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BACKGROUND: Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS: A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS: The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION: Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.
Anxiety is prevalent and disablingSubsyndromal anxiety is a risk factor for anxiety disordersSubsyndromal anxiety can be assessed with the GAD-7 (Generalised Anxiety Disorder-7 scale)Subsyndromal anxiety can be treated with life-style modification, psychotherapy and pharmacological treatment, including silexan, a natural compound.
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Objectives: To summarize evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The literature on CBT interventions for adult OCD, including BT and exposure and response prevention, was systematically reviewed to develop updated clinical guidelines for clinicians, providing comprehensive details about the necessary procedures for the CBT protocol. We searched the literature from 2013-2020 in five databases (PubMed, Cochrane, Embase, PsycINFO, and Lilacs) regarding study design, primary outcome measures, publication type, and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association. Results: We examined 44 new studies used to update the 2013 American Psychiatric Association guidelines. High-quality evidence supports CBT with exposure and response prevention techniques as a first-line treatment for OCD. Protocols for Internet-delivered CBT have also proven efficacious for adults with OCD. Conclusion: High-quality scientific evidence supports the use of CBT with exposure and response prevention to treat adults with OCD.
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OBJECTIVE: To summarize the evidence-based cognitive-behavioral therapy (CBT) treatment and propose clinical interventions for adult patients with obsessive-compulsive disorder (OCD). METHODS: A systematic review of the literature on CBT interventions for the treatment of adult OCD, comprising behavior therapy and exposure and response prevention (ERP) was done. The objective of this study is to present updated clinical guidelines to clinicians, providing comprehensive details regarding the necessary procedures to be incorporated into the CBT protocol. We searched the literature published from 2013-2020 in five databases (PubMed, Cochrane, Embase, Psycinfo and Lilacs), considering: study design, primary outcome measures, type of publication and language. Selected articles were assessed for quality with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). RESULTS: We examined 44 new studies used to update the APA guidelines from 2013. High-quality evidence supports CBT including ERP techniques as the first-line CBT treatment for OCD. In addition, protocols for internet-delivered CBT have also demonstrated their efficacy for the treatment of adults with OCD. CONCLUSION: CBT based on ERP is a widely used treatment according to high-quality scientific evidence to treat adults with OCD.
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Objectives: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). Methods: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). Results: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. Conclusion: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.
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OBJECTIVES: To summarize evidence-based pharmacological treatments and provide guidance on clinical interventions for adult patients with obsessive-compulsive disorder (OCD). METHODS: The American Psychiatric Association (APA) guidelines for the treatment of OCD (2013) were updated with a systematic review assessing the efficacy of pharmacological treatments for adult OCD, comprising monotherapy with selective serotonin reuptake inhibitors (SSRIs), clomipramine, serotonin and norepinephrine reuptake inhibitors (SNRIs), and augmentation strategies with clomipramine, antipsychotics, and glutamate-modulating agents. We searched for the literature published from 2013-2020 in five databases, considering the design of the study, primary outcome measures, types of publication, and language. Selected articles had their quality assessed with validated tools. Treatment recommendations were classified according to levels of evidence developed by the American College of Cardiology and the American Heart Association (ACC/AHA). RESULTS: We examined 57 new studies to update the 2013 APA guidelines. High-quality evidence supports SSRIs for first-line pharmacological treatment of OCD. Moreover, augmentation of SSRIs with antipsychotics (risperidone, aripiprazole) is the most evidence-based pharmacological intervention for SSRI-resistant OCD. CONCLUSION: SSRIs, in the highest recommended or tolerable doses for 8-12 weeks, remain the first-line treatment for adult OCD. Optimal augmentation strategies for SSRI-resistant OCD include low doses of risperidone or aripiprazole. Pharmacological treatments considered ineffective or potentially harmful, such as monotherapy with antipsychotics or augmentation with ketamine, lamotrigine, or N-acetylcysteine, have also been detailed.
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Antipsicóticos , Transtorno Obsessivo-Compulsivo , Humanos , Adulto , Antipsicóticos/uso terapêutico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Clomipramina/uso terapêutico , Aripiprazol/uso terapêutico , Risperidona , Brasil , Resultado do Tratamento , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/psicologiaRESUMO
This study aimed to identify the factors associated with a delay in treatment-seeking among patients with obsessive-compulsive disorder (OCD), a disabling neuropsychiatric disorder. To achieve this purpose, we conducted a cross-sectional study examining latency to treatment (LTT) and its associated correlates in 863 patients with OCD. We defined LTT as the time lag between the awareness of discomfort and/or impairment caused by symptoms and the beginning of OCD-specific treatment. To determine the socio-demographic and clinical characteristics associated with LTT, we built an interval-censored survival model to simultaneously assess the relationship between all variables, representing the best fit to our data format. The results of our study showed that approximately one-third of OCD patients sought treatment within two years of symptom awareness, one-third between two and nine years, and one-third after ten or more years. Median LTT was 4.0 years (mean = 7.96, SD = 9.54). Longer LTT was associated with older age, early onset of OCD symptoms, presence of contamination/cleaning symptoms and full-time employment. Shorter LTT was associated with the presence of aggression symptoms and comorbidity with hypochondriasis. The results of our study confirm the understanding that LTT in OCD is influenced by several interdependent variables - some of which are modifiable. Strategies for reducing LTT should focus on older patients, who work in a full-time job, and on individuals with early onset of OCD and contamination/cleaning symptoms.
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Transtorno Obsessivo-Compulsivo , Comorbidade , Estudos Transversais , Humanos , Hipocondríase/epidemiologia , Transtorno Obsessivo-Compulsivo/diagnósticoRESUMO
Obsessive-compulsive disorder (OCD) is a frequent, disabling disorder with high rates of treatment resistance. Transcranial direct current stimulation (tDCS) is a safe, tolerable noninvasive neuromodulation therapy with scarce evidence for OCD. This double-blind, randomized, and sham-controlled study investigates the efficacy of tDCS as add-on treatment for treatment-resistant OCD (failure to respond to at least one previous pharmacological treatment). On 20 consecutive weekdays (4 weeks), 43 patients with treatment-resistant OCD underwent 30 min active or sham tDCS sessions, followed by a 8 week follow-up. The cathode was positioned over the supplementary motor area (SMA) and the anode over the left deltoid. The primary outcome was the change in baseline Y-BOCS score at week 12. Secondary outcomes were changes in mood and anxiety and the occurrence of adverse events. Response was evaluated considering percent decrease of baseline Y-BOCS scores and the Improvement subscale of the Clinical Global Impression (CGI-I) between baseline and week 12. Patients that received active tDCS achieved a significant reduction of OCD symptoms than sham, with mean (SD) Y-BOCS score changes of 6.68 (5.83) and 2.84 (6.3) points, respectively (Cohen's d: 0.62 (0.06-1.18), p = 0.03). We found no between-group differences in responders (four patients in the active tDCS and one in the sham group). Active tDCS of the SMA was not superior to sham in reducing symptoms of depression or anxiety. Patients in both groups reported mild adverse events. Our results suggest that cathodal tDCS over the SMA is an effective add-on strategy in treatment-resistant OCD.
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Córtex Motor , Transtorno Obsessivo-Compulsivo , Estimulação Transcraniana por Corrente Contínua , Método Duplo-Cego , Humanos , Transtorno Obsessivo-Compulsivo/terapia , Resultado do TratamentoRESUMO
BACKGROUND: Obsessive-compulsive disorder (OCD) has a lifetime prevalence of 2-3% and is a leading cause of global disability. Brain circuit abnormalities in individuals with OCD have been identified, but important knowledge gaps remain. The goal of the new global initiative described in this paper is to identify robust and reproducible brain signatures of measurable behaviors and clinical symptoms that are common in individuals with OCD. A global approach was chosen to accelerate discovery, to increase rigor and transparency, and to ensure generalizability of results. METHODS: We will study 250 medication-free adults with OCD, 100 unaffected adult siblings of individuals with OCD, and 250 healthy control subjects at five expert research sites across five countries (Brazil, India, Netherlands, South Africa, and the U.S.). All participants will receive clinical evaluation, neurocognitive assessment, and magnetic resonance imaging (MRI). The imaging will examine multiple brain circuits hypothesized to underlie OCD behaviors, focusing on morphometry (T1-weighted MRI), structural connectivity (Diffusion Tensor Imaging), and functional connectivity (resting-state fMRI). In addition to analyzing each imaging modality separately, we will also use multi-modal fusion with machine learning statistical methods in an attempt to derive imaging signatures that distinguish individuals with OCD from unaffected siblings and healthy controls (Aim #1). Then we will examine how these imaging signatures link to behavioral performance on neurocognitive tasks that probe these same circuits as well as to clinical profiles (Aim #2). Finally, we will explore how specific environmental features (childhood trauma, socioeconomic status, and religiosity) moderate these brain-behavior associations. DISCUSSION: Using harmonized methods for data collection and analysis, we will conduct the largest neurocognitive and multimodal-imaging study in medication-free subjects with OCD to date. By recruiting a large, ethno-culturally diverse sample, we will test whether there are robust biosignatures of core OCD features that transcend countries and cultures. If so, future studies can use these brain signatures to reveal trans-diagnostic disease dimensions, chart when these signatures arise during development, and identify treatments that target these circuit abnormalities directly. The long-term goal of this research is to change not only how we conceptualize OCD but also how we diagnose and treat it.
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Mapeamento Encefálico , Encéfalo/diagnóstico por imagem , Imagem de Tensor de Difusão , Internacionalidade , Imageamento por Ressonância Magnética , Estudos Multicêntricos como Assunto/métodos , Transtorno Obsessivo-Compulsivo/diagnóstico por imagem , Adolescente , Adulto , Encéfalo/patologia , Encéfalo/fisiopatologia , Brasil , Estudos de Casos e Controles , Feminino , Humanos , Índia , Masculino , Pessoa de Meia-Idade , Países Baixos , Transtorno Obsessivo-Compulsivo/patologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Projetos de Pesquisa , Irmãos/psicologia , África do Sul , Estados Unidos , Adulto JovemRESUMO
There is a lack of information about alcohol use by transgender women. We estimated the prevalence of dangerous alcohol use in the last 12 months by transgender women, who are known as travestis in Brazil, and we identified the associated risk factors. Three hundred travestis were recruited using Respondent Driving Sampling (RDS). We applied the Alcohol Use Disorders Identification Test (AUDIT). We controlled the sample by applying a weight to each interviewee. Three quarters (74.2%) of travestis were regular drinkers, half (48.7%) scored over eight in the AUDIT and 14.8% scored over 20. The risk factors for alcohol use were: aged over 24, low income and unprotected sex. The dangerous use of alcohol is prevalent among travestis. Given that this group has a greater risk of HIV infection and transmission, and that the dangerous use of alcohol was associated with unsafe sex, specific intervention strategies are required.
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Consumo de Bebidas Alcoólicas/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Fatores de Risco , Fatores Socioeconômicos , Adulto JovemRESUMO
Abstract: There is a lack of information about alcohol use by transgender women. We estimated the prevalence of dangerous alcohol use in the last 12 months by transgender women, who are known as travestis in Brazil, and we identified the associated risk factors. Three hundred travestis were recruited using Respondent Driving Sampling (RDS). We applied the Alcohol Use Disorders Identification Test (AUDIT). We controlled the sample by applying a weight to each interviewee. Three quarters (74.2%) of travestis were regular drinkers, half (48.7%) scored over eight in the AUDIT and 14.8% scored over 20. The risk factors for alcohol use were: aged over 24, low income and unprotected sex. The dangerous use of alcohol is prevalent among travestis. Given that this group has a greater risk of HIV infection and transmission, and that the dangerous use of alcohol was associated with unsafe sex, specific intervention strategies are required.
Resumo: Informação sobre uso de álcool entre mulheres transgêneros são escassas. Estimamos a prevalência do uso perigoso de álcool nos últimos 12 meses entre mulheres transgêneros chamadas travestis no Brasil, e identificados os fatores de risco associados. Trezentas travestis foram recrutadas utilizando Respondent Driving Sampling (RDS). Aplicamos o Alcohol Use Disorders Identification Test (AUDIT). Controlamos a amostragem, com um peso aplicado a cada entrevistada. Três quartos (74,2%) das travestis eram bebedores regulares, metade (48,7%) obteve > 8 no AUDIT e 14,8% obtiveram > 20. Fatores de risco para o uso de risco de álcool foram: > 24 anos, baixa renda, raça negra, viver com a família, ter feito sexo por dinheiro, uso de drogas ilícitas nos últimos seis meses e sexo desprotegido. O uso perigoso de álcool é prevalente entre travestis. Tendo em vista que este grupo possui maior risco para a infecção e transmissão de HIV, e que o uso perigoso de álcool foi associado ao sexo inseguro, são necessárias estratégias de intervenção específicas.
Resumen: Existe falta de información sobre el consumo de alcohol por parte de mujeres transexuales. El estudio estimó la prevalencia de consumo excesivo de alcohol durante los últimos 12 meses por parte de mujeres transexuales, conocidas en Brasil como travestis, e identificó los factores de riesgo. Fueron reclutadas 300 travestis, utilizando la técnica de Respondent Driven Sampling (RDS). Aplicamos el Alcohol Use Disorders Identification Test (AUDIT). La muestra fue controlada, aplicando un peso a cada entrevistada. Tres cuartos (74,2%) de la muestra consumían alcohol regularmente, la mitad (48,7%) totalizó más de ocho puntos en el AUDIT y 14,8% sumaron más de 20 puntos. Los factores de riesgo para el consumo excesivo de alcohol fueron: edad por encima de 24 años, baja renta y sexo sin preservativo. El uso excesivo de alcohol es común entre las travestis. Debido a que el grupo presenta riesgo aumentado de transmisión del VIH, y que el uso excesivo de alcohol estuvo asociado al sexo inseguro, se necesitan estrategias específicas para mitigar los riesgos.
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Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Consumo de Bebidas Alcoólicas/epidemiologia , Pessoas Transgênero/estatística & dados numéricos , Fatores Socioeconômicos , Brasil/epidemiologia , Estudos Transversais , Fatores de RiscoRESUMO
BACKGROUND: Social Phobia (SP) is an anxiety disorder that frequently co-occurs with obsessive-compulsive disorder (OCD); however, studies that evaluate clinical factors associated with this specific comorbidity are rare. The aim was to estimate the prevalence of SP in a large multicenter sample of OCD patients and compare the characteristics of individuals with and without SP. METHOD: A cross-sectional study with 1001 patients of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders using several assessment instruments, including the Dimensional Yale-Brown Obsessive-Compulsive Scale and the Structured Clinical Interview for DSM-IV Axis I Disorders. Univariate analyses were followed by logistic regression. RESULTS: Lifetime prevalence of SP was 34.6% (N=346). The following variables remained associated with SP comorbidity after logistic regression: male sex, lower socioeconomic status, body dysmorphic disorder, specific phobia, dysthymia, generalized anxiety disorder, agoraphobia, Tourette syndrome and binge eating disorder. LIMITATIONS: The cross-sectional design does not permit the inference of causal relationships; some retrospective information may have been subject to recall bias; all patients were being treated in tertiary services, therefore generalization of the results to other samples of OCD sufferers should be cautious. Despite the large sample size, some hypotheses may not have been confirmed due to the small number of cases with these characteristics (type 2 error). CONCLUSION: SP is frequent among OCD patients and co-occurs with other disorders that have common phenomenological features. These findings have important implications for clinical practice, indicating the need for broader treatment approaches for individuals with this profile.
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Transtorno Obsessivo-Compulsivo/epidemiologia , Transtornos Fóbicos/epidemiologia , Adulto , Análise de Variância , Transtornos de Ansiedade/epidemiologia , Transtornos Dismórficos Corporais , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/psicologia , Transtornos Fóbicos/psicologia , Prevalência , Estudos Retrospectivos , Fatores Sexuais , Classe Social , Síndrome de Tourette/epidemiologiaRESUMO
BACKGROUND: The prevalence, sociodemographic aspects, and clinical features of body dysmorphic disorder (BDD) in patients with obsessive-compulsive disorder (OCD) have been previously addressed in primarily relatively small samples. METHODS: We performed a cross-sectional demographic and clinical assessment of 901 OCD patients participating in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. We used the Structured Clinical Interview for DSM-IV Axis I Disorders; Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS); Brown Assessment of Beliefs Scale; Clinical Global Impression Scale; and Beck Depression and Anxiety Inventories. RESULTS: The lifetime prevalence of BDD was 12.1%. The individuals with comorbid BDD (OCD-BDD; n = 109) were younger than were those without it. In addition, the proportions of single and unemployed patients were greater in the OCD-BDD group. This group of patients also showed higher rates of suicidal behaviors; mood, anxiety, and eating disorders; hypochondriasis; skin picking; Tourette syndrome; and symptoms of the sexual/religious, aggressive, and miscellaneous dimensions. Furthermore, OCD-BDD patients had an earlier onset of OC symptoms; greater severity of OCD, depression, and anxiety symptoms; and poorer insight. After logistic regression, the following features were associated with OCD-BDD: current age; age at OCD onset; severity of the miscellaneous DY-BOCS dimension; severity of depressive symptoms; and comorbid social phobia, dysthymia, anorexia nervosa, bulimia nervosa, and skin picking. CONCLUSIONS: Because OCD patients might not inform clinicians about concerns regarding their appearance, it is essential to investigate symptoms of BDD, especially in young patients with early onset and comorbid social anxiety, chronic depression, skin picking, or eating disorders.
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Transtornos Dismórficos Corporais/epidemiologia , Transtornos Mentais/epidemiologia , Transtorno Obsessivo-Compulsivo/epidemiologia , Adulto , Fatores Etários , Idade de Início , Transtornos de Ansiedade/epidemiologia , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Depressão/epidemiologia , Emprego/estatística & dados numéricos , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Feminino , Humanos , Modelos Logísticos , Masculino , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
UNLABELLED: Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. OBJECTIVES: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. RESULTS: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. CONCLUSION: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.
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Ansiedade/fisiopatologia , Medo/fisiologia , Transtorno Obsessivo-Compulsivo/fisiopatologia , Animais , Ansiedade/epidemiologia , Ansiedade/psicologia , Comorbidade , Modelos Animais de Doenças , Medo/psicologia , Humanos , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologiaRESUMO
Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. OBJECTIVES: The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. RESULTS: Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. CONCLUSION: It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.
A ansiedade é um componente importante da psicopatologia do transtorno obsessivo-compulsivo (TOC). Até o momento, a maioria das intervenções que provaram ser eficazes para o tratamento de TOC é semelhante àquelas desenvolvidas para outros transtornos de ansiedade. No entanto, estudos que investigaram a neurobiologia do TOC chegaram a conclusões que nem sempre são compatíveis com aquelas anteriormente associadas aos demais transtornos de ansiedade. OBJETIVOS: Neste artigo, revisamos o grau de sobreposição entre as características do TOC e a fenomenologia e fisiopatologia dos demais transtornos de ansiedade com o intuito de dar suporte ao racional que orienta a pesquisa nesse campo. RESULTADOS: Alguns dados sobre os neurocircuitos envolvidos na manifestação dos transtornos de ansiedade foram obtidos a partir do estudo de modelos animais de ansiedade, e da neuroimagem estrutural e funcional em humanos. Esses trabalhos sugerem que no TOC, além da disfunção das vias corticoestriatais, o funcionamento do circuito amigdalocortical, essencial para a apresentação da resposta de medo e processos de extinção dessa resposta, também pode estar prejudicado. CONCLUSÃO: É provável que a ansiedade seja uma dimensão relevante do TOC, com impacto em outras características desse transtorno. Consequentemente, estudos futuros podem se beneficiar da investigação dos fenômenos de medo e ansiedade e de suas relações com os tipos de obsessões e compulsões, idade de início do TOC, comorbidades e padrões de resposta ao tratamento.