Introdução: Ao longo da história, as parafilias foram ora consideradas patologias, ora não consideradas. O Manual Diagnóstico e Estatístico de Transtornos Mentais (DSM-5) estabeleceu a distinção entre parafilias e Transtornos Parafílicos (TP), sendo que apenas os TP foram considerados doenças. Por outro lado, a associação entre sintomas obsessivos e parafilias já foi cogitada por muitos autores. Porém, a falta de melhores definições dos sintomas parafílicos dificultava tais estudos. Objetivos: Avaliar a presença de TP e/ou parafilias em mulheres e a possível associação com transtorno obsessivo-compulsivo (TOC) e/ou com transtorno de personalidade obsessivocompulsiva (TPOC). Casuística e Métodos: As alunas (N=190) foram avaliadas por meio de questionários anônimos e autorresponsivos de TOC, TPOC, parafilias e TP. Para o TOC foi utilizada a escala de Yale-Brown. Para as demais variáveis foram utilizadas escalas baseadas no DSM-5, segundo o qual indivíduos parafílicos com comportamentos exibicionistas, frotteuristas, voyeuristas e pedofílicos são considerados portadores de TP porque, por definição, seus impulsos são realizados com quem não consentiu ou não tem capacidade de consentir essas práticas sexuais. Porém, se o indivíduo preenche os critérios para estas parafilias e não tem o respectivo comportamento nem sofrimento, ele terá a respectiva parafilia, mas não o TP. Resultados: As fantasias parafílicas mais frequentes foram: pelo menos uma parafilia (53,2%), Voyeurismo (30,2%) e Fetichismo (25,4%). As parafilias mais frequentes foram: pelo menos uma parafilia (24,5%), Voyeurismo (9%) e Fetichismo (8,5%). Quanto aos TP, os mais frequentes foram: pelo menos um TP (13,8%), Voyeurista (6,9%), do Masoquismo (3,7%) e Frotteurista (3,7%). O TOC subclínico (Yale-Brown entre 8 e 15) foi estatisticamente significativo quando associado a fantasias parafílicas, enquanto o TOC (Yale-Brown >= 16) quando associado a parafilias e TP. O TPOC foi estatisticamente significativo quando associado a fantasias, parafilias e TP. Conclusões: A intensidade dos sintomas de TOC foi diretamente relacionada à intensidade dos sintomas parafílicos, enquanto que o TPOC foi relacionado a fantasias parafílicas, parafilias e TP. Devido a limitações metodológicas como a ausência de instrumentos padronizados validados, os resultados obtidos nesta pesquisa foram considerados traços de associação / Introduction: Throughout history, paraphilias have been at times considered pathologies or not. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) established the distinction between paraphilias and Paraphilic Disorders (PD), with only PD considered as a disease. On the other hand, the association between obsessive symptoms and paraphilias has been considered by many authors. However, the lack of better definitions for paraphilic symptoms made such studies more difficult. Objectives: To assess the presence of PD and/or paraphilias in women and its possible association with obsessive-compulsive disorder (OCD) and/or with obsessive-compulsive personality disorder (OCPD). Case Series and Methods: Students (N=190) were assessed by means of anonymous, self-reported questionnaires on OCD, OCPD, paraphilias and PD. For OCD, the Yale-Brown scale was used. For the other variables scales based on DSM-5 were used, according to which paraphilic individuals with exhibitionistic, frotteuristic, voyeuristic, and pedophilic behaviors were considered as having PD, since, by definition, their impulses are carried out with non-consenting individuals or those unable to consent with such sexual practices. However, if the individual meets the criteria for such paraphilias but does not have the respective behavior or distress, he/she will have said paraphilia, but not PD. Results: The most frequent paraphilic fantasies were: at least one paraphilia (53.2 %), Voyeurism (30.2 %) e Fetishism (25.4 %). The most frequent paraphilias were: at least one paraphilia (24.5 %), Voyeurism (9 %) e Fetishism (8.5 %). As regard to PD, the most frequent were: at least one PD (13.8%), Voyeurist (6.9 %), of Masochism (3.7 %) and Frotteurist (3.7 %). Sub-clinical PD (Yale-Brown between 8 and 15) was statistically significant when associated with paraphilic fantasies, whereas OCD (Yale-Brown >= 16) when associated with paraphilias and PD. OCPD was statistically significant when associated with fantasies, paraphilias, and PD. Conclusions: The intensity of OCD was directly related to the intensity of paraphilic symptoms, whereas OCPD was related to paraphilic fantasies, paraphilias, and PD. The results point to traits of association between these clinical conditions, which recommends research in this direction

Obsessive-compulsive disorder (OCD) is a serious psychiatric condition manifested by repeated thoughts followed by stereotypic compulsive behavior. Alterations to cortico-thalamo-striato- cortical circuits are most often implicated in the pathophysiology of OCD. However, many studies have also found a changed volume, shape and activity of the hippocampus in OCD patients. This work focused on the activity of hippocampal CA1 cells during stereotypical checking behavior and on cognitive flexibility in a quinpirole (QNP) sensitization model of OCD. The activity of CA1 hippocampal cells during stereotypical checking was assessed in an enriched open-field test in QNP sensitized rats. Arc+ (activity-regulated cytoskeletal associated protein, or Arg 3.1) mRNA expression profiles were determined in CA1 coronal hippocampal sections following stereotypical checking. After the establishment of stereotypical checking (10 sessions), rats were exposed to the arena and sacrificed after 5 minutes. QNP sensitized animals visited the same objects with the same frequency as during previous sessions, while control rats did not. Locomotor activity was comparable between QNP treated rats and controls. Following sacrifice, rat brains were flash frozen and sliced to 20 µm thick sections. Sections, mounted on slides, were hybridized...

Syftet med denna uppsats är att ta reda på hur fem olika personer med OCD upplever framställningen av OCD i komediserien Scrubs samt dramafilmen The Aviator. Vidare togs det reda på varför intervjupersonerna upplever dessa framställningar som de gör och på vilka sätt de kan identifiera sig med dem. Studiens teoretiska ramverk är representationsteori, kodning och avkodning samt självkategoriseringsteori. Uppsatsens material består av kvalitativa intervjuer med fem olika intervjupersoner som alla har diagnosen OCD. Inför besvarandet av intervjufrågorna har intervjupersonerna tittat på avsnitt från Scrubs samt på filmen The Aviator där karaktärer med OCD finns med. Resultatet visar att fyra av fem intervjupersoner kan identifiera sig med fysiska tvångshandlingar som karaktären med OCD i Scrubs utför. Framställningen av OCD i The Aviator kan samtliga fem intervjupersoner identifiera sig med där majoriteten av dem identifierar sig i känslostämningen i form av stress, frustration och ångest som huvudkaraktären med OCD bitvis uppvisar. Den första slutsatsen är att intervjupersonerna upplever en mer adekvat framställning av OCD i The Aviator än i Scrubs, då framställningen i The Aviator innefattar en betydligt större del av det psykiska och känslomässiga lidande som OCD innebär. Den andra slutsatsen är att intervjupersonernas inställning till hur OCD framställs i Scrubs och The Aviator är beroende av den utsträckning i vilken de kan identifiera sig med detta.

Introduction: Obsessive-compulsive disorder (OCD) is a complex disorder that is associated with significantly impaired functioning. The current prevailing model of OCD implicates dysfunction of the serotonergic neurotransmitter system and fronto-striatal neural networks, but challenges in replicating findings within OCD samples are often attributed to clinical heterogeneity. OCD symptoms that develop or worsen within the perinatal period appears to reflect a distinct subtype of the disorder, but the genetic and neurobiological factors that contributes to its presentation in women is poorly understood. In this dissertation, we aimed to review the literature on the genetic architecture of OCD, identify potential gene candidates for perinatal OCD and analyze one serotonin system gene according to OCD and possible subtypes using meta-analytic techniques. Based on these findings, we then tested the association of serotonergic candidate gene polymorphisms with the presence of infant-related obsessive-compulsive symptoms (OCS). Lastly, we investigated the cortical morphological features associated with perinatal OCD and OCS symptom severity in postpartum mothers. Results: From prior reports in the literature and our own meta-analytic investigation, polymorphic variants in genes coding for the serotonergic transporter and serotonin 2A receptor subtype (SLC6A4 and HTR2A, respectively) appear to be candidates for perinatal OCD due to their association in female samples. However, upon investigation in our perinatal sample (n=107), we found no evidence to support the association of the 5-HTTLPR polymorphism of SLC6A4 with perinatal-related OCS, but larger samples are needed to confirm this finding. Due to technical challenges, the HTR2A polymorphism remains to be tested. Our novel whole-brain explorations revealed distinct cortical morphology associated with symptom worsening across the perinatal period, irrespective of diagnosis. Cortical parameters were not able to differentiate mothers with and without OCD; however, OCD mothers displayed positive correlations between cortical surface area and symptom severity in widespread regions, including the frontal, parietal, temporal and occipital cortex. Conclusions: Overall, this body of work aimed to fill the gap in the literature by exploring the possible genetic and cortical correlates of perinatal-related OCS and OCD. While 5-HTTLPR or HTR2A are candidates for perinatal OCD, it is not yet clear whether they increase susceptibility for the development of infant-related OCS in the perinatal period. Distinct cortical alterations in surface area appeared alongside OCS exacerbation in the postpartum period in regions that extend beyond the frontoparietal network. This suggests that additional neural networks may be contributing to symptom severity and that the cortical plasticity that occurs across the perinatal period may predispose women for risk of OCD. Future studies should continue to use a multiple perspective approach, that utilizes genetic and neurobiological techniques, in order to provide greater insight into the etiology of perinatal OCD. / Dissertation / Doctor of Philosophy (PhD) / Women are at greater risk for the development of mental illness in the time surrounding pregnancy and postpartum, known as the perinatal period. In the case of perinatal obsessive-compulsive disorder (OCD), mothers may experience unique worries in regard to their parenting or fears that their baby may be harmed. While these worries are common, they can become disruptive when persistent and impact the mother’s mood and ability to bond with the infant. Our current understanding of OCD includes the influence of genetic factors and brain changes, but little is understood about what factors may increase risk for OCD in the perinatal period. In this thesis, we aimed to review whether certain alterations within DNA segments, known as gene variants, may be linked to the development of OCD in females and if these gene changes, as well as differences in brain structures in postpartum mothers, are associated with OCD symptoms during the perinatal period. The genes we examined are important for regulating a chemical signaling substance in the brain known as serotonin. Based on our results, we did not find a relationship between serotonin gene variants and OCD symptoms in perinatal women. We also found no differences when comparing the cortical brain structures between mothers with OCD and healthy mothers; however, we observed that measures of surface area across several cortical brain regions were related to symptom worsening from pregnancy to postpartum, and also with symptom severity in postpartum mothers with OCD. These results suggest that there are widespread brain changes during the postpartum period that may increase a mother’s risk for developing OCD. Overall, the work in this thesis provides the first glimpse into potential risk factors for perinatal OCD.

No description available.

Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption thatmetacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.

Le trouble obsessionnel-compulsif (TOC) est un trouble anxieux fréquent et invalidant. Pour un grand nombre de patients, il existe une résistance aux thérapeutiques actuellement disponibles, soulignant toute l'importance de mieux préciser la physiopathologie du TOC. Le principal objectif de cette thèse est d’étudier les altérations anatomiques et fonctionnelles des voies thalamo-corticales intéressant le cortex orbitofrontal (COF) et le cortex cingulaire antérieur (CCA) dans le TOC. Pour cela, nous avons utilisé plusieurs outils complémentaires permettant d’appréhender cette problématique sous différents angles méthodologiques.Concernant les altérations anatomiques associées au TOC, nous avons rapporté les données de méta-analyses des études de neuro-imagerie volumétrique et morphométrique ainsi que les résultats d'une étude originale d'imagerie volumétrique. Une diminution du volume orbitofrontal, une augmentation du volume thalamique et une relation entre ces modifications de volumes ont été observées chez les patients avec TOC comparativement aux témoins. Les modifications de densité de matière grise concernaient le COF et le putamen dans le sens d'une augmentation et les cortex pariétal et préfrontal dorsolatéral dans le sens d'une diminution dans le TOC.Concernant les altérations fonctionnelles associées au TOC, nous avons détaillé un travail de méta-analyse des études d'imagerie fonctionnelle, un travail expérimental chez le primate basé sur des manipulations pharmacologiques intra-cérébrales, puis un travail expérimental chez l'homme reposant sur le développement d'une tâche comportementale originale couplée à l'imagerie fonctionnelle. Dans notre méta-analyse, nous avons décrit la participation fonctionnelle de régions comme le COF, le thalamus et le striatum lorsque des symptômes obsessionnels et compulsifs étaient provoqués chez des patients. Chez le primate subhumain, nous avons montré qu'une hyperactivation du noyau ventral-antérieur, par levée de l'inhibition GABAergique, entraînait l'apparition de comportements pseudo-compulsifs. Ensuite, à l'aide d'une tâche originale qui mettait les sujets en situation de vérifier, nous avons mis en évidence que les dysfonctions orbitofrontales associées au doute lors de la prise de décision n'étaient pas modulées ni par les informations contextuelles (signaux d'erreur), ni par la réponse comportementale chez les patients avec TOC comparativement à des sujets témoins.Enfin, la superposition des cartes morphométriques et fonctionnelles a trouvé une relation entre les altérations anatomiques et fonctionnelles au sein du COF. Nos résultats soulignent toute l'importance des voies thalamo-orbitofrontales dans la physiopathologie du TOC. / Obsessive-compulsive disorder (OCD) is a frequent and disabling anxiety disorder. Available treatments are effective for most patients but impairing residual symptoms and treatment resistance are common in OCD patients. Therefore, a better understanding of OCD pathophysiology is essential for further improvement of therapeutic strategies. The main goal of my thesis was to assess the anatomical and funtional thalamocortical alterations associated with OCD. Concerning the anatomical thalamocortical alterations associated with OCD, we conducted two meta-analyses of anatomical neuroimaging studies and an original volumetric neuroimaging study. We reported a smaller thalamic volume and a greater orbitofrontal volume, but also an inverse relationship between the volume changes in OCD patients compared with healthy subjects. Furthermore, we showed that gray matter density within the orbitofrontal cortex and the putamen were enhanced in OCD. Concerning the functional thalamocortical alterations associated with OCD, we reported data coming from a meta-analysis of functional neuroimaging studies, an experimental study in subhuman primates using local brain pharmacological manipulations and an event-related neuroimaging study in OCD patients. In our meta-analysis, we showed that the orbitofrontal cortex, the thalamus and the striatum were involved in the mediation of OCD symptoms. In subhuman primates, the pharmacologically induced overactivity within the ventralanterior thalamic nucleus leaded to the emergence of compulsive-like behaviors. Then, in our neuroimaging study, we found that doubt-related orbitofrontal dysfunctions were not modulated by neither error signals nor compulsive-like behaviors in OCD patients, compared with healthy subjects. Finally, we described by using meta-analytic data that anatomical and functional brain alterations overlap with the lateral orbitofrontal cortex in OCD. In conclusion, our results suggest that the thalamo-orbitofrontal network may play a primary role in the genesis and mediation of OCD symptoms.

Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal.

I chose the theme of obsessive-compulsive disorder as a topic of my thesis. The main reason was that it is a disorder I have worked as a therapist in individual or group therapy frequently. Also I have participated in several studies as evaluator in Psychiatric Centre, and I collected data from dozens of patients. In the first part the thesis deals with the symptoms, clinical picture, prevalence, aetiology and treatment of OCD. Thesis is focuses on behavioural and cognitive models of the disorder in detail, because the treatment used in the present group of patients was CBT. Various models of cognitive behavioural therapy I discuss in more detail, because they allow different views of what happens to the patient and how to change it. The practical part has two parts. The first deals with the effectiveness of group cognitive behavioral approach for OCD patients, who use antidepressants but were resistant to previous treatment and were attended a daycare center at the Prague Psychiatric Center. The second part of the thesis deals with finding a predictor of successful cognitive behavioral therapy in these patients. The aim was to determine whether certain demographic or clinical factors that we evaluated before treatment may predict success outcome. The result is the finding that severity of the...

O transtorno obsessivo compulsivo (TOC) é um transtorno psiquiátrico, caracterizado pela presença de obsessões e / ou compulsões. Estudos de neuroimagem funcional indicam que o TOC é um distúrbio heterogêneo relacionado ao circuito talâmico cortico-estriatal (CSTC) e as áreas que compõem este circuito incluem o nucleus accumbens (NAC), putâmen (PT), núcleo caudado (CN), córtex orbitofrontal (OFC) e o córtex cingulado anterior (ACC). As principais características do CSTC são a inervação do córtex frontal em direção ao estriado e cada pequeno circuito possui características específicas: afetiva/límbica, cognitivo e associativo dorsal e cognitivo ventral e motor. Neste trabalho comparamos o transcriptoma de casos e controles das três áreas estriatais (CN, NAC e PT) separadamente de tecido cerebral post mortem e as redes de co-expressão do striatum e de dois circuitos envolvidos no transtorno. Os resultados mostraram que diferentes processos biológicos, bem como a desregulação da conectividade de rede, são específicos para cada região do estriado e estão de acordo com o modelo tripartido do estriado e contribuem de diferentes formas para a fisiopatologia do TOC. Especificamente, a regulação dos níveis de neurotransmissores, processo pré-sináptico envolvido na transmissão sináptica química foram compartilhados entre NAC e PT. A resposta celular ao estímulo químico, resposta ao estímulo externo, resposta à substância orgânica, regulação da plasticidade sináptica e modulação da transmissão sináptica foram compartilhadas entre CN e PT. A maioria dos genes que possuem variantes comuns e / ou raras previamente associadas ao TOC que são diferencialmente expressas ou que fazem parte de módulos de co-expressão menos preservados em nosso estudo também sugerem especificidade de cada região estriatal. Os módulos de co-expressão preservados e menos preservados nos circuitos afetivo e cognitivo ventral corroboram com as assinaturas transcricionais de cada área e de cada circuito no TOC e nos controles. Este é o primeiro trabalho com a proposta de avaliar a expressão gênica em áreas estriatais, analisadas individualmente, envolvidas com o TOC, bem como as redes de co-expressão do estriado e dos circuitos individualmente / Obsessive compulsive disorder (OCD) is a psychiatric disorder, characterized by the presence of obsessions and/or compulsions. Functional neuroimaging studies indicate that OCD is a heterogeneous disorder related the cortical-striatal thalamic circuitry (CSTC) and the areas that compose this circuitry include the nucleus accumbens (NAC), putamen (PT), caudate nucleus (CN), orbitofrontal cortex (OFC) and subgenual cingulate gyri (ACC). The main characteristics of CSTC is the innervation of the frontal cortex in direction of the striatum and each small circuitries have specific characteristics in the affective, dorsal cognitive and ventral cognitive motor. In this work we compared the cases and controls transcriptome of the three striatal areas (CN, NAC and PT) separately from post mortem brain tissue and the co-expression networks of the striatum and of two circuits involved in the disorder. Results showed that different biological process as well as networks connectivity deregulation were specific for each striatum region according to the striatum tripartite model and contribute in different ways to OCD pathophysiology. Specifically, regulation of neurotransmitter levels, presynaptic process involved in chemical synaptic transmission were shared between NAC and PT. Cellular response to chemical stimulus, response to external stimulus, response to organic substance, regulation of synaptic plasticity, and modulation of synaptic transmission were shared between CN and PT. Most genes harboring common and/or rare variants previously associated with OCD that are differentially expressed or part of a least preserved co-expression modules in our study also suggest striatum sub regions specificity. The co-expression modules preserved and least preserved in affective and ventral cognitive circuitry corroborate with transcriptional signatures of each area and each circuitry in OCD and controls. This is the first work with the proposal to evaluate the gene expression in striatum areas individually, involved with OCD as well evaluate the coexpression networks in striatum and each circuitry