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      Obsessive-compulsive disorder during the COVID-19 pandemic

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          Abstract

          The new coronavirus outbreak was characterized as a pandemic by the World Health Organization in March 2020. Although the frequency of mental disorders is expected to increase during pandemics,1 the peculiarities of the COVID-19 pandemic can directly impact the clinical course of obsessive compulsive-disorder (OCD), a condition that affects approximately 3% of the general population.2 OCD is characterized by the presence of obsessions (which are unwanted and unpleasant thoughts, images, or urges) and/or compulsions (repetitive behaviors or mental rituals aimed at reducing the distress provoked by obsessions).3 Cleanliness, contamination, and fear of contracting a disease, which are topics of concern for patients with OCD, have now become a central theme of news and social media. Thus, we would like to elaborate on some possible implications of the COVID-19 pandemic for both diagnosis and clinical decision making about OCD. According to the current biopsychosocial model of psychiatric disorders, socio-cultural, biological, and psychological factors interact synergistically to determine the onset of different disorders. These factors include the patient’s beliefs and behaviors, which may be influenced by historical and environmental changes.4 Diagnostic classification systems, including the DSM-5 and ICD-11, include the core symptoms of disorders, as well as the level of distress experienced by patients and the impact of symptoms on functioning. Frequent handwashing, which was previously considered excessive and one of the most common symptoms of OCD, have now been normalized. Currently, considering time-consuming cleaning rituals as a single symptom seems insufficient to diagnose OCD. In such cases, clinical reasoning should counterbalance the degree of protection these rituals produce with their level of interference in functioning. Such reasoning is required to confirm an OCD diagnosis or consider treatment changes for those already on medication or in cognitive-behavioral therapy. Patients may experience a worsening of OCD symptoms in different dimensions, including, but not limited to, contamination/cleaning, aggression, and hoarding dimensions. Patients who had never presented such symptoms may experience their onset in the context of this major environmental change. Higher levels of avoidant behavior are also expected. Moreover, OCD patients can experience a worsening of depression and anxiety symptoms during major life events, among which the current pandemic should be included.1 Exposure and ritual prevention, a key behavioral technique in OCD treatment,5 should be carefully tailored during this period. Recommending unrestricted exposure to feared stimuli may prove imprudent. Psychological strategies for treating OCD should consider the well-being and safety of patients. Pharmacological strategies should be guided by the best evidence-based recommendations.5 Protection recommendations (e.g. hand washing) can reinforce the irrational beliefs of patients with OCD and poor insight. Therefore, engagement in exposure and ritual prevention activities may be lower, which could impact the long-term prognosis for OCD. Although the above considerations should be considered speculative, they are based on clinical experience and previous scientific research. Predictions regarding the outcome of OCD in response to stressful situations should be confirmed by longitudinal studies. Disclosure The authors report no conflicts of interest.

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          The clinical application of the biopsychosocial model.

          G Engel (1980)
          How physicians approach patients and the problems they present is much influenced by the conceptual models around which their knowledge is organized. In this paper the implications of the biopsychosocial model for the study and care of a patient with an acute myocardial infarction are presented and contrasted with approaches used by adherents of the more traditional biomedical model. A medical rather than psychiatric patient was selected to emphasize the unity of medicine and to help define the place of psychiatrists in the education of physicians of the future.
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            Obsessive–compulsive disorder

            Obsessive–compulsive disorder (OCD) is a highly prevalent and chronic condition that is associated with substantial global disability. OCD is the key example of the ‘obsessive–compulsive and related disorders’, a group of conditions which are now classified together in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the International Classification of Diseases, 11th Revision, and which are often underdiagnosed and undertreated. In addition, OCD is an important example of a neuropsychiatric disorder in which rigorous research on phenomenology, psychobiology, pharmacotherapy and psychotherapy has contributed to better recognition, assessment and outcomes. Although OCD is a relatively homogenous disorder with similar symptom dimensions globally, individualized assessment of symptoms, the degree of insight, and the extent of comorbidity is needed. Several neurobiological mechanisms underlying OCD have been identified, including specific brain circuits that underpin OCD. In addition, laboratory models have demonstrated how cellular and molecular dysfunction underpins repetitive stereotyped behaviours, and the genetic architecture of OCD is increasingly understood. Effective treatments for OCD include serotonin reuptake inhibitors and cognitive–behavioural therapy, and neurosurgery for those with intractable symptoms. Integration of global mental health and translational neuroscience approaches could further advance knowledge on OCD and improve clinical outcomes.
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              The descriptive epidemiology of obsessive-compulsive disorder.

              Since the early eighties, there has been a growing interest in the descriptive epidemiology of obsessive-compulsive disorder (OCD). In this narrative review, the authors describe the findings of a number of studies that employed selected instruments, such as the Diagnostic Interview Schedule, the Composite International Diagnostic Instrument, and the Schedule for Affective Disorders and Schizophrenia, to ascertain the prevalence and incidence rates for OCD in several different countries. We noted that there is a great heterogeneity of findings and that the potential reasons for this variability include not only the intrinsic characteristics of the population under study but also extrinsic factors (i.e., the several methodologically-informed decisions that are to be made before undertaking such investigations, such as the adoption of a specific diagnostic instrument). In order to further the knowledge on the epidemiology of OCD, it would be worthwhile to establish a global consensus regarding a standard assessment package for OCD, to produce more cross-culturally valid versions of the key research instruments, and to conduct studies specifically aimed at comparing the sociodemographic, clinical and prognostic aspects of OCD across different countries.
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                Author and article information

                Journal
                Braz J Psychiatry
                Braz J Psychiatry
                bjp
                Brazilian Journal of Psychiatry
                Associação Brasileira de Psiquiatria
                1516-4446
                1809-452X
                22 June 2020
                Jan-Feb 2020
                : 43
                : 1
                : 108
                Affiliations
                [1]Programa Transtornos do Espectro Obsessivo-Compulsivo, Laboratório de Psicopatologia e Terapêutica Psiquiátrica (LIM-23), Departamento e Instituto de Psiquiatria, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo (USP), São Paulo, SP, Brazil
                Author information
                http://orcid.org/0000-0002-6212-5568
                http://orcid.org/0000-0001-5959-5748
                http://orcid.org/0000-0001-7916-8567
                Article
                10.1590/1516-4446-2020-1189
                7861183
                32578691
                c4e557a5-8670-4026-ba59-395d8977bb33

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 May 2020
                : 2 June 2020
                Categories
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