Pediatric anxiety disorders characterized as Generalized, Separation, and Social Anxiety Disorders, are chronic debilitating conditions that leave children feeling tense and isolated, both physically and emotionally. Selective serotonin reuptake inhibitors (SSRIs) are a classification of antidepressants that can be prescribed to children diagnosed with these disorders. SSRIs have been shown to be effective in treating anxiety disorders in children. The purpose of this literature review was to examine and determine if there are more risks or benefits associated with SSRIs, as well as evaluate teaching and education regarding anxiety disorder medication compliance in both children and parents. A secondary purpose of this research was to provide recommendations in nursing practice to allow children to feel more involved in their medical regimen. The following databases were used for the search: CINAHL, Academic Search Premier, and Web of Science. Key terms used in the search include but are not limited to: child* and anxiety, not autism, and selective serotonin reuptake inhibitors, OR SSRI*, OR adolsecen*, not med*, pediatric*, OR side effects. The results suggest that the benefits of SSRI therapy in children with anxiety disorder, when taken on a regularly scheduled basis, outweigh the risks, however more research aimed at compliance with SSRI therapy in children and parents is necessary. Further research analyzing children with anxiety disorders is needed to assess SSRI usage based specifically on their developmental age, and the inclusion of appropriate teaching and explanation related to their diagnoses to identifying stressors that can include behavioral therapy as well.

Explores the relationship between recollections of parenting, Early Maladaptive Schemas (EMS), and symptoms of depression and anxiety in a sample of undergraduate students attending California State University, San Bernardino (N = 232). A correlational-regression approach was adopted to test the hypothesis. Parental socialization was measured with three different subscales. Psychological adjustment was measured by the Symptom Checklist-90-Revised. Early Maladaptive Schema was measured with the Schema Questionnaire-Short Form. Partial mediation of EMS was found with maternal connection and psychological control, but not with paternal socialization. Findings lend support to the schema model and suggest that clinical work with adults suffering from depression and/or anxiety may need to identify and re-structure EMS that develop from "toxic parenting."

Bibliography: leaves 149-178 / Anxiety Disorder is one of the most common disorders experienced by children and, if not managed, can extend into adulthood. Research has established a link between unintegrated primitive reflexes (UPR) and Learning Disorders. Learning Disorders are often co-morbid with symptoms of anxiety, however, the relationship between symptoms of anxiety and UPR have not been studied. This study aims to explore the relationship between the UPR and symptoms of anxiety in children between 10 – 13 years of age. No correlation was found between the total primitive reflex score and total symptoms of anxiety score; however, a significant relationship was found between symptoms of anxiety and the Moro, Plantar and Spinal Galant reflex. These UPR play an important role in balance. Research on balance dysfunction indicates a relationship with symptoms of anxiety. Prenatal maternal stress, common childhood illness and comorbidity with ADHD were also found to be factors in symptoms of anxiety in children. / Psychology / M.A. (Psychology)

Problématique : Au Québec, les troubles anxieux et dépressifs touchent près d’une personne sur cinq au cours de leur vie. Elles consultent majoritairement dans les services de première ligne (SPL) qui sont souvent dispensés en collaboration interprofessionnelle, mais qui ne semblent pas répondre efficacement à leurs besoins. Le rôle optimal (RO) infirmier permet d’intervenir lors du continuum de services. Un écart entre les rôles réels (RR) et le RO des infirmières semble s’observer dans les SPL. But : Décrire et analyser le RR de l’infirmière lors de la prestation des soins aux personnes atteintes de troubles dépressifs et anxieux dans les équipes multiprofessionnelles de première ligne. Méthodologie : 15 professionnels de la santé (infirmières [n=9], autres [n=6]) dans deux milieux de SPL ont participé à cette étude de cas multiples qualitative. Résultats : Trois catégories de facteurs influencent l’écart entre les RR et le RO des infirmières, soit les facteurs liés : 1) à l’équipe, 2) à la clientèle et 3) aux infirmières. La formation du RO des infirmières influence également l’écart. L’approche typiquement holistique et non stigmatisante des infirmières ainsi que la réduction de l’écart entre les RR et le RO semblent optimiser la prise en charge des TMC dans les SPL. Conclusion : Cette recherche met en lumière les facteurs pour réduire l’écart entre les RR et le RO. La formation des professionnels et l’organisation du travail dans le milieu clinique devrait mettre l’accent sur la collaboration interprofessionnelle, maximisant ainsi la pratique des professionnels selon leurs RO. / Problematic: In Québec, anxiety and depressive disorders affect nearly one in five people in their lives. They mainly consult in primary care services which are often provided in interprofessional collaboration but does not seem to succeed to effectively meet their needs. The optimal role allows nurses to intervene throughout the care plan. A difference between the nurse’s actual and optimal roles seems to be observed in the primary care services. Purpose: To describe and analyze the nurse’s actual roles in primary care multiprofessional teams during the delivery of care to people with depressive and anxiety disorders. Methods: 15 healthcare professionals (nurses [n=9], others [n=6]) in two primary care service environments participated in this qualitative multiple case study. Results: Three categories of factors influence the difference between the nurses’ actual and optimal roles: 1) the team, 2) the customer and 3) the nurses. Nurse’s training on the optimal role also influences the gap. The typical nurse’s holistic approach and the nurse’s actual role approaching the optimal role seem to contribute to primary care services in mental health. Conclusion: University training for health professionals and the organization of work in the clinical setting should focus on interprofessional collaboration, maximizing the contribution of optimal role. This research highlights the factors to reduce the gap between the nurse’s actual and optimal roles.

Catechol-O-methyltransferase (COMT) metabolises catechol-containing compounds, including dopamine. The aim of this thesis was to investigate whether COMT is involved in hippocampal function. This thesis also explored the role of functional polymorphisms within the COMT gene in the pathogenesis of schizophrenia and schizophrenia-related phenotypes. First, as part of a study investigating the role of COMT in schizophrenia, human hippocampal COMT mRNA levels were shown to be neither altered in schizophrenia or bipolar disease, nor affected by COMT genotype. Hence, functional COMT polymorphisms do not appear to operate by altering gross COMT mRNA expression. Importantly, this study showed that COMT is expressed in the human hippocampus. Second, the role of COMT in hippocampal neurochemistry was explored by studying the effect of pharmacological COMT inhibition on catecholamines and metabolites in rat hippocampal homogenates, and extracellularly, using microdialysis. Both demonstrated that COMT modulates hippocampal dopamine metabolism. Thus, hippocampal COMT is of functional significance with respect to dopamine. Third, the effect of COMT inhibition on hippocampus-dependent behaviour was investigated. The results suggested a memory-enhancing effect of pharmacological COMT inhibition on hippocampus-dependent associative and non-associative forms of short-term memory in rats. In contrast, acute COMT inhibition appeared to have no effect on behavioural correlates of ventral hippocampal function i.e. anxiety-like behaviour. In summary, the expression of COMT mRNA in the human hippocampus, as well as the effect of COMT inhibition on rat hippocampal neurochemistry and hippocampus-dependent behaviour provide evidence for a functional role of COMT in the hippocampus. Moreover, changes in COMT activity alter hippocampal dopamine metabolism, which could be a potential mechanism for the role of COMT in hippocampus-dependent short-term memory.

Introduction: Physical inactivity is thought to contribute to the emergence of non-communicable diseases in post-conflict settings of low-income countries. Sport-for-development (SfD) organisations in these regions claim to improve the health of programme participants. However, there is a paucity of supporting evidence. I assessed the impact of a voluntary community-based SfD intervention on the physical activity (PA), physical fitness (PF) and mental health (MH) of adolescents in Gulu, Uganda. Methods: The Acholi Psychosocial Assessment Instrument (APAI), standing broad jump (SBJ), multi-stage fitness test (MSFT) and BMI-for-age (BFA) were adapted to the local context. I tested their feasibility and reliability with a repeat-measures design (n=70). A cross-sectional analysis of a random sample was used to assess the local needs and establish the PF and MH of the adolescents reached by the intervention (n=1464). This was also the baseline assessment for the impact evaluation. It comprised a randomised control trial (n=144) nested within a cohort study (n=1400) and triangulated by cross-sectional assessment of PA using accelerometry (n=54). Results: The adapted PF and MH measures demonstrated good intra-tester reliability (ICC>0.75). Adolescents in Gulu predominantly had “healthy” BFA (>90%). They performed better than global norms for the SBJ (p<0.001), but worse for the MSFT (p<0.05). The girls who registered for the intervention had higher PF at baseline (p<0.05) and experienced no significant benefits when compared to the community. The aerobic capacity of the boys intervention group increased relative to the community (p<0.01), but was not significantly different to the trial control group whose PF also improved. The PA results concurred with this finding. Boys in the intervention group experienced a deterioration in MH relative to their peers (p<0.05). Implications: It is feasible to apply rigorous evaluation methods to SfD interventions. Although adolescents in Gulu have poor aerobic capacity, a voluntary programme may not reach those at risk. Interpreting the impact evaluation was limited by a lack of programme development theory, but suggested that opportunities for non-competitive play may confer PF benefit without harming MH. Further investigation is warranted.

oucos estudos avaliaram a associação da ingestão de ácidos graxos ômega 3 e transtornos de ansiedade. O presente estudo utilizou dados transversais do exame de linha de base (2008-2010) do Estudo Longitudinal Brasileiro de Saúde do Adulto - ELSA-Brasil para avaliar essa associação. A exposição dietética foi medida por um questionário quantitativo de frequência alimentar validado para a população brasileira e adaptado para o estudo, e os diagnósticos mentais foram avaliados pelo Clinical Interview Schedule-Revised Version - CIS-R, diagnosticando transtornos mentais de acordo com a Classificação Internacional de Doenças - CID-10. Modelos de regressão logística foram construídos utilizando quintis do consumo de ácidos graxos ômega 3, ácidos graxos ômega 6, razão de consumo n-6/n-3, e ácidos graxos poli-insaturados, usando o primeiro quintil como referência. Dos 15.105 sujeitos participantes do ELSA-Brasil, foram excluídos aqueles que relataram ingestão de menos de 500 ou mais de 4000 kcal, aqueles que relataram ingestão de suplementos n-3 ou n-6 e aqueles que foram submetidos a cirurgia bariátrica. Após as exclusões, 12268 participantes permaneceram na análise, dos quais 1893 (15,4%) apresentaram transtornos de ansiedade. Os indivíduos com transtorno de ansiedade eram mais jovens, de sexo feminino, menor escolaridade e renda, referiram tabagismo atual e atividade física mais leve. Valores mais altos de IMC e de proteína C reativa de alta sensibilidade foram observados nos indivíduos com ansiedade. A ingestão diária média de ácido eicosapentaenoico (EPA), ácido docosapentanoico (DPA) e ácido docosaexaenoico (DHA) foi significativamente menor em participantes com ansiedade. Um maior consumo desses três ácidos graxos da família ômega-3 foi observado em indivíduos com mais idade, maior renda e escolaridade, com dislipidemia, consumo de álcool e tabagismo atuais, e prática de atividade física vigorosa. Após o ajuste para variáveis sociodemográficas (idade, sexo, etnia e educação) fatores de risco cardiovascular (hipertensão, diabetes, dislipidemia, tabagismo, ingestão de álcool e atividade física), calorias totais, qualidade da dieta e depressão, os participantes do quinto quintil de ingestão de EPA, DHA e DPA mostraram associação inversa com transtornos de ansiedade: OR 0,82 (IC 95%, 0,69-0,98), OR 0,83 (IC 95%, 0,69-0,98) e OR 0,82 (IC 95%, 0,69-0,98), respectivamente. Participantes no quinto quintil de razão ômega-6/ômega-3 tiveram associação positiva com transtornos de ansiedade. Nenhuma associação foi encontrada com a ingestão de PUFA, ou ômega-3 e ômega-6 isoladamente com ansiedade após os ajustes. Nesta análise, uma alta ingestão de ômega-3 EPA, DHA e DPA foi inversamente associada com a presença de transtornos de ansiedade, enquanto que a alta razão ômega-6/ômega-3 foi diretamente associada à presença desses transtornos, sugerindo um possível efeito protetor dos ácidos graxos omega-3 EPA, DPA e DHA contra a ansiedade / Few studies have evaluated the association of omega-3 fatty acids intake and anxiety disorders. The present study used cross-sectional data from the baseline (2008-2010) examination of the Brazilian Longitudinal Study of Adult Health - ELSA-Brazil to evaluate this association. The dietary exposure was measured by a quantitative food frequency questionnaire validated for the brazilian population and adapted for the study, and the mental diagnoses were assessed by the Clinical Interview Schedule-Revised Version (CIS-R), diagnosing mental disorders according to the International Classification of Diseases - ICD-10. Logistic regression models were built using quintiles of omega-3 fatty acids, omega-6 fatty acids, omega-6/omega-3 ratio, and polyunsaturated fatty acids consumption, using the first quintile as a reference. Of the 15,105 subjects participating in ELSA-Brazil, those who reported ingestion of less than 500 or more than 4000 kcal, those who reported ingestion of omega-3 or omega-6 supplements and those had undergone bariatric surgery were excluded. After exclusions, 12,268 participants remained in the analysis, of whom 1893 (15.4%) had anxiety disorders. Subjects with anxiety disorder were younger, female, had lower education and income, reported current smoking and mild physical activity. Higher values of BMI and high sensibility C reactive protein were observed in subjects with anxiety. The mean daily intakes of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) were significantly lower in subjects with anxiety. A higher intake of these three omega-3 fatty acids was observed in older individuals with higher income and education, with current dyslipidemias, alcohol consumption and smoking, and vigorous physical activity. After adjustment for socio-demographic variables (age, sex, ethnicity and education), cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol intake and physical activity), total calories, diet quality and depression, EPA, DHA and DPA intakes showed an inverse association with anxiety disorders: OR 0.82 (95% CI, 0.69-0.98), OR 0.83 (95% CI, 0.69-0.98) and OR 0.82 (95% CI, 0.69-0.98), respectively. Participants in the fifth quintile of omega-6/omega-3 ratio had a positive association with anxiety disorders. No association was found with ingestion of PUFA, or omega-3 and omega-6 alone with anxiety after adjustments. In this analysis, a high intake of omega-3 EPA, DHA and DPA was inversely associated with the presence of anxiety disorders, while the higher omega-6 omega-3 ratio was directly associated with the presence of these disorders, suggesting a possible protector effect of omega-3 fatty acids EPA, DPA and DHA against anxiety

Made available in DSpace on 2016-01-26T12:51:16Z (GMT). No. of bitstreams: 1 kazuokawanonagamine_tese.pdf: 4436335 bytes, checksum: c1b23fd4cca930ca5e5a4810a91ebb78 (MD5) Previous issue date: 2007-05-18 / There is much evidence about the positive impact of physical activity on health, including reduction in morbimortality, and improvement in the general wellbeing. Regularly practicing physical activities reduces anxiety, stress, depression and burnout, enhances personal relationships and performance at work, reduces absenteeism and improves quality of life. The objectives of this study were to prospectively assess anxiety, depression, fatigue, burnout and quality of life in individuals before, during, and after their participation in a sixmonth physical activity program conducted at work. Wilcoxon test was used to analyze quantitative variables. A qualitative analysis of the participant s impressions of the program was also performed. Participants: female employees who answered to an advertisement affirming their availability for the program, met inclusion criteria (sedentary women, working 40 hours per week, no health problems, 75% of frequency in the program) and agreed to participate (mean age: 35 years old; SD: 7.5 years). Method: After a physical examination, anamnesis, anthropometrical assessment and testing to obtain heart rate, the participants joined a twice-weekly physical activity program after work that included: walking and/or jogging and localized exercise training (calisthenics exercise). On starting, and after three and six months of the program all participants completed the Beck Depression Inventory, Beck Anxiety Inventory, Chalder Fatigue Scale, Maslach Burnout Inventory and a measure of quality of life (QL) SF-36. Additionally, after six months, participants filled out a questionnaire about their participation in the program. Results: 39 participants xvi started the program, 17 remained until at least the third month and 12 completed the six months. Anxiety symptoms decreased from slight to minimal. There was a significant reduction in depressive symptoms (p=0.006), in fatigue (p=0.01) and burnout (p=0.02). There was an increase in all aspects of QL, with a significant increase in vitality (p=0.04). Participants who abandoned the program reported they did so because of domestic chores, academic activities and work. The highlighted positive aspects of the program were improved relationship with colleagues, wellbeing, health and benefits at work. Conclusions: Data from the study endorse reported benefits of regularly practicing physical activity. The positive testimonies by the participants and observed benefits, stress the importance of implementing this type of program, which can be conducted in the work place at a low cost. / Existem atualmente evidências a respeito do impacto positivo da prática de atividade física sobre a saúde, como redução da morbimortalidade relacionada a diversas doenças e aumento do bem-estar geral. A prática regular de atividade física reduz níveis de ansiedade, estresse, depressão e burnout, aprimora a relação interpessoal, o rendimento laboral, reduz o absenteísmo e promove qualidade de vida. Este estudo teve como objetivos avaliar prospectivamente sintomas de ansiedade, depressão, fadiga, burnout e qualidade de vida em funcionárias, antes, durante e após a participação em programa de atividade física regular durante seis meses, oferecido dentro da própria instituição. Os dados foram analisados com o teste estatístico não paramétrico Wilcoxon do sinal. Análise qualitativa da perspectiva das participantes sobre o programa foi também realizada. Casuística: funcionárias que responderam a anúncio sobre disponibilidade do programa, atenderam aos critérios de inclusão (sedentárias, regime de trabalho de 40 horas semanais, sexo feminino, freqüência de 75% e ausência de problemas de saúde) e concordaram em participar (média de idade: 35; dp:7,5). Método: Após exame físico, anamnese, avaliação antropométrica e treino para obter freqüência cardíaca, as participantes iniciaram programa de atividade física (duas vezes por semana, após o expediente: caminhada e/ou corrida e ginástica localizada. No início, no terceiro e após o sexto mês no programa todas responderam aos Inventários Beck de Ansiedade e de Depressão, Escala de Fadiga de Chalder, Inventário Maslach de Burnout, Medida de Qualidade de Vida (QV) SF-36. Após o sexto mês responderam a questionário sobre sua participação no programa. Resultados: Das 39 participantes iniciais, 17 continuaram até o terceiro mês e 12 até o sexto. Os sintomas de ansiedade passaram da classificação "leve" para mínima". Houve redução significante dos sintomas de depressão (p=0,006), de fadiga (p=0,01) e de burnout (p=0,02). Nota de Resumo Houve aumento em todos os domínios de QV, com aumento significante da Vitalidade (p=0,04). As justificativas fornecidas pelas participantes em relação ao abandono do programa incluíram principalmente atividades domésticas, acadêmicas e de trabalho. Os benefícios apontados incluíram relacionamento com colegas, bem-estar, melhora na saúde, no trabalho e na auto-estima. Conclusões: Os dados obtidos são compatíveis com os benefícios da prática regular de atividade física. A avaliação positiva da experiência pelas participantes e os benefícios observados indicam a relevância de programas como este, que podem ser realizados no próprio ambiente de trabalho e são de baixo custo.

oucos estudos avaliaram a associação da ingestão de ácidos graxos ômega 3 e transtornos de ansiedade. O presente estudo utilizou dados transversais do exame de linha de base (2008-2010) do Estudo Longitudinal Brasileiro de Saúde do Adulto - ELSA-Brasil para avaliar essa associação. A exposição dietética foi medida por um questionário quantitativo de frequência alimentar validado para a população brasileira e adaptado para o estudo, e os diagnósticos mentais foram avaliados pelo Clinical Interview Schedule-Revised Version - CIS-R, diagnosticando transtornos mentais de acordo com a Classificação Internacional de Doenças - CID-10. Modelos de regressão logística foram construídos utilizando quintis do consumo de ácidos graxos ômega 3, ácidos graxos ômega 6, razão de consumo n-6/n-3, e ácidos graxos poli-insaturados, usando o primeiro quintil como referência. Dos 15.105 sujeitos participantes do ELSA-Brasil, foram excluídos aqueles que relataram ingestão de menos de 500 ou mais de 4000 kcal, aqueles que relataram ingestão de suplementos n-3 ou n-6 e aqueles que foram submetidos a cirurgia bariátrica. Após as exclusões, 12268 participantes permaneceram na análise, dos quais 1893 (15,4%) apresentaram transtornos de ansiedade. Os indivíduos com transtorno de ansiedade eram mais jovens, de sexo feminino, menor escolaridade e renda, referiram tabagismo atual e atividade física mais leve. Valores mais altos de IMC e de proteína C reativa de alta sensibilidade foram observados nos indivíduos com ansiedade. A ingestão diária média de ácido eicosapentaenoico (EPA), ácido docosapentanoico (DPA) e ácido docosaexaenoico (DHA) foi significativamente menor em participantes com ansiedade. Um maior consumo desses três ácidos graxos da família ômega-3 foi observado em indivíduos com mais idade, maior renda e escolaridade, com dislipidemia, consumo de álcool e tabagismo atuais, e prática de atividade física vigorosa. Após o ajuste para variáveis sociodemográficas (idade, sexo, etnia e educação) fatores de risco cardiovascular (hipertensão, diabetes, dislipidemia, tabagismo, ingestão de álcool e atividade física), calorias totais, qualidade da dieta e depressão, os participantes do quinto quintil de ingestão de EPA, DHA e DPA mostraram associação inversa com transtornos de ansiedade: OR 0,82 (IC 95%, 0,69-0,98), OR 0,83 (IC 95%, 0,69-0,98) e OR 0,82 (IC 95%, 0,69-0,98), respectivamente. Participantes no quinto quintil de razão ômega-6/ômega-3 tiveram associação positiva com transtornos de ansiedade. Nenhuma associação foi encontrada com a ingestão de PUFA, ou ômega-3 e ômega-6 isoladamente com ansiedade após os ajustes. Nesta análise, uma alta ingestão de ômega-3 EPA, DHA e DPA foi inversamente associada com a presença de transtornos de ansiedade, enquanto que a alta razão ômega-6/ômega-3 foi diretamente associada à presença desses transtornos, sugerindo um possível efeito protetor dos ácidos graxos omega-3 EPA, DPA e DHA contra a ansiedade / Few studies have evaluated the association of omega-3 fatty acids intake and anxiety disorders. The present study used cross-sectional data from the baseline (2008-2010) examination of the Brazilian Longitudinal Study of Adult Health - ELSA-Brazil to evaluate this association. The dietary exposure was measured by a quantitative food frequency questionnaire validated for the brazilian population and adapted for the study, and the mental diagnoses were assessed by the Clinical Interview Schedule-Revised Version (CIS-R), diagnosing mental disorders according to the International Classification of Diseases - ICD-10. Logistic regression models were built using quintiles of omega-3 fatty acids, omega-6 fatty acids, omega-6/omega-3 ratio, and polyunsaturated fatty acids consumption, using the first quintile as a reference. Of the 15,105 subjects participating in ELSA-Brazil, those who reported ingestion of less than 500 or more than 4000 kcal, those who reported ingestion of omega-3 or omega-6 supplements and those had undergone bariatric surgery were excluded. After exclusions, 12,268 participants remained in the analysis, of whom 1893 (15.4%) had anxiety disorders. Subjects with anxiety disorder were younger, female, had lower education and income, reported current smoking and mild physical activity. Higher values of BMI and high sensibility C reactive protein were observed in subjects with anxiety. The mean daily intakes of eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) were significantly lower in subjects with anxiety. A higher intake of these three omega-3 fatty acids was observed in older individuals with higher income and education, with current dyslipidemias, alcohol consumption and smoking, and vigorous physical activity. After adjustment for socio-demographic variables (age, sex, ethnicity and education), cardiovascular risk factors (hypertension, diabetes, dyslipidemia, smoking, alcohol intake and physical activity), total calories, diet quality and depression, EPA, DHA and DPA intakes showed an inverse association with anxiety disorders: OR 0.82 (95% CI, 0.69-0.98), OR 0.83 (95% CI, 0.69-0.98) and OR 0.82 (95% CI, 0.69-0.98), respectively. Participants in the fifth quintile of omega-6/omega-3 ratio had a positive association with anxiety disorders. No association was found with ingestion of PUFA, or omega-3 and omega-6 alone with anxiety after adjustments. In this analysis, a high intake of omega-3 EPA, DHA and DPA was inversely associated with the presence of anxiety disorders, while the higher omega-6 omega-3 ratio was directly associated with the presence of these disorders, suggesting a possible protector effect of omega-3 fatty acids EPA, DPA and DHA against anxiety

Introdução: O presente estudo tem como objetivo avaliar a eficácia da estimulação magnética transcraniana de repetição (EMTr) em freqüência excitatória, aplicada ao córtex pré-frontal dorsolateral direito (CPFDLd), quando adicionada ao tratamento vigente de pacientes com transtorno obsessivocompulsivo (TOC) resistente. Método: 30 pacientes com TOC resistente ao tratamento foram alocados aleatoriamente para receber EMTr ativa ou placebo, sendo que a condição de tratamento permaneceu oculta para pacientes e avaliador. O tratamento vigente permaneceu estável por ao menos 8 semanas. A EMTr foi realizada com uma bobina em formato de oito à freqüência de 10Hz, com 110% do limiar motor em 30 sessões diárias de 40 séries de 5 segundos com 25 segundos de intervalo. A gravidade dos sintomas foi avaliada inicialmente, após 2 e 6 semanas de tratamento e 2 e 6 semanas de seguimento com a escala de Yale-Brown para avaliação de sintomas obsessivo-compulsivos (Y-BOCS), Escala de Impressão Clínica Global (CGI), Escala de Hamilton para ansiedade (HAM-A), Escala de Hamilton para depressão com 17 itens (HAM-D17), e inventário SF-36 de qualidade de vida. A medida primária de eficácia foi definida como redução de 30% ou mais nos escores da Y-BOCS e avaliação melhor ou muito melhor na sub-escala de melhora clínica da CGI ao término do seguimento. Resultados: A análise da medida primária de eficácia revelou que apenas um paciente em cada grupo preencheu critérios de resposta para o tratamento com EMTr (P=1.00). A análise de medidas repetidas dos escores de Y-BOCS mostrou um efeito significativo do tempo (F=7.33, P=0.002). Entretanto, não foi observada diferença entre os grupos ou interação grupo/tempo. A análise de medidas repetidas da CGI (gravidade), HAM-D17 e HAM-A também mostrou efeito significativo do tempo (P<0.001, =0.001 e <0.001 respectivamente), novamente sem diferença significativa entre os grupos ou interação. Conclusão: EMTr excitatória aplicada ao CPFDLd de pacientes com TOC resistente ao tratamento não foi diferente de placebo na redução de sintomas obsessivo-compulsivos ou melhora da impressão clínica global. Entretanto, ocorreu uma resposta placebo significativa / Introduction: The present study aims to evaluate the efficacy of added excitatory repetitive transcranial magnetic stimulation (rTMS), applied to the right dorsolateral prefrontal cortex in patients with treatment resistant obsessive-compulsive disorder (OCD). Methods: 30 treatment resistant OCD outpatients were randomized to receive either active or sham rTMS, remaining both patients and rater blind to treatment condition. Baseline treatment was kept stable for at least 8 weeks, and rTMS was performed with a figure-of-eight coil at 10Hz, 110% of motor threshold at 30 daily sessions of 40 trains of 5 seconds with 25 seconds interval. Symptom severity was determined at baseline and after 2 and 6 weeks of treatment and further 2 and 6 weeks of follow-up, using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Clinical Global Impression Scale (CGI), Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D17) and SF-36 quality of life inventory. The primary outcome measure was defined as 30% or more improvement in Y-BOCS scores and a much improved or improved score at the CGIimprovement subscale by the end of follow up. Results: The analysis of primary outcome measure revealed that only one patient on each group met response criteria for treatment with rTMS (P=1.00). Repeated-measures analysis of Y-BOCS scores showed a significant effect of time (F=7.33, P=0.002). However, no significant group effect or group by time interaction was observed. Repeated measures analysis of CGI (severity), HAM-D17 and HAM-A also showed a significant effect of time (P<0.001, =0.001 and <0.001 respectively) with no significant group effect or group by time interaction. Conclusion: Excitatory rTMS delivered to the rDLPFC of treatment resistant OCD patients was not different from placebo in reducing obsessive-compulsive symptoms or improving clinical global impression. However, a significant placebo response occurred