Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic

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.

Obsessive-compulsive disorder reinforcement during the COVID-19 pandemic.

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.

Tratamento psicoterápico do transtorno obsessivo-compulsivo: perspectivas da terapia cognitivo-comportamental e terapia analítico-comportamental / Psychotherapeutic treatment of obsessive-compulsive disorder: perspectives of cognitive-behavioral therapy and analytical-behavioral therapy

A Terapia Cognitivo-Comportamental e a Terapia Analítico-Comportamental são as abordagens teóricas mais estudadas no Transtorno Obsessivo-Compulsivo e ambas demonstraram-se eficazes. A literatura sobre o TOC contempla as duas formas de psicoterapia e compara as técnicas mais utilizadas em casos graves do transtorno, que caracterizam-se como desafios que podem ocorrer durante o tratamento. Objetivos: Apresentar os modelos cognitivo e comportamental do TOC; assinalar os desafios no tratamento do TOC e expor as principais técnicas no tratamento do TOC. Método: Revisão assistemática da literatura através da base de dados Capes, Scielo, e livros da área. Resultados: Constatou-se que em ambas as abordagens o TOC apresenta dificuldades no seu tratamento, especificamente em relação às técnicas utilizadas pelas abordagens Cognitivista e Comportamental. Conclusões: No contexto acadêmico esta discussão ressalta a necessidade do terapeuta cognitivo estudar mais a fundo a análise do comportamento, visto que o mesmo utilizará técnicas fundamentadas na Análise do Comportamento.(AU)

Context: Cognitive-Behavioral Therapy and Analytic-Behavioral Therapy are the most studied theoretical approaches in Obsessive-Compulsive Disorder and have proven to be effective. The literature on OCD deals with both forms of psychotherapy and compares the techniques most used in severe cases of the disorder, which are characterized as challenges that may occur during treatment. Objectives: To present the cognitive and behavioral models of OCD; the challenges in treating OCD. Method: Asystematic review of the literature through the Capes database, Scielo, and area books. Results: It was found that in both approaches the OCD presents difficulties in the treatment, specifically in relation to the techniques used by the Cognitive and Behavioral approaches. Conclusions: In the academic context, this discussion highlights the need for the cognitive therapist to study behavioral analysis, since he will use techniques based on Behavior Analysis.(AU)

Crack-cocaine dependence and aging: effects on working memory.

OBJECTIVE: To compare the working memory (WM) performance of young adult crack-cocaine dependent users, healthy older adults, and a control group of healthy young adults. METHODS: A total of 77 female participants took part in this study: 26 young adult crack-cocaine dependent users (CRK), 19 healthy older adults (HO), and 32 healthy younger adults (HC). All participants completed the N-back verbal task. RESULTS: A multivariate analysis of covariance was performed. The model included education, income, and medication use as covariates. A group effect (F6,140 = 7.192, p < 0.001) was found. Post-hoc analyses showed that the performance of the CRK and HO groups was reduced compared to the HC group in two N-back conditions. No differences between the HO and CRK groups on WM performance were found. CONCLUSIONS: CRK participants perform similar to HO participants on a WM task, despite the well-known effects of age on WM and the young age of CRK. These data point to a possible parallel between cognitive declines associated with crack use and developmental aging.

Crack-cocaine dependence and aging: effects on working memory

Objective: To compare the working memory (WM) performance of young adult crack-cocaine dependent users, healthy older adults, and a control group of healthy young adults. Methods: A total of 77 female participants took part in this study: 26 young adult crack-cocaine dependent users (CRK), 19 healthy older adults (HO), and 32 healthy younger adults (HC). All participants completed the N-back verbal task. Results: A multivariate analysis of covariance was performed. The model included education, income, and medication use as covariates. A group effect (F6,140 = 7.192, p < 0.001) was found. Post-hoc analyses showed that the performance of the CRK and HO groups was reduced compared to the HC group in two N-back conditions. No differences between the HO and CRK groups on WM performance were found. Conclusions: CRK participants perform similar to HO participants on a WM task, despite the well-known effects of age on WM and the young age of CRK. These data point to a possible parallel between cognitive declines associated with crack use and developmental aging.

Childhood neglect and increased withdrawal and depressive severity in crack cocaine users during early abstinence.

Studies have shown that environmental factors, such as exposure to childhood maltreatment, might shift the course of addiction. Little is known, however, about whether childhood physical neglect (PN) influences the severity of withdrawal and depressive symptoms during the detoxification period. This is a 3 weeks follow-up study. The participants were divided into 2 groups: those with a history of PN (PN+) (n=32) and those without a history of PN (PN-) (n=48). Clinical variables were assessed with the SCID-I, BDI-II, Childhood Trauma Questionnaire, Addiction Severity Index and Cocaine Selective Severity Assessment. Depressive symptom assessments were repeated at three time points. Withdrawal symptom assessments were repeated at five different points following detoxification. A repeated measures analysis of covariance indicated that the PN+ group exhibited a significantly lower reduction in the severity of withdrawal symptoms compared to the PN- group (p<0.05). Post hoc analyses showed that after 12 days of treatment, the severity of withdrawal symptoms in the PN+ group did not decrease in the same level as was observed in the PN- group. Moreover, a strong correlation was found between the severity of depression and the intensity of the abstinence symptoms during treatment. Patients who reported more depressive symptoms also exhibited more severe withdrawal symptoms. The ASI-6 indicated higher severity problems related to alcohol and psychiatric disorders in the PN+ groups. Our data support the role of childhood PN in the contingencies of the detoxification process of crack cocaine-dependent women.

Hair cortisol and stressful life events retrospective assessment in crack cocaine users.

BACKGROUND: Some evidence suggests that altered hypothalamic-pituitary-adrenal (HPA) axis functioning in cocaine users might play a role in the pathophysiology of substance abuse. This study aimed to investigate the relationship between exposure to negative life events and cortisol hair concentrations in crack cocaine users during the 3 months prior to admission to a detoxification program. METHODS: A total of 23 treatment-seeking, crack cocaine-dependent women were selected for this study 1 week after admission to an inpatient treatment at a locked treatment facility. The Paykel Life Events Scale measured the occurrence of stressful life events 3 months before admission. Hair cortisol concentration was measured during these three previous months. RESULTS: The partial correlations, using severity of dependence as control variable, revealed that there is a positive association between hair cortisol concentration and the number of negative life events exposure 90 days (r = .56; p = .007) and 30 days (r = .42; p = .048) prior to admission at the hospital. One-way ANOVA suggests that hair cortisol levels and stress load significantly increase over 3 months prior to hospitalization. CONCLUSIONS: The results of this study indicate that there is a positive association between measures of long-term cumulative cortisol secretion and the number of stressful events reported by women receiving inpatient treatment for crack cocaine dependence. Therefore, this study suggests that stress load can be objectively quantified and noninvasively assessed. SCIENTIFIC SIGNIFICANCE: This study is the first to investigate HPA axis functioning using hair cortisol concentrations among crack cocaine-dependent users. It is a promising strategy to assess stress load in substance abusers.

Tomada de decisão em dependentes de crack: um estudo com o Iowa Gambling Task / Decision making in addiction to crack: a study with the Iowa Gambling Task

Este estudo investigou como ocorre o processo de tomada de decisão em dependentes de crack pelo instrumento Iowa Gambling Task (IGT). Foram selecionados 30 participantes para o grupo de dependentes de crack - GDC, e 15 controles não usuários - GNU, de ambos os sexos. Para avaliar a intensidade de craving utilizou-se o Cocaine Craving Questionnaire-Brief. Houve diferenças significativas entre os grupos tanto no cálculo total, como no cálculo por blocos. A curva de aprendizagem do GDCmanteve-se constante e negativa na maior parte do jogo, havendo apenas no final um indício de aprendizagem. Em relação à classificação do desempenho na tarefa, as análises evidenciaram que um significativo número de participantes controles obtiveram desempenho não-prejudicado, oposto ao desempenho do GDC. As diferenças entre os grupos investigadas no IGT corroboraram com achado de estudo anterior, que evidenciou prejuízo no processo de tomada de decisão associado à dependência de cocaína e de crack.(AU)

This study investigated how decision-making process occurs in crack dependents through the Iowa Gambling Task (IGT). 30 participants were selected to crack dependent group - GDC, and 15 non-users controls - GNU, from both sexes. We used the Cocaine Craving Questionnaire-Brief to assess the craving intensity. There were significant differences between groups both in the total-calculus score and in the blocks scores. The learning curve of the GDC was constant and negative during almost all game, except in the very ending when a suggestion of learning was observed. Regarding the task performance's classification, the analysis showed that a significant number of controls participants achieved a non-impaired performance, opposed to GDC performance. The differences between groups investigated in the IGT corroborate with a previous study finding, about a worse decision-making process associated with cocaine and crack addiction.(AU)

Tomada de decisão em dependentes de crack: um estudo com o Iowa Gambling Task / Decision making in addiction to crack: a study with the Iowa Gambling Task

Este estudo investigou como ocorre o processo de tomada de decisão em dependentes de crack pelo instrumento Iowa Gambling Task (IGT). Foram selecionados 30 participantes para o grupo de dependentes de crack - GDC, e 15 controles não usuários - GNU, de ambos os sexos. Para avaliar a intensidade de craving utilizou-se o Cocaine Craving Questionnaire-Brief. Houve diferenças significativas entre os grupos tanto no cálculo total, como no cálculo por blocos. A curva de aprendizagem do GDCmanteve-se constante e negativa na maior parte do jogo, havendo apenas no final um indício de aprendizagem. Em relação à classificação do desempenho na tarefa, as análises evidenciaram que um significativo número de participantes controles obtiveram desempenho não-prejudicado, oposto ao desempenho do GDC. As diferenças entre os grupos investigadas no IGT corroboraram com achado de estudo anterior, que evidenciou prejuízo no processo de tomada de decisão associado à dependência de cocaína e de crack.

This study investigated how decision-making process occurs in crack dependents through the Iowa Gambling Task (IGT). 30 participants were selected to crack dependent group - GDC, and 15 non-users controls - GNU, from both sexes. We used the Cocaine Craving Questionnaire-Brief to assess the craving intensity. There were significant differences between groups both in the total-calculus score and in the blocks scores. The learning curve of the GDC was constant and negative during almost all game, except in the very ending when a suggestion of learning was observed. Regarding the task performance's classification, the analysis showed that a significant number of controls participants achieved a non-impaired performance, opposed to GDC performance. The differences between groups investigated in the IGT corroborate with a previous study finding, about a worse decision-making process associated with cocaine and crack addiction.

Exposição a trauma e transtorno de estresse pós-traumático em usuárias de crack / Trauma exposure and posttraumatic stress disorder in crack cocaine users

OBJETIVO: Verificar a ocorrência de trauma e transtorno de estresse pós-traumático (TEPT) em uma amostra de mulheres dependentes de cocaína tipo crack. MÉTODO: A amostra foi composta por 99 mulheres, entre 18 e 52 anos, internadas em uma unidade de desintoxicação e extensamente avaliadas por meio da SCID-I e a ASI-6. RESULTADOS: Verificou-se uma taxa de exposição a trauma de 86,9% entre mulheres dependentes de cocaína tipo crack. A taxa de TEPT na amostra foi de 15,1%. Os clusters de revivescência e hiperexcitabilidade foram os mais frequentes - 24,4% e 20,9% respectivamente. Entre os tipos de eventos relatados, os mais frequentes foram sofrer agressão/abuso físico e ser testemunha de violência a outros. CONCLUSÃO: Os resultados sugerem uma frequente exposição a eventos traumáticos. Com relação à idade da experiência traumática, sugere-se que as usuárias expostas a trauma durante a infância e adolescência apresentam um início do uso de drogas em idades mais precoces que aquelas cujo trauma ocorreu na vida adulta.

OBJECTIVE: To determine the occurrence of trauma and posttraumatic stress disorder (PTSD) in a sample of women addicted to crack cocaine type. METHOD: The sample comprised 99 women, between 18 and 52 years admitted to a detoxification unit and extensively assessed by SCID-I and ASI-6. RESULTS: There was a trauma exposure rate of 86.9% among women addicted to crack cocaine type. The rate of PTSD in the sample was 15.1%. The clusters of reexperiencing and hyperarousal were the most frequent, 24.4% and 20.9% respectively. Among the types of events reported most frequently were suffering assault/physical abuse and witnessing violence to others. CONCLUSION: The results suggest a frequent exposure to traumatic events. With regard to age of the traumatic experience, it is suggested that users exposed to trauma during childhood and adolescence showed a beginning drug use at earlier ages than those whose trauma occurred in adulthood.

Aprendizagem, trauma e comportamento violento / Learning, trauma and violent behavior

Este artigo tem o objetivo de analisar alguns fatores associados ao comportamentoantissocial, enfatizando a relação entre aprendizagem, trauma ecomportamento antissocial. As Teorias Desenvolvimentais destacam o papelda aprendizagem nos problemas de comportamento a partir de interaçõesdo indivíduo/ambiente. Nessa perspectiva, o comportamento antissocialconstitui-se em uma forma, ainda que inadequada, de enfrentamento àsexigências sociais. As Teorias Psicobiológicas, que investigam interaçãogene-ambiente, auxiliam no entendimento do impacto da reatividade dosubstrato neural e as alterações no desenvolvimento cognitivo a partir dessasinterações. Nesse sentido, o estresse/trauma tem sido associado a umacascata de respostas fisiológicas e neurobiológicas que produzem alteraçõesnos padrões de desenvolvimento cerebral, criando uma situação de vulnerabilidadeao surgimento de psicopatologias. Os fatores associados ao comportamentoantissocial são utilizados para a discussão do “Caso Raul”. Comisso, pretende-se contribuir tanto para a abordagem científica sobre o comportamentoviolento quanto para abordagens terapêuticas.(AU)

This article aims to analyze some factors associated with antisocial behavior,emphasizing the relationship between learning, trauma and antisocial behavior. The developmental theories emphasize the role of learning in behavioralproblems from individual/environmental interactions. From this perspective,antisocial behavior is a way, albeit inadequate, to confront the social requirements.Psychobiological theories, which investigate gene-environment interactions,help to understand the impact of the reactivity of the neural substrateand the changes in cognitive developments from these interactions. In thissense, stress/trauma has been associated with a cascade of physiologicaland neurobiological changes that produce the patterns of brain development,creating a situation of vulnerability to the emergence of psychopathology.Factors associated with antisocial behavior are used to discuss the “CaseRaul”. With this, we intend to contribute both to the scientific approach toviolent behavior and to the therapeutic approaches.(AU)

Aprendizagem, trauma e comportamento violento / Learning, trauma and violent behavior

Este artigo tem o objetivo de analisar alguns fatores associados ao comportamentoantissocial, enfatizando a relação entre aprendizagem, trauma ecomportamento antissocial. As Teorias Desenvolvimentais destacam o papelda aprendizagem nos problemas de comportamento a partir de interaçõesdo indivíduo/ambiente. Nessa perspectiva, o comportamento antissocialconstitui-se em uma forma, ainda que inadequada, de enfrentamento àsexigências sociais. As Teorias Psicobiológicas, que investigam interaçãogene-ambiente, auxiliam no entendimento do impacto da reatividade dosubstrato neural e as alterações no desenvolvimento cognitivo a partir dessasinterações. Nesse sentido, o estresse/trauma tem sido associado a umacascata de respostas fisiológicas e neurobiológicas que produzem alteraçõesnos padrões de desenvolvimento cerebral, criando uma situação de vulnerabilidadeao surgimento de psicopatologias. Os fatores associados ao comportamentoantissocial são utilizados para a discussão do “Caso Raul”. Comisso, pretende-se contribuir tanto para a abordagem científica sobre o comportamentoviolento quanto para abordagens terapêuticas.

This article aims to analyze some factors associated with antisocial behavior,emphasizing the relationship between learning, trauma and antisocial behavior. The developmental theories emphasize the role of learning in behavioralproblems from individual/environmental interactions. From this perspective,antisocial behavior is a way, albeit inadequate, to confront the social requirements.Psychobiological theories, which investigate gene-environment interactions,help to understand the impact of the reactivity of the neural substrateand the changes in cognitive developments from these interactions. In thissense, stress/trauma has been associated with a cascade of physiologicaland neurobiological changes that produce the patterns of brain development,creating a situation of vulnerability to the emergence of psychopathology.Factors associated with antisocial behavior are used to discuss the “CaseRaul”. With this, we intend to contribute both to the scientific approach toviolent behavior and to the therapeutic approaches.