que mejoren el acceso a la salud. Metodología: Basados en la lógica de redes integradas de servicios de salud con la incorporación de las tecnologías de la información y la comunicación. Resultados: Desde 1997 hasta el primer semestre de 218 se crearon 283 OCD. Se asistieron más de 70.000 consultas asincrónicas y se realizaron más de 5000 videoconferencias. Conclusiones: La modalidad de comunicación a distancia y telemedicina estimula el trabajo colaborativo interinstitucional favoreciendo la atención de los pacientes en origen

Introduction: Hospital de Pediatría "Prof. Dr. Juan P. Garrahan" has been a Pioneer in health care for children in Argentina and Latin America. Overall, 53% of the patients that are covered by the hospital live outside the metropolitan area of Buenos Aires. In August 1997, the Outreach Communication Office (OCO) was created as a tool to sustain continuous care for patients living in remote areas; its inauguration was the seed for the first telemedicine program in the country. Objectives: To promote the development of networks of health-care services. To initiate processes to improve Access to health care. Methods: Development of comprehensive health-care networks with the incorporation of information and communication technologies. Results: Between 1997 and the first semester of 218, 283 OCO's were created. Overall, 70,000 asynchronous consultations were conducted and more than 5000 videoconferences were held. Conclusions: The modality of outreach communication and telemedicine encourages interinstitutional collaboration favoring patient care at their site of origin

Application of repetitive transcranial magnetic stimulation in the treatment of obsessive-compulsive disorder / 上海交通大学学报（医学版）

At present, a considerable proportion of patients with obsessive-compulsive disorder (OCD) cannot be effectively relieved by standard drug and psychotherapy, so researchers have turned their attention to new directions of physiotherapy. Repetitive transcranial magnetic stimulation (rTMS), as an adjuvant therapy for refractory OCD, is a non-invasive nerve stimulation technique. Many studies have shown that rTMS is effective in the treatment of OCD. However, there were also disputes in the selection of stimulation targets, parameter settings and so on. This article systematically combs the setting and application of standard rTMS in the treatment of OCD, and comprehensive therapeutic effect of rTMS, and then discusses the deficiency of treatment so far, in order to put forward the future development direction and promote clinical treatment progress.

A perspectiva simbólica do espectro obsessivo-compulsivo: O "projeto" de Freud revisitado pelo arquétipo de Jung / The symbolic perspective of the obsessive-compulsive spectrum Freud: "Project" revisited by Jung's archetype / La perspectiva simbólica del espectro obsesivo-compulsivo: El "proyecto" de Freud revisitado por el arquetipo de Jung

O autor aborda o espectro obsessivo-compulsivo através da dimensão simbólica e arquetípica enraizada em três vertentes: neurológica, psicofarmacológica, e psicodinâmica. Associa os dinamismos arquétipos matriarcal, patriarcal, de alteridade e de totalidade com estruturas e funções do sistema nervoso. A seguir, o autor retoma a hipótese de Katz (1991), segundo a qual o TOC apresenta um distúrbio do processo de repressão (Freud) possivelmente por uma disfunção neuroquímica, envolvendo neurotransmissores, principalmente a serotonina. A interpretação arquetípica desta disfunção é a debilitação da função de delimitação, de organização e de contenção do Arquétipo Patriarcal, que compromete a eficácia de todo o quadro defensivo e configura sua exuberância sintomática projetiva e ritualizadora num esforço para suprir a deficiência. O autor tece considerações sobre a ineficiência da psicoterapia dinâmica exclusivamente verbal no TOC e a relativa eficiência da Terapia Comportamental Cognitiva e argumenta que a associação destas duas teorias através do conceito de técnicas expressivas poderá contribuir com maior eficiência no tratamento não só do TOC, como das fobias e da síndrome do pânico, desde que seja exercido dentro de um enfoque simbólico e arquétipo que inclua a relação terapêutica no nível transferencial criativo e defensivo. ■

The author approaches the obsessive-compulsive spectrum through the symbolic archetypal dimension rooted in three perspectives: neurological, psycho-pharmacological and psychodynamic. He associates matriarchal, patriarchal, alterity and totality archetypes with structures and functions of the nervous system. The author considers the hypothesis developed by Katz (1991) according to which OCD presents a disturbance of repression due to a neurotransmitter disfunction, mainly of serotonin. From an archetypal perspective, this neuro-chemical disfunction develops a deficiency of the delimiting, organizing and contention functions of the Patriarchal Archetype. The intensification of repression, projection and ritualization in OCD is a neurological and psychological reaction to deal with this deficiency. The author mentions his experience according to which exclusively verbal psychodynamic psychotherapy is largely inefficient in OCD, phobias and panic syndrome. He argues that the relative efficiency of Cognitive Behavior Therapy can be improved if exposure and avoidance techniques are employed as expressive techniques considering the transference relationship and the defenses present within an overall symbolic and archetypal theory of personality development. ■

El autor aborda el espectro obsesivo-compulsivo a través de la dimensión simbólica y arquetípica enraizada en tres vertientes: neurológica, psicofarmacológica, y psicodinámica. Asocia los dinamismos arquetipos matriarcal, patriarcal, de alteridad y de totalidad con estructuras y funciones del sistema nervioso. A continuación el autor retoma la hipótesis de Katz (1991), según la cual el TOC presenta un disturbio del proceso de represión (Freud) posiblemente por una disfunción neuroquímica, involucrando neurotransmisores, principalmente la serotonina. La interpretación arquetípica de esta disfunción es la debilitación de la función de delimitación, de organización y de contención del Arquetipo Patriarcal, que compromete la eficacia de todo el cuadro defensivo y configura su exuberancia sintomática proyectiva y ritualizadora en un esfuerzo por suplir la discapacidad. El autor hace consideraciones sobre la ineficiencia de la psicoterapia dinámica exclusivamente verbal en el TOC y la relativa eficiencia de la Terapia Comportamental Cognitiva y argumenta que la asociación de estas dos teorías a través del concepto de técnicas expresivas podrá contribuir con mayor eficiencia en el tratamiento no sólo del TOC, fobias y del síndrome del pánico, siempre que sea ejercido dentro de un enfoque simbólico y arquetipo que incluya la relación terapéutica en el nivel transferencial creativo y defensivo. ■

Efficacy and cost-effectiveness of internet-based cognitive behavioral therapy for obsessive-compulsive disorder / 上海交通大学学报（医学版）

Objective • To compare the therapeutic effect, cost, cost-effectiveness and utility between internet-based cognitive behavioral therapy (ICBT) and cognitive behavioral group therapy (CBGT) in the patients with obsessive-compulsive disorder (OCD). Methods • Twenty-eight patients who met the OCD diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) were assigned to ICBT group (n=16) and CBGT group (n=12) according to the patients' willingness. Both groups were treated for 6 weeks. The study compared differences in the severity of OCD and symptoms of anxiety and depressive at baseline, during treatment and after treatment, as well as differences in cost, cost-effectiveness and utility between two groups. Results • There was no significant difference in the scores of Yale-Brown Obsessive Compulsive Scale (YBOCS), Self-rating Depression Scale (SDS), Self-rating Anxiety Scale (SAS), and Visual Analog Scale (VAS) [a component of EuroQol Five Dimensions Questionnaire, (EQ-5D)] between the two groups at baseline (P=0.291, P=0.114, P=0.478, P=0.799). After treatment, the YBOCS scores decreased compared to pre-treatment in two groups. There was no statistical difference in subtraction rate of YBOCS between the two groups (P=0.291). The SDS scores of ICBT group also decreased after treatment compared to pre-treatment (P=0.003). The average cost per patient in ICBT group was 2 710.50 yuan less than that in CBGT group. When one YBOCS score per patient reduced, ICBT group spent 281.33 yuan less than CBGT group. The VAS scores were significantly improved after 6-week treatment and ICBT group has a more significant improvement. Conclusion • ICBT and CBGT have comparable and significant efficacy. And ICBT is a lower cost and more cost-effectiveness and utility treatment than CBGT.

Progress in augmentation therapy mechanism of obsessive compulsive disorder / 上海交通大学学报（医学版）

Administration of selective serotonin reuptake inhibitors (SSRI) is a widely used pharmacotherapeutic approach for obsessive-compulsive disorder (OCD) today. However, nearly half of the OCD patients do not respond to SSRI. It has been shown that some antipsychotic drugs can augment the therapeutic effect of SSRI in the patients with OCD, but the augmentation’s effect is still ineffective for some patients. Therefore, it is of great significance to explore the augmentation’s mechanism for further improvement of the clinical treatment. This article reviews some common used augmentation for OCD and discusses the underlying mechanisms.

Obsessive-compulsive symptoms in children with first degree relatives diagnosed with obsessive-compulsive disorder

Objective: A first-degree relative affected by obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) in childhood is an important risk factor for developing the disorder in adulthood. The relationship between a family history of OCD and the presence of OCS and its correlates in childhood is not well established. Methods: A total of 66 children whose parents or siblings have been diagnosed with OCD were assessed for the presence of OCS and clinical correlates. Results: Three children (4.5%) were reported to have received an OCD diagnosis and another 26 (39.4%) were identified as having OCS. Children with OCS had higher rates of coercive behavior and came from families with lower socioeconomic status. Contamination/cleaning dimension symptoms in the proband were associated with OCS in the assessed children. Conclusion: OCS are frequent among family members of individuals with OCD and are associated with socioeconomic status, coercive behaviors and proband contamination/cleaning symptoms. Future longitudinal studies should test the risk of developing OCD in association with these characteristics.

The comparison of risky and ambiguity decision making and cool executive functions between patients with obsessive compulsive disorder and healthy controls

Abstract Background: Executive functioning has been evaluated in obsessive compulsive disorder (OCD). Cool and hot executive functioning discrimination provided a different way of conceptualising executive functions. Objectives: The aim of this study was to compare ambiguity and risky decision-making and cool executive functions in an OCD and a healthy control group. The relationship between decision-making and cool executive functioning was investigated. Methods: Sixty-two OCD patients and 48 healthy control participants were compared. Decision-making was measured using the Iowa Gambling Task. The cool executive functioning was assessed using the Stroop Test and the Wisconsin Card Sorting Task (WCST). Results: The OCD group completed the WCST and the Stroop Test statistically significantly with a lower score than that of the control group. The OCD group had impaired response inhibition and set-shifting that indicate impaired cool executive functioning. In contrast to a lack of a statistically significant difference, the risky decision-making performance was worse in the OCD group than in the healthy control group and in the unmedicated OCD patients than in the medicated OCD patients. Discussion: The OCD patients had a poorer performance in risky decision-making and cool executive functioning. There was a link between risky decision-making performance and impaired cool executive functions.

Comparación de la respuesta inhibitoria en niños y adolescentes diagnosticados con trastorno obsesivo compulsivo (TOC) y trastorno por déficit de atención e hiperactividad (TDAH) / Comparing Inhibitory response in Children and Teenagers Diagnosed with Obsessive and Compulsive Disorder (OCD) and Attention Deficit Hyperactivity Disorder (ADHD)

Los trastornos de comportamiento tienen asociados una serie de factores que van más allá de los síntomas, entre los cuales está el funcionamiento cognoscitivo y la relación con los mismos sistemas neurofuncionales. En TOC y TDAH se han descrito dificultades en el funcionamiento ejecutivo, siendo la inhibición de respuestas una de las fallas comunes más consistentes en diferentes estudios, a pesar de que los dos cuadros clínicos difieren en las características de comportamiento relacionadas con esta habilidad. Este estudio comparó la respuesta inhibitoria de niños y adolescentes colombianos sanos y diagnosticados con TDAH o TOC. Se hizo un análisis descriptivo, comparativo, correlacional de casos y controles, donde se seleccionaron por muestreo intencionado a 31 pacientes con TDAH, 31 con TOC y 66 controles, de origen colombiano, de entre 10-19 años, a quienes se les aplicó el Test Stroop de Colores y Palabras segunda edición, haciendo análisis de las puntuaciones T de la interferencia calculada. Se encontró a través de test no paramétricos de Kruskal-Wallis diferencias generales entre los grupos clínicos con los controles (K-W:10.979, d/ = 2, p = 4.13x10-3); y diferencias específicas con el Test de Wilcoxon; entre Controles vs TOC (W-T p = 0.03), vs TDAH (W-T p = 2.00 x 10-3), pero no entre los grupos clínicos TOC vs TDAH (p = 0.27). Al comparar a través de test de U Mann-Whitney por rango de edad se encuentran diferencias entre los mismos grupos para los participantes entre 13-16 años en TDAH vs controles (p = 5.00 x 10-3), identificándose correlación entre edad e interferencia solo para el grupo TOC (R2:= 0.98). Conclusiones: Como se ha descrito en literatura científica, no se consigue identificar diferencias en el rendimiento entre casos y controles en cuanto a las habilidades de control inhibitorio de interferencia entre personas con TOC y TDAH, pero sí entre éstos y los controles, confirmando el aspecto común de fallas inhibitorias, aun cuando difieren en las manifestaciones conductuales. La edad representa un elemento importante indicando que hay un componente de cambio relacionado con maduración del sistema nervioso, llevando a mejor rendimiento en inhibición a medida que aumenta la edad, para el grupo de TOC.

Behavior disorders are associated with a number of factors that go beyond symptoms, including cognitive functioning and the relationship with the neurofunctional systems. In OCD and ADHD difficulties in executive functioning have been described, being the response inhibition one of the most consistent common failures in different studies despite that the two clinical pictures differ in behavioral characteristics related to this skill. The aim was to compare the inhibitory response of healthy Colombian children and adolescents and diagnosed with ADHD or OCD. A descriptive, comparative, correlational analysis of cases and controls, where the sample of 31 patients with ADHD, 31 with OCD and 66 controls were selected by intention, being of Colombian origin, between 10-19 years old to whom the Test Stroop of Colors and Words second edition was applied doing analysis of the scores T of the calculated interference. Through non-parametric Kruskal-Wallis tests, we identify general differences between the clinical groups with the controls (K-W:10.979, d/ = 2, p = 4.13x10-3). And specific differences with the Wilcoxon Test; Between Controls vs TOC (W-T p = 0.03), vs ADHD (W-T p = 2.00x10-3), but not between clinical groups TOC vs ADHD (p = 0.27). When comparing through U-Mann- Whitney test by age range differences are found between the same groups for participants between 13-16 years in ADHD vs controls (p = 5.00x10-3), identifying correlation between age and interference only for the TOC group (R2 = 0.98). As described in the scientific literature, it is not possible to identify differences in case-control performance in inhibitory control of interference between people with OCD and ADHD, but between these and controls, confirming the common aspect of inhibitory failures, even when differ in behavioral manifestations. Age represents an important element indicating that there is a change component related to maturation of the nervous system, leading to better inhibition performance as the age for the OCD group increases.

Neurose obsessiva ou TOC? / Obsessive neurosis or OCD?

O presente artigo discute a contribuição da psicanálise à teoria da neurose obsessiva, em face do atual prestígio dos manuais classificatórios e do avanço das neurociências. O esfacelamento da neurose obsessiva como unidade clínica e sua substituição pelo transtorno obsessivo compulsivo (TOC) pelo Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM) é discutido. Depois de observações sobre a especificidade epistêmica das duas abordagens, conclui-se que a psicanálise tem muito a contribuir numa abordagem multidisciplinar da psicopatologia na medida em que sua posição teórica particular valoriza a fala e a história do sujeito, em sua singularidade

This article discusses the contribution of psychoanalysis to the theory of obsessional neurosis, in this time of great prestige of the diagnostic and statistical manuals and advancement of neurosciences. The disintegration of obsessional neurosis as a clinical unit, and its replacement by obsessive compulsive disorder (OCD) by the Diagnostic and Statistical Manual of Mental Disorders (DSM) is discussed. After observations on the epistemic specificity of the two approaches, the conclusion is that psychoanalysis has much to contribute to a multidisciplinary approach to psychopathology in that its particular theoretical position values speech and the history of the subject, in its singularity

Características del self en pacientes con trastorno obsesivo compulsivo: una aproximación desde el enfoque integrativo supraparadigmatico / Self features in patients with obsessive compulsive disorder: an approach from supraparadigmatic integrative model

En la presente investigación, se intenta comprender el trastorno Obsesivo Compulsivo (TOC) más allá de los síntomas, como una forma de planear estrategias de intervención diferentes y que ayuden a aliviar el sufrimiento de los pacientes. Este trastorno presentaría una prevalencia aproximada entre un 1.5 por ciento y un 3 por ciento con variaciones en diferentes ciudades, por lo que es alta la presencia de él, sin embargo, la consulta por éste es baja, ya que el trastorno en sí conlleva vergüenza y miedo, afectando así a la persona en su identidad, en como el sujeto se aproxima al mundo, como desea que la vida sea para él. Se toma el marco referencial del Enfoque Integrativo Suprapradigmático, especialmente las funciones del Self propuestas por éste enfoque. La investigación es descriptiva y pretende caracterizar las funciones del Self de pacientes con TOC, la muestra es de 18 pacientes de un centro de atención psicológica de la ciudad de Santiago de Chile y que responden la Ficha de Evaluación Clínica Integral (FECI)...

In this research, we try to understand Obsessive Compulsive Disorder (OCD) beyond its symptoms, as a way of planning different intervention strategies to help alleviate the suffering of patients. This disorder has a prevalence between 1.5 percent and 3 percent with variations in different cities. Despite its high prevalence, consultation levels are low since the disorder itself is associated with shame and fear, affecting a person’s identity, the way the subject approaches the world and the life wished for. The reference frame adopted is the Suprapradigmatic Integrative Model, especially the functions of the Self proposed by this approach. The research is descriptive and aims to characterize the functions of the Self of patients with OCD. The sample is of 18 patients attended at a Psychological Services Center in Santiago, Chile, evaluated with the Integral Clinical Evaluation (FECI)...

Psicoterapia cognitiva individual del TOC / Individual cognitive psychotherapy of OCD

A case study is presented in which cognitive therapy is applied to a case of obsessive-compulsive disorder, with contamination and verification rituals. The treatment emphasizes the importance of intervening on the specific metacognitive biases that patients have on their intrusive thoughts. The center of the intervention is not in the obsessions, but in the biased assessments. The post treatment evaluation showed a moderate improvement, a reduction of the biases, and a notable improvement of the functionality of the patient.

Se presenta un estudio de caso en el que se aplica psicoterapia cognitiva en un paciente con trastorno obsesivo compulsivo con intrusiones de contaminación y duda con rituales de lavado y verificación. El tratamiento se basa en el modelo cognitivo del TOC, que propone que los sesgos a través de los cuales se valoran las ideas intrusivas son el principal factor de mantenimiento del trastorno. Las intervenciones que de él se derivan incluyeron psicoeducación y técnicas cognitivas para flexibilizar esos sesgos. La evaluación de resultados post tratamiento mostró una mejoría moderada de los síntomas, una marcada flexibilización de los sesgos y una notable mejoría en la funcionalidad del paciente.

Neuropsychological Correlates for Obsessive Slowness.

Aim : To assess the cognitive functioning of a group of patients with OCD and a group of matched normal controls. Method : Patients of OCD were screened for selection criteria. They were assessed on Wisconson Card Sorting Test (WCST) and Continuous Performance Test (CPT) for neuro-cognitive impairments and compared the same with matched controls. Conclusions : On WCST, clinical group performed poorly, which is statistically significant. On CPT, the patient groups made significantly more wrong responses, more missed responses and took more time to respond, which is statistically significant.

A Comparative Study of Social, Adaptive, Relational and Global Functioning of Adolescents with OCD and ADHD.

Aim – Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD) are one of the most common childhood and adolescent neuropsychiatric disorders. Adolescents with these disorders experience difficulties and impairments in various domains of life. However studies on functional impairments in adolescents with these disorders are lacking in India. This study was conducted with the aim to study and compare the functional impairments of Indian adolescents suffering with these disorders. Methods – 57 adolescents (36 having ADHD and 21 having OCD) between the age group 13 years to less than 18 years were recruited during the study period. HONOSCA, VABSII and C-GAS were applied to study the social, relational, emotional, adaptive and global functioning of these adolescents. The two groups were compared with each other using appropriate statistical methods. Result – Adolescents with ADHD had significantly greater impairments in the areas of ‘disruptive, antisocial and aggressive behavior’, ‘peer relationships’ and ‘self care and independence’ whereas adolescents with OCD had significantly greater impairments in the areas of ‘emotional and related problems’ and ‘poor school attendance’. Significantly greater number of adolescents with ADHD were below average in their functioning in the ‘receptive’ (77.8%) and ‘written’ (75%) subdomain and overall in the ‘communication’ domain (63.9%) as compared to the adolescents having OCD. Adolescents with ADHD were more impaired in their global functioning as compared to adolescents with OCD. Conclusion - There are important differences in the various correlates of functioning between the two groups of adolescents. The present findings have implications in the planning for treatment intervention in these adolescents to make them more cost effective and efficient.

Funcionamiento familiar, creencias e inteligencia emocional en pacientes con trastorno obsesivo-compulsivo y sus familiares / Family functioning, beliefs regarding illness and emotional intelligence in patients with Obsessive Compulsive Disorder and in their relatives

Mental health problems, specifically mental disorders, develop from a complex system and not from a single cause. Obsessive-compulsive disorder (OCD) affects more than 2% of the population and generally the course of the illness is insidious and chronic. When functioning adequately, family constitutes a very important resource to face health problems and to help to improve the patient's life quality. This is the reason why it is important to underline the relevance of a stable, good functioning of the family system aimed at attaining an optimal development of all its members. Such development may be hindered by the family's incapability to modify functioning patterns at crucial moments when they are trapped in a series of inadaptable interactions which prevent to give specific solutions to the problems that are appearing, and when reporting, within a context of expressed emotion, an emotional over-involvement and high levels of hostility and criticism towards the member with OCD. Family accommodation is a phenomenon typical of families where the identified patient exerts a control based on aggressiveness when his/her wishes are not rewarded within the group. There are very few researches on the functioning of families of patients diagnosed with obsessive-compulsive disorder. Generally, these researches are related with the partially negative effects that the interactions have on the behavior of patients and their relatives by preventing or hindering the development of the subject's system. The accordance between the patient's emotional regulation or emotional intelligence and their relatives has not been studied. On the other hand, the knowledge of the beliefs that relatives hold regarding the illness may be related with the functioning of the group as a family, whereas beliefs will provide consistency to family life because they provide continuity between past, present and future. They are also a way to address new and ambiguous situations such as mental illness. This is the reason why getting to know these family systems may allow elaborating more specific and effective intervention programs for groups and families. Objective To determine the family types through a member identified with obsessive-compulsive disorder; to compare the emotional intelligence profile between patients and relatives according to the perceived type of family; to compare the relatives' beliefs toward the illness according to the perceived type of family. Material and methods A sample of patients and their families with obsessive-compulsive disorder was obtained from those who were sent by the doctor in charge of their treatment to participate in a model of group therapy for OCD, consisting of cognitive behavioral theory, practices and psychoeducation. During the first session patients and their relatives answered the following instruments: Family Adjustment and Cohesion scales (FACES-II) by Olson, Profile of Emotional Intelligence (PIEMO) by Cortés et al., Beck Inventory of Anxiety. Relatives answered too the Beliefs and Attributions Questionnaire by Salorio et al. In addition, data on family structure was complied. The sample was constituted by 48 patients and 61 relatives. All instruments were self-applied. Once that the type was obtained according to the Olson's circumflex model, the emotional profile, the anxious and the depressive symptoms were compared through factorial 2x3 ANOVA. Beliefs and attributions were compared through simple ANOVA. Results Three types of families were determined as follows: high cohesion with chaotic standards for expressing emotions and ideas; high cohesion with a rigid expression of ideas and emotions; low cohesion with a little expression of ideas and emotions. Different profiles of emotional intelligence were found not only for patients but also for relatives, in each family type. Families with high cohesion and high adjustment appear as most emotionally intelligent, less anxious and depressed, and with beliefs more attuned to reality. This type of family function was the less frequent. For beliefs and illness attributions, it was observed that comprehension of the disorder increases in proportion to a higher family adaptation, while the tendency of family members to experience feelings of guilt either towards themselves or towards the patient is decreased. As a result, the perception of experiencing the patient's illness as a nuisance disappears. With regard to the results of the Beck scales, family members perceived a high cohesion and low adaptation had higher scores for depression and anxiety. In patients who show high levels of depression and anxiety perceive family functioning as a rigid structure, with little prospect of change and interaction that prevents growth (high cohesion, low adaptation), and in those perceived isolation, without significant emotional ties with other family members and with the rigidity that prevents problem situations. Conclusions The results obtained are congruent with Olson's statements in regard to family functioning in the specific case of obsessive- compulsive disorder; these findings permit to understand the family dynamics which may typify the symptoms in the identified patients, and also to explain the adjustment situation described in literature. Family intervention is justified, stressing the handling of emotions as an important element to be considered in order to obtain higher therapeutic benefits for the patient. This study found differences in adjustment between patients and their families, do not perceive the need for flexibility in the operation of the system to find solutions that do not perpetuate and sustain interactions that reinforce symptoms. As for depression and anxiety, similar levels in either condition may be observed, thus confirming the close relationship between both. It was found that in patients and relatives, higher levels of family adaptation correspond to lower levels of depressive and anxious symptoms. One of the first approaches to the dynamics of these systems must be headed towards the family systems of beliefs, as the ideas that family members hold regarding the importance of their participation in the whole process of the illness has an impact in its course. Many families have rigid systems that make them more vulnerable to the fluctuations that this illness presents since for their members it is important and decisive to have control over the ailment. Families with flexible systems of beliefs are more prone to experience losses with a feeling of acceptance and therefore it is easier for them to let their members to implement changes in their functioning, thus compensating and overcoming their limitations. In this sense it is important to attain a therapeutic collaboration relationship that may create within the family a sense of realistic control and may help also to put into action the system's capabilities to promote improvement. This idea allows for openness in the system that may lead it to consider that there are more efficient operational measures that those applied to date.

Los problemas de salud mental y específicamente los trastornos mentales se desarrollan a partir de un complejo sistema biopsicosocial y difícilmente se puede identificar una causa única. El trastorno obsesivo compulsivo (TOC) afecta a más de 2% de la población y en general el curso de la enfermedad es insidioso y crónico. La familia es un importante recurso para enfrentar los problemas de salud y facilitar el mejoramiento de la calidad de vida del paciente, cuando su funcionamiento es adecuado. Existen pocas investigaciones realizadas sobre el funcionamiento de las familias de pacientes diagnosticados con trastorno obsesivo-compulsivo. Generalmente estas investigaciones están relacionadas con los efectos potencialmente negativos que dichas interacciones tienen en las conductas de pacientes y familiares que impiden u obstaculizan el desarrollo del sistema y de los individuos. La concordancia de la regulación emocional o inteligencia emocional de los pacientes y sus familiares no ha sido estudiada. Por otra parte el conocimiento de las creencias sobre la enfermedad por parte de los familiares puede estar relacionado con el funcionamiento del grupo como familia. Es por ello que el conocimiento de estos sistemas familiares podrá permitir estructurar programas de intervención grupal o familiar más específicos y eficaces. Objetivo Determinar la tipología de las familias con un miembro identificado con trastorno obsesivo compulsivo, comparando tres aspectos: 1) El perfil de inteligencia emocional entre pacientes y familiares según el tipo de familia percibido. 2) La ansiedad y depresión entre pacientes y familiares según el tipo de familia percibido y 3) Las creencias de los familiares hacia la enfermedad según el tipo de familia percibido. Material y métodos Se obtuvo una muestra de pacientes y sus familiares con trastorno obsesivo compulsivo (TOC) los que fueron enviados por su médico tratante a participar en el modelo terapéutico grupal para TOC, que consiste en Teoría y Técnicas cognitivo conductuales y psicoeducativas. Durante la primera sesión los pacientes y sus familiares acompañantes contestaron los siguientes instrumentos: Escala de cohesión y adaptación familiar (FACES-II) de Olson et al., Perfil de Inteligencia Emocional (PIEMO 2000) de Cortés et al., Inventario de Ansiedad de Beck, Inventario de depresión de Beck. Los familiares contestaron además el Cuestionario de Creencias y Atribuciones sobre la enfermedad de Salorio et al. Además se recabaron datos sobre la estructura familiar. La muestra se conformó por 48 pacientes y 61 familiares. Todos los instrumentos fueron autoaplicados. Una vez obtenida la tipología según el modelo circumplejo de Olson se compararon el perfil emocional y los síntomas ansiosos y depresivos por medio de ANOVA factorial 2x3. Las creencias y atribuciones se compararon por medio de ANOVA simple. Resultados Se determinaron tres tipos de familia: 1. Las de alta cohesión con lineamientos caóticos para la expresión de emociones e ideas. 2. Las de alta cohesión con rigidez en la expresión de ideas y emociones y 3. Las de baja cohesión con escasa expresión de ideas y emociones. Se encontraron perfiles de inteligencia emocional diferentes tanto para pacientes como para familiares en cada uno de los tipos de familia. Las familias con alta cohesión y adaptación se manifiestan como las más inteligentes emocionalmente, menos ansiosas y deprimidas y con creencias más apegadas a la realidad. Sin embargo, este grupo fue el menos frecuente. Conclusiones Los resultados obtenidos son coherentes con los planteamientos de Olson en relación al funcionamiento de las familias. En el caso específico del trastorno obsesivo-compulsivo estos hallazgos permiten entender la dinámica familiar que pudiera caracterizar el mantenimiento de la sintomatología en los pacientes identificados. La intervención familiar es un elemento importante a considerar para obtener mayores beneficios terapéuticos para el paciente.

Estudio comparativo de las características clínicas, demográficas y el funcionamiento familiar en niños y adolescentes con trastorno obsesivo-compulsivo leve a moderado vs. grave / Children and adolescents with mild vs. severe Obsessive-Compulsive Disorder: a comparative study

Obsessive-compulsive disorder (OCD) is a prevalent neuropsychiatric disorder in children, adolescents and adults. Prevalence rates of 2% to 4% have been reported. Despite the presence of effective treatments, underdiagnosis in children and adolescents is frequent. In addition, OCD is frequently comorbid with externalizing disorders such as attention deficit hyperactivity disorder (ADHD) and anxiety disorders such as generalized anxiety disorder (GAD), panic disorder, social phobia and separation anxiety disorder. Comorbidity with affective disorders is frequent too. The OCD association with major depressive disorder (MDD) increases in adolescence, reaching similar rates in adults. The comorbidity and other clinical variables, such as the duration of illness, have been mentioned as predictors of severity and treatment response. An erratic family functioning has also been associated to the severity of the illness. The aim of this study was to determine if there were differences in demographic variables (sex and age), clinical variables (age onset of the illness and comorbid disorders) and family functioning between children and adolescents with mild/moderate vs. severe OCD. Methods In a comparative cross sectional design, 60 children and adolescents aged 6 to 1 7 years, who met criteria for OCD and were drug naive, were assessed. Subjects who were unable to complete the interviews or had severe neurological or medical comorbidities were excluded. Subjects were recruited at the inpatients and outpatients services of the Child Psychiatric Hospital Dr. Juan N. Navarro (HPIJNN). Trained physicians interviewed the subjects and their parents using the Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL), the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Global Assessment of Functioning Scale (GAS) and the family APGAR rating scale. Based on CY-BOCS scores, the sample was divided in mild/moderate OCD (CY-BOCS < 30 points) and severe OCD (CY-BOCS > 30 points). Statistical analyses: Descriptive statistics (frequencies, means, standard deviation) and comparative (t student and Chi square) were used. Univariate analysis and linear regression were conducted for assessing factors associated with OCD severity. Results The sample had a mean age of 12.57±2.91 years old, they were 71.7% male. The mean duration of their illness was 19±10.75 months. The average score of CY-BOCS was 22.76±8.66, family APGAR 14.68±6.02 and GAS 54.91±15.05. A relative with OCD symptoms was reported by 23.3% of the sample; in these relatives, the most common symptoms were those related to contamination fears and washing (1 6%), symmetry and order (6.6%), checking (3.3%) and hoarding (1.6%). The mean number of comorbid disorders was 3.1 6±1.68. The most frequent were MDD, ADHD and GAD. The internalizing disorders were reported as secondary to OCD. The most common obsessions in the sample were those related to contamination and germs 60% (n = 37), followed by fears to harm 58% (n = 35), somatic 26.7% (n= 1 6) and symmetry 20% (n = 12). The most common compulsions were washing 50% (n = 30), repeating 43% (n = 26) and checking 35% (n = 21). Six subjects reported contamination thoughts or rituals-related enuresis and encopresis (fear of contamination when using the bathroom or doing it only at a specific time). The main reason for attention seeking was the presence of anxiety or depressive symptoms (48%), externalized symptoms (27%), OCD symptoms (20%) and psychotic symptoms (5%). The KSADS-PL interview showed that 26% (n= 1 6), 33% (n = 20) and 43% (n = 26) of the sample reported academic, social and family dysfunction respectively. When the sample was divided according to their severity, 81.7% (n= 48) belonged to the mild/moderate OCD group and 18.3% (n = 1 1) to the severe OCD group; this had a shorter duration of illness (16.54±5.3, vs. 19.73±11.5 months; t= 0.913, df=58, p=0.003). The comparison of demographic characteristics, OCD in family members, and family functioning showed no differences between severity groups. Significant differences on rituals between groups were found, since they were reported in 45% of the severe OCD group and in 4% of the mild/moderate OCD group (%² = 14.9, df=1, p= 0.001). Although the severe OCD group had shorter duration of illness, some symptoms were present for a longer time than in the mild/moderate OCD group: checking (12.6±3 vs. 2.4±4.3 months, t = 3.58, df=58, p = 0.001), repeating (8.3±12 vs. 3.4±5.1 months, t = 2.1, df=58, p = 0.03) and the inclusion of others in their rituals (20.34±1 .7 vs. 2.6±4.4 months, t = 2, df = 58, p = 0.049). Two patients of the mild/ moderate OCD group and one of the severe OCD group were affected with schizophreniform disorder. Psychotic symptoms secondary to OCD were found only in the severe OCD group (45.5%). The main reason for attention seeking of the severe OCD group was the presence of obsessions and compulsions, and in the mild/ moderate OCD group the presence of internalized disorders. Univariate analysis showed that counting compulsions (F=7.27, p = 0.01) and rituals (F = 1 7.24, p = 0.000) were related to OCD severity. However, the linear regression model showed that only the presence of rituals predicted the severity of OCD (B = 0.591, t = 4.1, p<0.001). Discussion The studied sample represents 2.7% of the patients who were evaluated during a seven-month period at the HPIJNN, the inclusion of a screening instrument for OCD would be helpful for the identification of obsessions and compulsions in clinical samples of children and adolescents. The demographic characteristics of the present sample were similar to those reported in previous studies of pediatric OCD. The duration of illness reported by this sample suggests an age of onset around 10 years old; the frequency of obsessions and compulsions reported were also similar to those in other samples. In particular, compulsions without obsessions and the rituals involving others. Almost all the studied patients had comorbid disorders, which in many cases lead their attention seeking. It has been observed that subjects with severe obsessions regarding contamination and aggression seek for help more frequently than patients with other symptoms. Rituals were more frequently seen in patients with severe OCD; these symptoms have been associated to alterations in executive functions and have been related with psychosocial dysfunction. Conclusions: Subjects of the mild/moderate OCD group sought attention mainly due to the symptoms of comorbid disorders. Subjects with severe OCD had a shorter duration of illness and more frequency of psychotic symptoms. In the present sample, rituals predicted the severity of OCD (B = 0.591, t = 4.1, p<0.001).

El trastorno obsesivo-compulsivo (TOC) es un trastorno neuropsiquiátrico que afecta a niños, adolescentes y adultos. La prevalencia del TOC en población pediátrica se ha reportado en 2 a 4%. Pocos pacientes con TOC obtienen un diagnóstico correcto y reciben tratamiento adecuado. El TOC en niños y adolescentes se presenta frecuentemente en forma comórbida con otras patologías como trastorno por déficit de atención con hiperactividad, trastornos ansiosos y depresivos. La comorbilidad y otras variables clínicas y de funcionamiento familiar se han asociado a un incremento en la gravedad del TOC y pobre respuesta a tratamiento. Existe poca información acerca de las variables asociadas a la gravedad del TOC en niños y adolescentes mexicanos. El objetivo del presente trabajo fue comparar las variables demográficas (edad y sexo), clínicas (edad de inicio de la enfermedad y comorbilidad) y el funcionamiento familiar entre pacientes con TOC leve a moderado y TOC grave. Se obtuvo una muestra de 60 pacientes de seis a 1 7 años con diagnóstico de TOC vírgenes a tratamiento. Se excluyó a pacientes con trastornos neurológicos y/o médicos graves y a los que no concluyeron las evaluaciones. La muestra se dividió de acuerdo con la calificación obtenida en la escala para niños y adolescentes de síntomas obsesivo-compulsivos Yale-Brown (CY-BOCS) en TOC leve a moderado (CY-BOCS<30 puntos) y TOC grave (CY-BOCS>30 puntos) para comparar sus características demográficas y clínicas. Los pacientes se evaluaron con la entrevista diagnóstica K-SADS-PL, la escala de funcionamiento global (GAS), la escala CY-BOCS para determinar la gravedad del TOC pediátrico y el APGAR familiar para funcionalidad familiar. Los resultados se analizaron por medio de estadística descriptiva (frecuencias, porcentajes y promedios) y comparativa (prueba t de Student y chi cuadrada); para determinar los factores asociados a la gravedad, se emplearon análisis de varianza univariado y regresión lineal. Resultados La mayor parte de la muestra (71.7%) fueron varones, el promedio de edad fue de 12.57±2.91 años y el tiempo de evolución del TOC fue de 19±10.75 meses. La mayoría de los pacientes (81.7%) perteneció al grupo de TOC leve a moderado y 18.3% al grupo de TOC grave. Este grupo reportó menor tiempo de evolución que el grupo de TOC leve a moderado (p = 0.003), mayor frecuencia de rituales y mayor duración de las compulsiones de revisión, repetición y realización de rituales incluyendo a otros. El trastorno esquizofreniforme se presentó en dos pacientes del grupo de TOC leve y en un paciente del grupo de TOC grave. Los síntomas psicóticos secundarios a TOC se encontraron sólo en los pacientes con TOC grave (45.5% de este grupo). En este grupo las obsesiones y compulsiones llevaron a la búsqueda de atención psiquiátrica a la mayoría de los pacientes; mientras que en el grupo de TOC leve a moderado la búsqueda de atención se debió a los síntomas de trastornos depresivos o ansiosos. El modelo de regresión lineal mostró que la realización de rituales predecía la pertenencia al grupo de TOC grave (p<0.001). Conclusiones Los pacientes con TOC leve a moderado acudieron a consulta principalmente por la presencia de los trastornos comórbidos. Los pacientes con TOC grave reportaron menor duración de la enfermedad y mayor frecuencia de síntomas psicóticos relacionados con el TOC. En esta muestra, la presencia de rituales predijo la gravedad de los síntomas obsesivo-compulsivos.