Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presença de fatores de risco
- obsessões
- compulsões
- fenômenos sensoriais
- transtorno de personalidade esquizotípica
- transtorno de tique
- coordenação motora reduzida
- dificuldades sensório-perceptivas
- dificuldades no sequenciamento de tarefas motoras complexas
Outros fatores diagnósticos
- sexo masculino
Fatores de risco
- história familiar de TOC
- PANDAS (transtornos neuropsiquiátricos autoimunes pediátricos associados à infecção por estreptococos)
- gestação
- sexo masculino (início mais cedo, evolução mais crônica e resistência ao tratamento)
- maior frequência das compulsões (resistência ao tratamento)
- idade precoce de início (resistência ao tratamento)
- hospitalizações anteriores devidas ao TOC (resistência ao tratamento)
- transtorno de personalidade esquizotípica (resistência ao tratamento)
- transtorno de tique (resistência ao tratamento)
- anormalidades estruturais do cérebro específicas ou difusas (resistência ao tratamento)
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- nenhum exame inicial
Investigações a serem consideradas
- Entrevista Clínica Estruturada do DSM (SCID)
- Escala de Sintomas Obsessivo-Compulsivos de Yale-Brown (Y-BOCS)
- Impressão clínica global (CGI)
Algoritmo de tratamento
sintomas leves a moderados: sem transtornos de personalidade comórbidos ou sintomas dissociativos
sintomas graves ou com transtornos de personalidade comórbidos ou sintomas dissociativos
Colaboradores
Autores
Phillip J. Seibell, MD, FAPA
OCD and Anxiety Psychiatry of Westchester, P.C.
Hawthorne
NY
Declarações
PJS has received honoraria from Slack, Inc., for guest editing an issue on OCD.
Stefano Pallanti, MD, PhD
Professor of Psychiatry
Institute of Neuroscience
Florence
Italy
Declarações
SP declares that he has no competing interests. SP is an author of several references cited in this topic.
Silvia Bernardi, MD
Project Manager
New York State Psychiatric Institute
Columbia University
New York
NY
Declarações
SB receives research sponsorship from NYSPI, APA, and the Brain & Behavior Research Foundation. SB is also a board member of the New York council on Problem Gambling. SB is an author of a reference cited in this topic.
Megan Hughes-Feltenberger, PhD
Assistant Professor of Psychology in Psychiatry
Assistant Director of Education for Psychology
Weill Cornell Medical College
Assistant Attending Psychologist
NewYork-Presbyterian Hospital
New York
NY
Declarações
MHF declares that she has no competing interests.
Eric Hollander, MD
Clinical Professor of Psychiatry and Behavioral Sciences
Director
Compulsive, Impulsive and Autism Spectrum Disorder Program
Albert Einstein College of Medicine
Montefiore Medical Center
New York
NY
Declarações
EH has received research grants from, and has consulted for, Roche, GW Pharmaceuticals, and Bixink.
Agradecimentos
The authors would like to gratefully acknowledge Dr Ashley Braun, a previous contributor to this topic. AB declares that she has no competing interests.
Peer reviewers
Juliana Belo Diniz, MD
Psychiatrist
Department and Institute of Psychiatry
Clinical Hospital
University of Sao Paulo Medical School
Sao Paulo
Brazil
Disclosures
JBD declares that she has no competing interests.
Amit Nigam, MBBS, MRCPsych
Specialist Registrar in Forensic Psychiatry and Honorary Research Worker
National OCD Service
Queen Elizabeth II Hospital
Welwyn Garden City
Forensic Psychiatrist
West London Mental Health NHS Trust
London
UK
Disclosures
AN declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.
World Health Organization. International statistical classification of diseases and related health problems. 11th revision. Jan 2022 [internet publication].Full text
American Psychiatric Association. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry. July 2007 [internet publication].Full text
American Psychiatric Association. Guideline watch (March 2013): Practice guideline for the treatment of patients with obsessive-compulsive disorder. March 2013 [internet publication].Full text
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Transtorno de personalidade obsessivo-compulsivo (TPOC)
- Transtorno dismórfico corporal (TDC)
- Transtorno de sintomas somáticos
More DifferentialsGuidelines
- Diagnostic and statistical manual of mental disorders, fifth edition, text revision (DSM-5-TR)
- Deep brain stimulation for obsessive-compulsive disorder
More GuidelinesPatient information
Transtorno obsessivo-compulsivo
More Patient information
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