NEUROPSYCHOLOGICAL PREDICTORS OF TREATMENT RESPONSE TO COGNITIVE BEHAVIORAL GROUP THERAPY IN OBSESSIVE-COMPULSIVE DISORDER.

BACKGROUND: The available research on the relationship between neuropsychological functioning and the therapeutic outcome of obsessive-compulsive disorder (OCD) has yielded inconsistent results. In this study, our aim was twofold. First, we sought to evaluate the effects of cognitive behavioral group therapy (CBGT) on neurocognitive functions in OCD patients. Second, we assessed the viability of neuropsychological test performance as a predictor of treatment response to CBGT. METHODS: One hundred fifty carefully screened OCD patients were randomized to receive either 12-week CBGT (n = 75) or to remain on a waiting list (WL; n = 75) for the corresponding time. Forty-seven participants dropped out of the study, leaving 103 participants that were included in the analysis (CBGT, n = 61; WL, n = 42). Participants had several neuropsychological domains evaluated both at baseline and at end-point. RESULTS: A significant difference in obsessive-compulsive, anxiety, and depression symptoms was observed between treated patients and controls favoring the CBGT group, but no significant differences were found on neuropsychological measures after 3 months of CBGT. In addition, there were no differences between treatment responders and nonresponders on all neuropsychological outcome measures. Employing a conservative alpha, neuropsychological test performance did not predict CBGT treatment response. CONCLUSIONS: Although the CBGT group demonstrated significant improvement in OCD symptoms, no significant difference was found on all neuropsychological domains, and test performance did not predict treatment response.

Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study

Objectives: To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender. Methods: Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ≥ 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL). Results: The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3±3.8) and symmetry (85.3%; 5.9±3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006). Conclusions: OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD. .

Obsessive-compulsive symptoms and obsessive-compulsive disorder in adolescents: a population-based study.

OBJECTIVES: To estimate the prevalence of obsessive-compulsive symptoms (OCS) and disorder (OCD) among adolescents and to describe OCD characteristics according to gender. METHODS: Participants were selected by cluster sampling at seven high-schools in southern Brazil. In the first stage, 2,323 students were screened for OCS; in the second stage, adolescents scoring ≥ 21 on the OCI-R scale were individually interviewed. OCD diagnosis was established using a semi-structured interview (Schedule for Affective Disorders and Schizophrenia for School Aged Children: Present and Lifetime Version - K-SADS-PL). RESULTS: The past-month estimated prevalence of OCS was 18.3%, and the point estimated prevalence of OCD, 3.3%. Girls showed higher scores (OCS: 24.8 vs. 14.4%; OCD: 4.9 vs. 1.4%; p < 0.001). Only 9.3% of OCD adolescents had been diagnosed and 6.7% received treatment. The most frequent/severe DY-BOCS dimensions were miscellaneous (86.7%; mean score 6.3 ± 3.8) and symmetry (85.3%; 5.9 ± 3.8). Female OCD adolescents predominantly showed depression (p = 0.032), and male adolescents, tic disorders (p = 0.006). CONCLUSIONS: OCD is underdiagnosed in adolescents, and few are treated. Future studies should investigate the relationship between OCS and the onset of OCD.

Quality of life in adolescents with obsessive-compulsive disorder

Objective: To compare adolescents with and without obsessive-compulsive disorder (OCD) with regard to quality of life and to investigate the association between quality of life and clinical characteristics. Methods: Participants were recruited from an epidemiological study conducted at high schools in the city of Porto Alegre, southern Brazil. The sample comprised 75 adolescents with OCD and 150 without the disorder, aged between 14 and 18 years. Participants were assessed using the following instruments: Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), World Health Organization Quality of Life Assessment - Abbreviated Version (WHOQOL-BREF), Beck Anxiety Inventory (BAI), and Beck Depressive Inventory - II (BDI-II). Results: The two groups showed significant differences in relation to depression symptoms, anxiety symptoms, and quality of life (all domains), with a poorer performance among adolescents with OCD when compared to those without the disorder. Stepwise regression analysis revealed a significant association between BDI-II scores and quality of life, in all domains. Conclusions: Our findings suggest that adolescents with OCD, especially those with depression symptoms, have a poorer quality of life when compared with adolescents without OCD. .

Quality of life in adolescents with obsessive-compulsive disorder.

OBJECTIVE: To compare adolescents with and without obsessive-compulsive disorder (OCD) with regard to quality of life and to investigate the association between quality of life and clinical characteristics. METHODS: Participants were recruited from an epidemiological study conducted at high schools in the city of Porto Alegre, southern Brazil. The sample comprised 75 adolescents with OCD and 150 without the disorder, aged between 14 and 18 years. Participants were assessed using the following instruments: Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), World Health Organization Quality of Life Assessment - Abbreviated Version (WHOQOL-BREF), Beck Anxiety Inventory (BAI), and Beck Depressive Inventory - II (BDI-II). RESULTS: The two groups showed significant differences in relation to depression symptoms, anxiety symptoms, and quality of life (all domains), with a poorer performance among adolescents with OCD when compared to those without the disorder. Stepwise regression analysis revealed a significant association between BDI-II scores and quality of life, in all domains. CONCLUSIONS: Our findings suggest that adolescents with OCD, especially those with depression symptoms, have a poorer quality of life when compared with adolescents without OCD.

Skin picking and trichotillomania in adults with obsessive-compulsive disorder.

The objective of this study was to compare patients with obsessive-compulsive disorder (OCD) associated with pathologic skin picking (PSP) and/or trichotillomania, and patients with OCD without such comorbidities, for demographic and clinical characteristics. We assessed 901 individuals with a primary diagnosis of OCD, using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis I disorders. Diagnoses of PSP and trichotillomania were made in 16.3% and 4.9% of the sample, respectively. After the logistic regression analysis, the following factors retained an association with OCD-PSP/trichotillomania: younger (odds ratio [OR] = 0.979; P = .047), younger at the onset of compulsive symptoms (OR = 0.941; P = .007), woman (OR = 2.538; P < .001), with a higher level of education (OR = 1.055; P = .025), and with comorbid body dysmorphic disorder (OR = 2.363; P = .004). These findings support the idea that OCD accompanied by PSP/trichotillomania characterizes a specific subgroup.

Translation and adaptation into Brazilian Portuguese of the Obsessional Beliefs Questionnaire (OBQ-44).

INTRODUCTION: The Obsessional Beliefs Questionnaire (OBQ-44) is a self-administered instrument comprised of 44 items, designed to assess the beliefs of patients with obsessive compulsive disorder (OCD). The objective of this study was to describe the process of translation and adaption of the questionnaire into Brazilian Portuguese. METHOD: For the translation and adaptation of the OBQ-44, we first obtained authorization from the authors of the original scale to use the instrument. Subsequently, the scale was independently translated from English into Brazilian Portuguese by two health professionals with proficiency in English. Following comparison of the two translations, a preliminary version was obtained and tried out on a sample of 20 patients with a primary diagnosis of OCD. This pretest aimed to assess the patients' understanding of the items and to make any necessary language adaptations. Then, the scale was independently back-translated by two psychiatrists, also with proficiency in English. Following comparison of the two back-translations, a final version in English was developed; this version was evaluated and approved by the authors of the original instrument. RESULTS: The Brazilian Portuguese version of the OBQ-44, after the process of translation and adaptation here described, showed to be of easy interpretation by patients with different educational levels. The instrument can therefore be used to assess patients from different Brazilian socioeconomic contexts. CONCLUSION: OBQ-44 is a self-administered instrument of easy application. Therefore, it can be useful in the identification of dysfunctional beliefs in OCD patients, contributing toward a better understanding of the role played by such beliefs in the onset and maintenance of the disorder.

Tradução e adaptação para o português do Brasil do Obsessional Beliefs Questionnaire (OBQ-44) / Translation and adaptation into Brazilian Portuguese of the Obsessional Beliefs Questionnaire (OBQ-44)

INTRODUCTION: The Obsessional Beliefs Questionnaire (OBQ-44) is a self-administered instrument comprised of 44 items, designed to assess the beliefs of patients with obsessive compulsive disorder (OCD). The objective of this study was to describe the process of translation and adaption of the questionnaire into Brazilian Portuguese. METHOD: For the translation and adaptation of the OBQ-44, we first obtained authorization from the authors of the original scale to use the instrument. Subsequently, the scale was independently translated from English into Brazilian Portuguese by two health professionals with proficiency in English. Following comparison of the two translations, a preliminary version was obtained and tried out on a sample of 20 patients with a primary diagnosis of OCD. This pretest aimed to assess the patients' understanding of the items and to make any necessary language adaptations. Then, the scale was independently back-translated by two psychiatrists, also with proficiency in English. Following comparison of the two back-translations, a final version in English was developed; this version was evaluated and approved by the authors of the original instrument. RESULTS: The Brazilian Portuguese version of the OBQ-44, after the process of translation and adaptation here described, showed to be of easy interpretation by patients with different educational levels. The instrument can therefore be used to assess patients from different Brazilian socioeconomic contexts. CONCLUSION: OBQ-44 is a self-administered instrument of easy application. Therefore, it can be useful in the identification of dysfunctional beliefs in OCD patients, contributing toward a better understanding of the role played by such beliefs in the onset and maintenance of the disorder.

INTRODUÇÃO: O Obsessional Beliefs Questionnaire (OBQ-44) é um instrumento autorrespondido composto por 44 itens que avaliam as crenças de pacientes com transtorno obsessivo-compulsivo (TOC). O objetivo do presente estudo foi descrever o processo de tradução e adaptação da referida escala para o português do Brasil. MÉTODO: Para o processo de tradução e adaptação do OBQ-44, primeiramente foi obtida licença de uso da escala junto aos autores do instrumento original. Em seguida, a escala foi traduzida de inglês para português brasileiro de forma independente por dois profissionais de saúde com fluência em inglês. Comparando-se as duas escalas traduzidas, obteve-se uma versão preliminar, que foi aplicada a uma amostra de 20 pacientes com diagnóstico principal de TOC, visando observar sua compreensão e realizar adaptações de linguagem. A seguir, a escala foi retrotraduzida de forma independente por dois psiquiatras, também fluentes na língua inglesa. Comparadas as duas retrotraduções, gerou-se uma versão final em língua inglesa; esta versão foi avaliada e aprovada pelos autores do instrumento original. RESULTADOS: A versão em português do Brasil do OBQ-44, após sua tradução e adaptação, demonstrou ser de fácil compreensão por parte de pacientes de diferentes níveis educacionais. Portanto, a escala pode ser utilizada em pacientes das diversas classes econômicas e sociais que caracterizam o Brasil. CONCLUSÃO: O OBQ-44, por ser um instrumento autoaplicável e de fácil compreensão, pode ser útil na identificação de crenças disfuncionais em pacientes com TOC, auxiliando na compreensão do papel dessas crenças na origem e manutenção do transtorno.

Terapia cognitivo-comportamental com intervenção familiar para crianças e adolescentes com transtorno obsessivo-compulsivo: uma revisão sistemática / Cognitive behavioral therapy with family intervention for children and adolescents with obsessive-compulsive disorder: a systematic review

O transtorno obsessivo-compulsivo (TOC) é uma doença mental grave, com graves consequências para a dinâmica familiar. Desta forma, o envolvimento dos pais parece ser determinante na resolução dos sintomas desse transtorno. O objetivo deste estudo foi avaliar a qualidade da evidência para a recomendação de terapia cognitivo-comportamental (TCC) com intervenção familiar para crianças e adolescentes com TOC. A busca sistemática foi realizada nas bases de dados MEDLINE/PubMed, seguida da análise de resumos e artigos na íntegra por dois avaliadores independentes. Posteriormente, foi realizada a análise de evidência através do sistema Grading of Recommendations Assessment, Development and Evaluation (GRADE). O tamanho de efeito da intervenção foi calculado através do d de Cohen. Foram localizados 77 artigos no PubMed e mais 12 artigos após busca cruzada de referências. Destes, sete artigos foram incluídos na revisão, segundo os seguintes critérios: ser estudo de intervenção, envolver apenas crianças e/ou adolescentes e possuir diagnóstico clínico ou estruturado de TOC. A escala Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) foi utilizada por todos os artigos para a avaliação de desfecho, permitindo avaliar o tamanho de efeito das intervenções não controladas (d = 1,43), que resultou em uma diferença de médias de cerca 13 pontos (IC95 por cento 11,84-14,39; p < 0,001). Por outro lado, uma alta heterogeneidade foi detectada entre os estudos (I² = 67 por cento). A TCC com intervenção familiar parece ter um efeito importante na redução dos sintomas de TOC na infância e adolescência. No entanto, os poucos estudos disponíveis não nos permitem estabelecer um grau de evidência maior do que C para essa recomendação. Novos ensaios clínicos randomizados são necessários para confirmar essa recomendação.

Obsessive-compulsive disorder (OCD) is a severe mental disorder with serious consequences to family dynamics. Therefore, parental involvement seems to be a key factor for the successful treatment of this psychiatric disorder. The aim of this study was to evaluate the level of evidence available to allow recommendation of cognitive behavioral therapy (CBT) with family intervention for the treatment of children and adolescents with OCD. The systematic search was performed on MEDLINE/PubMed, followed by analysis of abstracts and full-length articles by two independent evaluators. Subsequently, an analysis of the evidence available was conducted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The effect size of the intervention was calculated using Cohen’s d. We found 77 articles on PubMed, plus 12 articles via cross-reference search. Of these, seven articles were included in this review, according to the following criteria: intervention study, involving only children and/or adolescents, and a having a structured or clinical diagnosis of OCD. The Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) was used for outcome evaluation in all articles, thus enabling assessment of the effect size of non-controlled interventions (d = 1.43), resulting in a mean difference of 13.11 points (95 percentCI 11.84-14.39; p < 0.001). Conversely, a high heterogeneity was detected among the studies (I² = 67 percent). Family-based CBT seems to have an important effect on the reduction of OCD symptoms in children and adolescents. However, the small number of studies available do not allow us to establish an evidence level higher than C for this recommendation. New randomized clinical trials are needed to confirm this recommendation.

A heterogeneidade do Transtorno Obsessivo-Compulsivo (TOC): uma revisão seletiva da literatura / Heterogeneity of Obsessive-Compulsive Disorder (OCD): a selective review of the literature

O Transtorno Obsessivo-Compulsivo (TOC) é um dos transtornos mentais mais prevalentes. No entanto, há ainda a falta de reconhecimento dos sintomas característicos, e isso pode levar ao atraso no diagnóstico e no tratamento. Não obstante, a variabilidade na expressão clínica e a diversidade dos sintomas são fatores complicadoresno momento do diagnóstico. Atualmente, este é feito com base nos manuais de classificação diagnóstica DSM-IV e CID-10 que descrevem o transtorno como uma entidade única. Contudo, o TOC é muitas vezes subdiagnosticado por ser um transtorno heterogêneo do ponto devista clínico e pelos fatores etiológicos e de resposta ao tratamento. Ascomorbidades tornam o diagnóstico ainda mais complexo. Assim, odiagnóstico diferencial acurado é de suma importância. Desse modo,este artigo revisa a literatura científica sobre as diversas manifestaçõesclínicas do transtorno, as comorbidades que dificultam o diagnóstico eos sintomas incomuns do TOC. (AU)

Obsessive-Compulsive Disorder (OCD) is one of the most prevalent mental disorders. In spite of this, the lack of recognition of its characteristic symptoms can lead to delay in the diagnosis and treatment. Moreover, the variability of clinical manifestations and the diversity of symptoms are confusing factors by the time of diagnosis. Currently, it is made based on the manuals of diagnostic classifi cation DSM-IV and CID-10 that describes the disorder as one single entity. However, OCD is underdiagnosed due to its heterogeneity from a clinical viewpoint and considering etiological factors and response to treatment. Comorbiditiesalso make the diagnosis even more complex. Therefore, the accurate differential diagnosis is extremely important. This paper intends to reviewthe available scientifi c literature regarding the diversity of clinical expression, the comorbidities that complicate the diagnosis, and the uncommon symptoms of OCD. (AU)

[Coping strategies, functional difficulties, and associated factors in institutionalized elderly]. / Estratégias de enfrentamento, dificuldades funcionais e fatores associados em idosos institucionalizados.

The aim of this study was to analyze the strategies used by elderly people to cope with functional difficulties, and to investigate a possible association between such strategies and variables like depressive symptoms, gender, schooling, marital status, and self-perceived health. 103 institutionalized elderly individuals participated in the study. They required assistance for at least one activity of daily living. The study was cross-sectional and used the following indicators: Personal Data Chart, Activities of Daily Living Scale, Modified Mini International Neuropsychiatric Interview, Mini-Mental Examination, Coping Strategies Inventory, and Geriatric Depression Scale. The most widely used coping strategies in the sample were self-control and problem solving. Significant associations were found between schooling and depression. The findings suggest that assessing coping strategies for stressful events can assist analysis of the situation and appropriate adaptation of the chosen strategies, so as to foster changes within the medical context.

Estratégias de enfrentamento, dificuldades funcionais e fatores associados em idosos institucionalizados / Coping strategies, functional difficulties, and associated factors in institutionalized elderly

O objetivo deste estudo é verificar as estratégias de enfrentamento utilizadas pelos idosos em face das dificuldades funcionais e a existência de associação entre o uso das estratégias e variáveis como sintomas depressivos, sexo, escolaridade, idade, estado civil e percepção da saúde. Participaram do estudo 103 idosos institucionalizados, que apresentavam necessidade de assistência em no mínimo uma atividade de vida diária. O delineamento foi transversal, com a utilização dos seguintes instrumentos: Ficha de Dados Pessoais, Escala de Atividades da Vida Diária, Breve Entrevista Internacional de Neuropsiquiatria Modificada, Mini-Exame do Estado Mental, Inventário de Estratégias de Coping e Escala de Depressão Geriátrica. As estratégias de enfrentamento mais utilizadas pela amostra foram a de autocontrole e resolução de problemas. Encontraram-se associações significativas entre as variáveis escolaridade e depressão. Os resultados da pesquisa sugerem que a avaliação das estratégias utilizadas em face de eventos estressores pode auxiliar na análise da situação e na adequação das estratégias escolhidas, ajudando também em processos de mudança no contexto clínico.

The aim of this study was to analyze the strategies used by elderly people to cope with functional difficulties, and to investigate a possible association between such strategies and variables like depressive symptoms, gender, schooling, marital status, and self-perceived health. 103 institutionalized elderly individuals participated in the study. They required assistance for at least one activity of daily living. The study was cross-sectional and used the following indicators: Personal Data Chart, Activities of Daily Living Scale, Modified Mini International Neuropsychiatric Interview, Mini-Mental Examination, Coping Strategies Inventory, and Geriatric Depression Scale. The most widely used coping strategies in the sample were self-control and problem solving. Significant associations were found between schooling and depression. The findings suggest that assessing coping strategies for stressful events can assist analysis of the situation and appropriate adaptation of the chosen strategies, so as to foster changes within the medical context.

Dificuldade funcional e coping em idosos / Functional difficulty and coping in elders

O objetivo deste estudo foi verificar as características das publicações indexadas nos últimos cinco anos que abordam os temas coping, dificuldade funcional e idosos. Os artigos foram revisados e classificados a partir de seis dimensões de análise: base de dados, ano de publicação, país de origem, tipo de delineamento, cruzamento de variáveis e resultados e conclusões dos estudos. O tratamento dos dados foi realizado através de análise dasfreqüências percentuais.(AU)

Dificuldade funcional e coping em idosos / Functional difficulty and coping in elders

O objetivo deste estudo foi verificar as características das publicações indexadas nos últimos cinco anos que abordam os temas coping, dificuldade funcional e idosos. Os artigos foram revisados e classificados a partir de seis dimensões de análise: base de dados, ano de publicação, país de origem, tipo de delineamento, cruzamento de variáveis e resultados e conclusões dos estudos. O tratamento dos dados foi realizado através de análise dasfreqüências percentuais.