Effectiveness of online group cognitive-behavior therapy for adolescents with obsessive-compulsive disorder: a pilot study.

OBJECTIVE: This study aims to evaluate the effectiveness of online group cognitive-behavioral therapy (GCBT) guided by the CAMALEO TOC manual in treating of adolescents with obsessive compulsive disorder (OCD). METHOD: A quasi-experimental study with a single group pre-posttest intervention. Over 12 weeks 11 adolescents aged 11 to 17 years with OCD received weekly online sessions of GCBT based on CAMALEO TOC manual. The Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms severity, the Family accommodation scale for obsessive-compulsive disorder interviewer-rated for family accommodation, the Children's Depression Inventory to assess depression symptoms, the Revised Children's Manifest Anxiety Scale for anxiety, and the Multidimensional Student Life Satisfaction Scale to assess life satisfaction. RESULTS: OCD symptoms decreased significantly (d = -1.55). A strong effect size (d = -1.03) was also found for family accommodation. No significant difference in OCD symptoms and family accommodation scores were found when controlling for differences between being in psychotherapeutic treatment, medication use, or psychiatric comorbidities. There was also no evidence that the intervention was effective in reducing symptoms of depression, anxiety or improving quality of life. CONCLUSION: We demonstrate the feasibility of a short-term online GCBT as an effective treatment for adolescents with OCD.

Instruments to assess suicide risk: a systematic review.

INTRODUCTION: Suicide is an issue of great severity in public health worldwide. This study aimed to investigate which instruments are most frequently used by healthcare professionals to assess suicide risk and how accessible such instruments are, as well as to determine the scope of suicide phenomena. METHOD: A systematic review was performed using the following Boolean searches: "scale AND suicide," "evaluation AND suicide," "questionnaire AND suicide." The articles retrieved were read and selected by two independent researchers - any discrepancies were addressed by a third researcher. RESULTS: From a total number of 206 articles, 20 instruments were identified as being currently used to assess suicide risk. The two most common were the Beck Scale for Suicide Ideation (BSI) and The Columbia - Suicide Severity Rating Scale (C-SSRS). CONCLUSION: Even though the two scales (BSI and C-SSRS) are the most frequently mentioned and used by healthcare professionals to assess suicide risk, both instruments present breaches in their structure and there is not yet a single instrument considered to be the gold standard. As a future perspective, there is the urgency of developing a new tool that can widely and completely assess all psychopathological aspects of suicidality.

Instruments to assess suicide risk: a systematic review

Abstract Introduction Suicide is an issue of great severity in public health worldwide. This study aimed to investigate which instruments are most frequently used by healthcare professionals to assess suicide risk and how accessible such instruments are, as well as to determine the scope of suicide phenomena. Method A systematic review was performed using the following Boolean searches: "scale AND suicide," "evaluation AND suicide," "questionnaire AND suicide." The articles retrieved were read and selected by two independent researchers - any discrepancies were addressed by a third researcher. Results From a total number of 206 articles, 20 instruments were identified as being currently used to assess suicide risk. The two most common were the Beck Scale for Suicide Ideation (BSI) and The Columbia - Suicide Severity Rating Scale (C-SSRS). Conclusion Even though the two scales (BSI and C-SSRS) are the most frequently mentioned and used by healthcare professionals to assess suicide risk, both instruments present breaches in their structure and there is not yet a single instrument considered to be the gold standard. As a future perspective, there is the urgency of developing a new tool that can widely and completely assess all psychopathological aspects of suicidality.

Impact of cognitive-behavioral group therapy for obsessive-compulsive disorder on family accommodation: A randomized clinical trial.

The aim of this study was to assess the impact of cognitive-behavioral group therapy (CBGT) with the brief involvement of family members on family accommodation and to identify predictors of family accommodation reduction (patient and family member characteristics). This randomized clinical trial assessed 98 pairs of patients with obsessive-compulsive disorder (OCD) and their family members: 52 (53.1%) were allocated to the intervention group (12 CBGT sessions - two with the family member), and 46 (46.9%) to a waiting list (control group). Symptom severity and family accommodation were assessed before and after CBGT. There was significant improvement of OCD symptoms and family accommodation scores after CBGT in the intervention group vs. the control group. The following variables were significant predictors of family accommodation reduction after multivariate analysis: patient characteristics - absence of comorbid unipolar disorder, lower obsession score, and higher education level; family member characteristics - higher hoarding score. The model explained 47.2% of the variance in family accommodation scores after treatment. CBGT for patients with OCD and the brief involvement of family members contributed to reduce family accommodation. Both patient and family member characteristics were predictors of family accommodation reduction. This finding can help qualify CBGT protocols.

Patient and family factors associated with family accommodation in obsessive-compulsive disorder.

AIM: Obsessive-compulsive disorder (OCD) impacts family functioning as family members modify their personal and family routines, participate in rituals, and provide reassurance. These behaviors have been identified as family accommodation (FA), a phenomenon that, if ignored, may facilitate OCD symptoms and lead to poorer prognosis. Because FA has been recognized as a predictor of treatment outcome, we examined the prevalence of FA and identified patient and family sociodemographic and clinical variables associated with FA in an outpatient sample. METHODS: The study comprised 228 subjects, namely, 114 patients with OCD and 114 family members, assessed before the patients entered a 12-session cognitive behavioral group therapy program. A multivariate linear regression model was used to control for confounding factors and to evaluate variables independently associated with FA. FA was evaluated using the Family Accommodation Scale for Obsessive-Compulsive Disorder-Interviewer Rated. RESULTS: FA was found to be highly prevalent among family members. Two patient factors positively associated with FA were OCD severity as measured by the Clinical Global Impressions Scale and higher scores on the Obsessions dimension of the Obsessive-Compulsive Inventory-Revised. Family members' characteristics that were positively associated with FA were higher scores on the Obsessive-Compulsive Inventory - Revised hoarding subscale and being the patient's spouse. CONCLUSION: Our findings suggest that the early identification of patients and family members who could benefit from interventions aimed at reducing FA could improve treatment outcomes.

Psychometric properties of the Brazilian version of the Obsessive Beliefs Questionnaire (OBQ-44).

The present study was designed to assess the psychometric properties of the Brazilian version of the Obsessive Beliefs Questionnaire (OBQ-44) in 104 patients with obsessive compulsive disorder (OCD) at the Hospital de Clínicas de Porto Alegre. The secondary objective was to ascertain whether a decline in OBQ-44 scores occurs after cognitive-behavioral group therapy (CBGT). Factor analysis identified three dysfunctional belief domains from the original scale. Internal consistency and reproducibility were very good and good, respectively. Sensitivity to treatment change (cognitive-behavioral group therapy) was good, and pre-post intervention standardized effect sizes (Cohen's d) were strong. The OBQ-44 plays an important role in this setting; as a user-friendly, self-administered instrument that lists the most common dysfunctional beliefs of OCD patients, it enables healthcare providers to assess whether their patients' beliefs change after treatment.

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.

Lócus de controle em psicólogos hospitalares

Esta pesquisa é de cunho quantitativo tendo como preocupação central identificar lócus de controle entre psicólogos hospitalares, utilizando a Escala de Reyes. A análise descritiva das variáveis sócio-demográficas apontaram que nos dois grupos estudados predominaram as mulheres, casados, com idade variando entre 20 e 40 anos. Ao identificar as diferenças de média intragrupos e os fatores de lócus de controle utilizou-se o Teste t-Student, não se encontrando diferença significativa para os fatores e entre os grupos, mesmo aparecendo relativo aumento da utilização do lócus de controle interno entre os participantes. Importante ressaltar que, embora a Psicologia Hospitalar transponha os limites do consultório, mantendo contato obrigatório com outras profissões, a enorme demanda social que definem os problemas da saúde, as diversas atuações do profissional dentro dos hospitais; o psicólogo hospitalar não difere em termos de lócus de controle de outros colegas de profissão(AU)

This research is quantitative stamp bearing focus identify locus of control among hospital psychologists, using Reyes scale. The descriptive analysis of socio-demographic variables, showed in two groups, prevailed women, married, aged between 20 and 40 years. By identifying the differences in average intra and factors of locus of control, the t-test Student not found a significant difference to the factors and between groups, even appearing on increased use of internal locus of control among participants. Important to note that while the Hospital psychology over the limits of the office, maintaining contact with other professions required, the huge demand that define the social problems of health, the various performances of the professional within the hospital, the hospital psychologist does not differ in terms of locus Control of other co-workers(AU)