Evaluation of Second Generation Antipsychotics, as Augmentative Plan, in Treatment-Resistant Obsessive-Compulsive Disorder

Introduction: Since around half of the patients with obsessive-compulsive disorder do not respond efficiently to current serotonin- reuptake inhibitors, the objective of the present study was to compare the effectiveness and safety of quetiapine against aripiprazole in patients with obsessive-compulsive disorder, who had not responded successfully to fluvoxamine. Methods: Forty-four patients with obsessive-compulsive disorder, who had not responded efficaciously to fluvoxamine, at maximum dose (300 milligrams per day) and duration (twelve weeks), were allocated randomly in a double-blind assessment to take quetiapine (n=22) or aripiprazole (n=22), plus their serotonin-reuptake inhibitor for twelve weeks. While treatment response was evaluated by the Yale- Brown Obsessive-Compulsive Scale (YBOCS), as the main outcome scale, Clinical Global Impressions-Severity Scale (CGI-S) was also used as an ancillary measure. Results: 54.54% of patients in the quetiapine group and 27.27% of them in the aripiprazole group responded partially to the abovementioned on treatment adds. According to the findings, the YBOCS score dropped from 31.18+/-4.93 to 27.97+/-3.71 (p<0.01), and 33.27 +/- 3.90 to 30.72+/-4.67 (p < 0.06), for quetiapine and aripiprazole, respectively. In this regard, no substantial alteration regarding CGI-S was evident in each of the aforementioned groups. Conclusion: This assessment indicated that patients with treatment-resistant obsessivecompulsive disorder could benefit more from adding quetiapine, in comparison with aripiprazole, to their current serotonergic medication.

Comparison of Different Kinds of Memory in Bipolar Disorder With or Without ObsessiveCompulsive Disorder Comorbidity

Background: One challenging area in psychological pathology pertains to the comorbidity of the psychological disorders. Bipolar disorder can be pointed out among the most critical psychological diseases featuring common psychiatric comorbidity. The purpose of this study is to compare different kinds of memory in Bipolar Disorder with or without obsessive-compulsive disorder (OCD) comorbidity. Methods: Sixty samples selected in 3 groups: 20 bipolar patients, 20 bipolar disorder with OCD comorbidity, and 20 healthy volunteers. Samples were selected using the available sampling method. Data collection tool included 3 questionnaires: Demographic Information Questionnaire, Comprehensive International Diagnostic Interview (CIDI), Wechsler’s Memory Scale. Data analyzed by multivariate analysis of covariance and descriptive statistics. Results: The results of multivariate analysis of variance analysis showed that at the level of 0.001, there was a significant difference at least regarding one of the memory variables, between the subjects of the 3 groups of bipolar/OCD, bipolar disorder and healthy. According to the mean of the groups, the weakest function is related to patients with bipolar/OCD. Conclusion: The results of the study showed that memory damage is more common in the bipolar/ OCD group, which should consider the treatment processes of these patients.

Estimulação Cerebral Profunda. Perspectivas da neuromodulação em desordens neuropsiquiátricas

Introdução: A estimulação cerebral profunda (DBS – Deep Brain Stimulation) vem sendo empregada desde a década de 80 no tratamento de doenças motoras. Recentemente, suas aplicações em transtornos neuropsiquiátricos têm sido estudadas. Objetivos: Analisar a literatura recente quanto à aplicação de DBS no manejo de desordens psiquiátricas, tais como depressão maior, transtorno obsessivo compulsivo (TOC), depressão maior (DM), transtorno bipolar de humor (TBH) e síndrome de Tourette (ST). Metodologia: Buscou-se nos bancos de dados Scielo, Medline e PubMed os descritores “Deep Brain Stimulation”, “Depression”, “Obsessivecompulsive disorder”, “Bipolar Disorder” e “Neuromodulation”. Foram considerados trabalhos de estudos de série de casos, coorte, revisão sistemática e de metanálise publicados entre os anos de 1999 a 2019. Resultados: Foi realizada uma revisão de parte da literatura, levantando 43 artigos, dos quais 29 foram utilizados para a redação desse trabalho, somado a 3 capítulos de livro para uma breve descrição da técnica de DBS. Discussão: As normas para tratamento cirúrgico em doenças psiquiátricas, inclusive por DBS, são: doença primária, sintomas severos ou incapacitantes e refratariedade às demais formas de tratamento disponíveis. Trabalhos envolvendo pequenos ensaios clínicos randomizados apontam que DBS pode reduzir os sintomas do TOC, havendo melhora significativa na qualidade de vida a longo prazo, bem como redução de sintomas depressivos. Na DM, resultados satisfatórios foram obtidos em diferentes trabalhos. Ao analisar a resposta de pacientes submetidos ao DBS ao longo de 8 anos, houve efeito antidepressivo sustentado durante o seguimento. Em relação ao TBH, existem poucos trabalhos disponíveis com o uso do DBS. Em um estudo prospectivo de 2 anos, 7 pacientes com TBH foram submetidos a DBS e apresentaram relativa melhora dos sintomas depressivos. Nenhum deles apresentou episódios de mania ou hipomania. Na ST, observou-se melhora clínica utilizando o núcleo centro medial do tálamo e o globo pálido medial como alvos. Não foi encontrada uma padronização entre as desordens psiquiátricas tratadas por DBS e os diferentes alvos estereotáxicos. Conclusões: A introdução de DBS como alternativa terapêutica para distúrbios psiquiátricos ainda é relativamente recente na literatura médica, sendo necessária a realização de mais trabalhos para concluir sua real eficácia. Entretanto, os resultados revisados parecem promissores.

Obsessive-compulsive and related disorders

Obsessive-compulsive and related disorders comprise several syndromes, to which repetitive thoughts or behaviours are central. Compulsive behaviour is concerned most with hygiene, orderliness, checking, grooming, and hoarding, whereas obsessive thoughts (rumination) focus on harm avoidance and cultural taboos. Compulsive behaviours resemble stereotypic movements seen in animals or cultural rituals. Cognitively, anticipating potential future risk scenarios may help in minimising threat, suggesting that obsessivecompulsive disorder may be a by-product of foresight. Obsessive-compulsive disorder is often linked to life events that require heightened vigilance for threat, including sexual maturation (puberty), pregnancy, and childbirth. While most individuals with obsessive-compulsive disorder follow a ‘slow’ life-history strategy, cases with increased impulsivity and reduced inhibitory control seem to pursue a ‘fast’ life-history strategy.