ABSTRACT
El trastorno obsesivo-compulsivo (TOC) afecta al 2% de la población general, llegando en ocasiones a causar un deterioro funcional severo y de la calidad de vida de las personas afectadas. Entre el 10 y el 30% de los pacientes con este trastorno no responde a los tratamientos recomendados: farmacológicos y terapia cognitivo-conductual. La Food and Drug Administration de los Estados Unidos (FDA) aprobó en el año 2008 la Estimulación cerebral profunda (ECP) para pacientes con TOC resistente a tratamiento. La ECP, utilizada frecuentemente para el tratamiento de la enfermedad de Parkinson refractaria, es una opción viable para los pacientes con TOC resistente, con efectos adversos poco frecuentes y transitorios. (AU)
Obsessive-compulsive disorder (OCD) affects 2% of the general population, sometimes resulting in severe impairment of functional capacity and quality of life of affected people. Between 10 and 30% of these patients do not respond to recommended treatments: pharmacological and cognitive behavioral therapy. In 2008, the FDA approved Deep Brain Stimulation (DBS) for patients with OCD resistant to treatment. DBS, frequently used for the treatment of refractory Parkinson's disease, is a viable option for the treatment of patients with resistant OCD, with infrequent and transient adverse effects. (AU)
Subject(s)
Humans , Deep Brain Stimulation/methods , Obsessive-Compulsive Disorder/therapy , Patient Dropouts/statistics & numerical data , Quality of Life , Signs and Symptoms , Deep Brain Stimulation/adverse effects , Deep Brain Stimulation/trends , Mental Disorders/surgery , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/drug therapyABSTRACT
Due to the phenotypical heterogeneity of Obsessive-Compulsive Disorder [OCD] and its subtypes, and due to the high rate of co-morbid psychopathology, it remains a challenge to treat OCD using medication effectively, behavioral therapy and cognitive therapy. Selective serotonin reuptake inhibitors [SSRIs] are first-line pharmacotherapy treatments OCD, but up to 50% of patients do not respond to initial treatment of OCD. Therefore, treatment options for non-responders include augmentation of antidepressants with antipsychotics and other medications
Subject(s)
Antipsychotic Agents , Cognitive Behavioral Therapy , Selective Serotonin Reuptake Inhibitors , Antidepressive Agents , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/epidemiologyABSTRACT
Tique psíquico e TOC (transtorno obsessivo-compulsivo) compõe a "síndrome auto-obsessiva" com duas modalidades: psicomotora e psicoatuante, respectivamente, que aparentam uma auto-hipnose inconsciente. Esquisitices e algumas neuroses nem sempre são bem distintas, e casos de pessoas célebres são apresentados. Confirma-se a falta de lesões anatômicas evidentes nesta síndrome, se bem que a bioquímica e o mapeamento eletrônico das zonas cerebrais possam denotar hiperatividade. "Egrégora" é a condensação de pensamentos, por afinidade, de várias pessoas, ou de fluido-magnetismo de muitos animais afins, e que pode justificar, além da visão, a "contaminação" da "SAO", principalmente dos tiques.
Psychic tic and obsessive compulsive disturbance (OCD) compound the "auto-obsessive syndrome" that has two forms: psychomotor and psychoactive, respectively, and both seem an unconscious auto-hipnosis. Queerness and some neurosis are not always well distinguishable, and a few cases of celebrated persons are presented. The lack of anatomic lesions is confirmed in this syndrome, although the biochemistry and the map of the cerebral zones can denote hyperactivity. "Égregora" is a condensation of thinking, byaffinity, from various persons, or of fluid-magnetism from many related animals, and that can justify, in addition to the vision, the "contamination" of the "AOS", mainly in the tics.
Subject(s)
Humans , Male , Female , Tic Disorders , Tics , Obsessive-Compulsive Disorder/classification , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/physiopathology , Obsessive-Compulsive Disorder/therapy , Compulsive Behavior/etiology , Compulsive Behavior/psychologyABSTRACT
The data which addresses the validity of the proposed unique subgroup of children with early and abrupt onset of obsessive-compulsive disorder (OCD) and/or tic disorder subsequent to streptococcal infection was reviewed. The aetiology of OCD and tic disorder is unknown, although it appears that both disorders may arise from a variety of genetic and environmental factors. Post-streptococcal autoimmunity has been postulated as one such mechanism. Although much research remains to be done, an increasing body of evidence provides support for the postulate that OCD may arise from post-streptococcal autoimmunity. The unique clinical characteristic of the PANDAS sub group, the presence of volumetric changes in basal ganglia and the dramatic response to immunomodulatory treatment suggest that symptoms arise from a combination of local, regional and systemic dysfunction and further research is required in order to provide novel strategies of prevention and treatment.
Subject(s)
Autoimmune Diseases of the Nervous System/complications , Autoimmune Diseases of the Nervous System/immunology , Bacterial Infections/complications , Bacterial Infections/immunology , Child , Humans , Infant , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/microbiology , Streptococcal Infections/complications , Streptococcal Infections/immunologyABSTRACT
Wilson's disease (WD) is a genetic neurodegenerative disorder; it exhibits wide heterogeneity in symptoms and usually presents with liver disease and/ or neuropsychiatric manifestations. The common neurological manifestations observed are dysarthria, gait disturbance, dystonia, rigidity, tremor, dysphagia and chorea. The frequent psychiatric manifestations reported are personality and mood changes, depression, phobias, cognitive impairment, psychosis, anxiety, compulsive and impulsive behavior. Isolated obsessive-compulsive disorder (OCD) is a rare presentation of WD. Reported herein is a case of a 17-year-old boy with isolated OCD. He presented to the psychiatrist with symptoms of contamination obsessions and washing compulsions, along with compulsion of repeated feet tapping and was treated with adequate doses of fluoxetine for 6 months but did not improve. Later on, he was diagnosed as a case of WD and showed improvement with chelating and behavior therapy. This implies the importance of the occurrence of isolated psychological symptoms in WD.
Subject(s)
Adolescent , Chelation Therapy , Hepatolenticular Degeneration/complications , Humans , Magnetic Resonance Imaging , Male , Obsessive-Compulsive Disorder/etiologyABSTRACT
Introducción: La dermatitis atópica (DA) severa suele tener un componente psiquiátrico que puede influir en el desencadenamiento y exacerbación de los síntomas cutáneos. La neuroimagen funcional podría objetivar disfunciones neuronales existentes en estos pacientes.Objetivo: Investigar la presencia de trastornos de la perfusión cerebral en pacientes con DA severa y describir sus características mediante SPECT. Materiales y métodos: 11 pacientes adultos con DA severa fueron estudiados por evaluación psiquiátrica clínica y SPECT cerebral con 99mTc-ECD. Resultados: 90.3 por ciento de los pacientes presentaron un trastorno de ansiedad generalizada, 63.6 por ciento un trastorno obsesivo compulsivo y 63.6 por ciento depresión. Todos los pacientes presentaron trastornos de perfusión, que predominaron en la corteza prefrontal. Se evidenciaron alteraciones concordantes con los patrones descritos en pacientes que asocian síntomas depresivos y ansiosos. Conclusiones: Demostramos la presencia frecuente de alteraciones de la perfusión cerebral en la DA severa con componente psiquiátrico y describimos sus características mediante un método de neuroimagen.
Subject(s)
Male , Adolescent , Adult , Humans , Female , Middle Aged , Tomography, Emission-Computed, Single-Photon , Cerebrovascular Circulation/physiology , Organotechnetium Compounds , Dermatitis, Atopic/complications , Telencephalon , Mental Disorders , Mental Disorders/etiology , Depression/etiology , Precipitating Factors , Radiopharmaceuticals , Telencephalon/blood supply , Obsessive-Compulsive Disorder/etiology , Anxiety Disorders/etiologyABSTRACT
The purpose of the research was to investigate the resultant psychological problems of adults who were physically abused in childhood. It was hypothesized that adults who had been physically abused in childhood would be at greater risk in the development of psychological problems i.e., anxiety, depression, OCD and hostility as compared to those adults who had not been abused in childhood. In order to measure abused childhood, a checklist questionnaire was prepared after conducting pilot study, where as the Symptoms Assessment - 45 scale was selected for measuring psychological problems of adults. The sample for the present research comprised of one hundred and one [101] adults, 50 males and 51 females. Their ages ranged between 18 to 26 years. A Checklist questionnaire and the SA-45 were administered on a large population, then on the basis of cut off scores, non abused and abused groups were identified. The t-test and other descriptive statistics were applied for analyzing the data.For interpreting the results, 0.05 level of significance was set. The hypotheses have significantly been proved that the adults who have been abused tend to develop anxiety, depression, OCD and hostility later in life as compared to those adults who have not been abused in childhood
Subject(s)
Humans , Male , Female , Child Abuse/psychology , Surveys and Questionnaires , Psychophysiology , Obsessive-Compulsive Disorder/etiology , Depression/etiology , Depressive Disorder/etiology , Anxiety/etiology , Anxiety Disorders/etiology , Hostility , Child , AdultSubject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Obsessive-Compulsive Disorder/etiology , Rheumatic Fever/psychology , Psychiatric Status Rating ScalesABSTRACT
Nesta revisão narrativa, o nosso objetivo foi descrever as síndromes neuropsiquiátricas pós estreptocócicas e discuti-las à luz das evidências científicas atuais sobre os possíveis mecanismos patogenéticos envolvidos. Nos últimos anos, uma série de distúrbios do movimento, como tiques, distonia, parkinsonismo, e transtornos psiquiátricos, como o transtorno obsessivo-compulsivo (TOC) e o transtorno da hiperatividade com déficit de atenção (THDA), vem sendo considerada parte do espectro das manifestações pós-estreptocócicas. O termo PANDAS (acrônimo do inglês: pediatric autoimmune neuropsychiatric disorder associated with streptococcus) foi inclusive cunhado para descrever um subgrupo de pacientes com TOC e tiques que inibe flutuação clínica dos sintomas associada a infecção estreptocócica. Entretanto a análise crítica das evidências clinicolaboratoriais não apóia esse espectro ampliado das manifestações pós-estreptocócicas. Apenas na coréia de Sydenham há evidências consistentes de patogênese mediada por processo auto-imune pós-estreptocócico.
In this narrative review, our objective was to describe the post-streptococcal neuropsychiatric syndromes and to discuss the possible pathogenetic mechanisms involved in their clinical expression. Recently, several movement disorders, such as tics, dystonia, and parkinsonism, and psychiatric disorders like obsessive-compulsive disorders (OCD) and attention deficit hyperativity disorder (ADHD), are being considered part of a putative spectrum of post-streptococcal infection disorder. The term PANDAS (pediatric autoimmune neuropsychiatric disorder associated with streptococcus) has been introduced to describe a subset of patients with these diagnoses in which onset of symptoms or symptom exacerbations are related to streptococcal infection. However the critical analysis of clinical and laboratory data does not support the hypothesis of an extended spectrum of post-streptococcal neuropsychiatric disorders. Only for Sydenham chorea there is consistent evidence for a post-streptococcal autoimmune mediated pathogenesis.
Subject(s)
Humans , Child , Cerebrum/immunology , Chorea/etiology , Central Nervous System Diseases/etiology , Streptococcal Infections/complications , Risk Factors , Streptococcus pyogenes , Tourette Syndrome/etiology , Obsessive-Compulsive Disorder/etiology , Motor Disorders/etiology , Tic Disorders/etiologyABSTRACT
OBJETIVO: Revisar as teorias e evidências das bases neurobiológicas do transtorno obsessivo-compulsivo e da síndrome de Tourette. FONTES DOS DADOS: Revisão dos estudos que investigam a neuroanatomia, neuroimagem, genética e imunologia desses transtornos. SíNTESE DOS DADOS: Os comportamentos ritualísticos e pensamentos repetitivos têm sido cada vez mais estudados em nosso meio. As definições dessas entidades formam um continuum espectral de sintomas com prevalência significativa na população. CONCLUSÕES: Os avanços das neurociências possibilitaram a exploração dos aspectos genéticos do sistema nervoso central e seu funcionamento, fornecendo novas perspectivas para o tratamento de pacientes com transtorno obsessivo-compulsivo e síndrome de Tourette.
Subject(s)
Humans , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/etiology , Tourette Syndrome/diagnosis , Tourette Syndrome/etiology , Diagnosis, Differential , Obsessive-Compulsive Disorder/therapy , Tourette Syndrome/therapyABSTRACT
O distúrbio obsessivo compulsivo (DOC) é um dos quadros psiquiátricos de mais difícil compreensäo. Os estudos que caracterizam os pacientes adultos com DOC säo poucos e esse número é ainda mais limitado quando nos referimos a pacientes com diagnóstico do DOC pelo DSM-III-R. Diante disso, o presente estudo foi realizado com o objetivo de descrevr as características sócio-demográficas e clínicas de 50 pacientes. Apesar das limitaçöes do nosso estudo, os resultados foram, em geral, consistentes com os achados prévios da literatura, monstrando uma consistência entre as culturas
Subject(s)
Medical Records , Obsessive-Compulsive Disorder/epidemiology , Obsessive-Compulsive Disorder/etiology , Surveys and QuestionnairesABSTRACT
O distúrbio obsessivo-compulsivo (DOC) é um dos quadros psiquiátricos de mais difícil compreensao. Os estudos que caracterizam os pacientes adultos com DOC sao poucos e esse número é ainda mais limitado quando nos referimos a pacientes com diagnóstico de DOC pelo DSM-III-R. Diante disso, o presente estudo foi realizado com o objetivo de descrever as características sócio-demográficas e clínicas de 50 pacientes. Apesar das limitaçoes do nosso estudo, os resultados foram, em geral, consistentes com os achados prévios da literatura, mostrando uma consistência entre as culturas
Subject(s)
Humans , Male , Female , Clomipramine/therapeutic use , Haloperidol/therapeutic use , Neurotransmitter Uptake Inhibitors , Selective Serotonin Reuptake Inhibitors , Obsessive-Compulsive Disorder/drug therapy , Obsessive-Compulsive Disorder/etiology , Socioeconomic FactorsABSTRACT
Se presenta el caso clínico de adolescente de 14 años con síndrome de Asperger quien desarrollo en su período puberal, un trastorno obsesivo compulsivo. Se discute la relación de estos trastornos y se plantean interrogantes en esta asociación
Subject(s)
Humans , Male , Adolescent , Developmental Disabilities/complications , Obsessive-Compulsive Disorder/etiology , Developmental Disabilities/diagnosis , Obsessive-Compulsive Disorder/complications , Obsessive-Compulsive Disorder/diagnosis , Disease Progression , Psychic SymptomsABSTRACT
O transtorno obsessivo compulsivo (TOC), caracterizado por obsessoes e compulsoes, foi descrito com freqüência aumentada em várias doenças que acometem primariamente of gânglios da base sugerindo que estas estruturas também estivessem acometidas no TOC. Os gânglios da base, que no passado se acreditava estarem implicados apenas no comportamento motor, sao na verdade, importantes em inúmeras outras funçoes psíquicas como o processamento de vivências cognitivas. Estudos recentes utilizando imagem de ressonância magnética mostraram tendências a diminuiçao do núcleo caudado em pacientes com TOC. De forma coerente, estudos com neuroimagem funcional, sugerem a implicaçao de um circuito cerebral envolvendo o córtex órbito-frontal, o giro cíngulo, o núcleo caudado e o tálamo na patofisiologia do TOC. Entre as diversas hipóteses formuladas a partir desses achados, especula-se que um déficit no funcionamento do núcleo caudado levaria a uma filtragem inadequada de preocupaçoes que entao estimulariam o córtex órbito-frontal a desencadear açoes adaptativas: as compulsoes.
Subject(s)
Basal Ganglia/physiopathology , Obsessive-Compulsive Disorder/etiology , Basal Ganglia/anatomy & histologyABSTRACT
Este niño consultó por múltiples dolores cambiantes y por incomodidad en la vida social del colegio porque tenía dificultades con profesores y compañeros. Se empezó su estudio determinando que padecía de un trastorno de ansiedad, relacionado con su discapacidad para la educación física, la cual no informó y mantuvo en silencio por su competitividad. Entre los antecedentes tuvo una hemorragia cerebral del lactante y como secuela una hemiparesia. Se encontró que padecía una psicopatología estable y crónica que es el trastorno obsesivo-compulsivo desde los cinco años de edad. Respondió con remisión al tratamiento disminuyendo la angustia pero persistiendo los fenómenos obsesivos-compulsivos
Subject(s)
Humans , Male , Child , Obsessive-Compulsive Disorder/classification , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/nursing , Obsessive-Compulsive Disorder/psychology , Anxiety Disorders/classification , Anxiety Disorders/diagnosis , Anxiety Disorders/etiology , Anxiety Disorders/nursing , Anxiety Disorders/psychologyABSTRACT
El trastorno obsesivo-compulsivo (TOC) es una patología frecuente. Como sucede en medicina, sino se explora su presencia no va ha encontrarse. La naturaleza del cuadro es tan intensamente perturbadora y los hallazgos terapéuticos tan prometedores, que indagar por su presencia pueden ser de gran beneficio para quien lo padece. A propósito de la descripción de un caso clínico se revisan los antecedentes hitóricos, epidemiología, criterios de diagnóstico diferencial y tratamiento de este tipo de desórdenes psiquiátricos.
Subject(s)
Humans , Obsessive-Compulsive Disorder/classification , Obsessive-Compulsive Disorder/diagnosis , Obsessive-Compulsive Disorder/etiology , Obsessive-Compulsive Disorder/history , Obsessive-Compulsive Disorder/therapy , Obsessive-Compulsive Disorder/epidemiology , Anxiety , Psychotherapy , Serotonin , Fluoxetine , Clomipramine , Tourette SyndromeABSTRACT
Revisäo sobre os principais trabalhos relacionando o Distúrbio Obsessivo-Complusivo (DOC) e Depressäo, classificando-os em depressäo secundária ao DOC, DOC secundário à depressäo e DOC como forma atípica de depressäo, salientando a importância de cada um. Discutiu-se criticamente alguns achados biológicos comuns às duas entidades clínicas