Relationship between obsessive-compulsive disorders and diseases affecting primarily the basal ganglia.

Obsessive-compulsive disorder (OCD) has been reported in association with some neurological diseases that affect the basal ganglia such as Tourette's syndrome, Sydenham's chorea, Parkinson's disease, and Huntington's disease. Furthermore, studies such as neuroimaging, suggest a role of the basal ganglia in the pathophysiology of OCD. The aim of this paper is to describe the association of OCD and several neurologic disorders affecting the basal ganglia, report the existing evidences of the role of the basal ganglia in the pathophysiology of OCD, and analyze the mechanisms probably involved in this pathophysiology.

Obsessive-compulsive disorder and Tourette syndrome: is there a relationship?

The authors describe the main characteristics of Obsessive-Compulsive Disorder, the fourth most frequent psychiatric disease, and Tourette Syndrome. Considered completely separate disorders, there is growing scientific evidence that there is a connection between them. The authors present clinical, genetic and neuroimaging data reinforcing this idea, and call attention to the importance of research in this area, as they believe that the definition of more homogenous subgroups will facilitate the identification of biological marker and predictors of treatment response.

[Obsessive-compulsive disorder and the basal ganglia]. / Transtorno obsessivo-compulsivo e os gânglios da base.

Obsessive-compulsive disorder (OCD), characterized by obsessions and compulsions, was described as more frequent in patients with primary lesions of the basal ganglia suggesting that these brain structures may be also altered in OCD. The basal ganglia, that were considered important only for the motor control, are known now as crucial for many other mental functions as processing of cognitive experience. Recent studies using magnetic resonance image have found a tendency for smaller caudate nucleus in patients with OCD. Consistently, studies using functional neuroimaging suggest implication of a neurocircuit that includes the orbitalfrontal cortex, the cingulate cortex, caudate nucleus and thalamus in the pathophysiology of OCD. Among several hypotheses formulated to explain these findings, some authors speculated that a deficit of the caudate nucleus function would lead to inadequate filtering of worry inputs which would trigger the orbitalfrontal cortex to develop adaptative responses: the compulsions.

[Neuropsychiatric disorders in systemic lupus erythematosus: a multidisciplinary review]. / Alterações neuropsiquiátricas no lúpus eritematoso disseminado (LED): uma revisão multidisciplinar.

Neuropsychiatric alterations appear in 14-75% of lupic patients. Verified in 59% of the patients, psychiatric changes are the most frequent. Psychic symptoms are primarily related to the disease and secondary to uremia, hypertension, infection, and corticosteroids. Manifestations were also seen as a reaction to this chronic disease, which are potentially severe and causing many limitations to the patients. The authors review the literature considering the multidisciplinary aspects of this disease related to its pathogenesis, clinical features, diagnosis, differential diagnosis, and treatment.

[Psychic changes in systemic lupus erythematosus: a multidisciplinary prospective study]. / Alterações psíquicas no lúpus eritematoso disseminado: um estudo prospectivo multidisciplinar.

Despite the high prevalence of psychic symptoms in lupus patients, there are few systematic studies in this area. Through a multidisciplinary approach, the authors developed a prospective study to characterize and correlate psychopathological aspects with clinical and laboratory data concerning neural manifestations of the disease. Out of 23 patients studied, 12 showed psychic alterations, which were interpreted as primary manifestations of the disease. All of them presented organic mental syndromes (DSM-III-R) in which cognitive symptoms were the most prominent, followed by affective, catatonic and hallucinatory features. The neurologic findings (seizure, migraine and muscular atrophy), as well as the ophthalmologic alterations (hemorrhage and soft exudates) were frequent and concomitant with the psychic features. The laboratory findings were: LE cells 50%; anti-Sm: 16%; anti-U1 RNP: 50%; anti-Ro/SS-A: 50%; anti-nDNA: 58%; decreased CH50 or fractions (C3, C4): 67%; anti-P: 18%; antigangliosides IgG: 67%; antigangliosides IgM: 78%. The cerebrospinal fluid analysis showed: increased cellularity: 18%; elevated protein: 36%; antigangliosides IgG: 67%; antigangliosides IgM: 33%; immunocomplexes: 36%. In spite of the absence of an adequate control group and of the small number of patients, the multidisciplinary approach leads to a better characterization of the nervous system involvement in this disease.

[Depression in the elderly: a review]. / Depressão no idoso: uma revisão.

With the increase in life expectancy during recent years, the elderly population and its medical problems are increasing considerably. Depression in the elderly is an important example of this situation. In this article, the authors discuss special aspects of depression in the elderly, its clinical presentation, prevalence, course, etiologic factors, diagnosis, and treatment. They draw attention to the risk of not correctly identifying and treating those patients.

[Catatonic syndrome caused by autoimmune disease: spontaneous remission]. / Síndrome catatônica por doença auto-imune: recuperação espontânea.

The psychiatric manifestations of systemic lupus erythematosus and other autoimmune diseases, which may precede by many years systemic involvement, should be held in mind by both the internist and psychiatrist. This case report focuses on a female catatonic patient without metabolic disturbances, whose evolution did not suggest a schizophrenic disorder. Immune complexes were demonstrated to be present in cerebrospinal fluid (CSF) obtained during psychotic crisis and immunologic tests showed circulating immune complexes with a positive antinuclear factor. (1/800) and a nucleolar pattern with immunofluorescence. The psychiatric picture receded concomitantly with a fall in CSF immune complexes and with an increase in circulating immune complexes, without the administration of immunosuppressive drugs. The catatonic syndrome is a rare manifestation in patients with autoimmune disease and few cases have been reported without systemic manifestation. This report emphasizes the need for increased awareness of the psychiatric effects brought about by autoimmune diseases and shows that CSF immune complexes are valuable markers for their diagnosis.

[Psychiatric interconsultation: concepts and development]. / Interconsulta psiquiátrica: conceito e evolução.

There has been an important development of consultation-liaison psychiatry in the last fifty years. Psychosocial factors and psychiatric symptoms which can be present in many somatic ilnesses have been considered as deserving of more specialized care. This could be achieved by a multidisciplinary team with the presence of a psychiatrist either permanently (consultation-liaison psychiatry) or episodically (psychiatric consultation). The Brazilian experience in this field can be illustrated describing the "Serviço de Interconsultasa do IPQ HC-FMUSP". Organized in 1979, this clinic has been rendering both psychiatric consultation and liaison work (which, from a practical point of view, are complementary services). The clinic is also involved with research and medical education. There is agreement that psychiatric care in a general hospital brings evident benefits to the patient, to the psychiatrist, to non-psychiatric physicians, and to other team members not only in terms of developing new professional opportunities, but also in terms of broadning the research field and improving medical education.