Estimulación cerebral profunda: tratamiento para pacientes con diagnóstico de trastorno obsesivo-compulsivo resistente / Deep brain stimulation: treatment for patients diagnosed with disorder obsessive-compulsive resistant

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)

Pharmacotherapy of obsessive-compulsive disorder during pregnancy: a clinical approach

Obsessive-compulsive disorder (OCD) is a relatively common psychiatric disorder in the perinatal period. However, specific pharmacological treatment approaches for patients with OCD during pregnancy have not been satisfactorily discussed in the literature. In addition, there are no randomized controlled studies on the treatment of this disorder during pregnancy. The present paper discusses the pharmacological treatment of OCD in the light of data on the safety of antipsychotics and serotonergic antidepressants during pregnancy and their efficacy in the non-perinatal period. Treatment decisions should be individualized because the risk-benefit profile of pharmacotherapy is an important issue in the treatment of pregnant women with any psychiatric diagnosis.

Efectividad y seguridad del escitalopram comparado paroxetina fluvoxamina, clomipramina para pacientes mayores de 16 años con diagnóstico de Trastorno Obsesivo Compulsivo / Effectiveness and safety of escitalopram compared to paroxetine fluvoxamine, clomipramine for patients over 16 years of age with a diagnosis of Obsessive Compulsive Disorder

Introducción: se estima que la prevalencia del Trastorno Obsesivo Compulsivo (TOC) en la población general es de 1.6% (1), siendo uno de los principales trastornos que afecta a niños y adolescentes. Estudios realizados en Colombia muestran mayor incidencia de este trastorno en las mujeres con respecto a los hombres, evidenciándose una fuerte relación con episodios psicóticos y otros tipos de trastornos como la esquizofrenia. Objetivo: esta evaluación de tecnología tiene como objetivo examinar los beneficios y riesgos del uso del Escitalopram en el Trastorno Obsesivo Compulsivo, como uno de los criterios para informar la toma de decisiones relacionada con la posible inclusión de tecnologías en el Plan Obligatorio de Salud, en el marco de su actualización integral para el año 2015. Metodología: a partir de la pregunta PICO se establecieron los criterios de elegibilidad para la realización de la búsqueda de la evidencia científica (ensayos clínicos, revisiones sistemáticas de estudios observacionales y estudios de cohortes analíticas). Se realizó la tamización y selección de la evidencia evaluando su calidad y posteriormente se realizó la extracción de datos y la síntesis de la evidencia. Resultados: Se identificaron dos experimentos clínicos con asignación aleatoria, controlados por placebo, para evaluar la efectividad y tolerabilidad del Escitalopram en el manejo del TOC, sin embargo, ambos estudios se encontraban fuera del rango de fechas establecidas para la búsqueda de la literatura, por lo que no fueron considerados para la elaboración del presente informe. Uno de los experimentos clínicos realizado con Escitalopram fue incorporado en una revisión sistemática y un meta-análisis más recientes. El propósito del meta-análisis fue evaluar la relación dosis-respuesta de los Inhibidores Selectivos de la Recaptación de la Serotonina con la tasa de mejoría de los pacientes medido como el cambio promedio en la escala Y-BOC. Los resultados sugieren que altas dosis de ISRS son más efectivas para el tratamiento de esta enfermedad (F = 10,8, df = 3, P <0,001). Asimismo, no hubo una tendencia significativa en términos de la proporción de abandonos relacionadas a la dosis del ISRS (X2 = 1,6, df = 1, p = 0,20). Ninguna de las diferentes categorías de dosis de ISRS difería de placebo, o entre sí, en términos de la proporción de causas abandonos de la terapia. Conclusiones: los pocos experimentos clínicos ejecutados a la fecha en el TOC, están focalizados en demostrar la efectividad de los Inhibidores Selectivos de la Recaptación de la Serotonina como un grupo, por lo que no se ha acumulado un cuerpo de evidencia suficiente para establecer le efectividad de cada uno de estos medicamentos de manera más específica. Varios estudios se han ejecutado para investigar algunos aspectos más generales de los ISRS, como por ejemplo la utilidad de emplear estos medicamentos a altas dosis para mejorar el índice de respuesta de los pacientes a estos tratamientos. En dos experimentos clínicos registrados hasta la fecha, el Escitalopram mostró ser más efectivo en comparación con el placebo en el tratamiento del TOC, además de ser bien tolerado por los sujetos durante terapias de largo término.(AU)

Obsessive-compulsive (anankastic) personality disorder: toward the ICD-11 classification

Obsessive-compulsive personality disorder (OCPD) is an early-onset disorder characterized by perfectionism, need for control, and cognitive rigidity. Its nosological status is currently under review. Historically, OCPD has been conceptualized as bearing a close relationship with obsessive-compulsive disorder (OCD). In this article, we discuss the diagnosis of OCPD in anticipation of its review for the ICD-11, from the perspective of clinical utility, global applicability, and research planning. Considering the recent establishment of an obsessive-compulsive and related disorders (OCRD) category in DSM-5, we focus on the relationship between OCPD and the disorders that are currently thought to bear a close relationship with OCD, including DSM-5 OCRD, and other compulsive disorders such as eating disorder and autistic spectrum disorder (that were not included in the DSM-5 OCRD category), as well as with the personality disorders, focusing on nosological determinants such as phenomenology, course of illness, heritability, environmental risk factors, comorbidity, neurocognitive endophenotypes, and treatment response. Based on this analysis, we attempt to draw conclusions as to its optimal placement in diagnostic systems and draw attention to key research questions that could be explored in field trials.

Endophenotypes and serotonergic polymorphisms associated with treatment response in obsessive-compulsive disorder

OBJECTIVES: Approximately 40-60% of obsessive-compulsive disorder patients are nonresponsive to serotonin reuptake inhibitors. Genetic markers associated with treatment response remain largely unknown. We aimed (1) to investigate a possible association of serotonergic polymorphisms in obsessive-compulsive disorder patients and therapeutic response to selective serotonin reuptake inhibitors and (2) to examine the relationship between these polymorphisms and endocrine response to intravenous citalopram challenge in responders and non-responders to serotonin reuptake inhibitors and in healthy volunteers. METHODS: Patients with obsessive-compulsive disorder were classified as either responders or non-responders after long-term treatment with serotonin reuptake inhibitors, and both groups were compared with a control group of healthy volunteers. The investigated genetic markers were the G861C polymorphism of the serotonin receptor 1Dβ gene and the T102C and C516T polymorphisms of the serotonin receptor subtype 2A gene. RESULTS: The T allele of the serotonin receptor subtype 2A T102C polymorphism was more frequent among obsessive-compulsive disorder patients (responders and non-responders) than in the controls (p<0.01). The CC genotype of the serotonin receptor subtype 2A C516T polymorphism was more frequent among the non-responders than in the responders (p<0.01). The CC genotype of the serotonin receptor subtype 1Dβ G681C polymorphism was associated with higher cortisol and prolactin responses to citalopram (p<0.01 and p<0.001, respectively) and with a higher platelet-rich plasma serotonin concentration among the controls (p<0.05). However, this pattern was not observed in the non-responders with the same CC genotype after chronic treatment with serotonin reuptake inhibitors. This CC homozygosity was not observed in the responders.

Association study between genetic monoaminergic polymorphisms and OCD response to clomipramine treatment / Estudo de associação entre polimorfismos genéticos monoaminérgicos e resposta à clomipramina no tratamento do TOC

In the present paper, we investigated the 5HTTLPR and STin2 polymorphisms in the promoter region of the serotonin transporter gene (SLC6A4), the G861C polymorphism (rs6296) of the serotonin receptor 1D beta (HTR1B), the T102C (rs6113) and C516T (rs6305) polymorphisms of the serotonin receptor gene subtype 2A (HTR2A), the DAT UTR, DAT intron 8 and DAT intron 14 of the dopamine transporter gene (SLC6A3), the Val-158-Met (rs4680) polymorphism of the COMT and the silent mutation G1287A (rs5569) in the norepinephrine transporter gene (SLC6A2). We genotyped 41 obsessive-compulsive disorder (OCD) outpatients, classified as good-responders (n=27) and poor-responders (n=14) to treatment with clomipramine according to the Yale Brown Obsessive-Compulsive Scale (YBOCS). Patients who achieved a reduction in symptoms of 40 percent or more in YBOCS after 14 weeks of treatment were considered good-responders. Genotypes and alleles distribution of the investigated polymorphisms were compared between both groups. We did not find association between the studied polymorphisms and clomipramine response in our sample.

No presente estudo, investigaram-se os polimorfismos 5HTTLPR e STin2 da região promotora do gene transportador de serotonina (SLC6A4), o G861C (rs6296) do receptor de serotonina 1D beta (HTR1B), os polimorfismos T102C (rs6113) e C516T (rs6305) do gene do receptor da serotonina subtipo 2A (HTR2A), os polimorfismos UTR, intron 8 e intron 14 do gene transportador de dopamina (SLC6A3), o Val-158-Met (rs4680) da COMT e a mutação G1287A (rs5569) do gene do transportador de norepinefrina (SLC6A2). Foram genotipados 41 pacientes com transtorno obsessivo-compulsivo (TOC), classificados como bons-respondedores (n=27) e maus-respondedores (n=14) ao tratamento com clomipramina, por meio do uso da Escala de Sintomas Obsessivos-Compulsivos Yale Brown (YBOCS). Foram considerados bons-respondedores os pacientes que tiveram redução nos sintomas em 40 por cento ou mais na YBOCS, após 14 semanas de tratamento. A distribuição dos genótipos e alelos estudados foi comparada entre os dois grupos. Não foi encontrada associação entre estes polimorfismos investigados e a resposta à clomipramina na amostra estudada.

Altered Brain Activation in Ventral Frontal-Striatal Regions Following a 16-week Pharmacotherapy in Unmedicated Obsessive-Compulsive Disorder

Recent studies have reported that cognitive inflexibility associated with impairments in a frontal-striatal circuit and parietal region is a core cognitive deficit of obsessive-compulsive disorder (OCD). However, few studies have examined progressive changes in these regions following clinical improvement in obsessive-compulsive symptoms. To determine if treatment changes the aberrant activation pattern associated with task switching in OCD, we examined the activation patterns in brain areas after treatment. The study was conducted on 10 unmedicated OCD patients and 20 matched controls using event-related functional magnetic resonance imaging. Treatment improved the clinical symptoms measured by the Yale-Brown Obsessive Compulsive Scale and behavioral flexibility indicated by the switching cost. At baseline, OCD showed significantly less activation in the dorsal and ventral frontal-striatal circuit and parietal regions under the task-switch minus task-repeat condition compared with controls. After treatment, the neural responses in the ventral frontal-striatal circuit in OCD were partially normalized, whereas the activation deficit in dorsal frontoparietal regions that mediate shifting attention or behavioral flexibility persisted. It is suggested that altered brain activation in ventral frontal-striatal regions in OCD patients is associated with their cognitive flexibility and changes in these regions may underlie the pathophysiology of OCD.

Acomodação familiar e criticismo percebido em pacientes com transtorno obsessivo-compulsivo / Family accommodation and perceived criticism in patients with obsessive-compulsive disorder

OBJETIVO: O transtorno obsessivo-compulsivo (TOC) causa importante impacto sobre a dinâmica familiar. Frequentemente, ocorrem modificações na rotina da família, a qual acaba se adaptando aos sintomas e às exigências do paciente, fenômeno denominado acomodação familiar. Portadores de TOC podem sentir-se, ainda, alvo de críticas por parte de pessoas de seu convívio. Alguns estudos associam pior prognóstico a maiores Índices de Acomodação Familiar e criticismo percebido. Este artigo tem como objetivo verificar possíveis associações entre tipos de sintomas predominantes (dimensões) determinados pela escala DYBOCS, em relação ao funcionamento familiar e percepção crítica dos pacientes. MÉTODO: Quarenta e nove pacientes e seus familiares foram avaliados por meio da aplicação de escalas para medição dos índices de criticismo percebido (Perceived Criticism Scale) e acomodação familiar (Family Accommodation Scale), além de escalas para medir a intensidade dos sintomas obsessivo-compulsivos (Dimensional Yale-Brown Obsessive-Compulsive Scale, Yale-Brown Obsessive-Compulsive Scale), depressivos e ansiosos (Hamilton and Beck depression and anxiety inventories). Compararam-se os resultados aos índices obtidos pela DYBOCS e a outras variáveis clínicas relacionadas ao TOC. RESULTADOS: Encontraram-se correlações estatísticas entre gravidade das dimensões agressividade e contaminação, com maior acomodação familiar. Foi verificado também maior criticismo por parte dos pacientes portadores de colecionismo. CONCLUSÃO: Diferentes subtipos de TOC exercem diferentes padrões de influência no contexto familiar. Mais estudos com esse enfoque são necessários para melhor orientação comportamental a pacientes e familiares.

OBJECTIVE: The obsessive-compulsive disorder causes significant impact on the family function, leading to changes in the routine of the family, which adapt itself according to the symptoms and the requirements of the patient, a family phenomenon known as accommodation. OCD patients may be still subject to criticism by those of its relationships. Some studies evince worse prognosis related to higher rates of family accommodation and perceived criticism. This paper aims to determine possible associations between types of predominant symptoms (dimensions determined by the scale DYBOCS) and the family accommodation and critical perception of the patients. METHOD: Forty-nine patients and their relatives were evaluated by the Perceived Criticism Scale, Family Accommodation Scale, the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale-Brown Obsessive-Compulsive Scale and the Hamilton and Beck depression and anxiety scales. RESULTS: There was significant statistical correlation between severities of the aggressive and contamination/ cleaning dimensions with higher family accommodation. There was also a higher perceived criticism for patients with hoarding. CONCLUSION: Different contents of obsessive-compulsive symptoms perform different patterns of influence in the family context. These results remain more speculation and studies with proper designs and sample size must be conducted.

Estrategias terapéuticas para el Trastorno Obsesivo-Compulsivo refractario al tratamiento / Therapeutic strategies for obsessive-compulsive disorder refractory to treatment

El trastorno obsesivo-compulsivo (TOC) constituye una enfermedad crónica incapacitante con profundas implicancias para el funcionamiento social. Todas las esferas vitales de los pacientes que padecen este trastorno se ven afectadas. El tratamiento con inhibidores de la recaptación de serotonina es efectivo en el 40 a 60 de los pacientes con TOC, transformando a un importante porcentaje de pacientes en no respondedores al tratamiento. Además, entre aquellos pacientes que responden, a menudo no se observa una remisión completa, la cual debería constituir el objetivo de todo tratamiento del TOC. Se describe como pacientes con TOC refractarios al tratamiento a aquellos que han recibido tratamientos adecuados de primera línea sin lograrse una respuesta satisfactoria. Se revisan en este artículo diferentes estrategias terapéuticas, convencionales y alternativas, para el abordaje de este grupo de pacientes.

Obsessive-compulsive disorder (OCD) is a chronic disabling disease with profound implications for social functioning. OCD affects all spheres of functioning of patients who suffer the disorder. Treatment with serotonin reuptake inhibitors is effective in 40 to 60 of patients with OCD, but a large percentage of patients are non responsive to treatment. Those patients who do respond often do not fully remit, which should be the standard goal of treatment in OCD. Treatment refractory patients with OCD are those who undergo adequate trials of first-line therapies without a satisfactory response. Conventional treatment and alternative treatment options for this population are reviewed.

Aspectos clínicos y terapéuticos del trastorno obsesivo compulsivo refractario al tratamiento antidepresivo / Clinical and therapeutic aspects of refractory obsessive compulsive syndrome

The obsessive compulsive disorder (TOC) is a clinical disorder which represents a challenge for therapists, since not only the acute clinical state but also its evolution shows difficulties in its treatment , with high figures of little response or frequent relapses. Antidepressants have been considered as the drugs of choice, using other biological techniques or psychotherapy in parallel form to the antidepressants or because of deficient response to the drugs. The optimization of treatment depends on the correct use of drugs, for the adequate time or the use of a combination of antidepressants. There has been use of antipsychotics, studies which require a longer space of time in order to establish a clinical answer. In actuality these states, together with others, have been incorporated to the concept specter of obsessive-compulsiveness, which in conjunction with new therapeutic procedures with more mythological evidence could be of help to these syndromes.

El Trastorno obsesivo compulsivo (TOC) es un cuadro clínico que representa un desafío para los terapeutas, pues tanto el cuadro clínico agudo como su evolución muestra dificultades en su tratamiento, con cifras altas de escasa respuesta o recaídas frecuentes. Los antidepresivos han sido considerados como los fármacos de primera elección, empleándose otras técnicas biológicas o psicoterapéuticas ya sea en forma paralela al uso de antidepresivos o bien luego de la falta de respuesta a estos fármacos. La optimización del tratamiento depende del correcto uso de los fármacos, por tiempos adecuados o el uso de combinaciones de antidepresivos. Se han utilizado antipsicóticos, estudios que requieren un plazo más prolongado para establecer su respuesta clínica. En la actualidad estos cuadros junto a otros han sido incorporados bajo el concepto de espectro obsesivo-compulsivo, que junto a nuevos procedimientos terapéuticos con mayor evidencia metodológica podrán ser de ayuda en estos trastornos.

Response of symptom dimensions in obsessive-compulsive disorder to treatment with citalopram or placebo

OBJECTIVE: There is increasing evidence that the symptoms of obsessive-compulsive disorder lie on discrete dimensions. Relatively little work has, however, explored the relationship between such factors and response to pharmacotherapy. METHOD: Data from a multi-site randomized placebo-controlled study of citalopram in obsessive-compulsive disorder were analyzed. Factor analysis of individual items and symptom categories of the Yale-Brown Obsessive-Compulsive Scale Checklist were undertaken, and the impact of symptom dimensions on treatment outcomes was analysed. RESULTS: Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist individual items yielded 5 factors (contamination/cleaning, harm/checking, aggressive/sexual/religious, hoarding/symmetry, and somatic/hypochondriacal). Hoarding/symmetry was associated with male gender, longer duration of obsessive-compulsive disorder and early onset, whereas contamination/cleaning was associated with female gender. Citalopram was more effective than placebo, but high scores on the symmetry/hoarding and contamination/cleaning subscales predicted worse outcome at the end of study while high scores on the aggressive/religious/sexual subscale predicted better outcome. Factor analysis of Yale-Brown Obsessive-Compulsive Scale Checklist symptom clusters yielded a 4 factor solution, but confirmed that symmetry/ordering was associated with male gender, early onset, and long duration of obsessive-compulsive disorder while high scores on the hoarding subscale predicted worse response to pharmacotherapy. CONCLUSION: Citalopram shows good efficacy across the range of obsessive-compulsive disorder symptom dimensions. The relatively worse response of symmetry/hoarding to a selective serotonin reuptake inhibitor is consistent with other evidence that this symptom dimension is mediated by the dopamine system. There may be associations between symmetry/hoarding, male gender, early onset, tics, and particular...

OBJETIVO: Há crescentes evidências de que os sintomas do transtorno obsessivo-compulsivo residem em dimensões discretas. Alguns estudos têm sugerido que esses fatores possuem suportes neurobiológicos específicos. No entanto, poucos trabalhos têm explorado a relação entre tais fatores e a resposta à farmacoterapia. MÉTODO: Foi realizada a análise fatorial dos itens individuais e categorias de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown e foi analisado o impacto da dimensão dos sintomas no desfecho dos tratamentos. RESULTADOS: A análise fatorial exploratória dos itens individuais da Escala de Obsessão e Compulsão de Yale-Brown produziu cinco fatores (contaminação/limpeza, dano/verificação, agressividade/sexual/religioso, colecionismo/simetria e somático/hipocondríaco). Colecionismo/simetria foi associado ao sexo masculino, longa duração do transtorno obsessivo-compulsivo e início precoce, ao passo que contaminação/limpeza foi associado ao sexo feminino. O citalopram foi mais eficaz do que placebo, mas altos escores nas subescalas de simetria/colecionismo e de contaminação/limpeza predisseram desfecho pior ao final do estudo, ao passo que altos escores na subescala agressividade/sexual/religioso predisseram melhor desfecho. Uma análise fatorial de sintomas do checklist da Escala de Obsessão e Compulsão de Yale-Brown produziu uma solução com quatro fatores, mas confirmou que simetria/ordenação estava associado ao sexo masculino, início precoce e longa duração do transtorno obsessivo-compulsivo, enquanto altos escores na subescala colecionismo predisseram uma resposta pior à farmacoterapia. CONCLUSÃO: O citalopram demonstra boa eficácia ao longo das dimensões do espectro de sintomas do transtorno obsessivo-compulsivo. A resposta relativamente pior de simetria/colecionismo a um inibidor seletivo da recaptação da serotonina é consistente com outras evidências de que essa dimensão de sintomas é mediada pelo sistema...

Resistência e refratariedade no transtorno obsessivo-compulsivo / Resistance and refractoriness in obsessive-compulsive disorder

OBJETIVO E MÉTODO: Apesar de existirem terapêuticas eficazes para o tratamento do transtorno obsessivo-compulsivo, uma parcela significativa dos pacientes acometidos por tal condição não alcança ou não mantém a remissão dos sintomas mesmo com tratamento adequado. O alívio do sofrimento destes pacientes com os tratamentos existentes representa um desafio para o clínico, que, nestas situações, se vê, freqüentemente, sem respostas satisfatórias. O objetivo desta revisão da literatura é avaliar os conceitos e critérios de resistência e refratariedade ao tratamento, abordar os aspectos intrínsecos e extrínsecos à fenomenologia descritiva do transtorno obsessivo-compulsivo que possam influenciar a resposta aos tratamentos convencionais preconizados, e propor um fluxo de alternativas terapêuticas para casos resistentes e refratários às diversas abordagens. CONCLUSÃO: A literatura evidencia que tanto aspectos intrínsecos à fenomenologia do transtorno obsessivo-compulsivo, quanto aspectos extrínsecos podem colaborar para que pelo menos 30 por cento dos pacientes não obtenham o resultado desejado. Várias alternativas de tratamento e/ou de potencialização, sejam psicofarmacológicas, biológicas ou psicoterápicas, estão disponíveis, mas vários estudos ainda são necessários para que as evidências apontem na direção mais adequada para a remissão dos sintomas.

OBJECTIVE AND METHOD: Despite the existence of effective therapeutic alternatives for obsessive-compulsive disorder, a significant number of patients does not achieve or does not maintain remission after adequate treatment. The relief of these patients’ suffering with the available treatments is a clinical challenge related to many unanswered questions. The objective of this literature review is to evaluate the current concepts of treatment resistance and refractoriness, to describe the intrinsic and extrinsic factors of obsessive-compulsive disorder’s phenomenology that might influence treatment response to conventional treatment, and to present a fluxogram of therapeutic alternatives for resistant or refractory obsessive compulsive disorder patients. CONCLUSION: The literature evinces that intrinsic and/or extrinsic phenomenological aspects of obsessive-compulsive disorder may collaborate to the fact that, at least 30 percent of obsessive-compulsive disorder patients do not respond to conventional treatment. Several therapeutic or augmentation alternatives, psychopharmacological, biological or even psychotherapeutical exists, but more studies are necessary to evince the correct way to symptom remission.

Terapias de base cognitivo-comportamental do transtorno obsessivo-compulsivo: revisão sistemática da última década / Cognitive-behavior therapy for obsessive-compulsive disorder: a systematic review of the last decade

OBJETIVO: Revisar de forma sistemática os estudos controlados e meta-análises que envolveram tratamento cognitivo ou comportamental do transtorno obsessivo-compulsivo publicados na última década. MÉTODO: Análise sistemática de ensaios clínicos randomizados e meta-análises indexados no Medline e PsycInfo. RESULTADOS: Os estudos avaliados confirmam que a exposição e prevenção de resposta e a terapia cognitiva são eficazes no tratamento do transtorno obsessivo-compulsivo de crianças, adolescentes e adultos. Em adultos, o uso concomitante de inibidores da recaptação da serotonina e exposição e prevenção de resposta ou terapia cognitiva não foi associado a um efeito adicional na resposta ao tratamento. No transtorno obsessivo-compulsivo infantil, o uso combinado de inibidores da recaptação da serotonina e exposição e prevenção de resposta foi superior aos dois tratamentos isoladamente. A exposição e prevenção de resposta associada à terapia cognitiva resultou em benefícios significativos em pacientes com predominância de pensamentos obsessivos e sua modalidade em grupo também produziu redução significativa dos sintomas obsessivos e compulsivos. CONCLUSÃO: Atualmente, as terapias de base cognitivo-comportamental são as mais adequadas para o tratamento do transtorno obsessivo-compulsivo; porém, mais estudos envolvendo follow-up em longo prazo, tratamento em grupo e uso concomitante de medicação são necessários.

OBJECTIVE To perform a systematic review of controlled trials and meta-analysis that involved cognitive and/or behavioral treatment for obsessive-compulsive disorder. METHOD: A systematic review of randomized controlled trials and meta-analysis published on the last decade and indexed on Medline and PsycInfo. RESULTS: Studies have confirmed that exposure and response prevention and cognitive therapy are effective methods for the treatment of obsessive-compulsive disorder in children, adolescents and adults. Among adults, the combined use of serotonin-reuptake inhibitors and exposure and response prevention or cognitive therapy was not associated with any additional therapeutic effect. Among children, the combination of serotonin-reuptake inhibitors and exposure and response prevention are superior to either treatment alone. Exposure and response prevention associated with cognitive therapy may result in significant benefits to patients with predominant obsessive thoughts and its group modality also reduces obsessive-compulsive symptoms. CONCLUSION: At the present time, cognitive and behavioral therapies have shown to be highly effective psychotherapeutic approaches for the treatment of obsessive-compulsive disorder. Nevertheless, more studies are still needed, mainly those focusing on long-term follow-up, group-treatment and the combined use with serotonin-reuptake inhibitors.