ESTRATEGIAS CLINICAS E EFICACIA DAS INTERVENÇÕES NO TRATAMENTO DO TRANSTORNO OBSESSIVO-COMPULSIVO
DOI:
https://doi.org/10.18623/rvd.v23.8013Keywords:
Transtorno Obsessivo-Compulsivo, Terapêutica, Genômica, Microbiota Intestinal, Estimulação Cerebral ProfundaAbstract
O Transtorno Obsessivo-Compulsivo (TOC) é um transtorno psiquiátrico crônico que compromete significativamente a qualidade de vida e a funcionalidade dos indivíduos acometidos, sobretudo nos casos com resposta limitada ao tratamento convencional. Este estudo sintetiza evidências científicas recentes sobre as estratégias clínicas e a eficácia das intervenções no tratamento do TOC por meio de uma revisão narrativa na base de dados PubMed. Os avanços na compreensão da fisiopatologia destacam a identificação de 30 loci genéticos associados ao risco do transtorno e sua relação com circuitos neurais de controle inibitório. Evidências apontam para a participação do eixo microbiota-intestino-cérebro, sugerindo que alterações intestinais contribuem para mecanismos neuroinflamatórios. No âmbito terapêutico, a terapia cognitivo-comportamental associada à Exposição e Prevenção de Resposta (TCC/ERP) permanece como padrão-ouro, enquanto novas modalidades e intervenções mediadas pela internet ganham espaço. A farmacoterapia segue essencial, especialmente em casos de resposta insuficiente à psicoterapia. Para o TOC refratário, a estimulação cerebral profunda (DBS), guiada por técnicas de conectômica, apresenta resultados favoráveis ao permitir precisão na definição de alvos e redução sintomática. Conclui-se que a integração entre intervenções consolidadas e avanços em genômica e neuromodulação amplia as possibilidades de manejo individualizado, embora demandem estudos clínicos mais robustos.
References
Aarnoudse-Moens CS, Weisglas-Kuperus N, van Goudoever JB, Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and/or very low birth weight children. Pediatrics. 2009;124(2):717–728. [PubMed: 19651588]
AMERICAN PSYCHIATRIC ASSOCIATION [APA]. Manual diagnóstico e estatístico de transtornos mentais: DSM-5-TR. 5. ed. rev. Porto Alegre: Artmed, 2023.
BECK, Judith S. Terapia cognitivo-comportamental: teoria e prática. 3. ed. Porto Alegre: Artmed, 2021.
Challacombe FL, Salkovskis PM, Woolgar M, Wilkinson EL, Read J, Acheson R. Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood. Infant Behav Dev. 2016;44:11–20. [PubMed: 27259042]
Chaudron LH, Nirodi N. The obsessive-compulsive spectrum in the perinatal period: a prospective pilot study. Arch Womens Ment Health. 2010;13(5):403–410. [PubMed: 20221779]
CLARK, David A.; BECK, Aaron T. Terapia cognitiva dos transtornos de ansiedade: ciência e prática. Porto Alegre: Artmed, 2012.
Fawcett EJ, Power H, Fawcett JM. Women are at greater risk of OCD than men: a meta-analytic review of OCD prevalence worldwide. J Clin Psychiatry. 2020;81(4).
FOA, Edna B. Cognitive behavioral therapy of obsessive-compulsive disorder. Dialogues in Clinical Neuroscience, [S. l.], v. 12, n. 2, p. 199–207, 2010.
HUDEPOHL, N.; MACLEAN, J. V.; OSBORNE, L. M. Perinatal Obsessive-Compulsive Disorder: Epidemiology, Phenomenology, Etiology, and Treatment. Current Psychiatry Reports, v. 24, n. 4, p. 229-237, 2022.
Hutner LCL, Nagle-Yang S, Williams K, Osborne LM, eds. The APA Textbook of Women’s Reproductive Mental Health. Washington, DC: APA Publishing; 2021 (forthcoming).
MACKAY, M. et al. The Gut-Brain Axis and the Microbiome in Anxiety Disorders, Post-Traumatic Stress Disorder and Obsessive-Compulsive Disorder. Current Prevalence Neuropharmacology, v. 22, n. 5, p. 866-883, 2024.
MAITI, R. et al. Pharmacological augmentation of serotonin reuptake inhibitors in patients with obsessive-compulsive disorder: A network meta-analysis. Acta Psychiatrica Scandinavica, v. 148, n. 1, p. 19-31, 2023.
McGuinness M, Blissett J, Jones C. OCD in the perinatal period: is postpartum OCD (ppOCD) a distinct subtype? A review of the literature. Behav Cogn Psychother. 2011;39(3):285–310. [PubMed: 21208486]
MEYER, G. M. et al. Deep Brain Stimulation for Obsessive-Compulsive Disorder: Optimal stimulation sites. Biological Psychiatry, v. 96, n. 2, p. 101-113, 2024.
Miller ES, Hoxha D, Wisner KL, Gossett DR. Obsessions and Compulsions in Postpartum Women Without Obsessive Compulsive Disorder. J Womens Health (Larchmt). 2015;24(10):825–830. [PubMed: 26121364]
Miller ML, O’Hara MW. Obsessive-compulsive symptoms, intrusive thoughts and depressive symptoms: a longitudinal study examining relation to maternal responsiveness. J Reprod Infant Psychol. 2020;38(3):226–242. [PubMed: 31431052]
Nasiri K, Czuzoj-Shulman N, Abenhaim HA. Association between obsessive-compulsive disorder and obstetrical and neonatal outcomes in the USA: a population-based cohort study. Arch Womens Ment Health. 2021.
NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE [NICE]. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. London: NICE, 2019. (NICE Guideline CG31). Disponível em: https://www.nice.org.uk/guidance/cg31. Acesso em: 4 ago. 2026.
POLAK, M.; TANZER, N. K. Internet-Based Cognitive Behavioural Treatments for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Clinical Psychology & Psychotherapy, v. 31, n. 3, e2989, 2024.
SHETH, S. A.; MAYBERG, H. S. Deep Brain Stimulation for Obsessive-Compulsive Disorder and Depression. Annual Review of Neuroscience, v. 46, p. 341-358, 2023.
STROM, N. I. et al. Genome-wide analyses identify 30 loci associated with obsessive-compulsive disorder. Nature Genetics, v. 57, n. 6, p. 1389-1401, 2025.
Uguz F, Onder Sonmez E, Sahingoz M, Gokmen Z, Basaran M, Gezginc K, et al. Neuroinflammation in the fetus exposed to maternal obsessive-compulsive disorder during pregnancy: a comparative study on cord blood tumor necrosis factor-alpha levels. Compr Psychiatry. 2014;55(4):861–865. [PubMed: 24480417]
Uguz F, Yuksel G, Karsidag C, Guncu H, Konak M. Birth weight and gestational age in newborns exposed to maternal obsessive-compulsive disorder. Psychiatry Res. 2015;226(1):396–398. [PubMed: 25660733]
WOLF, N. et al. Inference-Based Cognitive Behavioral Therapy versus Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: A Multisite Randomized Controlled Non-Inferiority Trial. Psychotherapy and Psychosomatics, v. 93, n. 6, p. 397-411, 2024.
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