RESUMO
Obsessive-compulsive disorder (OCD) encompasses a broad range of symptoms representing multiple domains. This complex phenotype can be summarized using a few consistent and temporally stable symptom dimensions. The objective of this study was to assess the psychometric properties of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS). This scale measures the presence and severity of obsessive-compulsive (OC) symptoms within six distinct dimensions that combine thematically related obsessions and compulsions. The DY-BOCS includes portions to be used as a self-report instrument and portions to be used by expert raters, including global ratings of OC symptom severity and overall impairment. We assessed 137 patients with a Diagnostic and Statistical Manual-IV diagnosis of OCD, aged 6-69 years, from sites in the USA, Canada and Brazil. Estimates of the reliability and validity of both the expert and self-report versions of the DY-BOCS were calculated and stratified according to age (pediatric vs. adult subjects). The internal consistency of each of the six symptom dimensions and the global severity score were excellent. The inter-rater agreement was also excellent for all component scores. Self-report and expert ratings were highly intercorrelated. The global DY-BOCS score was highly correlated with the total Yale-Brown Obsessive-Compulsive Scale score (Pearson r = 0.82, P<0.0001). Severity scores for individual symptom dimensions were largely independent of one another, only modestly correlated with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. No major differences were observed when the results were stratified by age. These results indicate that the DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in natural history, neuroimaging, treatment response and genetic studies when administered by expert clinicians or their highly trained staff.
Assuntos
Transtorno Obsessivo-Compulsivo/diagnóstico , Escalas de Graduação Psiquiátrica , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno Obsessivo-Compulsivo/classificação , Psicologia do Adolescente , Psicologia da Criança , Psicometria/métodos , Reprodutibilidade dos Testes , Índice de Gravidade de Doença , Estatísticas não ParamétricasRESUMO
Obsessive-compulsive disorder (OCD) clinical presentation is remarkably diverse, and can vary both within and across patients over time. This variability in the phenotypic expression has led to the hypothesis that OCD is a heterogeneous disorder and that this heterogeneity obscures the findings of clinical, natural history and treatment response studies and complicates the search for vulnerability genes. A complete understanding of what comprises OCD and the underlying etiological mechanisms will require a dramatic change in how the disorder is conceptualized. In this review, several different approaches that may represent the first steps in this reconceptualization are discussed. These approaches include (1) narrowing the phenotype to identify categorically defined more homogeneous and mutually exclusive subtypes of OCD, (2) considering OC symptom dimensions as quantitative components of the more complex OCD phenotype and (3) broadening the phenotype to include other etiologically related conditions. A combined dimensional approach within distinctive subgroups is proposed as probably the most effective in helping to identify the heritable components of OCD. By identifying heritable components of OCD, it should be possible to find genes for these separate components. The review continues with the illustration of the possible role of some epigenetic risk and protective factors in the OCD presentation and the relevance of examining associated traits and/or endophenotypes to enhance our ability to understand the genetic basis of OCD. To conclude, we discuss the variability in treatment outcome and the significance of the development of specific pharmacological and/or behavioral based therapies tailored to each of these phenotypes.
Assuntos
Heterogeneidade Genética , Transtorno Obsessivo-Compulsivo/genética , Epigênese Genética , Predisposição Genética para Doença , Humanos , Transtorno Obsessivo-Compulsivo/epidemiologia , Fenótipo , PrevalênciaRESUMO
OBJECTIVE: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder with a bimodal age at onset and range of treatment outcomes. This study attempted to ascertain the importance of the age at OCD symptom onset for a better phenotypic precision. Therefore, the authors compared adult OCD patients with an early symptom onset to OCD patients with a later symptom onset. METHOD: Forty-two adult outpatients with OCD were evaluated with semistructured interviews: 21 with symptom onset before the age of 10 (early-onset group) and 21 with symptom onset after the age of 17 (late-onset group). RESULTS: Early onset was associated with higher scores on the Yale-Brown Obsessive Compulsive Scale, higher frequencies of tic-like compulsions, higher frequency of sensory phenomena, and a higher rate of comorbid tic disorders. The early-onset group also responded less well to treatment with clomipramine and selective serotonin reuptake inhibitors. CONCLUSIONS: The results indicate that age at onset may be an important factor in subtyping OCD and that the phenotypic differences found were not restricted to childhood.
Assuntos
Clomipramina/uso terapêutico , Transtorno Obsessivo-Compulsivo , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Masculino , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/tratamento farmacológico , Transtorno Obsessivo-Compulsivo/psicologia , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
OBJECTIVE: This study examined the frequency and age at onset of psychiatric disorders among children with rheumatic fever, Sydenham's chorea, or both and a comparison group. METHOD: Twenty children with rheumatic fever, 22 with Sydenham's chorea, and 20 comparison children were assessed by means of a semistructured interview and rating scales for tic disorders and obsessive-compulsive disorder. RESULTS: Obsessive-compulsive symptoms were more frequent in both the Sydenham's chorea and rheumatic fever groups than in the comparison group. The Sydenham's chorea group had a higher frequency of major depressive disorder, tic disorders, and attention deficit hyperactivity disorder (ADHD) than both the comparison and rheumatic fever groups. ADHD symptoms were associated with a higher risk of developing Sydenham's chorea. CONCLUSIONS: Both the rheumatic fever and Sydenham's chorea groups were associated with a higher risk of developing neuropsychiatric disorders than the comparison group. ADHD appears to be a risk factor for Sydenham's chorea in children with rheumatic fever.
Assuntos
Coreia/diagnóstico , Transtornos Mentais/diagnóstico , Febre Reumática/diagnóstico , Fatores Etários , Idade de Início , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Brasil/epidemiologia , Criança , Coreia/epidemiologia , Comorbidade , Transtorno Depressivo/diagnóstico , Transtorno Depressivo/epidemiologia , Feminino , Humanos , Masculino , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Transtorno Obsessivo-Compulsivo/diagnóstico , Transtorno Obsessivo-Compulsivo/epidemiologia , Prevalência , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Febre Reumática/epidemiologia , Febre Reumática/psicologia , Tiques/diagnóstico , Tiques/epidemiologiaRESUMO
BACKGROUND: Recent studies have suggested that obsessive-compulsive disorder (OCD) is a heterogeneous disorder with some forms related to tics and Tourette's disorder. The present study was undertaken to investigate the sensory phenomena in patients with OCD and/or Tourette's disorder to determine if these phenotypic features represent valid clinical indices for differentiating tic-related OCD from non-tic-related OCD. METHOD: We evaluated 20 adult outpatients with OCD, 20 with OCD plus Tourette's disorder, and 21 with Tourette's disorder, using a semistructured interview designed to assess several definitions of sensory phenomena reported in the literature. DSM-III-R criteria were used for the OCD and Tourette's disorder diagnoses. RESULTS: Sensory phenomena including bodily sensations, mental urges, and a sense of inner tension were significantly more frequent in the 2 Tourette's disorder groups when compared with the OCD alone group. Feelings of incompleteness and a need for things to be "just right" were reported more frequently in the OCD plus Tourette's disorder group compared with the other 2 groups. CONCLUSION: Sensory phenomena may be an important phenotypic measure for grouping patients along the OCD-Tourette's disorder spectrum. Sensory phenomena include bodily and mental sensations. Bodily sensations include focal or generalized body sensations (usually tactile, muscular-skeletal/visceral, or both) occurring either before or during the patient's performance of the repetitive behaviors. These sensations are more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone. Mental sensations include urge only, energy release (mental energy that builds up and needs to be discharged), incompleteness, and just-right perceptions. They are all more frequently found in patients with OCD plus Tourette's disorder than in patients with OCD alone.
Assuntos
Cognição , Transtorno Obsessivo-Compulsivo/diagnóstico , Sensação/fisiologia , Síndrome de Tourette/diagnóstico , Adulto , Análise de Variância , Conscientização/fisiologia , Cognição/fisiologia , Estudos de Coortes , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Imaginação/fisiologia , Masculino , Transtorno Obsessivo-Compulsivo/epidemiologia , Transtorno Obsessivo-Compulsivo/psicologia , Prognóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Fatores Sexuais , Tato/fisiologia , Síndrome de Tourette/epidemiologia , Síndrome de Tourette/psicologia , Percepção Visual/fisiologiaRESUMO
BACKGROUND: Obsessive-compulsive disorder (OCD) is heterogeneous, with some forms related to Gilles de la Tourette's syndrome (GTS). This is a phenomenological study designed to investigate the nature of these possible OCD subtypes and the relationship between OCD and GTS. METHOD: We evaluated 20 adult outpatients with OCD, 21 with GTS, and 20 with OCD plus GTS using a semi-structured interview designed to assess cognitive, sensory and autonomic phenomena preceding repetitive behaviours. RESULTS: More cognitions and autonomic anxiety and fewer sensory phenomena were reported in OCD than in GTS. Like the GTS group, the OCD plus GTS group reported more sensory phenomena and fewer cognitions than the OCD group. CONCLUSIONS: The presence or absence of cognitions, sensory phenomena, and autonomic anxiety distinguishes repetitive behaviours in patients with OCD from those with OCD plus GTS, and GTS. These subjective experiences may be useful in subtyping OCD and may represent valid predictors of prognosis and treatment response.
Assuntos
Transtorno Obsessivo-Compulsivo/psicologia , Síndrome de Tourette/psicologia , Adolescente , Adulto , Idoso , Ansiedade/etiologia , Doenças do Sistema Nervoso Autônomo/psicologia , Transtornos Cognitivos/psicologia , Comportamento Compulsivo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Sensação/etiologiaRESUMO
This article discusses current controversies and future directions in basal ganglia research, detailing behavioral aspects, anatomic models, neurochemistry, pharmacology, and diagnostic methods as well as surgical techniques. A neuroethologic perspective is highlighted. Furthermore, the relevant literature pertaining to contemporary molecular approaches such as brain microinjections of embryonic or genetically modified cells, for therapeutic purposes and the use of transgenic and knockout animals.
Assuntos
Doenças dos Gânglios da Base , Neurociências/tendências , Projetos de Pesquisa , Animais , Doenças dos Gânglios da Base/patologia , Doenças dos Gânglios da Base/fisiopatologia , Doenças dos Gânglios da Base/terapia , Modelos Animais de Doenças , Previsões , HumanosRESUMO
Coreia de Sydenham (CS) e uma desordem neuropsiquiatrica, considerada uma compilacao da Febre Reumatica (quadro auto-imune pos-infeccao estreptococcica). Uma incidencia mais alta de sintomas compulsivos obsessivos (SOC) e desordem compulsiva obsessiva (TOC) foi documentado em pacientes de CS. TOC tambem foi descrito mais frequentemente em pacientes com o Sindrome de Tourette (ST) e ha varias linhas de pesquisa sugerindo que algumas formas de TOC podem representar uma expressao variante de ST. O estudo presente visa determinar a frequencia de tiques vocais, alem de sintomas obsessivo-compulsivos na Coreia de Sydenham (CS) e na Febre Reumatica sem CS (RF). Metodo: Foram avaliadas trinta e nove criancas com febre reumatica (22 com o CS e 17 com febre reumatica sem CS) (RF). Os pacientes foram diagnosticados de acordo com os criterios Jones. Foram executadas avaliacoes psiquiatricas e neurologicas em todos os pacientes. A Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiological version (K-SADS-E), Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Yale Global Tics Severity Scale (YGTSS) foram administrados a todos os pacientes. Resultados: A amostra de CS apresentou 14 pacientes com tiques vocais (63,64 por cento) e 8 pacientes com SOC (36,36 por cento). A amostra de FR apresentou 5 pacientes com SOC (29,41 por cento) e nenhum com tique vocal. Conclusoes: Os dados sugerem que tiques vocais sao encontrados mais frequentemente em criancas com a Coreia de Sydenham, e SOC sao encontrados, frequentemente, tanto em pacientes com CS como em pacientes com FR sem CS.