Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research.

Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.

Neurocircuit models of obsessive-compulsive disorder: limitations and future directions for research

Obsessive-compulsive disorder (OCD) is a common psychiatric condition classically characterized by obsessions (recurrent, intrusive and unwanted thoughts) and compulsions (excessive, repetitive and ritualistic behaviors or mental acts). OCD is heterogeneous in its clinical presentation and not all patients respond to first-line treatments. Several neurocircuit models of OCD have been proposed with the aim of providing a better understanding of the neural and cognitive mechanisms involved in the disorder. These models use advances in neuroscience and findings from neuropsychological and neuroimaging studies to suggest links between clinical profiles that reflect the symptoms and experiences of patients and dysfunctions in specific neurocircuits. Several models propose that treatments for OCD could be improved if directed to specific neurocircuit dysfunctions, thereby restoring efficient neurocognitive function and ameliorating the symptomatology of each associated clinical profile. Yet, there are several important limitations to neurocircuit models of OCD. The purpose of the current review is to highlight some of these limitations, including issues related to the complexity of brain and cognitive function, the clinical presentation and course of OCD, etiological factors, and treatment methods proposed by the models. We also provide suggestions for future research to advance neurocircuit models of OCD and facilitate translation to clinical application.

The volition, the mode of movement selection and the readiness potential.

A growing body of evidence suggests that the mode of movement selection is relevant for the readiness potential, namely, internal (or free) selection of movements is associated with increased readiness potential amplitudes compared to predetermined or externally guided selection. It is little acknowledged, however, that this finding may be ascribed to the different expression of volition (i.e., conscious experience of choice) rather than to the mode of movement selection per se. To probe this issue, we conducted two experiments: in Experiment 1, a mental task was employed to distract sixteen volunteers from the selection and performance of incidental movements, which consisted of pressing one of two buttons according to either free or externally guided modes of movement selection; in Experiment 2, another sixteen individuals performed the same motor task, however, they were encouraged to attend to their intention to act. As result, the increased readiness potential amplitude before freely selected movements was found exclusively in Experiment 2. More detailed analysis suggested that the attention to the initiation of movements was associated with greater readiness potential in its medial and late portion, while the attention to the movement selection, with more global increase of the component. The study suggests that much of the higher demands on motor preparatory activities ascribed to the internal selection of movements in previous studies actually depends on individual's attention and, thus, probably corresponds to volitional processes.

Quality of internet information available to patients on websites in Portuguese.

OBJECTIVE: Patients and their relatives often look for information about their diseases on the internet. Diabetes mellitus (DM), systemic arterial hypertension (SAH), and acute myocardial infarction (AMI) are the most prevalent in Brazil, thus, information on these pathologies is extremely searched for on the internet. For this reason, this study attempted to evaluate the quality of information available in Portuguese on the web regarding these disorders. METHODS: The first 20 websites in Portuguese for each disease through the Google® search algorithm were selected. The Discern Questionnaire (DQ) and Health on the Net (HON) were used as tools in order to evaluate the quality of information. To assess adequacy, international and Brazilian guidelines for different co-morbidities were used. RESULTS: When evaluating the information content available, 45%, 95%, and 85% of pages had the definition of DM, SAH, and AMI, respectively. Only 25% of the websites regarding the three co-morbidities had specific information on diagnosis and treatment. Only 15%, 20%, and 10% of the websites had HON certification, respectively. Using the DQ approach, scores higher than 50% were obtained in 70% of the DM websites, in 65% of SAH websites, and in 55% of the AMI websites. CONCLUSION: The available information in Portuguese on the internet regarding the three pathologies selected (DM, SAH, and AMI) is quite often inadequate and insufficient.

Qualidade da informação da internet disponível para pacientes em páginas em português / Quality of internet information available to patients on websites in Portuguese

OBJETIVO: Pacientes e seus familiares frequentemente procuram na internet informações a respeito de suas doenças. Diabetes mellitus (DM), hipertensão arterial sistêmica (HAS) e infarto agudo do miocárdio (IAM) são muito prevalentes no Brasil, e informações sobre estas patologias são bastante procuradas na internet. Por isso, buscamos avaliar a qualidade da informação relacionada com estas doenças disponível em português na internet. MÉTODOS: Foram selecionadas as primeiras 20 páginas em português de cada uma das doenças escolhidas, através do algoritmo de busca do Google®. Como ferramentas para avaliar a qualidade da informação foram utilizados o Discern Questionnarie (DQ) e o Health on Net (HON). Para saber se as informações eram adequadas, foram utilizadas as diretrizes (guidelines) brasileiras e internacionais para as diferentes comorbidades. RESULTADOS: Ao avaliar o conteúdo das informações disponíveis, 45%, 95%, 85% das páginas continham, respectivamente, a definição de DM, HAS e IAM. Com relação ao diagnóstico e ao tratamento, somente 25% das páginas das três comorbidades apresentavam especificamente esta informação. Somente 15%, 20% e 10% das páginas tinham a certificação pelo HON, respectivamente. Em função do DQ, as páginas obtiveram notas maiores que 50% em 70% das páginas de DM, 65% nas de HAS e 55% nas de IAM. CONCLUSÃO: A informação disponível em português na internet sobre as três patologias escolhidas (DM, HAS e IAM) é frequentemente inadequada e insuficiente.

OBJECTIVE: Patients and their relatives often look for information about their diseases on the internet. Diabetes mellitus (DM), systemic arterial hypertension (SAH), and acute myocardial infarction (AMI) are the most prevalent in Brazil, thus, information on these pathologies is extremely searched for on the internet. For this reason, this study attempted to evaluate the quality of information available in Portuguese on the web regarding these disorders. METHODS: The first 20 websites in Portuguese for each disease through the Google® search algorithm were selected. The Discern Questionnaire (DQ) and Health on the Net (HON) were used as tools in order to evaluate the quality of information. To assess adequacy, international and Brazilian guidelines for different co-morbidities were used. RESULTS: When evaluating the information content available, 45%, 95%, and 85% of pages had the definition of DM, SAH, and AMI, respectively. Only 25% of the websites regarding the three co-morbidities had specific information on diagnosis and treatment. Only 15%, 20%, and 10% of the websites had HON certification, respectively. Using the DQ approach, scores higher than 50% were obtained in 70% of the DM websites, in 65% of SAH websites, and in 55% of the AMI websites. CONCLUSION: The available information in Portuguese on the internet regarding the three pathologies selected (DM, SAH, and AMI) is quite often inadequate and insufficient.