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Acta sci., Health sci ; 44: e56546, Jan. 14, 2022.
Article in English | LILACS | ID: biblio-1367534


The aim of the study is to determine the psychological well-being of patients who underwent stem cell transplantation. This cross-sectional study was conducted with 100 patients. Data were collected face-to-face using an introductory information form and the Brief Symptom Inventory.When the results of the patients were examined, the interpersonal sensitivity of the sub-dimensions of the scale was found to be 5.0 ± 4.06, depression 7.60 ± 5.37, and anxiety disorder 7.90 ± 5.34. There was a significant difference between the diagnosistime of the patients and all sub-factors of the scale, except phobic anxiety. It was found that the psychological state of the patients was directly related to the time of first diagnosis. As a result, the importance of following the psychological processof the patients during the treatment process was revealed when planning nursing care.

Humans , Male , Female , Adult , Middle Aged , Aged , Patients/psychology , Stem Cell Transplantation/nursing , Emotional Adjustment/ethics , Nursing Care/ethics , Anxiety Disorders/diagnosis , Anxiety Disorders/nursing , Anxiety Disorders/rehabilitation , Paranoid Disorders/diagnosis , Paranoid Disorders/nursing , Paranoid Disorders/therapy , Psychotic Disorders/diagnosis , Psychotic Disorders/nursing , Psychotic Disorders/therapy , Somatoform Disorders/diagnosis , Somatoform Disorders/nursing , Somatoform Disorders/therapy , Bone Marrow , Demography/statistics & numerical data , Cross-Sectional Studies , Depression/diagnosis , Depression/nursing , Hostility , Neoplasms/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/nursing , Obsessive-Compulsive Disorder/therapy
Arq. bras. neurocir ; 40(4): 333-338, 26/11/2021. tab
Article in English | LILACS | ID: biblio-1362075


Obsessive-compulsive disorder (OCD), a disabling chronic neuropsychiatric disease, entails high economic costs to society and has high morbidity and mortality rates. The first-line treatments for OCD are selective serotonin reuptake inhibitors and cognitivebehavioral therapy. However, this disorder has the highest refractory index to noninvasive treatment. Alternatively, ablative thermocoagulation neurosurgical techniques have shown efficacy and few adverse effects. The present systematic review aimed to identify validated protocols to observe the effectiveness of ablative procedures in the treatment of severe and refractory OCD, as well as their possible adverse effects and benefits. This review supports the effectiveness of ablative methods by presenting them as a safe non-experimental therapeutic option for cases of highlyrefractory OCD. Additional relevant findings were the improvement in cognitive function, functional capacity, affective orientation, and quality of life, which contribute to the destigmatization of this surgical technique. Further controlled studies may lead to the individualization of recommendations of targets for ablative thermocoagulation.

Electrocoagulation/psychology , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/therapy , Psychosurgery/methods , Electrocoagulation/methods , Obsessive-Compulsive Disorder/diagnosis
Article in Spanish | LILACS | ID: biblio-1411974


La terapia cognitivo conductual (TCC), es el tratamiento de elección para el trastorno obsesivo compulsivo (TOC), principalmente la exposición con prevención de respuesta (EPR). En pacientes que presentan TOC co-ocurrente con trastorno del espectro autista (TEA) se cree que la TCC tendría un menor efecto debido al empobrecimiento de la comprensión de las propias emociones y de la rigidez cognitiva de estos pacientes. A través de la siguiente revisión se busca evaluar la efectividad de la TCC en pacientes que tengan TOC en asociación a TEA en niños, adolescentes y adultos. Métodos: Se realizó una búsqueda de artículos, de los últimos 10 años, que abordasen la efectividad de la TCC en niños, adolescentes o adultos con TOC y TEA en conjunto. Resultados: A pesar de que no todos los estudios concuerdan en sus resultados, la mayoría de éstos, indican que hay efectividad en la TCC en disminuir la sintomatología del TOC en pacientes con TEA co-ocurrente tanto en niños como en adolescentes y adultos. Existen terapias de TCC con ciertas adaptaciones que mejorarían los resultados de estos pacientes al personalizar su tratamiento, por lo que se incentiva al mayor desarrollo de este tipo de terapias. Conclusión: Los estudios revisados respaldan que a pesar de la rigidez que presentan los pacientes con TEA co-ocurrente, la TCC es efectiva para tratar TOC en niños, adolescentes y adultos, especialmente al realizar adaptaciones de esta.

The treatment of choice for obsessive compulsive disorder (OCD) is cognitive behavioral therapy (CBT), mainly exposure with response prevention (ERP). In patients with OCD co-occurring with autism spectrum disorder (ASD), it is believed that CBT should have a lesser effect due to the impoverishment of the understanding of their own emotions and the cognitive rigidity of these patients. The following review seeks to evaluate the effectiveness of CBT in patients who have OCD in association with ASD in children, adolescents and adults. Methods: A search was carried out for articles, from the last 10 years, that addressed the effectiveness of CBT in children, adolescents or adults with OCD and ASD together. Results: Although not all studies agree on their results, most of these indicate that CBT is effective in reducing OCD symptoms in patients with co-occurring ASD in children, adolescents and adults. There are CBT therapies with certain adaptations that would improve the results of these patients by personalizing their treatment, which is why the further development of this type of therapy is encouraged. Conclusion: The reviewed studies support that despite the rigidity that patients with co-occurring ASD present, CBT is effective to treat OCD in children, adolescents and adults, especially when making adaptations to it.

Humans , Male , Female , Child , Adolescent , Adult , Cognitive Behavioral Therapy/methods , Autism Spectrum Disorder/therapy , Obsessive-Compulsive Disorder/therapy , Autism Spectrum Disorder/complications , Obsessive-Compulsive Disorder/complications
Trends psychiatry psychother. (Impr.) ; 43(2): 81-84, Apr.-June 2021.
Article in English | LILACS | ID: biblio-1290332


Abstract The COVID-19 pandemic is unquestionably impacting on the mental health of the population worldwide. Fear of contamination can both increase levels of stress in healthy individuals and intensify psychiatric symptoms in patients with pre-existing conditions, especially obsessive-compulsive disorder (OCD). During the COVID-19 pandemic, the imminent risk of contamination creates a logical need for self-surveillance and hygiene habits. However, this kind of information can have drastic implications for subjects with OCD, since cognitive distortions and compensatory strategies (cleansing rituals) are no longer irrational or oversized - rather, these ideas become legitimate and socially accepted, generating plausible validation for the intensification of compulsive cleaning rituals. Patients who presented remission of OCD symptoms would be more likely to have a relapse, and subclinical patients may scale up and ultimately be diagnosed with OCD due to the reinforcement of their habits, emotions and thoughts.

Humans , Communicable Disease Control , COVID-19/prevention & control , Obsessive-Compulsive Disorder/psychology , Cognitive Behavioral Therapy , Hand Disinfection , SARS-CoV-2 , Obsessive-Compulsive Disorder/therapy
Arch. Clin. Psychiatry (Impr.) ; 47(1): 1-6, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1088742


Abstract Background Obsessive-compulsive disorder is a challenging disease in terms of remission rates and treatment approaches. All theoretical approaches are needed for a better understanding. Compared to other theories, it has not been examined sufficiently from the perspective of gestalt theory in the literature. Objective To examine and compare the Gestalt Contact Styles of patients with obsessive-compulsive disorder (OCD) and the Control Group and to examine the relationship between Gestalt Contact Styles and OCD symptoms. Methods 50 OCD patients were compared with the healthy control group. All patients were evaluated with the Yale Brown Obsessive-Compulsive Scale (Y-BOCS), the Padua Inventory (PI), and the Gestalt Contact Styles Scale-Revised Form (GCSS-RF). For the control group, GCSS-RF was applied. Results The scores of the OCD patients for GCSS-RF "Retroflection" and "Deflection" subscales were significantly higher than the Control Group. Statistically significant high scores were found between the subscales of Padua Inventory "contamination obsessions and washing compulsions", "obsessional thoughts", "obsessional impulses" and "checking compulsions" subtypes and Gestalt contact styles in the Patient Group in a symptomatological examined manner. With these findings, in terms of Gestalt Contact Styles, it is seen that the difference between Patient and Control Groups is significantly different. There was no significant relationship between the Yale-Brown total score of the Patient Group and the GCSS-RF subscales. Discussion In conclusion, the findings of the study showed significant differences in terms of Gestalt Contact Styles (Retroflection, Contact, Deflection, Desensitization, Confluence) in Patient and Control Groups and OCD symptoms. These results are important to Gestalt Therapists in terms of shedding light on the therapeutic intervention to be done for an OCD patient and contributing to the literature.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Psychiatric Status Rating Scales , Communication , Gestalt Theory , Obsessive-Compulsive Disorder/psychology , Personality Inventory , Data Interpretation, Statistical , Statistics, Nonparametric , Defense Mechanisms , Obsessive-Compulsive Disorder/therapy
Rev. bras. neurol ; 55(4): 10-12, out.-dez. 2019.
Article in English | LILACS | ID: biblio-1095492


For many years, the cerebellum was thought to be only responsible for balance, movement, planning and execution. Nowadays, it is well accepted that most cerebellar connections are involved in non-motor functions. Herein, we provide a case report in which a 27-year-old Brazilian male, diagnosed with Obsessive-Compulsive Disorder (OCD), has demonstrated cerebellar features that could be connected to Spinocerebellar ataxia type 1 (SCA-1), an autosomal dominant polyglutamine neurodegenerative disorder that had been previously ruled out. Since obsessive compulsive symptoms (OCS) are known to correlate with alterations in the cortico-striato-thalamo-cortical circuitry, we propose a possible association between OCS and SCA onset.

Durante muitos anos, o cerebelo foi considerado responsável exclusivamente pelo controle das funções de equilíbrio, movimento, planejamento e execução. Atualmente, já está consagrada a participação das conexões cerebelares em funções não-motoras. Apresentamos um relato de caso de um paciente de 27 anos de idade, diagnosticado com Transtorno Obsessivo-Compulsivo (TOC). O paciente apresentava sintomas cerebelares compatíveis com o diagnóstico de ataxia espinocerebelar tipo 1 (SCA-1), um distúrbio da poliglutamina, autossômico dominante neurodegenerativo, que havia sido previamente descartado. Como os sintomas obsessivos compulsivos (SOC) são conhecidos por correlacionar-se com alterações nos circuitos cortico-estriato-tálamo-cortical, propomos uma possível associação entre o SOC e o início da SCA.

Humans , Male , Adult , Spinocerebellar Ataxias/complications , Spinocerebellar Ataxias/diagnosis , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/therapy , Genetic Testing , Gait Ataxia , Dysarthria , Ataxin-1/genetics , Neurologic Examination/methods
Rev. med. (Säo Paulo) ; 98(4): 273-278, jul.-ago. 2019.
Article in English | LILACS | ID: biblio-1023537


Obsessive-Compulsive disorder (OCD) is a common psychiatric condition that leads to significant impairment in everyday life. Advancements in neurobiological investigations contributed to a better understanding of pathophysiological mechanisms behind OCD, leading to the understanding that current models employed to conceptualize OCD are not adequate and might be a significant factor in precluding further advancements in how OCD is treated. In this paper, we will use OCD as a model to discuss the limitations of the current diagnostic systems in Psychiatry and to present the novel perspectives based on neurobiological findings that might lead to considerable advancements in treatments for OCD.

Neurobiology/trends , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/therapy
Rev. Hosp. Ital. B. Aires (2004) ; 39(2): 64-66, jun. 2019.
Article in Spanish | LILACS | ID: biblio-1048015


El trastorno obsesivo-compulsivo (TOC) afecta al 2% de la población general, llegando en ocasiones a causar un deterioro funcional severo y de la calidad de vida de las personas afectadas. Entre el 10 y el 30% de los pacientes con este trastorno no responde a los tratamientos recomendados: farmacológicos y terapia cognitivo-conductual. La Food and Drug Administration de los Estados Unidos (FDA) aprobó en el año 2008 la Estimulación cerebral profunda (ECP) para pacientes con TOC resistente a tratamiento. La ECP, utilizada frecuentemente para el tratamiento de la enfermedad de Parkinson refractaria, es una opción viable para los pacientes con TOC resistente, con efectos adversos poco frecuentes y transitorios. (AU)

Obsessive-compulsive disorder (OCD) affects 2% of the general population, sometimes resulting in severe impairment of functional capacity and quality of life of affected people. Between 10 and 30% of these patients do not respond to recommended treatments: pharmacological and cognitive behavioral therapy. In 2008, the FDA approved Deep Brain Stimulation (DBS) for patients with OCD resistant to treatment. DBS, frequently used for the treatment of refractory Parkinson's disease, is a viable option for the treatment of patients with resistant OCD, with infrequent and transient adverse effects. (AU)

Humans , Deep Brain Stimulation/methods , Obsessive-Compulsive Disorder/therapy , Patient Dropouts/statistics & numerical data , Quality of Life , Signs and Symptoms , Deep Brain Stimulation/adverse effects , Deep Brain Stimulation/trends , Mental Disorders/surgery , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/drug therapy
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 40(4): 420-423, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-959265


Objective: The beneficial effects of psychopharmacological and cognitive behavioral therapy (CBT) on the brain are not well understood. In a previous study, we found smaller pituitary volumes in patients with obsessive-compulsive disorder (OCD). The purpose of this study was to examine the effect of CBT on pituitary gland volume. Methods: A total of 81 patients with various anxiety disorders and the same number of healthy controls underwent magnetic resonance imaging, and their pituitary gland volumes were compared at baseline. Pituitary gland volumes were also measured before and after CBT in the patient group. Results: OCD patients had smaller pituitary gland volumes at baseline than healthy controls (0.54±0.29 cm3 for OCD patients vs. 0.82±0.30 cm3 for healthy controls; p < 0.001). We found no significant changes in OCD patient pituitary gland volume after the 16-week treatment period, with mean pre- and post-treatment values of 0.54±0.29 cm3 and 0.56±0.32 cm3, respectively (p > 0.05). Conclusion: Our results indicate an absence of post-CBT volumetric changes in the pituitary gland of OCD patients.

Humans , Male , Female , Adult , Young Adult , Pituitary Gland/anatomy & histology , Cognitive Behavioral Therapy/instrumentation , Obsessive-Compulsive Disorder/therapy , Organ Size/physiology , Pituitary Gland/diagnostic imaging , Severity of Illness Index , Magnetic Resonance Imaging , Cognitive Behavioral Therapy/methods , Treatment Outcome
Rev. Assoc. Med. Bras. (1992, Impr.) ; 64(11): 963-982, Nov. 2018. tab
Article in English | LILACS | ID: biblio-976806


The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.

Humans , Male , Female , Adult , Aged , Deep Brain Stimulation/methods , Depressive Disorder/therapy , Obsessive-Compulsive Disorder/therapy , Brazil , Treatment Outcome , Evidence-Based Medicine , Middle Aged
Trends psychiatry psychother. (Impr.) ; 39(4): 270-275, Oct.-Dec. 2017. tab
Article in English | LILACS | ID: biblio-904595


Abstract Introduction Comorbid obsessive-compulsive disorder (OCD) is common in bipolar disorder (BD). Clinical characteristics, functionality and familial pattern of this comorbidity are largely understudied. Objective To assess clinical profile, familial loading of psychiatric disorders and level of functioning in remitted BD patients who have comorbid OCD and to compare results with those of remitted BD patients without OCD. Methods Remitted BD-I subjects were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Family Interview for Genetic Studies (FIGS). BD patients with and without OCD were compared. Group differences were analyzed using the chi-square test and the independent samples t test. Values <0.05 were considered statistically significant. Results Of the 90 remitted BD-I patients, 35.5% (n=32) had obsessive-compulsive symptoms/OCD. The BD-OCD group showed significantly lower GAF scores, higher rates of suicidal attempts, hospitalizations, manic and depressive episodes compared to the group with BD only (p<0.05). In addition, first and second-degree relatives had higher rates of BD-OCD and OCD, but not of BD. Conclusions BD-OCD is characterized by more severe BD, more dysfunction and higher familial loading of BD-OCD and OCD. Larger studies involving relatives of probands will help to confirm our findings and to delineate nosological status of BD-OCD comorbidity.

Resumo Introdução Transtorno obsessivo-compulsivo (TOC) comórbido é comum no transtorno bipolar (TB). Características clínicas, funcionalidade e história familiar dessa comorbidade são pouco estudadas. Objetivo Avaliar o perfil clínico, a carga familiar de transtornos psiquiátricos e o nível de funcionalidade em pacientes com TB em remissão que apresentam TOC comórbido e comparar os resultados com aqueles obtidos em pacientes com TB em remissão sem TOC. Métodos Indivíduos com TB-I em remissão foram avaliados usando a Entrevista Clínica Estruturada para o DSM-IV- Transtornos do Eixo I, Escala de Avaliação Global do Funcionamento, Escala de Depressão de Hamilton, Escala de Mania de Young, Escala Obsessivo-Compulsiva de Yale-Brown e Entrevista Familiar para Estudos Genéticos. Pacientes com TB com e sem TOC foram comparados. Diferenças entre os grupos foram analisadas usando o teste do qui-quadrado e o teste t para amostras independentes. Valores <0,05 foram considerados estatisticamente significativos. Resultados Dos 90 pacientes com TB-I em remissão, 35,5% (n=32) tinham sintomas obsessivo-compulsivos/TOC. O grupo com TB-TOC mostrou escores significativamente mais baixos na Escala de Avaliação Global do Funcionamento, maiores taxas de tentativas de suicídio, hospitalizações, episódios maníacos e depressivos quando comparado ao grupo com apenas TB (p<0,05). Além disso, familiares de primeiro e segundo grau mostraram maiores níveis de TB-TOC e TOC, mas não de TB. Conclusões TB-TOC se caracteriza por TB de maior gravidade, mais disfunção e maior carga familiar de TB-TOC e TOC. Estudos maiores envolvendo familiares de probandos ajudarão a confirmar nossos achados e a delinear o status nosológico de TB-TOC comórbidos.

Humans , Male , Female , Adult , Bipolar Disorder/complications , Bipolar Disorder/epidemiology , Genetic Predisposition to Disease , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/epidemiology , Psychiatric Status Rating Scales , Suicide, Attempted , Bipolar Disorder/psychology , Bipolar Disorder/therapy , Family , Comorbidity , Prevalence , Cost of Illness , Hospitalization , Interview, Psychological , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy
Rev. neuro-psiquiatr. (Impr.) ; 79(4): 239-246, oct.-dic. 2016. tab
Article in Spanish | LILACS, LIPECS | ID: biblio-836263


Los antidepresivos serotoninérgicos, la farmacoterapia de primera lnea para el trastorno obsesivo-compulsivo (TOC), producen una respuesta cl¡nica favorable en 40-60% de los pacientes. Los medicamentos con eficacia en el tratamiento del TOC, seg£n los diversos mecanismos de acción, son: 1) sustancias que influyen sobre laserotonina: antidepresivos serotonin‚rgicos (inhibidores selectivos de la recaptación de serotonina y clomipramina), bloqueadores de los receptores 5-HT3 (ondansetrón y granisetr¢n) y antagonistas 5-HT1A (pindolol); 2) antipsicóticos: aripiprazol, risperidona y haloperidol; 3) anticonvulsivantes / estabilizadores del  nimo: lamotrigina; 4) farmacos relacionados con la función glutamatórgica: memantina, N-acetilciste¡na y ketamina; 5) anti-inflamatorios: celecoxib; 6) opi ceos: morfina; 7) farmacos que aumentan la funci¢n colinérgica; y 8) anti-andrógenos. Es de esperarse queen el futuro crezca el repertorio de alternativas farmacológicas para el tratamiento de esta entidad cl¡nica.

Serotoninergic antidepressants, the first line of pharmacotherapy for obsessive-compulsive disorder (OCD), induce afavorable clinical response in 40-60% of patients. Drugs that have shown efficacy for OCD treatment, on the basis of different mechanisms of action, are: 1) substance that work on serotonin: serotoninergic antidepressants (selective serotonin reuptake inhibitors and clomipramine), 5-HT3 receptor blockers (ondansetron and granisetron), and 5-HT1A antagonists (pindolol); 2) antipsychotic drugs: aripiprazole, risperidone and haloperidol; 3) anticonvulsant drugs / mood stabilizers: lamotrigine; 4) glutamatergic function-related drugs: memantine, N-acetylcysteine and ketamine; 5) anti-inflammatory drugs: celecoxib; 6) opioid drugs: morphine; 7) drugs that increase cholinergic function; 8) anti-androgen drugs. The repertoire of pharmacological alternatives for the treatment of OCD is expected to grow in the future.

Humans , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Drug Therapy , Obsessive-Compulsive Disorder/therapy
Braz. J. Psychiatry (São Paulo, 1999, Impr.) ; 38(4): 287-293, Oct.-Dec. 2016. tab, graf
Article in English | LILACS | ID: lil-798082


Objective: Exposure and response prevention (ERP) is effective to treat obsessive-compulsive disorder (OCD), but the lack of tolerance to the aversion nature of exposure techniques results in a high drop-out rate. There have been reports of a generic stress endurance effect of serotonin (5-HT) in the central nervous system (CNS) which might be explained by suppression of defensive fixed action patterns. Previous studies have proposed that higher baseline 5-HT concentration and slow decrease in concentration during drug treatment of OCD were predictors of good clinical response to 5-HT reuptake inhibitors. The objective of this study was to investigate whether pre-treatment platelet rich plasma (PRP) 5-HT concentration is associated with latency of treatment response and final response to an ERP protocol for obsessive-compulsive disorder (OCD). Methods: Thirty adult and treatment-free OCD patients were included in an 8-week, 16-session ERP protocol. 5-HT concentration was determined at baseline and after treatment. Patients with a reduction ≥30% on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at the end of ERP were defined as responders. Results: A positive correlation between baseline 5-HT concentration and reduction of symptoms on the Y-BOCS was observed after 4 weeks. Baseline 5-HT concentration was not correlated with clinical response after 8 weeks of ERP, possibly due to the similar though delayed clinical response of patients with lower (compared to those with higher) baseline 5-HT concentration. Patients with higher 5-HT baseline concentration also showed more improvement in depressive symptoms with treatment. Conclusion: The present results partially support the hypothesis of a stress endurance effect of 5-HT in OCD patients. According to the literature, fast onset responders possibly have more or larger 5-HT containing neurons, higher endogenous 5-HT synthesis or lower monoamine oxidase activity; all these hypotheses remain to be investigated.

Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Aversive Therapy , Blood Platelets/chemistry , Serotonin/blood , Cognitive Behavioral Therapy/methods , Serotonin Receptor Agonists/blood , Obsessive-Compulsive Disorder/therapy , Psychiatric Status Rating Scales , Severity of Illness Index , Biomarkers/blood , Follow-Up Studies , Treatment Outcome , Depression/diagnosis , Depression/therapy , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/blood
Bogotá; IETS; mayo 2016. 52 p. tab, ilus.
Monography in Spanish | BRISA, LILACS | ID: biblio-846429


Problema de investigación: Analizar los costos y la efectividad del escitalopram comparado con paroxetina, sertralina, fluoxetina, fluvoxamina y clomipramina como terapia de mantenimiento de primera línea en pacientes con trastorno obsesivo compulsivo en Colombia. Tipo de evaluación económica: Análisis de costo-efectividad. Población objetivo: Pacientes mayores de 18 años con diagnóstico de trastorno obsesivo compulsivo. Intervención y comparadores: Comparadores: paroxetina, sertralina, fluoxetina, fluvoxamina y clomipramina. Horizonte temporal: 32 semanas. Perspectiva: Sistema General de Seguridad Social en Salud (SGSSS). Tasa de descuento: No aplica. Estructura del modelo: Árbol de decisión. Fuentes de datos de efectividad y seguridad: Reporte de efectividad y seguridad, Ensayos clínicos aleatorios. Desenlaces y valoración: Años de vida ajustados por calidad (AVAC). Costos incluidos: Costo de los medicamentos, Costo de procedimientos, Costo de los eventos adversos. Fuentes de datos de costos: SISMED, Manual tarifario ISS 2001. Resultados del caso base: En el escenario del caso base, fluvoxamina, fluoxetina, paroxetina y clomipramina son dominados por sertralina y escitalopram. El costo por AVAC es $16.084.456 de escitalopram comparado con sertralina. Análisis de sensibilidad: Los análisis de sensibilidad y el diagrama de tornado mostraron que las variables con mayor impacto sobre las estimaciones de costo-efectividad del escitalopram son la probabilidad de respuesta y retiro por eventos adversos del medicamento sertralina. Conclusiones y discusión: Escitalopram parece ofrecer una mejor relación entre costos y efectividad respecto a sus comparadores. La principal limitación de este estudio se centra en la ausencia de ensayos clínicos de no inferioridad con un horizonte de largo plazo. La principal limitación de este estudio se centra en la ausencia de ensayos clínicos de no inferioridad con un horizonte de largo plazo.(AU)

Humans , Adult , Citalopram/administration & dosage , Preventive Maintenance , Fluoxetine/administration & dosage , Fluvoxamine/administration & dosage , Clomipramine/administration & dosage , Paroxetine/administration & dosage , Sertraline/administration & dosage , Obsessive-Compulsive Disorder/therapy , Technology Assessment, Biomedical , Health Evaluation/economics , Cost-Benefit Analysis/economics , Colombia , Drug Therapy, Combination
Bogotá; IETS; mayo 2016. 37 p. tab, graf.
Monography in Spanish | BRISA, LILACS | ID: biblio-846788


Tecnologías evaluadas: Nuevas: escitalopram, paroxetina, fluvoxamina y clomipramina\r\nActuales: sertralina y fluoxetina. Población: Pacientes mayores\tde\t18 años\tcon trastorno\tobsesivo\r\ncompulsivo en Colombia. Perspectiva: La perspectiva del presente AIP corresponde al tercer pagador,\r\nque en este caso es el Sistema General de Seguridad Social en Salud (SGSSS) en Colombia. Horizonte temporal: El horizonte temporal de este AIP en el caso base es de un año. Adicionalmente, se reportan las estimaciones del impacto presupuestal para los años 2 y 3, bajo el supuesto de la inclusión en el POS en el año 1. Costos incluídos: Costo por mg de los medicamentos. Fuente de costos: SISMED. Escenarios: En el escenario 1 se considera una igualación progresiva de las participaciones de mercado de todos los medicamentos analizados hasta llegar al año 3. En el escenario 2, además de una participación\tde\tmercado\tigual para\ttodos los medicamentos, se asume un precio común para las nuevas alternativas con base en la metodología de inclusión de grupos terapéuticos definida por el Ministerio de Salud y Protección\r\nSocia. Resultados: Para la inclusión en el POS de escitalopram, paroxetina, fluvoxamina y Clomipramina como terapia de mantenimiento para pacientes con diagnóstico de trastorno obsesivo ompulsivo en Colombia, se requeriría una inversión de $99.508.967.049 en el año 1 y de $ en el año 3. En el caso que los medicamentos del escenario nuevo sean incluidos con un precio igual basado en las metodología de grupos terapéuticos del Ministerio de Salud y protección Social, el impacto presupuestal\r\nse reduciría a $ en el año 1 y $19.887.249.147, en el año 3.(AU)

Humans , Adult , Preventive Maintenance , Obsessive-Compulsive Disorder/therapy , Citalopram/therapeutic use , Fluoxetine/therapeutic use , Fluvoxamine/therapeutic use , Clomipramine/therapeutic use , Paroxetine/therapeutic use , Colombia , Sertraline/therapeutic use , Costs and Cost Analysis/methods , Biomedical Technology
Summa psicol. UST ; 12(1): 111-120, 2015. tab
Article in Spanish | LILACS | ID: lil-783381


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)...

Humans , Male , Adolescent , Adult , Female , Young Adult , Middle Aged , Self Concept , Obsessive-Compulsive Disorder/psychology , Obsessive-Compulsive Disorder/therapy
Rev. bras. ter. comport. cogn ; 15(3): 37-56, dez. 2013. tab
Article in Portuguese | LILACS | ID: lil-717696


O Transtorno Obsessivo-Compulsivo (TOC) é um quadro caracterizado por obsessões e compulsões, provocando prejuízos em contextos sociais, familiares e de trabalho. O presente estudo teve como objetivo demonstrar a relevância de análises funcionais molares associadas ao instrumental da ACT, ilustrando com um caso clínico de TOC. Ao longo de 68 sessões, foi possível identificar padrões comportamentais amplos de comunicação agressiva, busca de controle e habilidade de argumentação verbal, funcionalmente relacionados ao TOC, bem como ampla sensibilidade a contextos sócio-verbais de literalidade e de dar razões, relacionados a forte padrão de esquiva experiencial. A compreensão das contingências atuais e históricas propiciaram a aceitação dos estados privados aversivos e o comprometimento com a exposição a contextos terapêuticos, no sentido de enfraquecer comportamentos funcionalmente semelhantes aos obsessivo-compulsivos, porém com menor relevância emocional, o que levou ao enfraquecimento dos sintomas de TOC e a melhorias nas relações com familiares e colegas de trabalho...

Obsessive-Compulsive Disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions, with losses in social, family and labor contexts. This study aimed to show the relevance of molar functional analyses associated to ACT interventions, illustrating it with a case of OCD. Along 68 sessions, it has been possible to identify ample behavior patterns of aggressive communication, search for control and verbal argumentation skills, functionally related to OCD symptoms, as well as ample sensitivity to social/verbal contexts of literality and reason giving, leading to a strong pattern of experiential avoidance. Understanding of current and historical contingencies led to the acceptance of aversive private states and commitment to the exposure to therapeutic contexts, in order to weaken behaviors that were functionally related to the obsessive-compulsive ones, but less emotionally relevant, which led to weakening of OCD symptoms and improvements in relationships with relatives and coworkers...

Humans , Acceptance and Commitment Therapy , Obsessive-Compulsive Disorder/therapy