Objectives: The first objective of this research was to examine whether symptom dimensions in obsessive-compulsive disorder (OCD) are associated with unique neuropsychological performance profiles. The second objective of this research was to further understand the strengths and weaknesses of two models of symptom dimensions in OCD from a quantitative perspective—conventional subtyping by overt symptom, and the core dimensions model. Finally, the third objective of this research was to investigate the efficacy and treatment acceptability of a cognitive remediation program targeting neurocognitive deficits associated with OCD. Methods: Study 1 reviewed critically studies describing the assessment of differences in neuropsychological functioning between symptom dimensions of OCD, the results of which informed succeeding studies examining: i) the characterization of symptom dimensions in OCD and; ii) the remediation of neuropsychological domains commonly affected in OCD. Accordingly, study 2 compared the suitability of two common statistical approaches, factor analysis and cluster analysis, commonly used in the existing literature to define symptom dimensions based on responses collected from the industry-standard symptom questionnaire, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), in characterizing symptom dimensions in OCD. Neuropsychological task data were then used to examine the validity of an alternative model of symptom dimensions in OCD (Study 3). Finally, we conducted a feasibility study (Study 4) examining the use of an established cognitive remediation protocol, Goal Management Training (GMT), to target the deficits in neurocognitive function identified in the preceding studies. Results: Much of the existing literature on neuropsychological task performance differences between symptom dimensions of OCD is limited by methodological issues, primarily those concerning methods for defining symptom dimensions. Here, a comparison of the two most common methods for defining dimensions revealed that neither cluster analysis nor factor analysis produced conceptually meaningful subgroups. By exemplifying differences in neuropsychological task performance between those with harm avoidance and those with incompleteness symptoms, however, concrete evidence was provided to support the core dimensions model of OCD. Pilot data point towards the feasibility and efficacy of GMT as a cognitive remediation program for OCD. Conclusions: Pursuing the definition of meaningful, distinct symptom dimensions of OCD is not recommended with the combination of current statistical practices and symptom measures. The early evidence presented here shows promise for the validity of the core dimensions model. Preliminary evidence suggests that the neuropsychological impairments observed in this population, although subtle, may be effectively addressed using Goal Management Training. / Thesis / Doctor of Philosophy (PhD)

Ongoing controversies regarding the clinical and nosological status of ADHD in adults emphasize the need for studies examining whether <i>DSM-IV</i> ADHD symptom dimensions and subtypes identified in research with children are valid for adults. Firm symptom criteria validated by data from adult samples have not been developed. Moreover, many clinic-referred adults present with attentional complaints and exhibit symptoms, neurocognitive weaknesses, and secondary problems similar to those seen in ADHD. However, data are mixed regarding the profile of neurocognitive deficits involved in adult expressions of ADHD, and it is unknown whether patterns of weakness in neurocognitive performance can be identified that reliably discriminate adults with ADHD from those with other neurobehavioral disorders (e.g., learning disabilities, LD). The purpose of this study was to further (a) evaluate the discriminant validity of <i>DSM-IV</i> ADHD in adults, (b) examine the nature and severity of neurocognitive deficits in adult ADHD, and (c) clarify the diagnostic utility of executive functioning measures among clinic-referred adults. Overall, results supported the discriminant validity of adult ADHD, but little support emerged for the existence of separate <i>DSM-IV</i> subtypes. Importantly, symptom ratings supported the existence of two broad symptom domains consistent with those delineated in <i>DSM-IV</i>. Moreover, principal components analysis of neuropsychological data identified three dimensions of neurocognitive executive functioning (EF; verbal working memory; sustained intention; and effortful learning) in which ADHD adults (n=35) performed significantly less well than those who received an LD diagnosis (n=24) or no diagnosis (n=21). Furthermore, composite scores in these EF domains generated correct classifications that were significantly better than chance when classifying adults that (a) did and did not meet criteria for ADHD, (b) met criteria for ADHD or LD, and (c) met criteria for ADHD or no clinical diagnosis. Classification results were robust when submitted to a jackknife (leave-one-out) validation procedure. Finally, results provided general support for the developmental lag hypothesis of frontal-subcortical functioning in ADHD when considered vis-à-vis child ADHD data, but findings also supported the notion that ADHD in adults is associated with continuing dysfunction in specific neuroanatomical pathways believed to subserve executive attentional functions (e.g., dorsolateral prefrontal-subcortical; anterior cingulate-subcortical; orbitofrontal-subcortical). / Ph. D.

Orientador: Albina Rodrigues Torres / Resumo: Introdução: O transtorno obsessivo-compulsivo (TOC) apresenta expressiva heterogeneidade de sintomas. Análises fatoriais têm mostrado que obsessões e compulsões de simetria, ordenação, repetição e contagem se caracterizam como uma dimensão separada. Apesar de a dimensão de simetria ser manifestação comum do TOC, estudos sobre esta dimensão são escassos na literatura. Objetivo: investigar a prevalência, a gravidade e o perfil sociodemográfico e clínico de pacientes que apresentam sintomas da dimensão de simetria em uma amostra clínica de pacientes com TOC. Método: estudo transversal com 1001 pacientes do banco de dados do Consórcio Brasileiro de Pesquisa em Transtornos do Espectro Obsessivo-Compulsivo. Diversas variáveis independentes foram investigadas através de instrumentos estruturados, tais como: Questionário sobre história natural do TOC, Escalas de Yale-Brown (Y-BOCS) e Escala Dimensional de Sintomas Obsessivo-compulsivos (DY-BOCS), Escala de Fenômenos Sensoriais (USP-SPS), Inventário de Depressão de Beck (BDI), Escala de Crenças de Brown (BABS) e Entrevista Clínica Estruturada para Transtornos do Eixo I do DSM-IV (SCID-I). Após a análise descritiva, foram feitas análises bivariadas entre possíveis fatores associados à presença da dimensão de simetria através do teste de qui-quadrado ou exato de Fisher e o teste t de Student ou Mann-Whitney. Como medidas de tamanho de efeito, foram calculadas razões de chances (odds ratios-OR) com intervalos de confiança e D de Cohen. P... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Obsessive-compulsive disorder (OCD) presents an expressive heterogeneity of symptoms. Factorial analyses have shown that obsessions and compulsions of symmetry, ordering, repetition, and counting are characterized as a separate symptom dimension. Although the symmetry dimension is a common manifestation of OCD, studies on this dimension are scarce in the literature. Objective: to investigate the prevalence, severity, and the sociodemographic and clinical profile of patients with symmetry symptoms in a clinical sample of OCD patients. Method: a cross-sectional study with 1001 patients from the database of the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders. Several independent variables were investigated through structured instruments, such as: OCD Natural History Questionnaire, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Dimensional Obsessive-Compulsive Scale (DY-BOCS), Sensory Phenomena Scale (USP-SPS), Beck Depression Inventory (BDI), Brown Assessment of Beliefs Scale (BABS), and Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I). After the descriptive analysis, bivariate analyses were performed between possible factors associated with the presence of the symmetry dimension using the chi-square or Fisher's exact test and the Student's t-test or Mann-Whitney test. As measures of effect size, odds ratios (ORs) with confidence intervals and Cohen's D were calculated. Finally, a logistic regression was performed to cont... (Complete abstract click electronic access below) / Mestre

Background. Previous studies of the dimensional structure of panic attack symptoms have mostly identified a respiratory and a vestibular/mixed somatic dimension. Evidence for additional dimensions such as a cardiac dimension and the allocation of several of the panic attack symptom criteria is less consistent. Clarifying the dimensional structure of the panic attack symptoms should help to specify the relationship of potential risk factors like anxiety sensitivity and fear of suffocation to the experience of panic attacks and the development of panic disorder. Method. In an outpatient multicentre study 350 panic patients with agoraphobia rated the intensity of each of the ten DSM-IV bodily symptoms during a typical panic attack. The factor structure of these data was investigated with nonlinear confirmatory factor analysis (CFA). The identified bodily symptom dimensions were related to panic cognitions, anxiety sensitivity and fear of suffocation by means of nonlinear structural equation modelling (SEM). Results. CFA indicated a respiratory, a vestibular/mixed somatic and a cardiac dimension of the bodily symptom criteria. These three factors were differentially associated with specific panic cognitions, different anxiety sensitivity facets and suffocation fear. Conclusions. Taking into account the dimensional structure of panic attack symptoms may help to increase the specificity of the associations between the experience of panic attack symptoms and various panic related constructs.