Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis.

Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database's inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.

Investigation of Guar Gum and Xanthan Gum Influence on Essential Thyme Oil Emulsion Properties and Encapsulation Release Using Modeling Tools.

This study explores the influence of hydrocolloid interactions between Guar Gum (GG) and Xanthan Gum (XG) on the stability and release dynamics of essential thyme oil emulsions. We systematically characterized six emulsions with varying GG and XG ratios, employing spray-drying techniques for the encapsulation process. The stability of the emulsions was quantitatively analyzed, revealing a marked decrease in stability rates correlated with higher initial emulsion activity (zero-order kinetic constant r = -0.972). Furthermore, this study demonstrated that emulsions with carefully optimized hydrocolloid ratios could achieve high encapsulation efficiency (74%) and controlled release profiles. Kinetic modeling and diffusion analyses elucidated that increased XG concentrations tend to reduce diffusivity, thereby enhancing emulsion stability. The effective diffusivity of the thyme oil within the emulsion matrix was determined to be within a range of 0.7 to 2.4 × 10-10 m2/s, significantly influencing release kinetics. The Pearson correlation matrix underlined a substantial negative association between emulsion activity and effective diffusivity (r = -0.740), indicating that denser hydrocolloid networks impede oil mobility. The findings conclusively establish that the interplay of GG and XG concentrations is pivotal in dictating the emulsion's physicochemical properties, with denser networks formed by higher XG content leading to slower oil release rates and enhanced stability. This research provides critical insights for the design of encapsulated food and pharmaceutical products, highlighting the imperative of strategic hydrocolloid selection to realize specific functional attributes and performance criteria.

Enhancing Antioxidant Retention through Varied Wall Material Combinations in Grape Spray Drying and Storage.

The encapsulation of bioactive compounds, which spans phytochemicals, vitamins, antioxidants, and other precious substances, has risen to prominence as a crucial area of interest spanning various domains, including food, pharmaceuticals, and cosmetics. This investigation delved into the efficacy of distinct wall materials-whey protein isolate, high methoxy pectin, and gum arabic-when employed individually or in combination to encapsulate and preserve phenolic compounds and antioxidants during storage. The encapsulation process involved spray-drying bioactive compounds extracted from grapes. Over a span of 120 days, the stability of these encapsulated compounds was meticulously evaluated, encompassing assessments via different antioxidant capacity assays, phenolic content analyses, and high-performance liquid chromatography measurements. The modeling of retention kinetics during storage facilitated the comprehension of the release mechanisms. Notably, the findings underscore the pivotal role of wall materials in preserving these bioactive compounds, with each material or combination of materials exhibiting varying degrees of protective capacity. Remarkably, the synergistic blend of whey protein, pectin, and gum arabic showcased the utmost retention of bioactive compounds over this study's period. The amassed data distinctly show that an amalgamation of wall materials can indeed considerably enhance the stability of encapsulated bioactive compounds, presenting promising applications within the realms of both the food and pharmaceutical industries.

A gestão da pandemia de covid-19 e as suas repercussões para o gestor do SUS / The management of the COVID-19 pandemic and its repercussions for the SUS manager

Resumo Este artigo discute os desafios enfrentados pelos gestores estaduais do Sistema Único de Saúde (SUS) no contexto da pandemia de covid-19 e as consequências produzidas em suas vidas pessoais. A partir de entrevistas com gestores estaduais, tornou-se evidente que a pandemia demandou o replanejamento das ações e serviços de saúde, a estruturação de novos serviços e leitos hospitalares, o uso de telemedicina e a contratação e capacitação de profissionais. Também emergiu a ausência de políticas integradas e de uma coordenação nacional, que levou à adoção de diferentes estratégias por parte dos estados. Estes fatores, assim como a politização da pandemia, a negação da doença e a tentativa do governo federal de impor tratamentos ineficazes para a covid-19 foram consideradas entre as maiores dificuldades vivenciadas pelos gestores. Fazer a gestão do SUS se tornou um exercício de risco, com repercussões deletérias não apenas para si e para a sua gestão, mas também para suas famílias e amigos. Se, por um lado, o contexto extenuante afetou a saúde física e mental dos gestores, que passaram a lidar com excesso de peso, ansiedade e angústia, de outro, foi fonte de motivação por catalisar solidariedade, empatia e o compartilhamento entre os atores políticos.

Abstract This article discusses the challenges faced by the state managers of the Brazilian National Health System (SUS) in the context of the COVID-19 pandemic and the consequences for their personal lives. From interviews with state managers, it became evident that the pandemic implied the replanning of health actions and services, the structuring of new hospital services and beds, the use of telemedicine, and the hiring and training of professionals. It also exposed the lack of integrated policies and national coordination, which led to states adopting different strategies. These factors, as well as the politicization of the pandemic, the denial of the disease, and the attempt of the federal government to impose ineffective treatments for COVID-19 were considered among the greatest difficulties experienced by managers. Managing the SUS became a risky exercise, with deleterious repercussions not only for themselves and their management, but also for their families and friends. If, on the one hand, the strenuous context affected the managers' physical and mental health, who began dealing with overweight, anxiety, and anguish, on the other hand, it was a source of motivation for catalyzing solidarity, empathy, and sharing among political actors.

Online group therapies for anxiety, obsessive-compulsive, and trauma-related disorders: a systematic review.

Background: This systematic review examined the existing literature to determine the evidence supporting the efficacy of online group treatments for anxiety-, obsessive-compulsive- and trauma-related disorders (AOTDs). Methods: A systematic review using the PUBMED, PsycInfo, Web of Science, and ClinicalTrials databases with no language, date, or study design filters was performed. The inclusion criteria comprised studies that examined individuals who had received a formal diagnosis of AOTDs, were aged 18 years or older, and had baseline and endpoint assessments of symptom severity using formal tools. Results: Five studies on social anxiety disorder (SAD), four on post-traumatic stress disorder (PTSD) and one on tic disorders (TDs) were found. The studies were open-label (n = 2) and randomized controlled trials (RCTs) (n = 8), with five of the RCTs being non-inferiority trials. Most studies were conducted in the US and investigated psychological CBT based interventions via internet-based therapies (IBT: n = 4), video teleconferencing (VTC: n = 5) or a combination of both (n = 1). In SAD, IBT studies associated with a clinician assisted web-based forum (here termed "forum-enhanced" studies) were superior to waiting lists and not inferior to similar versions that were also "forum enhanced" but self-guided, "telephone enhanced" by a contact with a non-specialist, and "email enhanced" by a contact with a clinician individually. Studies involving VTC have shown comparable effectiveness to in-person interventions across some online group CBT based treatments for PTSD. Two open trials also demonstrated symptoms reductions of social anxiety and tics through VTC. Conclusion: There is evidence supporting the effectiveness of online group treatments for SAD and PTSD. Further studies from different research groups may be needed to replicate the use of these and other forms of online treatments in individuals with SAD, PTSD, and other clinical populations, such as OCD, panic disorder, agoraphobia and specific phobias. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023408491.

A longitudinal evaluation of free will related cognitions in obsessive-compulsive disorder.

BACKGROUND: Individuals with obsessive-compulsive disorder (OCD) often feel compelled to perform (compulsive) behaviors, thus raising questions regarding their free will beliefs and experiences. In the present study, we investigated if free will related cognitions (free will beliefs or experiences) differed between OCD patients and healthy subjects and whether these cognitions predicted symptom changes after a one-year follow up. METHODS: Sixty OCD outpatients were assessed for their beliefs in and experiences of free will at baseline and after one year of treatment. A subsample of 18 OCD patients had their beliefs compared to 18 age and gender matched healthy controls. A regression analysis was performed to investigate whether free will cognitions at baseline were able to predict long-term OCD severity scores. RESULTS: Patients with OCD and healthy controls do not seem to differ in terms of their beliefs in free will (U = 156.0; p = 0.864). Nonetheless, we found significant negative correlation between (i) duration of illness and strength of belief in determinism (ρ = -0.317; p = 0.016), (ii) age and perception of having alternative possibilities (ρ = -0.275; p = 0.038), and (iii) symptoms' severity and perception of having alternative possibilities (ρ = -0.415; p = 0.001). On the other hand, the experience of being an owner of ones' actions was positive correlated with the severity of symptoms (ρ = 0.538; p < 0.001) and were able to predict the severity of OCD symptoms at the follow up assessment. CONCLUSIONS: Older individuals or those with a greater severity of symptoms seem to have a perception of decreased free will. In addition, patients with a longer duration of illness tend to have a lower strength of belief in determinism. Finally, the experience of being the owner of the compulsions, along with the baseline severity of symptoms, can be a predictor of a worse outcome in the OCD sample.

Are mental disorders related to disbelief in free will? A systematic review.

BACKGROUND: The nature and existence of free will have been debated for centuries. Since some psychiatric disorders are known to interfere with one's ability to control their actions and thoughts (e.g., schizophrenia), the investigation of the psychiatric facet of free will beliefs seems to be relevant. In this systematic review, we were interested in clarifying if and how having a mental disorder affects individuals' beliefs in free will by comparing psychiatric vs. non-psychiatric samples. METHODS: A systematic search of MEDLINE, Web of Science, EMBASE, and PsycINFO databases was performed between 04 and 09 November 2020. The search strategy included "free will" and related constructs and terms related to DSM-5 mental disorders characterized by psychotic, compulsive, avoidant, or impulsive symptoms. Eligible designs of studies included case-control and cohort studies. Study selection took place in committee meetings consisting of six researchers. Quality assessment of the selected studies was performed through the Joanna Briggs Institute Appraisal Checklist for Case Control Studies. RESULTS: After removing duplicates, a total of 12,218 titles/abstracts were screened. Inclusion and exclusion criteria were followed, and three articles were eventually selected. CONCLUSIONS: It is not possible to provide unequivocal confirmation that having a mental disorder can or cannot affect someone's belief in free will. Studies with different mental disorders should be conducted in this field. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018109468.

Habitual versus affective motivations in obsessive-compulsive disorder and alcohol use disorder.

OBJECTIVE: To (1) confirm whether the Habit, Reward, and Fear Scale is able to generate a 3-factor solution in a population of obsessive-compulsive disorder and alcohol use disorder (AUD) patients; (2) compare these clinical groups in their habit, reward, and fear motivations; and (3) investigate whether homogenous subgroups can be identified to resolve heterogeneity within and across disorders based on the motivations driving ritualistic and drinking behaviors. METHODS: One hundred and thirty-four obsessive-compulsive disorder (n = 76) or AUD (n = 58) patients were assessed with a battery of scales including the Habit, Reward, and Fear Scale, the Yale-Brown Obsessive-Compulsive Scale, the Alcohol Dependence Scale, the Behavioral Inhibition/Activation System Scale, and the Urgency, (lack of ) Premeditation, (lack of ) Perseverance, Sensation Seeking, and Positive Urgency Impulsive Behavior Scale. RESULTS: A 3-factor solution reflecting habit, reward, and fear subscores explained 56.6% of the total variance of the Habit, Reward, and Fear Scale. Although the habit and fear subscores were significantly higher in obsessive-compulsive disorder (OCD) and the reward subscores were significantly greater in AUD patients, a cluster analysis identified that the 3 clusters were each characterized by differing proportions of OCD and AUD patients. CONCLUSIONS: While affective (reward- and fear-driven) and nonaffective (habitual) motivations for repetitive behaviors seem dissociable from each other, it is possible to identify subgroups in a transdiagnostic manner based on motivations that do not match perfectly motivations that usually described in OCD and AUD patients.

Evidências Neurobiológicas de Viés Atencional no Transtorno Obsessivo-Compulsivo: Revisão Sistemática / Neurobiological Evidence of Attentional Bias in Obsessive-Compulsive Disorder: Systematic Review

Resumo O viés atencional corresponde à alocação de recursos de atenção a materiais irrelevantes à tarefa. Supõe-se que pacientes com transtorno obsessivo-compulsivo (TOC) apresentem viés atencional voltado à ameaça. Com o objetivo de descrever os achados neurobiológicos do viés atencional voltado à ameaça no TOC, foi realizada uma busca sistemática por estudos experimentais com investigação neurobiológica nas bases de dados: MEDLINE, Web of Science, Scopus e LILACS. Quatro estudos com grupo controle são descritos nos resultados, todos indicam diferenças estatisticamente significativas na atividade encefálica associada a atenção em pacientes. Os achados neurobiológicos dos estudos incluídos na revisão sugerem a alocação de recursos da atenção a estímulos irrelevantes, independente da valência emocional no TOC.

Abstract The attentional bias is the allocation of attentional resources to irrelevant stimuli during a task. It is assumed that patients with obsessive-compulsive disorder (OCD) presents attentional bias toward threatening stimuli. In order to describe OCD's neurobiological findings of attentional bias towards a threat, it was performed a systematic review of experimental studies with neurobiological assessment in the following databases: MEDLINE, Web of Science, Scopus and LILACS. Four studies with control group are described in this review, all presenting statistically significant differences in brain activity associated with attention in patients. The neurobiological findings of the studies included in the review suggest allocation of attentional resources to irrelevant stimuli, regardless of the emotional valence in OCD.

Representação Espacial das Doenças Negligenciadas no Estado do Tocantins / Spatial Representation of Neglected Diseases in Tocantins State

As doenças negligenciadas consistem em agravos prevalentes em toda a população, mas com maior incidência em indivíduos em situação de vulnerabilidade social. O georreferenciamento surge neste momento como estratégia de orientação da ESF no controle de agravos, atuando como instrumento de reconhecimento, análise, definição de prioridades e intervenção, através da inter-relação entre os princípios da atenção básica e da vigilância em saúde. Este estudo teve como objetivo entender o comportamento dos agravos hanseníase, leishmaniose tegumentar americana, leishmaniose visceral e tuberculose, consideradas moléstias negligenciadas, encontradas no Estado do Tocantins, sob perspectiva da análise espacial, no período de 2013 a 2017, e justificadas por meio de análise bibliográfica complementar. A metodologia empregada amparou-se no princípio metodológico ecológico observacional descritivo, que possibilitou o discernimento sobre tais doenças, a partir de dados secundários colhidos no Sistema de Informática do Sistema Único de Saúde (DATASUS) com posterior espacialização e representação cartográfica, através da elaboração de mapas temáticos que melhor caracterizasse as variáveis estudadas por meio do software QGIS. Como resultado, foi possível analisar a distribuição dos agravos em estudo no estado do Tocantins, trazendo as possíveis causas relacionadas à dificuldade de controle destas moléstias neste território. Concluiu-se que apesar das doenças negligenciadas serem possíveis de controle, infelizmente, a gestão de saúde não tem conseguido aplicar estratégias suficientes para a redução do índice de morbidade, e o georreferenciamento mostrou-se como um forte instrumento de suporte para a adoção de táticas pontuais para o manejo de doenças.

Electroconvulsive therapy for trichotillomania in a bipolar patient.

A recent review on the use of electroconvulsive therapy (ECT) in obsessive-compulsive-related disorders (OCRDs) identified reports of trichotillomania (TTM) in only three patients, but it did not describe the specific effect of ECT on hair-pulling behaviors. The authors present a case report of Mrs. A, a 77-year-old widowed housewife with a lifelong history of episodic TTM and bipolar disorder who was effectively treated with ECT. However, on each attempt to withdraw ECT, her condition deteriorated. Eventually, a decision was made to maintain ECT (one session every week), which resulted in no further relapse over the followup period. ECT shows some potential promise for reducing hair-pulling behaviors in the context of severe depression.

A Systematic Review of the Utility of Electroconvulsive Therapy in Broadly Defined Obsessive-Compulsive-Related Disorders.

OBJECTIVE: To assess the efficacy of electroconvulsive therapy (ECT) in DSM-5 obsessive-compulsive-related disorders (OCRDs) and conditions subsumed under an "extended" OCD spectrum, including tic disorders and self-injurious behaviors. DATA SOURCES: A systematic search of the MEDLINE, Web of Science, Scopus, and LILACS databases and other sources was performed between June 6 and July 2, 2017. Search terms included (Autis*) AND (ECT OR electroconvulsive), (Self-injur*) AND (ECT OR electroconvulsive), (Tic* OR Tourette) AND (ECT OR electroconvulsive), (Body Dysmorphic Disorder OR Dysmorphophobi*) AND (ECT OR electroconvulsive), (Hoard*) AND (ECT OR electroconvulsive), (Trichotillomani*) AND (ECT OR electroconvulsive), (Skin Picking OR Excoriation) AND (ECT OR electroconvulsive), (Grooming) AND (ECT OR electroconvulsive), (Kleptomani*) AND (ECT OR electroconvulsive), and (Pyromani*) AND (ECT OR electroconvulsive). No search restrictions (ie, date, language, or document type) were used. STUDY SELECTION: Fifty-two records that described the individual responses of OCRDs to ECT (involving 69 patients) were selected. DATA EXTRACTION: Clinical data and responses of individual cases were recorded. Data from responders were compared to nonresponders. RESULTS: All records were case reports or case series; there were no randomized controlled trials. Of the 69 OCRD participants who had undergone ECT, a positive response was reported in 73.4% of the cases (including 44.0% of the BDD, 74.1% of the tic disorder, and 85.7% of the self-injurious behavior patients). At follow-up, the majority of responders who had abstained from further ECT had experienced relapse. However, a positive response was obtained in all participants who received a new course of ECT. Patients who responded positively to ECT were likely to report previous unsuccessful treatment with antipsychotics (P < .001) and antidepressants (P = .007). CONCLUSIONS: The finding that more than 70% of the reviewed cases showed some response to ECT should not be considered unequivocal evidence of its efficacy in OCRDs. The available evidence suggests that a randomized controlled trial of ECT in OCRDs may be warranted, particularly in severe tic disorders and self-injurious behaviors.

Prevalence and correlates of electroconvulsive therapy delivery in 1001 obsessive-compulsive disorder outpatients.

Individuals with obsessive-compulsive disorder (OCD) who sought treatment in seven different specialized centers (n=1001) were evaluated with a structured assessment battery. Thirteen OCD patients (1.3% of the sample) reported having been treated with electroconvulsive therapy (ECT) in the past. They were older and exhibited higher global severity of OCD symptoms, but were less likely to display symmetry/ordering and contamination/washing symptoms. They also had greater suicidality and increased rates of psychosis. Finally, OCD patients exposed to ECT were more frequently treated with antipsychotics, although they did not differ in terms of responses to adequate trials with serotonin reuptake inhibitors.