Cristiano Nabuco de Abreu

Anorexia nervosa e bulimia nervosa: abordagem cognitivo-construtivista de psicoterapia

Dos transtornos alimentares, a anorexia nervosa e a bulimia nervosa sao os que mais tem levado pacientes adolescentes, geralmente do sexo feminino, a buscar ajuda. Tal ajuda ocorre por meio do tratamento fornecido por uma equipe multidisciplinar formada por psicologos, psiquiatras e nutricionistas. A Psicoterapia tem se mostrado um dos componentes mais eficazes para a melhora das pacientes com bulimia nervosa e para os casos de anorexia nervosa cujos estudos ainda se fazem necessarios. Assim, o objetivo do texto sera discutir: (a) os preceitos envolvendo as bases teorico-praticas das abordagens cognitivo-construtivistas; (b) as caracteristicas psicologicas mais comuns dos referidos pacientes; (c) os programas de atendimento (protocolos) desenvolvidos pelos autores e (d) as conclusoes gerais da pratica clinica envolvendo os resultados e outras consideracoes.

Avaliação da equivalência semântica e consistência interna de uma versão em português do Internet Addiction Test (IAT)

OBJECTIVE: The aim of this study was to cross-culturally adapt the Internet Addiction Test (IAT) to the Portuguese language. METHODS: The translation and evaluation process consisted of five steps: (1) translation; (2) back-translation; (3) peer review and evaluation of semantic equivalency by experts; (4) instrument evaluation through a sample of students, by evaluating their understanding level; and (5) analysis of the instruments internal consistency (Cronbachs alpha-coefficient). RESULTS: The instrument was translated and adapted to Portuguese. As shown, the Portuguese version of the IAT was easily understood and the internal consistency value was 0.85. DISCUSSION: The translated and adapted IAT displays a satisfactory internal consistency. In a further step, measurement and reproducibility analyses have to be conducted.

Internet and video game addictions: a cognitive behavioral approach

Background: While several benefits are attributed to the Internet and video games, an important proportion of the population presents symptoms related to possible new technological addictions and there has been little discussion of treatment of problematic technology use. Although demand for knowledge is growing, only a small number of treatments have been described. Objective: To conduct a systematic review of the literature, to establish Cognitive Behavioral Therapy (CBT) as a possible strategy for treating Internet and video game addictions. Method: The review was conducted in the following databases: Science Direct on Line, PubMed, PsycINFO, Cochrane Clinical Trials Library, BVS and SciELO. The keywords used were: Cognitive Behavioral Therapy; therapy; treatment; with association to the terms Internet addiction and video game addiction. Given the scarcity of studies in the field, no restrictions to the minimum period of publication were made, so that articles found until October 2013 were accounted. Results: Out of 72 articles found, 23 described CBT as a psychotherapy for Internet and video game addiction. The manuscripts showed the existence of case studies and protocols with satisfactory efficacy. Discussion: Despite the novelty of technological dependencies, CBT seems to be applicable and allows an effective treatment for this population.

Adaptação transcultural da Massachusetts General Hospital (MGH) Hairpulling Scale para o idioma português (Brasil)

CONTEXTO: A tricotilomania (TTM) caracteriza-se pelo ato de arrancar, de forma recorrente, os proprios cabelos por prazer, gratificacao ou alivio de tensao, acarretando perda capilar perceptivel. A Massachusetts General Hospital (MGH) Hairpulling Scale e um instrumento utilizado recentemente em muitos estudos para avaliar sintomas de TTM. OBJETIVO: O presente trabalho teve como objetivo adaptar essa escala para o idioma portugues. METODOS: Envolveu cinco etapas: (1) traducao; (2) retraducao; (3) revisao tecnica e avaliacao das equivalencias semântica e conceitual por especialistas em saude mental; (4) avaliacao do instrumento por estudantes, por meio da avaliacao do grau de compreensao e (5) analise da consistencia interna do instrumento pelo coeficiente alfa de Cronbach. RESULTADOS: O instrumento foi traduzido e adaptado para o idioma portugues. Demonstrou ser de facil compreensao e o valor da consistencia interna correspondeu a 0,96. CONCLUSAO: O instrumento encontra-se traduzido e adaptado para o idioma portugues. Sao necessarias analises de equivalencia de mensuracao e reprodutibilidade.

Group treatment for trichotillomania: cognitive-behavioral therapy versus supportive therapy.

OBJECTIVE Trichotillomania is a psychiatric condition characterized by the chronic pulling and plucking of ones own hair. Cognitive-behavioral therapy shows promise as a treatment for trichotillomania and might be preferable to pharmacotherapy. However, there have been no randomized, controlled studies of the efficacy of group cognitive-behavioral therapy. METHOD We evaluated 44 subjects, recruited from April 2009 to May 2010, all of whom met DSM-IV criteria for a diagnosis of trichotillomania. Subjects were randomized to receive 22 sessions of either group cognitive-behavioral therapy or group supportive therapy (control). Treatment evaluation was non-blind and used self-report scales. The primary outcome measure was the improvement of hair-plucking behavior as assessed by the Massachusetts General Hospital Hairpulling Scale. Secondary measures included scores on the Beck Depression Inventory, the Beck Anxiety Inventory, and the Social Adjustment Scale-Self-Report. RESULTS Both groups showed significant posttreatment improvement in the scores from the Massachusetts General Hospital Hairpulling Scale (F = 23.762, P < .001) and the Beck Depression Inventory (F = 6.579, P = .003). The decrease in hair-plucking behavior over time was significantly greater in the study group than in the control group (F = 3.545, P < .038). There were no significant differences between the pretreatment and posttreatment time points or between the groups in the scores from the Beck Anxiety Inventory and the Social Adjustment Scale-Self-Report. CONCLUSIONS We conclude that group cognitive-behavioral therapy is a valid treatment for trichotillomania. This treatment model should be further revised and expanded to address comorbidities such as anxiety and social maladjustment. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01968343.

Treating kleptomania: cross-cultural adaptation of the Kleptomania Symptom Assessment Scale and assessment of an outpatient program

BACKGROUND Kleptomania is characterized by repetitive stealing and has severe consequences for patients. Stigma, a lack of standardized therapy and a limited number of assessment tools hinder advances in treatment. This study provides preliminary data on the Portuguese-language version of the Kleptomania Symptom Assessment Scale (P-K-SAS) and preliminary data on an outpatient program. METHODS Experts in the field analyzed an initial P-K-SAS version, produced through translation/back-translation, in order to arrive at a final version. Eight patients currently on cognitive-behavioral therapy (CBT) and 10 patients under maintenance CBT were initially assessed, then re-assessed 6months later. RESULTS The mean P-K-SAS score was higher among patients initiating CBT than among those under maintenance CBT (21.1±8.0 vs. 11.3±7.5; Mann-Whitney U=15.0, P=.024). The final version of the P-K-SAS presented excellent reliability (Cronbachs alpha=0.980; inter-item correlation, 0.638-0.907). CONCLUSIONS The P-K-SAS presented solid psychometrics and seems ready for use in assessing the effectiveness of treatments for kleptomania. The findings suggest that kleptomania patients need follow-up treatment that goes beyond the traditional 12-session structure.

Programa de Orientação a Pais de Adolescentes Dependentes de Internet (PROPADI)

Neste artigo, e descrito o Programa de Orientacao a pais dos pacientes dependentes de Internet desenvolvido por nosso Ambulatorio. Por se tratar de um trabalho inedito, sao descritos os temas de cada encontro bem como as implicacoes no resultado final junto aos adolescentes, profissionais e a familia como um todo.

Indicações para internação hospitalar completa ou parcial

Este artigo discute as indicacoes para tratamento hospitalar total e parcial em transtornos alimentares. A literatura basica sobre o tema e revisada, explicando tipos e locais de tratamento e guias terapeuticos para abordagem de pacientes nestas condicoes.