Manuela C. Borges

Quality of life and symptom dimensions of patients with obsessive-compulsive disorder

The aim of this study was to evaluate the impact of different dimensions of obsessive-compulsive symptoms, of co-morbid anxious depressive symptoms, and of sociodemographic characteristics on the quality of life of patients with obsessive-compulsive disorder (OCD). We evaluated 53 patients with OCD and 53 age- and gender-matched individuals from the community with a sociodemographic questionnaire, the Structured Clinical Interview for the Diagnosis of Diagnostic and Statistical Manual of Mental Disorders, fourth Edition, (DSM-IV), the Short-Form Health Survey-36 (SF-36), the Saving Inventory-Revised, the Obsessive-Compulsive Inventory-Revised, the Beck Depression Inventory and the Beck Anxiety Inventory. A series of stepwise linear regression analyses were performed, having the SF-36 dimensions as the dependent variables and the sociodemographic and clinical features as the independent ones. Patients with OCD displayed significantly lower levels of quality of life in all dimensions measured by the SF-36, except bodily pain. A model that included depressive symptoms, hoarding and employment status predicted 62% of the variance of the social functioning dimension of the quality of life of patients with OCD. Washing symptoms explained 31% of the variance of limitation due to physical health problems. Further, a series of models that included depressive, but not obsessive-compulsive symptoms, explained the remaining SF-36 dimensions. The severity of depressive and anxiety symptoms seems, therefore, to be powerful determinants of the level of quality of life in patients with OCD.

Auditory, visual, tactile, olfactory, and bodily hallucinations in patients with obsessive-compulsive disorder.

Although much attention has been paid to patients who lack insight into their obsessional beliefs, less importance has been given to individuals with obsessive-compulsive disorder (OCD) who display perceptual disturbances typically found in psychotic disorders, including schizophrenia, schizoaffective disorders, or mood disorders with psychotic features. We would like to call the attention to a phenomenon that has been neglected in the psychiatric literature: the occurrence of hallucinations and related phenomena in patients with OCD. In this case report, we describe five clinical vignettes of patients with OCD with hallucinations in several different sensory modalities, including the auditory, the visual, the tactile, the olfactory, and the cenesthetic ones. Further psychopathological research should clarify the clinical significance of hallucinations among patients with OCD.

THE BRAZILIAN PORTUGUESE VERSION OF THE SAVING INVENTORY-REVISED: INTERNAL CONSISTENCY, TEST-RETEST RELIABILITY, AND VALIDITY OF A QUESTIONNAIRE TO ASSESS HOARDING

Pathological hoarding results in clutter that precludes normal activities and creates distress or dysfunction. It may lead to an inability to complete household functions, health problems, social withdrawal, and even death. The aim of this study was to describe the validation of the Brazilian version of the hoarding assessment instrument, the Saving Inventory–Revised. Sixty-five patients with obsessive-compulsive disorder (OCD) and 70 individuals from the community were assessed using the Structured Clinical Interview for the Diagnosis of DSM–IV (clinical sample), the Saving Inventory–Revised, the Obsessive-Compulsive Inventory–Revised, the Beck Depression Inventory, and the Beck Anxiety Inventory. The Brazilian version of the Saving Inventory–Revised exhibited high internal consistency (Cronbachs alpha = .94 for OCD and .84 for controls), high to moderate test-retest reliability and, using the hoarding dimension of the Obsessive-Compulsive Inventory–Revised as a reference point, high to moderate convergent validity. The Saving Inventory–Revised total scores also correlated significantly with comorbid anxiety and depressive symptoms.

Concordância entre relato de pais e professores para sintomas de TDAH: resultados de uma amostra clínica brasileira

CONTEXTO: O diagnostico de TDAH em criancas e adolescentes, segundo os criterios do DSM-IV, requer que os sintomas estejam presentes em, ao menos, dois ambientes distintos (principalmente escola e casa). Apesar da importância do relato de pais e professores, esse tema tem sido pouco investigado no Brasil. OBJETIVO: Investigar a concordância entre os relatos de pais e professores de uma amostra clinica de criancas e adolescentes com diagnostico de TDAH. METODOS: A amostra era composta por 44 criancas e adolescentes com idades variando entre 6 e 16 anos (40 meninos e 4 meninas), com diagnostico clinico de TDAH. Foram comparadas as respostas de pais e professores no questionario SNAP-IV, visando a calcular taxas de concordância entre diferentes fontes de informacao para sintomas de TDAH. RESULTADOS: Concordância para o diagnostico de TDAH ocorreu em aproximadamente metade dos casos; pais relataram mais sintomas de TDAH que professores. CONCLUSAO: Os achados aqui apresentados podem mostrar que informacoes acerca da sintomatologia de TDAH nao sao bem divulgadas para professores brasileiros, indicando a necessidade de se investir em sessoes educacionais sobre o transtorno, tendo em vista a importância do relato de profissionais de educacao para o diagnostico de TDAH.CONTEXTO: O diagnostico de TDAH em criancas e adolescentes, segundo os criterios do DSM-IV, requer que os sintomas estejam presentes em, ao menos, dois ambientes distintos (principalmente escola e casa). Apesar da importância do relato de pais e professores, esse tema tem sido pouco investigado no Brasil. OBJETIVO: Investigar a concordância entre os relatos de pais e professores de uma amostra clinica de criancas e adolescentes com diagnostico de TDAH. METODOS: A amostra era composta por 44 criancas e adolescentes com idades variando entre 6 e 16 anos (40 meninos e 4 meninas), com diagnostico clinico de TDAH. Foram comparadas as respostas de pais e professores no questionario SNAP-IV, visando a calcular taxas de concordância entre diferentes fontes de informacao para sintomas de TDAH. RESULTADOS: Concordância para o diagnostico de TDAH ocorreu em aproximadamente metade dos casos; pais relataram mais sintomas de TDAH que professores. CONCLUSAO: Os achados aqui apresentados podem mostrar que informacoes acerca da sintomatologia de TDAH nao sao bem divulgadas para professores brasileiros, indicando a necessidade de se investir em sessoes educacionais sobre o transtorno, tendo em vista a importância do relato de profissionais de educacao para o diagnostico de TDAH.

Síndromes disexecutivas do desenvolvimento e adquiridas na prática clínica: três relatos de caso

Sindromes disexecutivas podem ser observadas em diversas condicoes neuropsiquiatricas, como transtorno do deficit de atencao e hiperatividade (TDAH), traumatismos cranioencefalicos (TCE) ou esquizofrenia, frequentemente se associando a ampla gama de comprometimento, incluindo ambientes familiar, academico e profissional. O objetivo do presente estudo e apresentar tres casos de disfuncoes executivas, nos quais, embora todos os pacientes tenham QI dentro dos limites da normalidade, existe significativo comprometimento social e ocupacional. O primeiro caso apresenta uma jovem que sofreu TCE, com queixas de dificuldades de memoria para material novo, alem de apatia e diminuicao de iniciativa e persistencia. O segundo caso versa sobre uma mulher que apresenta problemas desde a educacao infantil, com historico de tratamentos ineficazes e nenhum diagnostico formal. Segundo relato de informante colateral, ha deficits de planejamento, comportamentos antissociais, aversao a gratificacoes tardias e dificuldades de ativacao. O ultimo caso refere-se a individuo do sexo masculino, avaliado depois de grave TCE apos acidente de carro. Ha relato de mudanca de comportamento com desinibicao, diminuicao da persistencia e desatencao, relatadas como mais graves do que as apresentadas durante a infância, apesar de desempenho normal em testes de funcoes executivas. A avaliacao de disfuncoes executivas (do desenvolvimento ou adquiridas) pode ser de extrema importância para servir como base de tratamento visando a diminuicao de comprometimento nas atividades cotidianas.

Dementia Developing in Late-onset and Treatment-refractory Obsessive-compulsive Disorder

BackgroundAlthough several studies have been conducted in an attempt to characterize the phenotype and underlying pathophysiology of individuals with early-onset obsessive-compulsive disorder (OCD), the literature on patients who develop OCD later in life remains sparse. ObjectiveTo describe clinical outcomes in the 7-year follow-up of a patient with late-onset OCD. MethodSingle case report. ResultsA 64-year-old woman exhibiting a 7-year history of treatment-refractory late-onset OCD developed significant cognitive deterioration. We suggest that the association between late-onset treatment refractory OCD and dementia may stem from at least 3 different scenarios. First, dementia may be an inexorable end-point of some forms of malignant, primary, and late-onset obsessional illness. Second, late-onset OCD and dementia may result from a common pathophysiologic basis, such as in fronto-temporal dementia. Finally, the association between both conditions may result by the interaction between vulnerability toward OCD-type symptoms and the nonspecific effects of a neurodegenerative process. In our case, although subclinical OCD was likely to be “unmasked” by cognitive decline and/or bilateral caudate vascular lesions, ensuing cognitive deterioration could be ascribed to development of Alzheimer dementia. ConclusionOur observation suggests that treatment refractoriness in an individual with late-onset OCD may indicate underlining organicity.

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.

Standardization of the normative group for the third version of the test of visual attention - TAVIS

Despite the importance of objective measures of attention to clinical practice, there is a paucity of Brazilian standardized tests. Objective The aim of the present study was the standardization of a normative group for the third version of a computerized test of visual attention (TAVIS-3), developed to evaluate children and adolescents in the 6 to 17 years age range. Methods 631 students from 3 schools in Rio de Janeiro city were assessed with TAVIS-3, administered by experienced psychologists, following parents’ authorization. Results The normative groups were determined considering performance of different age groups: from 6 to 10 years (with scores for 5 different ages); from 11 to 12 and from 13 to 17 years. Three tasks (focused, shifted and sustained attention) were standardized for each age group. Conclusion The standardization of a normative group for TAVIS-3 discriminated performance ranges for distinct age groups, allowing its use as a neuropsychological assessment of attention.

Transtornos parafílicos em pacientes com transtorno obsessivo-compulsivo: série de casos

In order to elucidate the relationship between impulse control disorders and obsessive-compulsive disorder (OCD), it is essential to study more clinically homogenous subgroups of patients with impulsive disorders. Using four cases of patients with OCD and comorbid paraphilias (transvestic fetishism, sadism, gynandromorphophilia, and exhibitionism) as reference-points, we discuss the concepts of compulsivity, impulsivity, and the temporal relationship between them. The case studies here described suggest that (1) patients with OCD and comorbid paraphilias tend to develop OCD first, (2) once developing paraphilic fantasies, desires, or behaviors, patients with OCD can exhibit typical compulsive behaviors in an attempt to keep these phenomena under control, (3) patients with OCD and ego-dystonic sexual obsessions can develop paraphilic fantasies, desires, or behaviors with similar content to the first phenomenon, (4) OCD and paraphilias can follow independent courses in the same patient, and (5) patients with OCD and paraphilias may not present obsessions with sexual content. The distress presented by patients with OCD and paraphilias give good reason for the continuous investigation of this association, aiming at clarifying the neurobiological mechanisms underlying this association.