Beruflich Dokumente
Kultur Dokumente
OBJETIVOS
Adquirir noes sobre as bases biolgicas do TOC, mais especificamente
sobre:
Neurotransmissores e a neuroqumica cerebral do TOC;
Sintomas OC associados ao uso de substancias;
Doenas cerebrais e sintomas OC;
Gnglios basais, doenas autoimunes e o TOC;
Alteraes neurofisiolgicas no TOC e o modelo crtico-tlamo-
estriado-cortical;
Alteraes morfolgicas cerebrais;
Fatores neuroprotetores e neurotxicos;
Disfunes neuropsicolgicas e reas cerebrais envolvidas;
A gentica do TOC.
INTRODUO
Dopamina
Coreia de Sydenham
A CS, tambm chamada de dana de So Vito, caracteriza-se
principalmente por movimentos anormais repentinos e involuntrios da face,
dos braos, das mos e das pernas, pela sbita deteriorao da escrita, por
movimentos repentinos dos braos e das pernas e est relacionada a
alteraes nos chamados gnglios basais, estruturas cerebrais envolvidas na
coordenao dos movimentos. Um estudo verificou que 82% das crianas com
CS apresentavam sintomas OC que se iniciaram vrios dias antes do incio da
Coreia, aumentavam e diminuam juntamente com as anormalidades motoras
(Sweedo 1989;1993).
Estudos de neuroimagem
Tcnicas como a tomografia computadorizada por emisso de fton nico
(SPECT), tomografia por emisso de psitrons (PET) e, em especial, a
ressonncia magntica funcional (RMf) possibilitaram a visualizao do crebro
em funcionamento. Permitiram tambm comparar o metabolismo cerebral de
indivduos com e sem TOC e identificar as regies relacionadas ao transtorno.
Diferentes estratgias tem sido utilizadas identificar as reas envolvidas no
TOC. Essas estratgias comparam as imagens funcionais cerebrais de
indivduos com diagnstico de TOC com as imagens de indivduos sadios
(controles), ou dos prprios indivduos com TOC antes e depois de tratamentos,
ou durante a provocao de sintomas. As comparaes podem ser do
funcionamento cerebral de indivduos com TOC: 1) do crebro em repouso;
2)antes e depois do tratamento farmacolgico ou psicoterpico; 3)em estado de
repouso e durante a provocao dos sintomas. So ainda comparadas as
reas cerebrais recrutadas (solicitadas) durante a execuo de testes
neuropsicolgicos nos quais so propostas tarefas que se supe sejam crticas
para o indivduo com TOC, como tomada de uma deciso, inibio motora e
cognitiva, tempo de reao, memria de trabalho, entre outras e que poderiam
estar comprometidas no transtorno.
Vis de ateno
Portadores do TOC em consequncia da ansiedade e da hipervigilncia
podem aumentar o foco da ateno em estmulos que representam ameaa ou
perigo e ter dificuldade em desviar a ateno de tais estmulos configurando
um vis da ateno, o que comum quando existe medo de contaminao ou
nojo. Um estudo verificou que portadores de TOC demoram mais tempo para
desviar a ateno de estmulos (fotos) provocadores de medo ou nojo do que
os controles (Cisler 2010).
BDNF
O BDNF (Brain Derived Neurotrophic Factor) promove a proliferao neuronal,
a regenerao, molda a conectividade neuronal durante o desenvolvimento
cerebral e participa da plasticidade neuronal no crebro adulto. Desenvolve em
particular um papel chave em funes neurais que regulam as respostas aos
estmulos ambientais como eventos estressores. Tambm est envolvido em
psicopatologias humanas como os transtornos depressivos e ansiosos. Por
exemplo, a depresso maior tem sido associada com baixos nveis sricos de
BDNF que normalizam com o tratamento farmacolgico e no farmacolgico.
No TOC estudos iniciais em pacientes que no haviam utilizado medicamentos
observaram que os nveis sricos de BDNF eram menores do que nos
controles (Wang 2011). O papel do BDNF no TOC entretanto necessita ser
melhor compreendido
GENTICA
TOC em familiares
A prevalncia maior do TOC em familiares do que na populao em geral
est bem documentada. Estudos iniciais constataram uma maior prevalncia de
TOC em familiares de indivduos com TOC: risco TOC clinico e sub-clnico de
16% nos pais de indivduos com TOC e de 3% nos controles (Black,1992); de
10,3% para TOC clnico e 7,9% para TOC sub-clnico nos familiares de
pacientes e de 1,9% e 2% nos familiares de controles, respectivamente (Pauls
e cols 1995). Outro estudo encontrou uma prevalncia para a toda a vida em
familiares de primeiro grau de indivduos com TOC de 22.5% e de 2.6%
nos controles. As taxas foram particularmente aumentadas quando os
probandos apresentavam compulses de alinhamento (45.4% vs. 18.8%)
(Hanna,2005).
Nestadt e colaboradores (2000) compararam a prevalncia de TOC nos
familiares de 343 indivduos com TOC e nos familiares de 300 controles.
Verificaram que era bem mais elevada nos familiares de indivduos com TOC:
de 11,7% vs. 2,7%. Verificaram, ainda, que a idade de incio estava fortemente
associada com a incidncia familiar. Nenhum caso foi detectado em familiares
de pacientes cujo TOC tinha iniciado aps os 18 anos.
Finalmente um estudo de metanlise agregando os resultados de cinco
estudos genticos sobre o TOC concluiu que a razo das chances de vir a ter
TOC em familiares de primeiro grau de indivduos com o transtorno era quatro
vezes maior do que nos familiares de indivduos normais. O risco estimado foi
de 8,2% e de 2% (Hetema 2001).
Estudos de gmeos
Existem vrios relatos de caso e uma nica srie de casos com 30 pares de
gmeos com TOC. Nessa srie foi encontrada uma concordncia de 87% para
os 15 pares de gmeos monozigticos e de 47% para os 15 pares de gmeos
dizigticos (Carey,1981). No conjunto de casos de gmeos publicados at o
presente 54 (68%) de 80 pares de gmeos monozigticos eram concordantes
comparados com 9 (31%) de 29 pares dizigticos. At o presente momento
no foram feitos estudos de adoo no TOC.
SAPAP3
Em resumo:
Nas ltimas duas dcadas um grande nmero de estudos se dedicaram a
identificar os componentes genticos que poderiam estar envolvidos na
transmisso gentica e na etiologia do TOC. Os resultados tem sido um tanto
desalentadores e poucos estudos encontraram associao com genes
candidatos. Certamente existem influncias genticas na etiologia do TOC e
seu efeito talvez seja modesto, pelo menos para a maioria dos pacientes. Os
determinantes genticos no foram detectados pelas tcnicas tradicionais.
Esses estudos em geral tem um poder limitado pelo pequeno tamanho das
amostras, no foram replicados e os resultados encontrados no apoiam uma
hiptese biolgica sustentvel, que ao mesmo tempo integre os fentipos tanto
do ponto de vista clnico como cognitivos, e as variantes genticas encontradas
com tcnicas de sequenciamento gentico. Dificuldades adicionais decorrem
da heterogeneidade do transtorno e at da diversidade gentica das
populaes. Novas tcnicas de busca de variantes genticas no genoma esto
sendo desenvolvidas e outras ainda sero aplicadas que podero confirmar os
resultados e encontrar respostas mais especficas. At o presente momento
no h um acordo quanto ao modelo de transmisso gentica se gene
dominante, polignico, mendeliano dominante ou codominante ou misto, que
ainda no foi possvel de ser estabelecido no TOC (Hemmings, 2006; Nestadt
2010).
RESUMO E DESTAQUES
BIBLIOGRAFIA
1. Murphy DL, Zohar J, Benkelfat C, Pato MT, Pigott TA, Insel TR.Obsessive-
compulsive disorder as a 5-HT subsystem-related behavioural disorder. Br J
Psychiatry Suppl. 1989 Dec;(8):15-24.
2. Hollander E, DeCaria CM, Nitescu A, Gully R, Suckow RF, Cooper TB, Gorman
JM, Klein DF, Liebowitz MR. Serotonergic function in obsessive-compulsive disorder.
Behavioral and neuroendocrine responses to oral m-chlorophenylpiperazine and
fenfluramine in patients and healthy volunteers. Arch Gen Psychiatry. 1992
Jan;49(1):21-8.
3. Marchesi C, Tonna M, Maggini M. Obsessive-compulsive disorder followed by
psychotic episode in long-term ecstasy misuse. The World Journal of Biological
Psychiatry 2007, 1-4, First article CASE REPORT Download by Yale University
Sterling Memorial on 18 September 2007.
4. Dvorkin A, Silva C, McMurran T, Bisnaire L, Foster J, Szechtman H. Features of
compulsive checking behavior mediated by nucleus accumbens and orbital frontal
cortex. Eur J Neurosci. 2010 Nov;32(9):1552-63.
5. van der Wee NJ, Stevens H, Hardeman JA, Mandl RC, Denys DA, van Megen
HJ, Kahn RS, Westenberg H Enhanced dopamine transporter density in
psychotropic-naive patients with obsessive-compulsive disorder shown by
[123I]{beta}-CIT SPECT. Am J Psychiatry. 2004 Dec;161(12):2201-6.
6. Chakrabarty K, Bhattacharyya S, Christopher, R., and Khanna, S. 2005.
Glutamatergic dysfunction in OCD. Neuropsychopharmacology. 30:17351740.
7. Wu K, Hanna GL, Rosenberg DR, Arnold PD. The role of glutamate signaling in
the pathogenesis and treatment of obsessive-compulsive disorder. Pharmacol
Biochem Behav. 2012 Feb;100(4):726-35.
8. Willour VL, Yao Shugart Y, Samuels J, Grados M, Cullen B, Bienvenu OJ 3rd,
Wang Y, Liang KY, Valle D, Hoehn-Saric R, Riddle M, Nestadt G.Replication study
supports evidence for linkage to 9p24 in obsessive-compulsive disorder. Am J Hum
Genet. 2004 Sep;75(3):508-13.
9. Khazaal Y, Krenz S, Benmebarek M, Zullino DF. Worsening of obsessive-
compulsive symptoms under methadone tapering. Prog Neuropsychopharmacol
Biol Psychiatry. 2006 Sep 30;30(7):1350-2.
10. Kalra SK, Swedo SE. Children with obsessive-compulsive disorder: are they just
"little adults"? Clin Invest. 2009 Apr;119(4):737-46.
11. Swedo SE, Leonard HL, Garvey M, Mittleman B, Allen AJ, Perlmutter S, et al.
Pediatric autoimmune neuropsychiatric disorders associated with streptococcal
infections: clinical description of the first 50 cases. Am J Psychiatry. 1998
Feb;155(2):264-71.
12. Asbahr FR, Negro AB, Gentil V, Zanetta DM, da Paz JA, Marques-Dias MJ,
Kiss MH. Obsessive-compulsive and related symptoms in children and adolescents
withrheumatic fever with and without chorea: a prospective 6-month study. Am J
Psychiatry. 1998 Aug;155(8):1122-4.
13. Swedo SE, Rapoport JL, Cheslow DL, Leonard HL, Ayoub EM, Hosier DM, et al.
High prevalence of obsessive-compulsive symptoms in patients with Sydenhams
chorea. Am J Psychiatry. 1989 Feb;146(2):246-9.
14. Swedo SE, Leonard HL, Schapiro MB, Casey BJ, Mannheim GB, Lenane MC,
Rettew DC. Sydenhams chorea: physical and psychological symptoms of St Vitus
dance. Pediatrics 1993; 91:706713.
15. Dale RC, Heyman I, Giovannoni G, Church AW. Incidence of anti-brain
antibodies in children with obsessive-compulsive disorder. Br J Psychiatry. 2005
Oct;187:314-9.
16. Morris CM, Pardo-Villamizar C, Gause CD, Singer HS. Serum autoantibodies
measured by immunofluorescence confirm a failure to differentiate PANDAS and
Tourette syndrome from controls. J Neurol Sci. 2009 Jan 15;276(1-2):45-8.
17. Lewin AB, Chang S, McCracken J, McQueen M, Piacentini J. Comparison of
clinical features among youth with tic disorders,obsessive-compulsive disorder
(OCD), and both conditions. Psychiatry Res. 2010 Jul 30;178(2):317-22.
18.
Miguel EC, do Rosrio-Campos MC, Prado HS, do Valle R, Rauch SL, Coffey
BJ, Baer L, Savage CR, O'Sullivan RL, Jenike MA, Leckman JF. Sensory
phenomena in obsessive-compulsive disorder and Tourette's disorder. J Clin
Psychiatry. 2000 Feb;61(2):150-6.
19.
Pujol J, Soriano-Mas C, Alonso P, Cardoner N, Menchn JM, Deus J, et al.
Mapping structural brain alterations in obsessive-compulsive disorder. Arch Gen
Psychiatry. 2004 Jul;61(7):720-30.
20.
Atmaca M, Yildirim H, Ozdemir H, Tezcan E, Poyraz AK. Volumetric MRI study
of key brain regions implicated in obsessive-compulsive disorder. Prog
Neuropsychopharmacol Biol Psychiatry. 2007 Jan 30;31(1):46-52.
21. Valente AA Jr, Miguel EC, Castro CC, Amaro E Jr, Duran FL, Buchpiguel CA,
Chitnis X, McGuire PK, Busatto GF. Regional gray matter abnormalities in
obsessive-compulsive disorder: a voxel-based morphometry study. Biol Psychiatry.
2005 Sep 15;58(6):479-87
22. van den Heuvel OA, Remijnse PL, Mataix-Cols D, Vrenken H, Groenewegen HJ,
Uylings HB, van Balkom AJ, Veltman DJ. The major symptom dimensions of
obsessive-compulsive disorder are mediated by partially distinct neural systems.
Brain. 2009 Apr;132(Pt 4):853-68.
23. Radua J, Mataix-Cols D.Voxel-wise meta-analysis of grey matter changes in
obsessive-compulsive disorder. Br J Psychiatry. 2009 Nov;195(5):393-402.
24. Radua J, van den Heuvel OA, Surguladze S, Mataix-Cols D Meta-analytical
comparison of voxel-based morphometry studies in obsessive-compulsive disorder
vs other anxiety disorders. Arch Gen Psychiatry. 2010 Jul;67(7):701-11.
25. Szeszko PR, Christian C, Macmaster F, Lencz T, Mirza Y, Taormina SP, Easter
P, Rose M, Michalopoulou GA, Rosenberg DR.Gray matter structural alterations in
psychotropic drug-naive pediatric obsessive-compulsive disorder: an optimized
voxel-based morphometry study. Am J Psychiatry. 2008 Oct;165(10):1299-307.
26. Lzaro L, Bargall N, Castro-Fornieles J, Falcn C, Andrs S, Calvo R, Junqu
C.Brain changes in children and adolescents with obsessive-compulsive disorder
before and after treatment: a voxel-based morphometric MRI study. Psychiatry Res.
2009 May 15;172(2):140-6.
27. Saxena S, Brody AL, Schwartz JM, Baxter LR Neuroimaging and frontal-
subcortical circuitry in obsessive-compulsive disorder. Br J Psychiatry Suppl.
1998;(35):26-37.
28. Saxena S, Rauch SL. Functional neuroimaging and the neuroanatomy of
obsessive-compulsive disorder. Psychiatr. Clin. North Am. 2000; 23:563586.
29. Baxter LR Jr, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC,
et al. Caudate glucose metabolic rate changes with both drug and behavior therapy
for obsessive-compulsive disorder. Arch Gen Psychiatry 1992; 49(9):681-9.
30. Gilbert AR, Moore GJ, Keshavan MS, Paulson LA, Narula V, Mac Master FP,
Stewart CM, Rosenberg DR. Decrease in thalamic volumes of pediatric patients with
obsessive-compulsive disorder who are taking paroxetine. Arch Gen Psychiatry
2000; 57(5):449-56.
31. Nakao T, Nakagawa A, Yoshiura T, Nakatani E, Nabeyama M, Yoshizato C,
Kudoh A,Tada K, Yoshioka K, Kawamoto M, Togao O, Kanba S.Brain activation of
patients with obsessive-compulsive disorder during neuropsychological and
symptom provocation tasks before and after symptom improvement: a functional
magnetic resonance imaging study. Biol Psychiatry. 2005 Apr 15;57(8):901-10.
32. Saxena S, Gorbis E, O'Neill J, Baker SK, Mandelkern MA, Maidment KM,
Chang S, Rapid effects of brief intensive cognitive-behavioral therapy on brain
glucose metabolism in obsessive-compulsive disorder. Mol Psychiatry. 2009
Feb;14(2):197-205.
33. Lzaro L, Cald X, Junqu C, Bargall N, Andrs S, Morer A, Castro-Fornieles
Cerebral activation in children and adolescents with obsessive-compulsivedisorder
before and after treatment: a functional MRI study. J Psychiatr Res. 2008
Oct;42(13):1051-9.
34. Breiter HC, Rauch SL, Kwong KK, Baker JR, Weisskoff RM, Kennedy DN,
Kendrick AD, Davis TL, Jiang A, Cohen MS, Stern CE, Belliveau JW, Baer L,
O'Sullivan RL, Savage CR, Jenike MA, Rosen BR. Functional magnetic resonance
imaging of symptom provocation in obsessive-compulsive disorder. Arch Gen
Psychiatry. 1996 Jul;53(7):595-606.
35. Rauch SL, Jenike MA, Alpert NM, Baer L, Breiter HC, Savage CR, Fischman AJ.
Regional cerebral blood flow measured during symptom provocation in obsessive-
compulsive disorder using oxygen 15-labeled carbon dioxide and positron emission
tomography. Arch Gen Psychiatry. 1994 Jan;51(1):62-70.
36. Nabeyama M, Nakagawa A, Yoshiura T, T, Nakatani E, Togao O, Yoshizato
C,Yoshioka K, Tomita M, Kanba S. Functional MRI study of brain activation
alterations in patients with obsessive-compulsive disorder after symptom
improvement. Psychiatry Res. 2008 Aug 30;163(3):236-47.
37. Rotge JY, Guehl D, Dilharreguy B, Cuny E, Tignol J, Bioulac B, Allard M,
Burbaud P, Aouizerate B. Provocation of obsessive-compulsive symptoms: a
quantitative voxel-based meta-analysis of functional neuroimaging studies. J
Psychiatry Neurosci. 2008 Sep;33(5):405-12
38. Gilbert AR, Akkal D, Almeida JR, Mataix-Cols D, Kalas C, Devlin B, Birmaher B,
Phillips ML.Neural correlates of symptom dimensions in pediatric obsessive-
compulsive disorder: a functional magnetic resonance imaging study. J Am Acad
Child Adolesc Psychiatry. 2009 Sep;48(9):936-44.
39. Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips
ML. Distinct neural correlates of washing, checking, and hoarding symptom
dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry 2004;
61(6):564-76.
40. Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, Baker SK,
Baxter LR Jr. Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J
Psychiatry. 2004 Jun;161(6):1038-48.
41. van den Heuvel OA, Veltman DJ, Groenewegen HJ, Cath DC, van Balkom AJ,
van Hartskamp J, Barkhof F, van Dyck R. Frontal-striatal dysfunction during
planning in obsessive-compulsive disorder. Arch Gen Psychiatry. 2005
Mar;62(3):301-9.
42. Cougle JR, Salkovskis PM, Wahl K. Perception of memory ability and
confidence in recollections in obsessive-compulsive checking. J Anxiety Disord.
2007;21(1):118-30.
43. Nakao T, Nakagawa A, Nakatani E, Nabeyama M, Sanematsu H, Yoshiura T,
Togao O, Tomita M, Masuda Y, Yoshioka K, Kuroki T, Kanba S. Working memory
dysfunction in obsessive-compulsive disorder: a neuropsychological and functional
MRI study. Psychiatr Res. 2009 May;43(8):784-91
44. Cha KR, Koo MS, Kim CH, Kim JW, Oh WJ, Suh HS, Lee HS. Nonverbal
memory dysfunction in obsessive-compulsive disorder patients with checking
compulsions. Depress Anxiety. 2008;25(11):E 115-20
45. Nedeljkovic M, Kyrios M, Moulding R, Doron G, Wainwright K, Pantelis C,
Purcell R, Maruff P. Differences in neuropsychological performance between
subtypes of obsessive-compulsive disorder. Aust N Z J Psychiatry. 2009
Mar;43(3):216-26.
46. Jaafari N, Frasca M, Rigalleau F, Rachid F, Gil R, Oli JP, Guehl D, Burbaud P,
Aouizerate B, Rotg JY, Vibert N; for Insight Study Group. Forgetting what you have
checked: A link between working memory impairment and checking behaviors in
obsessive-compulsive disorder. Eur Psychiatry. 2011 Sep 15.
47. da Rocha FF, Alvarenga NB, Malloy-Diniz L, Corra H. Decision-making
impairment in obsessive-compulsive disorder as measured by the Iowa Gambling
Task. Arq Neuropsiquiatr. 2011 Aug;69(4):642-7.
48. Starcke K, Tuschen-Caffier B, Markowitsch HJ, Brand M. Dissociation of
decisions in ambiguous and risky situations in obsessive-compulsive disorder.
Psychiatry Res. 2010 Jan 30;175(1-2):114-20.
49. Chamberlain SR, Fineberg NA, Menzies LA, Blackwell AD, Bullmore ET,
Robbins TW, Sahakian BJ. Impaired cognitive flexibility and motor inhibition in
unaffected first-degree relatives of patients with obsessive-compulsive disorder. Am
J Psychiatry. 2007 Feb;164(2):335-8.
50. Page LA, Rubia K, Deeley Q, Daly E, Toal F, Mataix-Cols D, Giampietro V,
Schmitz N, Murphy DG. A functional magnetic resonance imaging study of
inhibitory control in obsessive-compulsive disorder. Psychiatry Res. 2009 Dec
30;174(3):202-9.
51. Remijnse PL, Nielen MM, van Balkom AJ, Cath DC, van Oppen P, Uylings HB,
Veltman Reduced orbitofrontal-striatal activity on a reversal learning task in
obsessive-compulsive disorder. Arch Gen Psychiatry. 2006 Nov;63(11):1225-36.
52. Chamberlain SR, Menzies L, Hampshire A, Suckling J, Fineberg NA, del Campo
N, Aitken M, Craig K, Owen AM, Bullmore ET, Robbins TW, Sahakian BJ.
Orbitofrontal dysfunction in patients with obsessive-compulsive disorder and their
unaffected relatives. Science. 2008 Jul 18;321(5887):421-2.
53. Chamberlain SR, Menzies L. Endophenotypes of obsessive-compulsive
disorder: rationale, evidence and future potential. Expert Rev Neurother. 2009
Aug;9(8):1133-46.
54. Cisler JM, Olatunji BO. Components of attentional biases in contamination fear:
evidence for difficulty in disengagement. Behav Res Ther. 2010 Jan;48(1):74-8.
55. Wang Y, Mathews CA, Li Y, Lin Z, Xiao Z. Brain-derived neurotrophic factor
(BDNF) plasma levels in drug-nave OCD patients are lower than those in healthy
people, but are not lower than those in drug-treated OCD patients. J Affect Disord.
2011 Sep;133(1-2):305-10.
56. Konuk N, Tekin IO, Ozturk U, Atik L, Atasoy N, Bektas S, Erdogan A.Plasma
levels of tumor necrosis factor-alpha and interleukin-6 in obsessive compulsive
disorder. Mediators Inflamm. 2007;2007:65704..
57. Nestadt G, Grados M, Samuels JF. Genetics of obsessive-compulsive disorder.
Psychiatr Clin North Am. 2010 Mar;33(1):141-58.
58. Black DW, Noyes R Jr, Goldstein RB, Blum N.A family study of obsessive-
compul- sive disorder. Arch Gen Psychiatry 1992;49:3628. Arch Gen Psychiatry.
1992 May;49(5):362-8.
Pauls DL, Alsobrook JP 2nd, Goodman W, Rasmussen S, Leckman JF. A family
study of obsessive-compulsive disorder.Am J Psychiatry. 1995 Jan;152(1):76-84
59. Hanna GL, Himle JA, Curtis GC, Gillespie BW. A family study of obsessive-
compulsive disorder with pediatric probands. Am J Med Genet B Neuropsychiatr
Genet. 2005 Apr 5;134B(1):13-9.
60. Nestadt G, Samuels J, Riddle M, Bienvenu OJ 3rd, Liang KY, LaBuda M,
Walkup J,Grados M, Hoehn-Saric R. A family study of obsessive-compulsive
disorder. Arch Gen Psychiatry. 2000 Apr;57(4):358-63.
61. Hettema JM, Neale MC, Kendler KS. A review and meta-analysis of the genetic
epidemiology of anxiety disorders. Am J Psychiatry 2001; 158(10):1568-78
62. Carey G, Gottesman I. Twin and family studies of anxiety, phobic, and
obsessive disorders anxiety: new research and changing concepts. In: Klein DF,
Rabkin JG, editors. Anxiety: new research and changing concepts. New York:
Raven Press; 1981. p. 11736.
63. Walitza S, Wendland JR, Gruenblatt E, Warnke A, Sontag TA, Tucha O, Lange
KW. Genetics of early-onset obsessive-compulsive disorder. Eur Child Adolesc
Psychiatry. 2010 Mar;19(3):227-35.
64. Hu XZ, Lipsky RH, Zhu G, Akhtar LA, Taubman J, Greenberg BD, Xu K, Arnold
PD, Richter MA, Kennedy JL, Murphy DL, Goldman D.Serotonin transporter
promoter gain-of-function genotypes are linked to obsessive-compulsive disorder.
Am J Hum Genet. 2006 May;78(5):815-26.
65. Bloch MH, Landeros-Weisenberger A, Sen S, Dombrowski P, Kelmendi B, Coric
V, Pittenger C, Leckman JF.Association of the serotonin transporter polymorphism
and obsessive-compulsive disorder: systematic review. Am J Med Genet B
Neuropsychiatr Genet. 2008 Sep 5;147B(6):850-8
66. Dickel DE, Veenstra-VanderWeele J, Cox NJ, Wu X, Fischer DJ, Van Etten-Lee
M, Himle JA, Leventhal BL, Cook EH Jr, Hanna GL. Association testing of the
positional and functional candidate gene SLC1A1/EAAC1 in early-onset obsessive-
compulsive disorder. Arch Gen Psychiatry. 2006 Jul;63(7):778-85.
67. Stewart SE, Fagerness JA, Platko J, Smoller JW, Scharf JM, Illmann C, Jenike
E, Chabane N, Leboyer M, Delorme R, Jenike MA, Pauls DL. Association of the
SLC1A1 glutamate transporter gene and obsessive-compulsive disorder. Am J Med
Genet B Neuropsychiatr Genet. 2007 Dec 5;144B(8):1027-33.
68. Samuels J, Nestadt G. Evidence for potential relationship between SLC1A1 and
a putative genetic linkage region on chromosome 14q to obsessive-compulsive
disorder with compulsive hoarding. Am J Med Genet B Neuropsychiatr Genet. 2008
Sep 5;147B(6):1000-2
69. Voyiaziakis E, Evgrafov O, Li D, Yoon HJ, Tabares P, Samuels J, Wang Y,
Riddle MA, Grados MA, Bienvenu OJ, Shugart YY, Liang KY, Greenberg BD,
Rasmussen SA,Murphy DL, Wendland JR, McCracken JT, Piacentini J, Rauch SL,
Pauls DL, NestadtG, Fyer AJ, Knowles JA.Association of SLC6A4 variants with
obsessive-compulsive disorder in a large multicenter US family study. Mol
Psychiatry. 2011 Jan;16(1):108-20
70. Sampaio AS, Fagerness J, Crane J, Leboyer M, Delorme R, Pauls DL, Stewart
SE. Association between polymorphisms in GRIK2 gene and obsessive-compulsive
isorder: a family-based study. CNS Neurosci Ther. 2011 Jun;17(3):141-7.
71. Welch JM, Lu J, Rodriguiz RM, et al. Cortico-striatal synaptic defects and OCD-
like behaviours in Sapap3-mutant mice. Nature 2007;448:894900.
72. Bienvenu OJ, Wang Y, Shugart YY, Welch JM, Grados MA, Fyer AJ, Rauch
SL,McCracken JT, Rasmussen SA, Murphy DL, Cullen B, Valle D, Hoehn-Saric R,
Greenberg BD, Pinto A, Knowles JA, Piacentini J, Pauls DL, Liang KY, Willour VL,
Riddle M, Samuels JF, Feng G, Nestadt G. Sapap3 and pathological grooming in
humans: Results from the OCD collaborative genetics study. Am J Med Genet B
Neuropsychiatr Genet. 2009 Jul 5;150B(5):710-20.
73. Boardman L, van der Merwe L, Lochner C, Kinnear CJ, Seedat S, Stein DJ,
Moolman-Smook JC, Hemmings SM. DJ,Moolman-Smook JC, Hemmings SM.
Investigating SAPAP3 variants in the etiology of obsessive-compulsive disorder and
trichotillomania in the South African white population. Compr Psychiatry. 2011 Mar-
Apr;52(2):181-7.
74. Millet B, Chabane N, Delorme R, Leboyer M, Leroy S, Poirier MF, Bourdel MC,
Mouren-Simeoni MC, Rouillon F, Loo H, Krebs MO. Association between the
dopamine receptor D4 (DRD4) gene and obsessive-compulsivedisorder. Am J Med
Genet B Neuropsychiatr Genet. 2003 Jan 1;116B(1):55-9.
75. Hemmings SM, Stein DJ.The current status of association studies in obsessive-
compulsive disorder. Psychiatr Clin North Am. 2006 Jun;29(2):411-44.
Fig.1 O circuito crtico-estriado-tlamo-cortical (adaptado de Kalra,2009)