Daniela Tusi Braga

Cognitive-behavioral group therapy for obsessive-compulsive disorder : a 1-year follow-up

Objective:  The aim of this study was to evaluate the results of cognitive‐behavioral group therapy (CBGT) for obsessive–compulsive disorder (OCD) over a 1‐year follow‐up period.

Full remission and relapse of obsessive-compulsive symptoms after cognitive-behavioral group therapy: a two-year follow-up

OBJECTIVE The aim of this study was to assess whether the results obtained with 12 sessions of cognitive-behavioral group therapy with obsessive-compulsive patients were maintained after two years, and whether the degree of symptom remission was associated with relapse. METHOD Forty-two patients were followed. The severity of symptoms was measured at the end of cognitive-behavioral group therapy and at 18 and 24 months of follow-up. The assessment scales used were the Yale-Brown Obsessive-Compulsive Scale, Clinical Global Impression, Beck Depression Inventory, and Beck Anxiety Inventory. RESULTS The reduction in symptom severity observed at the end of treatment was maintained during the two-year follow-up period (F = 57.881; p < 0.001). At the end of the treatment, 9 (21.4%) patients presented full remission, 22 (52.4%) presented partial remission, and 11 (26.2%) had unchanged scores in the Yale-Brown Obsessive-Compulsive Scale. After two years, 13 patients (31.0%) presented full remission, 20 (47.6%) had partial remission, and 9 (21.4%) had unchanged Yale-Brown Obsessive-Compulsive Scale scores. The full remission of symptoms at the end of the treatment was a protective factor against relapse (chi2 = 4,962; df = 1; p = 0.026). CONCLUSION Our findings underscore the importance of attaining full remission of obsessive-compulsive symptoms during treatment and the need for new therapeutic strategies to achieve this.

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.

Symptom dimensional approach and BDNF in unmedicated obsessive-compulsive patients: an exploratory study.

UNLABELLED IntroductionThe dimensional approach of the obsessive-compulsive symptoms may help to find more homogeneous groups of patients. The brain derived neurotrophic factor (BDNF) may help to identify neurobiological differences between obsessive-compulsive symptom dimensions. METHODS We compared serum BDNF (pg/μg) levels of 25 unmedicated patients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for obsessivecompulsive disorder (OCD) and 25 controls, using the Dimensional Yale-Brown Obsessive-Compulsive Scale, the Yale-Brown Obsessive-Compulsive Scale and the Becks Anxiety and Depression Inventories. RESULTS There were no sociodemographic differences between the groups. The standard error of mean serum BDNF levels were reduced in unmedicated OCD patients (0.47+0.038) when compared to healthy controls (0.75+0.060) (P<.001). The patients with the presence of sex/religion obsessive-compulsive symptoms (OCS) dimension (P=.002), with chronic course of OCS (P=.022) and the presence of lifetime major depression (P=.016) and social anxiety (P=.030) presented higher levels of BDNF than OCD patients without those features. The severity of aggression (P=.039) and sex/religion (P<.001) OCS dimension presented direct (moderate and strong, respectively) correlation with serum BDNF levels in this sample. Serum BDNF levels were decreased in OCD patients when compared to healthy controls.Discussion/ConclusionSexual and religious content of symptoms and aggression and sex/religion dimensions severity should be better explored, since these specific OCS dimensions could be based on neurocircuits diverse from those of the other OCS dimensions.

Patient and family factors associated with family accommodation in obsessive–compulsive disorder

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.

Cognitive dysfunction in post-traumatic obsessive–compulsive disorder

Objective: To investigate whether patients who develop obsessive–compulsive disorder (OCD) after posttraumatic stress disorder, i.e. post-traumatic OCD (PsT-OCD), display a distinctive neurocognitive pattern of dysfunction. Methods: Patients with PsT-OCD (n = 16), pre-traumatic OCD (PrT-OCD) (n = 18), non-traumatic OCD (NonT-OCD) (n = 67) and healthy controls (n = 17) had their performance compared on the following neuropsychological tests: the Wisconsin Card Sorting Test, the Iowa Gambling Task, the Wechsler Memory Scale Logical Memory, the Brief Visual Memory Test – Revised, and the Wechsler Abbreviated Scale for Intelligence. Results: Patients with OCD, as a group, were characterized by poor set-shifting abilities and impaired verbal and visuospatial memories. Impaired set-shifting abilities were found to correlate with the severity of obsessive–compulsive symptoms in all groups of patients with OCD, with the exception of PsT-OCD. Only patients with PsT-OCD were characterized by impaired visuospatial recognition, which was found to correlate with poor set-shifting abilities in this particular group of patients, but not in individuals with other types of OCD or in healthy controls. Conclusions: Our study suggests that PsT-OCD is associated with a distinctive pattern of neurocognitive dysfunction, thus providing support for a different subtype of OCD.

Translation and adaptation into Brazilian Portuguese of the Family Accommodation Scale for Obsessive-Compulsive Disorder - interviewer-Rated (FAS-IR)

OBJETIVO: Descrever o processo de traducao e adaptacao para o portugues do Brasil da Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). METODO: O processo de traducao e adaptacao da escala envolveu quatro profissionais de saude bilingues. A escala foi inicialmente traduzida de forma independente para o portugues do Brasil por dois profissionais. A seguir, as duas versoes foram comparadas, resultando em uma versao inicial em portugues que foi aplicada a 15 familiares de pacientes com transtorno obsessivo-compulsivo (TOC), com diferentes niveis de instrucao, deliberadamente escolhidos para coletar as sugestoes de ajuste linguistico. Subsequentemente, a escala foi retrotraduzida independentemente por outros dois profissionais da saude. Depois de comparar as duas retrotraducoes, uma nova versao da escala foi gerada em ingles. Essa versao foi revisada e aprovada pelos autores da escala original. RESULTADOS: A versao em portugues do Brasil da escala FAS-IR mostrou ser facilmente compreendida e pode ser usada em familiares de pacientes com TOC de diferentes niveis socioeconomicos. CONCLUSAO: A FAS-IR adaptada ao portugues do Brasil fara com que profissionais de saude possam avaliar o nivel de acomodacao em familiares de pacientes com TOC e permitira a realizacao de futuros estudos com os objetivos de 1) estudar a influencia da acomodacao familiar na manutencao e, possivelmente, na facilitacao dos sintomas do TOC e 2) examinar o efeito da acomodacao familiar sobre os resultados do tratamento em populacoes de paises de lingua portuguesa.

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.