O Transtorno Obsessivo Compulsivo (TOC) afeta de 2% a 4% da população pediátrica. Entre os fatores associados com a pior resposta ao tratamento do TOC pediátrico encontram-se a presença de sintomas de ansiedade nos pais, presença de histórico psiquiátrico nos familiares de primeiro grau, maior grau de acomodação familiar (AF) e ambiente familiar com características disfuncionais. No entanto, poucos estudos até o momento investigaram a variação da ansiedade parental, da acomodação familiar e do ambiente familiar em relação à resposta ao tratamento do TOC pediátrico. Nesse estudo foram avaliados, prospectivamente, 43 pais (31 mães e 12 pais) de 33 jovens com TOC (7 a 17 anos), antes e após o tratamento de seus filhos por 14 semanas com Terapia Cognitiva Comportamental (TCC) em grupo ou com fluoxetina. Os instrumentos utilizados para avaliar os pais foram: o Inventário de Ansiedade Traço e Estado (IDATE), a Escala de Acomodação Familiar (FAS), a Escala de Ambiente Familiar (FES-R) e um questionário para avaliar a presença de sintomas ansiosos, sintomas obsessivo-compulsivos (SOC), sintomas depressivos e uso nocivo de substâncias nos familiares de primeiro grau dos jovens com TOC. Os sintomas dos filhos foram avaliados pela Escala Yale-Brown de Sintomas Obsessivo-Compulsivos (Y-BOCS). De modo geral, os pais não apresentaram redução significativa da ansiedade traço ou estado, e não foi observada associação entre a variação da ansiedade parental e a melhora clínica dos filhos. No entanto, para os pais cujos familiares de primeiro grau não tinham sintomas psiquiátricos, houve associação significativa entre a redução da ansiedade traço e estado com a melhora clínica dos filhos. A acomodação familiar diminuiu após o tratamento dos filhos, e essa redução associou-se à melhora clínica dos jovens. No ambiente familiar, as subdimensões coesão e lazer aumentaram após o tratamento dos filhos, sendo que a variação da gravidade do TOC associou-se com a variação da coesão familiar. Esses resultados indicam que, mesmo sem uma abordagem focada na família, o tratamento do TOC pediátrico pode exercer impacto positivo sobre a acomodação familiar e o ambiente familiar. Estudos futuros poderão esclarecer as influências recíprocas entre esses fatores familiares e o tratamento do TOC pediátrico / Obsessive-Compulsive Disorder (OCD) occurs in 2% to 4% of the pediatric population. A worse prognosis has been associated with the presence of anxiety symptoms among parents, the presence of psychiatric symptoms among first-degree relatives, higher levels of family accommodation (FA) and a greater dysfunction in the family environment. So far, few studies have investigated the associations between the variation of parental anxiety, family accommodation and family environment with the response to pediatric OCD treatment. Forty-three subjects, 31 mothers and 12 fathers, of 33 children and adolescents with OCD (between 6 to17 years old), were evaluated before and after treatment of their children with group Cognitive-Behavioral Therapy (CBT) or fluoxetine for 14 weeks. The instruments used to assess the parents were: the State-Trait Anxiety Inventory (STAI), the Family Accommodation Scale (FAS), the Family Environment Scale - Real form (FES-R), and a questionnaire to assess the presence of anxiety symptoms, obsessive-compulsive symptoms, depressive symptoms and substance abuse in the first degree relatives of the youths. The children\'s symptoms were assessed by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). After their children\'s treatment, parents showed no significant reduction in their trait or state anxiety, and parental anxiety was not related to children\'s response to treatment. However, a decrease in anxiety levels after treatment was observed among those whose first degree-relatives did not report psychiatric symptoms. Family accommodation decreased after the children\'s treatment, and this decrease accompanied the children\'s clinical improvement. In the family environment, the sub-dimensions cohesion and leisure increased after the children\'s treatment, and cohesion accompanied the children\'s clinical improvement. These results suggest that, even without a family-focused approach, the child-focused treatment of pediatric OCD may have a positive impact on family accommodation and family environment. Future studies should further clarify the reciprocal influences of family factors and the treatment of pediatric OCD

Resumo HOUNIE, A.G. Transtornos do espectro obsessivo-compulsivo e febre reumática: um estudo de transmissão familiar. São Paulo, 2003. 174p. Tese (Doutorado) – Faculdade de Medicina, Universidade de São Paulo. A febre reumática (FR) é uma doença autoimune causada por anticorpos desenvolvidos contra o estreptococo beta hemolítico do grupo A (SBHGA). Estudos recentes amparam a noção de que a FR esteja associada ao transtorno obsessivo-compulsivo (TOC), independentemente da presença de outras manifestações no sistema nervoso central (ex.: coréia de Sydenham - CS). O TOC freqüentemente surge acompanhado por outros transtornos, como aqueles denominados de transtornos do espectro obsessivo (TEO), entre eles, a síndrome de Tourette (ST), o transtorno de tiques crônicos (TTC) e o transtorno dismórfico corporal (TDC). Alguns deles parecem apresentar uma relação geneticamente determinada. Um subgrupo de TOC é geneticamente relacionado à ST, podendo ser considerado uma expressão fenotípica alternativa de seu genótipo. Um recente estudo de famílias de portadores de TOC encontrou alta freqüência de TDC nos seus familiares de primeiro grau, além de transtornos de tiques. Neste estudo de famílias buscamos verificar a freqüência de TOC e TEO relacionados em familiares de portadores de FR, com ou sem CS e em um grupo controle, na tentativa de determinar se existe agregação familiar desses transtornos em famílias com FR. Foram avaliados 98 probandos e seus 381 familiares de primeiro grau (FPG). Dos 98 probandos, 31 eram portadores de FR sem CS, 28 tinham FR com CS e 39 eram controles sem FR recrutados em um ambulatório de ortopedia. Entrevistadores treinados avaliaram os sujeitos por meio de entrevistas semi-estruturadas (KSADS e SCID). Vinhetas clínicas foram elaboradas e avaliadas por psiquiatras independentes que faziam a melhor estimativa diagnóstica (best estimate diagnosis). Estes avaliadores eram cegos quanto a se os sujeitos eram probandos ou familiares e quanto ao grupo a que pertenciam. As comparações entre as freqüências dos transtornos entre os três grupos foram feitas por meio dos testes de Fisher, qui-quadrado, pelas Equações de Estimação Generalizadas (GEE) e pela análise de Kaplan-Meier. Resultados foram considerados estatisticamente significantes quando o nível descritivo (p, bicaudado) do teste foi menor ou igual a 0,05. Os TEO combinados foram mais freqüentes em FPG de portadores de FR como um todo (com e sem CS) do que em FPG de probandos controles (p=0,03). O TTC foi mais freqüente em FPG de probandos com CS do que FPG de controles (p=0,05). O TAG foi mais freqüente em FPG de portadores de FR do que em FPG de controles (p=0,008). Subdividindo os probandos baseados na presença de um TEO, os transtornos de tiques somados (p,GEE=0,01), o TDC (p,GEE=0,02), e o TAG (x2=0,004) individualmente e os TEO combinados (p,GEE=0,02) foram mais freqüentes em FPG de portadores de FR na presença de TEO comparados aos FPG de controles. Os TEO foram mais freqüentes (sem alcançar significância estatística, p=0,09) nos FPG de portadores de FR sem um TEO do que nos FPG de controles. A febre reumática nos probandos elevou o risco de seus familiares apresentarem um TEO. Esse risco foi ainda maior se o probando, além de apresentar FR, tinha ele próprio um TEO. É possível que um subgrupo da FR seja relacionado a TEO e que fatores de susceptibilidade para FR e para TEO tenham um efeito aditivo. Portanto, a FR pode ser considerada um fator de risco para TEO. / Summary Hounie, A.G. Obsessive-compulsive spectrum disorders and rheumatic fever: a family study. São Paulo, 2003. 174p. Tese (Doutorado) – Faculdade de Medicina, Universidade de São Paulo. Rheumatic fever (RF) is an autoimmune disease caused by antibodies against group A beta hemolytic streptococcus (GABHS). Some studies support the notion that RF be associated with obsessive-compulsive disorder (OCD) independent of its manifestations on the central nervous system (eg., Sydenham’s Chorea - SC). OCD is often accompanied by other disorders, which are known as obsessive-compulsive spectrum disorders (OCSD), such as Tourette syndrome (TS), chronic tic disorder (CTD) and body dysmorphic disorder (BDD). Some of those putative OCSD seem to share a genetic relationship. An OCD subgroup is genetically related to TS, being considered an alternative phenotype. A recent OCD family study found higher rates of BDD and tic disorders among first-degree relatives (FDR) of OCD probands. This is a family study that assessed the frequency of OCD and OCSD in first-degree relatives of RF probands (with and without SC) in order to verify if there was aggregation of those disorders in RF families. We assessed 98 probands and their 381 first-degree relatives. Of the 98 probands, 31 had RF without SC, 28 had RF with SC and 39 were controls without RF recruited in an orthopedic clinic. Trained interviewers assessed subjects with semi-structured interviews (KSADS and SCID). Clinical vignettes were elaborated and evaluated by independent psychiatrists that assigned best estimate diagnosis. These raters were blind to subject status regarding group and if they were probands or relatives. Comparisons between frequencies of disorders were done with Fisher and chi-square tests, generalized estimated equations (GEE), and Kaplan-Meier survival analyses. Results were considered statistically significant if their level of significance was less or equal to 0.05 (p, two-tailed). OCSD combined were more frequent in FDR of RF probands (with or without SC) than in FDR of controls (p=0.03). CTD was more frequent in FDR of SC probands than FDR of controls (p=0.05). Generalized anxiety disorder (GAD) was more frequent in FDR of RF probands than in FDR of controls (p=0.008). Subdividing probands based on the presence of an OCSD, tic disorders combined (GEE, p=0.01), BDD (GEE, p=0.02), GAD (x2=0.004), and OCSD combined (GEE, p=0.02) were more frequent in FDR of RF probands with an OCSD than in FDR of controls. OCSD were also more frequent (non-significantly, p=0.09) in FDR of RF probands without an OCSD than in FDR of controls. RF in the probands increased the risk of OCSD in their family members. This risk was even higher if the proband had RF plus an OCSD. It is possible that a subgroup of RF is associated to OCSD and susceptibility factors linked to RF and to OCSD may have an additive effect. Therefore RF may be a risk factor for OCSD.

O presente trabalho tem como objetivo avaliar as contribuições da perspectiva evolucionista para a compreensão dos processos psicológicos humanos, e em particular para o entendimento das psicopatologias, com especial atenção para o transtorno obsessivo-compulsivo, resgatando também algumas proposições levantadas em um trabalho anterior a partir da investigação de estereotipias comportamentais apresentadas por animais em cativeiro, na busca de possíveis contribuições para a compreensão de seu análogo nos humanos. Para cumprir este objetivo, são descritos os níveis de análise característicos da aplicação da abordagem evolucionista, sendo discutida a noção de patologia, e mais especificamente psicopatologia, numa perspectiva evolucionista. Dentro do campo da psicologia evolucionista, são discutidos os conceitos de modularidade da mente, sistemas funcionais e ambiente de adaptação evolutiva. É realizada então a exploração de uma psicopatologia humana específica, o transtorno obsessivo-compulsivo, ou TOC, descrevendo sua fenomenologia e destacando a classificação das diferentes categorias de sintomas, que servirão como um parâmetro para o levantamento de hipóteses evolucionistas. É discutida a presença de comportamentos compulsivos e ritualizados fora do contexto da psicopatologia, levantando a questão de um possível continuum entre estes fenômenos, da vida cotidiana ao transtorno obsessivo-compulsivo. Segue-se um levantamento dos principais estudos epidemiológicos, visando à caracterização da manifestação deste transtorno ao redor do mundo, com atenção ao seu caráter homogêneo, às particularidades e às diferenças entre gêneros. São levantados os dados mais consensuais a respeito da psicobiologia do TOC, como a participação de doenças infecciosas na manifestação de sintomas obsessivo-compulsivos. Buscando recuperar a perspectiva filogenética na abordagem da neurociência, é discutido modelo do cérebro triuno de Paul MacLean. São apresentados os modelos animais utilizados na investigação do TOC, iniciando-se a aproximação com a etologia, sendo retomados alguns de seus conceitos fundamentais, que têm sido usados freqüentemente na abordagem do transtorno obsessivo-compulsivo, como padrão fixo ou modal de ação, atividade deslocada, estereotipia comportamental, e ritualização. São discutidas por fim as principais hipóteses evolucionistas sobre o transtorno obsessivo-compulsivo, com destaque para os modelos que apresentam idéias similares: o modelo de simulação de cenários de risco, o modelo de prevenção de situações de risco, e o sistema motivacional de segurança. Tais modelos sugerem que o desenvolvimento do TOC envolve uma alteração em um sistema funcional voltado para a prevenção de riscos. O predomínio de sintomas de caráter social, sobretudo aqueles ligados a adequação a normas e regras, sugere também o envolvimento de um sistema funcional específico, indicando a importância das pressões seletivas que conduziram ao desenvolvimento de um \"cérebro social\", a partir de adaptações que favoreceram o estabelecimento de relações sociais complexas. / The purpose of the present investigation is to evaluate the contributions of evolutionary perspective for the understanding of the human psychological processes, particularly the human psychopathologies, specially focused on the obsessive-compulsive disorder, also rescuing some propositions of a previous work which investigated behavioral stereotypies, presented by animals in captivity, in the search of possible contributions for the understanding of its similar in the humans, the OCD. To accomplish this aim, the characteristic levels of analysis used by the evolutionary approach are described, and then are applied to discuss the idea of pathology, and more specifically, psychopathology. Inside the evolutionary psychology field, the concepts of modularity of the mind, functional systems and environment of evolutionary adaptedness are also presented. Then it is explored a specific human psychopathology, the obsessive compulsive disorder, or OCD, by describing its phenomenology and the classification of the different categories of symptoms, that will serve as a parameter for the evolutionary hypotheses. It is discussed the presence of compulsive and ritualized behaviors out of the context of the psychopathology, pointing to a possible continuum among these phenomena, from the daily rife to the obsessive-compulsive disorder. A description of the main epidemiological studies is accomplished, seeking to the characterization of this disorder around the world, with attention to its homogeneous character, to the particularities and the differences between genders. We proceed pointing the most consensual data regarding the psychobiology of OCD, as the possible involvement of infectious diseases in the manifestation of obsessive-compulsive symptoms. Looking for recovering the phylogenetic perspective in the approach of the neuroscience, the Paul MacLean\'s triune brain is discussed. The animal models used in the investigation of OCD are presented, beginning to come close to the ethology field, being retaken some of their fundamental concepts, that have frequently been used in the approach of the obsessive-compulsive disorder, as fixed or modal action pattern, displacement activity, behavioral stereotypy, and ritualization. Then we finally discuss the main evolutionary hypotheses on the obsessive-compulsive disorder, highlighting the models that present similar ideas: the model of simulation of risk scenarios, the model of prevention of risk situations, and the security motivacional system. Such models suggest that the development of OCD involves an alteration in a functional system aimed for the prevention of risks. The prevalence of symptoms of social character, specially those related to acceptance of norms and rules, also suggests the involvement of a specific functional system, indicating the importance of the selective pressures that led to the development of a \"social brain\", starting from adaptations that favored the establishment of complex social relationships.

INTRODUCTION: Initial examination of treatment worries suggest they may represent an important construct; however, previously used measures were limited by their specificity, scale format, and lack of parent report. Therefore the present study sought to examine the initial outcomes and psychometrics of newly developed corresponding measures of treatment worries in youth (Treatment Worries Questionnaire – Child; TWQ-C) and their parents (Treatment Worries Questionnaire – Parent; TWQ-P). METHODS: Participants were 94 youth (7-17-years old) and parent dyads presenting for psychosocial treatment of an anxiety disorder. Prior to initiation of treatment, dyads completed the TWQ-C and TWQ-P along with a host of additional child and parent report measures, and three clinician-rated measures. RESULTS: Treatment worries were endorsed in the mild-moderate range by youth and the TWQ-C demonstrated good-excellent internal consistency and test-retest reliability, a strong three-factor structure, and consistent convergent and divergent relationships. Treatment worries were endorsed in the low mild range by parents and the TWQ-P demonstrated fair-good internal consistency and test-retest reliability, a less empirically, but theoretically, supported four-factor structure, and consistent divergent relationships, but variable (by factor) convergent relationships. DISCUSSION: The results of the present study provide information on the concept of treatment worries and support the use of the TWQ-C and TWQ-P as broad assessments of the concept in a variety of populations. Low endorsement of worries among parents likely relates to the nature of the present sample (treatment-seeking) and may have contributed significantly to the less ideal psychometrics of the TWQ-P in comparison to the TWQ-C. Future investigation of treatment worries using the TWQ-C and TWQ-P in a variety of samples is warranted.

The purpose of this qualitative, exploratory study was to develop a deeper understanding of educational and other social experiences and relationships of post-secondary students who were clinically diagnosed with primary obsessive-compulsive disorder (OCD). The researcher also investigated their strengths, weaknesses, coping strategies, and quality of life through mental and physical health. The majority of people with OCD have obsessions and compulsions that last greater than an hour each day or severely impact daily life. Obsessions are irritating feelings or mental pictures that individuals try to block or mitigate with irrational physical or mental compulsions, often appearing as excessive hand washing in reaction to a contamination obsession. Participants comprised seven university students who completed three self-report questionnaires and two semi-structured interviews with the researcher. Five participants submitted self-report journals. These data were examined using interpretative phenomenological analysis (IPA).The present study advanced previous research as it documented extensive lifelong characteristics, experiences, and relationships from these students. It yielded salient findings related to their OCD functional impairment and quality of life. Further, it showed that as students, their intellectual integration seemed to play a greater role in academic persistence than did their social integration. In addition, participants’ university policy and practice recommendations were congruent with a similar study from about a decade ago indicating that perhaps few or none of the past recommendations were implemented for the benefit of such students. Present recommendations should be implemented accordingly.

No description available.

No description available.

Acceptance and commitment therapy (ACT) has been used with promising results for adults with obsessive-compulsive disorder (OCD). There are currently no published studies utilizing ACT for pediatric OCD. An investigative pilot study utilizing a nonconcurrent multiple baseline design examined the extent of treatment effects when ACT is employed for pediatric OCD. Three children under the age of 12 were enrolled in a nine-session ACT treatment protocol. The primary dependent variable was number of obsessive cognitions as recorded by participants within a participant-observer framework. Treatment response was also evaluated using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Results indicated that two of three participants successfully responded to treatment as evidenced by significant reductions in selfobserved frequency of obsessive cognitions. Results further indicated large reductions for all participants on the CY-BOCS with a mean score decrease of 47.26%. Implications and future directions were considered. The research yielded results that indicated that ACT may be useful in the treatment of pediatric OCD and that further research is warranted.

No description available.

No description available.