Obsessive-compulsive disorder: Influence of age at onset on comorbidity patterns

Purpose: This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset. Methods: Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis. Results: Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse-control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse-control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample. Conclusions: Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value. © 2008 Elsevier Masson SAS. All rights reserved.

Função motora fina, sensorial e perceptiva de escolares com transtorno do déficit de atenção com hiperatividade

OBJETIVO: Caracterizar e comparar as funções motoras fina, sensorial e perceptiva de escolares com Transtorno do Déficit de Atenção com Hiperatividade (TDAH) e escolares com bom desempenho escolar sem alterações de comportamento. MÉTODOS: Participaram 22 escolares do ensino fundamental, de gênero masculino, distribuídos em: GI - 11 escolares com Transtorno do Déficit de Atenção com Hiperatividade; e GII - 11 escolares com bom desempenho acadêmico e sem alterações de comportamento. Os escolares foram submetidos à aplicação do Protocolo de Avaliação da Função Motora Fina, Sensorial e Perceptiva e da Escala de Disgrafia. RESULTADOS: Houve diferença nas tarefas de função motora fina, função sensorial e função perceptiva entre o GI e o GII, com desempenho inferior do GI. Todos os escolares de GI apresentaram disgrafia. CONCLUSÃO: Escolares com Transtorno do Déficit de Atenção com Hiperatividade apresentam desempenho inferior aos escolares com bom desempenho acadêmico em relação às funções motoras fina, sensorial e perceptiva. Tais dificuldades podem causar impacto significativo sobre o desempenho acadêmico, uma vez que comprometem o desenvolvimento da linguagem escrita, ocasionando disgrafia nesses escolares.

Coordenação motora fina de escolares com dislexia e transtorno do déficit de atenção e hiperatividade

OBJETIVOS: descrever e comparar o desempenho da coordenação motora fina em escolares com dislexia e com transtorno do déficit de atenção e hiperatividade utilizando parâmetros de desempenho motor e idade cronológica da Escala de Desenvolvimento Motor. MÉTODO: participaram 22 escolaresdo ensino fundamental, de ambos os gêneros, na faixa etária de 6 a 11 anos de idade distribuídos em: GI: 11 escolares com transtorno do déficit de atenção e hiperatividade e GII: 11 com dislexia. Como procedimento, provas de motricidade fina da Escala de Desenvolvimento Motor foram aplicadas. RESULTADOS: os resultados revelaram diferença estatisticamente significante entre a idade motora fina e a idade cronológica de GI e GII. Conforme a classificação da Escala do Desenvolvimento Motor, 90% dos escolares de GI e GII apresentaram desenvolvimento motor fino muito inferior ao esperado para a idade e 10% dos escolares com dislexia apresentam desenvolvimento normal baixo ao esperado para a idade e 10% dos escolares com transtorno do déficit de atenção e hiperatividade apresentaram desenvolvimento inferior ao esperado para a idade. CONCLUSÃO: concluímos que tanto os escolares com dislexia como os com TDAH deste estudo apresentam atrasos na coordenação motora fina, demonstrando que os participantes desta pesquisa apresentam dificuldades em atividades que exijam destreza, quadro característico do transtorno do desenvolvimento da coordenação. Estudos complementares estão sendo conduzidos pelos autores deste estudo para poder verificar e comprovar se o perfil motor fino dos escolares encontrados neste estudo se assemelham ou se diferem de acordo com o quadro apresentado pelos mesmos.

Desempenho de escolares com transtorno de déficit de atenção e hiperatividade em tarefas metalinguisticas e de leitura

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Distúrbio de hiperatividade e déficit de atenção na síndrome de apnéia obstrutuiva do sono: Há melhora com tratamento cirúrgico?

Neuropsychological disorders are frequently associated with obstructive ventilatory disorders (OVD). Aim: To analyze the incidence of neuropsychological disorders in Brazilian children with OVD, using a screening questionnaire and to compare the answers given before and after surgery. Patients and Methods: We studied 30 children with clinical diagnosis of OVD. The children were divided into 3 groups: group I, children aged 4 to 7; group II, from 8 to 10; and group III, children over 11. The applied questionnaires were answered by the parents or tutors, and comprised 30 questions, 10 for each disorder: attention deficit, hyperactivity and impulsivity. The children were diagnosed with one of the disorders when presented 3 or more positive answers. The follow up interview occurred 6 months after adenotonsillectomy. Results: There was a predominance of male gender (60.6%) over female gender (39.4%). Group II presented the highest number of significant changes, with reductions raging from 87.5% to 33.3% of patients with attention deficit, 75% to 50% of the hyperactive patients, and 50% to 33% of the impulsive patients. Conclusion: There was neuropsychological improvement after the surgery, which occurred mainly in the children from group II. More interaction among health professionals is necessary when diagnosing and following up similar cases.

Percepção viso-motora de escolares com Transtorno do Déficit de Atenção com Hiperatividade

PURPOSE: The aim of this study was to characterize and to compare the visual-motor perception of students with Attention Deficit with Hyperactivity Disorder (ADHD) with students with good academic performance. METHODS: Forty students from 2nd to 5th grades of an elementary public school, male gender (100%), aged between 7 and 10 years and 8 months old participated, divided into: GI (20 students with ADHD) and GII (20 students with good academic performance), paired according to age, schooling and gender with GI. The students were submitted to Developmental Test of Visual Perception (DTVP-2). RESULTS: The students of GI presented low performance in spatial position and visual closure (reduced motor) and inferior age equivalent in reduced motor perception, when compared to GII. CONCLUSION: The difficulties in visual-motor perception presented by students of GI cannot be attributed to a primary deficit, but to a secondary phenomenon of inattention that interferes directly in their visual-motor performance.

Relação entre as habilidades metalinguísticas, leitura e compreensão leitora em escolares com Transtorno do Déficit de Atenção com Hiperatividade

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Clinical features of obsessive-compulsive disorder with hoarding symptoms: A multicenter study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Level of insight and clinical features of obsessive-compulsive disorder with and without body dysmorphic disorder

Introduction: Body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) have several similarities and are included among the obsessive-compulsive spectrum of disorders. However, the content of preoccupations and level of insight of BDD patients differ from OCD patients. Objective: To compare the level of insight regarding obsessive-compulsive symptoms (OCS) and other clinical features in OCD patients with and without comorbid BDD. Methods: We evaluated 103 OCD patients (n=25, comorbid BDD), according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria using the Structured Clinical Interview for DSM-IV, the Yale-Brown Obsessive-Compulsive Scale, the University of Sao Paulo Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, and the Brown Assessment of Beliefs Scale. Resylts: The study groups differed significantly on several clinical features, including level of insight. A worse level of insight regarding OCS was independently associated with the presence of comorbid BDD. Lower educational level, more psychiatric comorbidities, presence of somatic and hoarding obsessions, and presence of intrusive images were associated with BDD comorbidity, even after adjusting for possible confounders. Conclusion: The presence of BDD in OCD patients is associated with poorer insight into obsessional beliefs and higher morbidity, reflected by lower educational levels and higher number of psychiatric comorbid disorders in general.

Early onset obsessive-compulsive disorder with and without tics

Introduction: Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations. Objective: The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated. Methods: Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the early onset group (EOG): before 11 years of age, 75 patients had an intermediate onset (IOG), and 95 patients were from the late onset group (LOG): after 18 years of age. From the 160 EOG, 60 had comorbidity with tic disorders. The diagnostic instruments used were: the Yale-Brown Obsessive Compulsive Scale and the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS), Yale Global Tics Severity Scale; and Structured Clinical Interview for DSM-IV Axis I Disorders-patient edition. Statistical tests used were: Mann-Whitney, full Bayesian significance test, and logistic regression. © MBL Communications Inc.

O conceito de TDAF: concepções e práticas de profissionais da saúde e educação

Pós-graduação em Saúde Coletiva - FMB

A psicopatologização da infância no contemporâneo: um estudo sobre a expansão do diagnóstico de transtorno de déficit de atenção e hiperatividade

The expansion of psychiatric labeling does not reach only the adult population, but also the problematic related to childhood have been captured by the speeches and practices of the medical-psychiatric knowledge and turned into psychopathologies which tend to be treated with the main resource made available by psychiatrics in the present times: the psychotropic drugs. This work presents a critical thinking on the expansion of the diagnoses of “attention deficit disorder and hyperactivity” (ADHD) both in children and teenagers and on the conduction of drug therapies. It follows that the processes of childhood psycho-pathologization and the trivializing of psychotropic drug prescription are related to the overvaluation of the biological conception of psychic suffering and to the economic interests of the great pharmaceutical laboratories which by means of several strategies influence the medical practices, factors that lead to exposure of these patients to possible side effects and the risks of stigmatization that must be considered.

ADHD and medicalization: consideration of the senses and meanings of symptoms presented by children diagnosed

The present paper is a reflection on the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) and its relations to the process of medicalization as well as the meanings and perspectives apprehended through three case studies of children diagnosed with such disorder in a doctoral research in which the main purpose was to understand the meanings and peculiarities of ADHD symptomatology .We’ve utilized the model of qualitative research, grounded in psychoanalytic perspective, and conducted the psychodiagnosis for three children who were referred for psychological treatment. The survey found that those children had few experiences of both continence and frustration tolerance. It was evidenced how the school uses the logic of medicalization to try solving the problems with their children when it came to the school dimension. The variety of symptomatic manifestations and psychic dynamics presented by the cases that were studied revealed the weaknesses and inconsistencies of the referred diagnosis.

Transtorno de déficit de atenção e hiperatividade: a medicalização e a coação no desenvolvimento moral

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Learning strategies evaluation in students with attention deficit hyperactivity disorder

This study aim to verify the use of learning strategies in students of the elementary level presenting interdisciplinary diagnosis of attention dei cit hyperactivity disorder (ADHD). Nine students, male gender, attending 3rd to 9th grade level of the elementary level, average age 10 years and 7 months, presenting interdisciplinary diagnosis of attention dei cit hyperactivity disorder (ADHD). h e students were submitted to the application of the Evaluation of Learning Strategies from elementary level – EAVAP-EF – scale, which aimed to evaluate the strategies reported and used by students in situation of study and learning, as follows: cognitive strategies, metacognitive strategies and absence of dysfunctional metacognitive strategies. h e general result at EAVAP-EF scale, showed that students with ADHD reached the percentile 25%, considered as low performance in the use of the learning strategies. For the variable absence of dysfunctional metacognitive strategies, the students presented percentile 30%, percentile 25% for cognitive strategies and 55% for metacognitive strategies. h e results showed that ADHD students do not use ef ectively the learning cognitive and metacognitive strategies and present the use of dysfunctional metacognitive strategies. h ese alterations match with the framework of ADHD because the entry of information, either visual or auditory, showed alterations, derived from inattention, which af ected the learning in classroom situation.