Gabriel Coutinho

Assessment of executive functions in obese individuals with binge eating disorder

OBJECTIVE The aim of this study was to assess executive functions of obese individuals with binge eating disorder. METHOD Thirty-eight obese individuals with binge eating disorder were compared to thirty-eight obese controls without binge eating disorder in terms of their executive functions. All individuals were assessed using the following instruments: Digit Span, Trail Making Tests A and B, Stroop Test and the Wisconsin Card Sorting Test. In addition, four subtests from the Behavioral Assessment of the Dysexecutive Syndrome Battery were also used, namely the Zoo Map Test, the Modified Six Elements Test, the Action Program Test and the Rule Shift Cards Test. RESULTS When compared to obese controls, obese individuals with binge eating disorder presented significant impairment in the following tests: Digit Span backward, Zoo Map Test, Modified Six Elements Test, and Action Program Test. Subjects with binge eating disorder also showed significant more set shifting and perseverative errors in the Wisconsin Card Sorting Test. In other measures such as the Digit Span Forward, the Trail Making Test, the Stroop Test and the Rule Shift Cards Test, obese subjects with binge eating disorder did not differ significantly from obese subjects without binge eating disorder. CONCLUSION These results suggest that, in the present sample, obese individuals with binge eating disorder presented executive deficits, especially impairments relating to problem-solving, cognitive flexibility and working memory.

Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders

OBJECTIVE According to studies of prevalence, up to 70% of adults with attention deficit/hyperactivity disorder have at least one psychiatric comorbidity, which leads to diagnostic and therapeutic difficulties as well as more severe functional impairment. There is a paucity of data on the comorbidity of attention deficit/hyperactivity disorder and eating disorders. The objective of this study was to review the literature regarding the attention deficit/hyperactivity disorder/eating disorders comorbidity, performing a critical analysis of relevant data. METHOD Articles in Medline, Lilacs, SciELO, ISI and PsycINFO databases from 1980 up to 2008, were searched. The references from the articles were used as additional sources of data. RESULTS Fourteen articles were found: five prevalence studies, four case reports, three case-control studies, one symptom-assessment study of attention deficit/hyperactivity disorder and eating disorders, and one article regarding possible causes of the association between attention deficit/hyperactivity disorder and eating disorders. These articles suggested that adult women with attention deficit/hyperactivity disorder are at higher risk of developing eating disorders, especially bulimia nervosa. Bulimia Nervosa rates found in attention deficit/hyperactivity disorder groups ranged from 1% to 12%, versus 0% to 2% in control groups. CONCLUSIONS Although there seems to be a relationship between attention deficit/hyperactivity disorder and eating disorders, the reduced number of studies available, with various methodologies, and small sample sizes limit the generalization of the findings.

Transtornos alimentares comórbidos em uma amostra clínica de adultos com transtorno do déficit de atenção com hiperatividade

Although comorbidity between attention-deficit/hyperactivity disorder (ADHD) and eating disorders (ED) is relevant for clinical treatment, it is seldom investigated. METHODS: 86 DSM-IV attention deficity hyperactivity disorder patients out of 107 self-referred adults in a specialized center for attention deficity hyperactivity disorder were interviewed using SCID-R to evaluate the lifetime prevalence of ED and other comorbid conditions. RESULTS: Nine attention deficity hyperactivity disorder patients had comorbid eating disorders; binge eating disorder (BED) was the most common diagnosis. The group with eating disorders presented a higher prevalence of other comorbid disorders (p=0.02). No significant differences were found on gender, age at assessment, schooling level and type of attention deficity hyperactivity disorder between groups. CONCLUSION: Attention deficity hyperactivity disorder clinical samples may have a high prevalence of BED comorbidity. Patients with attention deficity hyperactivity disorder and eating disorders may have a different comorbid profile.

Tradução e adaptação cultural da Barratt Impulsiveness Scale (BIS-11) para aplicação em adultos brasileiros

OBJECTIVES: The objective of this study was to translate, make transcultural adaptation and assess the semantic, idiomatic and literal equivalence of the Barratt Impulsiveness Scale (BIS-11). METHODS:This scale assesses the presence of impulsive manifestations from the theoretical model proposed by Ernst Barratt. Firstly, the BIS-11 original version in English was translated to Portuguese by six bilingual researches. After this, was made the back-translation to English by a translator that was born in United States. Then, the three versions (original, translated and back-translated) were assessed by a specialists committee which made and analyze and comments about the process and then we reach the final translated version of BIS-11. The original and translated version of BIS-11 was applied in two samples from general population with proficiency both in English and Portuguese. This method was adopted to assess the literal, semantic e idiomatic equivalence of these versions by mean of correlation analyses. CONCLUSION: The final results of quantitative analyses show that the final version of BIS-11 is satisfactory.

Transtorno do déficit de atenção e hiperatividade: contribuição diagnóstica de avaliação computadorizada de atenção visual

OBJETIVO: Identificar se o desempenho num teste de atencao visual permite diferenciar criancas e adolescentes portadoras de TDAH de individuos normais. METODOS: 102 criancas e adolescentes com diagnostico de TDAH, segundo os criterios do DSM-IV, submeteram-se ao Teste de Atencao Visual (TAVIS-III) e tiveram seus desempenhos comparados a 678 controles pareados de um grupo controle. Os individuos foram selecionados de duas escolas particulares e uma escola publica, de modo sequencial com autorizacao dos pais. RESULTADOS: Uma analise com curvas ROC revelou que os indices tempo medio de reacao na tarefa de atencao seletiva, numero de erros por omissao na tarefa de atencao alternada e numero de erros por acao na tarefa de atencao sustentada, quando comprometidos simultaneamente, revelaram sensibilidade e especificidade elevadas, com um valor preditivo positivo de 87,5%. O valor preditivo negativo da associacao de escores normais naqueles tres indices foi de 99%. CONCLUSAO: TAVIS-III revelou-se eficiente para discriminar individuos normais de portadores de TDAH nesta amostra.

Clinical Applicability and Cutoff Values for an Unstructured Neuropsychological Assessment Protocol for Older Adults with Low Formal Education

Background and Objectives The neuropsychological exam plays a central role in the assessment of elderly patients with cognitive complaints. It is particularly relevant to differentiate patients with mild dementia from those subjects with mild cognitive impairment. Formal education is a critical factor in neuropsychological performance; however, there are few studies that evaluated the psychometric properties, especially criterion related validity, neuropsychological tests for patients with low formal education. The present study aims to investigate the validity of an unstructured neuropsychological assessment protocol for this population and develop cutoff values for clinical use. Methods and Results A protocol composed by the Rey-Auditory Verbal Learning Test, Frontal Assessment Battery, Category and Letter Fluency, Stick Design Test, Clock Drawing Test, Digit Span, Token Test and TN-LIN was administered to 274 older adults (96 normal aging, 85 mild cognitive impairment and 93 mild Alzheimer`s disease) with predominantly low formal education. Factor analysis showed a four factor structure related to Executive Functions, Language/Semantic Memory, Episodic Memory and Visuospatial Abilities, accounting for 65% of explained variance. Most of the tests showed a good sensitivity and specificity to differentiate the diagnostic groups. The neuropsychological protocol showed a significant ecological validity as 3 of the cognitive factors explained 31% of the variance on Instrumental Activities of Daily Living. Conclusion The study presents evidence of the construct, criteria and ecological validity for this protocol. The neuropsychological tests and the proposed cutoff values might be used for the clinical assessment of older adults with low formal education.

Estudo Normativo do Token Test versão reduzida: dados preliminares para uma população de idosos brasileiros

INTRODUCAO: A preservacao das habilidades de compreensao da fala nos idosos esta correlacionada com a preservacao das funcoes cognitivas. Essa habilidade e caracteristica fundamental para a comunicacao e sua avaliacao possibilita a identificacao de deficits cognitivos mais especificos, alem de facilitar o desenvolvimento de estrategias de intervencao mais precoces e eficientes. OBJETIVO: Disponibilizar normas contemporâneas para a utilizacao de um instrumento de avaliacao da compreensao verbal, o Token Test, para idosos brasileiros saudaveis. METODO: Uma amostra com 120 idosos (76 mulheres), com medias de 71,1 anos para idade e de 6,9 anos de educacao formal para escolaridade, foi avaliada utilizando o Miniexame do Estado Mental, para identificacao da existencia de comprometimento cognitivo, e o Token Test, para avaliacao da compreensao da fala. RESULTADOS: Foram encontradas correlacoes significativas (p < 0,01) entre o escore do Token Test e a educacao formal e a idade, os quais corresponderam respectivamente a 5% e 21% da variância compartilhada. Tais variaveis foram consideradas nas tabelas normativas. CONCLUSAO:Nossos dados indicam que as normas disponibilizadas aqui sao suficientemente representativas. Este trabalho abre caminho para estudos futuros de comparacao entre o desempenho no Token Test de idosos saudaveis e daqueles em processos de declinio cognitivo.

Disfunção executiva como uma medida de funcionalidade em adultos com TDAH

This article addresses the presence and the clinical presentation of executive dysfunction in patients with ADHD. Because symptoms of executive dysfunction apparently determine functional abnormalities in daily activities, the study of the correlations between such manifestations and abnormalities in formal neuropsychological tests becomes clinically relevant. The relatively recent realization of the pivotal role of executive dysfunction in ADHD has kindled interest in neuropsychological research, but the data generated thus far are still not fully consistent. An updated view of these issues suggests that the available neuropsychological semiology is not sufficient to identify or predict the full constellation of practical symptoms of ADHD in daily life. Thus, more research is needed to establish secure links between neuropsychological testing and symptoms of executive dysfunction in the practical functioning of patients with ADHD.

Desempenho neuropsicológico de tipos de transtorno do déficit de atenção e hiperatividade (TDAH) em tarefas de atenção visual

OBJECTIVE: To compare the effect of ADHD subtypes in tasks of focused, shifted and sustained attention in a visual attention test (TAVIS-III). Indexes of hit reaction time, omission errors and commission errors were considered for each task. METHODS: One hundred two children and adolescents aged from 6 to 17 years old recruited from one public and two private schools in the city of Rio de Janeiro with ADHD diagnosis, according to DSM-IV criteria, were evaluated. Three groups were created following the subtypes determined by the semi-structured interview (P-CHIPS). Group performances were compared in order to determine subtype effects. RESULTS: The combined subtype (C) was the most common group (n = 65; 63.7%), followed by the inattentive subtype (I) (n = 32; 31.4%). Hyperactive-impulsive (HI) group was excluded from statistical analysis due to its low frequency. The performance of the C group was found comparatively worse only in the sustained attention task, where subjects presented slower hit reaction time and committed more commission errors (p < 0.05) than the I group. CONCLUSION: Only in longer tasks of visual attention, combined patients had a worse performance than Inattentive ones.

Normative data of the Barratt Impulsiveness Scale 11 (BIS-11) for Brazilian adults

OBJECTIVE The Barratt Impulsiveness Scale (BIS-11) is a valid and reliable instrument, and one of the most often used tools to assess impulsivity. This study assesses the performance of a large sample of adults by using a version of BIS-11 adapted to Brazilian Portuguese. METHODS We assessed 3,053 adults from eight Brazilian states. Internal consistencies and performance data were presented for two correction criteria of BIS-11: original and the two-factor score. RESULTS The associations between age, sex, region, and education and the BIS-11 scores present very small effect sizes. Therefore, we provided a percentile rank parameter for the different BIS-11 subscores considering the whole sample. Given the internal consistency of the two correction systems, we found that only the two-factor system fulfills the psychometric criteria of Cronbachs alpha (cutoff value of at least 0.6). CONCLUSION Our results support the use of the Brazilian adaptation of BIS-11 in different regions of the country as a measure of impulsivity. Since high impulsiveness is a characteristic of several dysfunctional behaviors, the establishment of normative parameters is of utmost relevance and should be extended to other age ranges and populations in future studies.