Mônica Duchesne

Neuropsicologia dos transtornos alimentares: revisão sistemática da literatura

BACKGROUND The pathophysiology of eating disorders is still unknown, with many factors possibly involved. The existence of a central nervous system (CNS) dysfunction is being investigated with particular interest. One of the most employed strategies to reach this goal is the evaluation of cognitive functioning of patients with eating disorders with neuropsychological tests. OBJECTIVE To evaluate the current knowledge about the neuropsychology of ED. METHODS We performed a review of several data bases (including MedLINE, PsychoINFO, LILACS and Cochrane Data Bank), using terms related to main theme of interest. The review comprised articles published up to January, 2004. RESULTS Anorexia Nervosa (AN) was the most studied ED from the neuropsychological point-of-view, with studies tending to elicit attentive, visuo-spatial, and visuo-constructive deficits among such patients. On the other side, patients with Bulimia Nervosa (BN) exhibited deficits in the selective aspects of attention and in executive functions. As yet, there is no study covering the neuropsychological aspects of binge-eating disorder. After successful treatment, individuals show improvement of some cognitive deficits, while other seem to persist. CONCLUSIONS The ED are possibly associated with a certain degree of neuropsychological dysfunction, even though there is no consensus with regard to which function is particularly impaired. The fact that some cognitive dysfunction tend to disappear after treatment argues in favor of the hypothesis that these are functional deficits. Other deficits, however, tend to persist, suggesting that they may precede the development of eating disorders or even contribute to their development or to a worse prognosis. The study of the neuropsychological aspects of ED may help tailoring more selective therapeutic approaches to patients suffering from these disorders.

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.

The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients.

AIMS Several studies have demonstrated worse perception of quality of life (QoL) among patients with type 2 diabetes mellitus (T2DM). The purpose of our study was to assess QoL in a clinical sample of patients with T2DM and its association with depressive symptoms and glycemic control. METHODS One hundred outpatients from a sequential sample underwent clinical and psychiatric evaluation. The Problem Areas of Diabetes scale (PAID) and the Beck Depression Inventory (BDI) were used to assess, respectively, QoL and the presence of overall psychopathology. The levels of glycated hemoglobin (HbA1c) were used as the main parameter of glycemic control. RESULTS The perception degree of the QoL related with diabetes was associated with the severity of depressive symptoms (r=0.503; p<0.001), but not with HbA1c levels (p=0.117). However, the severity of general psychopathology, evaluated through the BDI scores, predicted the metabolic control, measured by HbA1c levels, among the patients in our sample (r=0.233; p=0.019). CONCLUSIONS In our study, PAID was a valuable tool for the evaluation of QoL in T2DM and the screening of depressive symptoms. However, no correlation observed between PAID scores and HbA1c levels. Self-perception evaluation of T2DM patient can help to identify susceptible subjects to current depression.

Influence of attention-deficit/hyperactivity disorder on binge eating behaviors and psychiatric comorbidity profile of obese women

OBJECTIVE Previous studies have reported higher prevalence rates of attention-deficit/hyperactivity disorder (ADHD) both in eating disorders (ED) and in obese patients. We compared the psychiatric comorbidity profile of obese ADHD women with non-ADHD obese women and how ADHD symptoms impact in binge eating behaviors. DESIGN Cross-sectional study of a clinical sample. SUBJECTS 171 adult women were evaluated at a specialized clinic in obesity and ED. MEASUREMENTS Participants complete a semi-structured interview and psychopathology rating scales. A hierarchical regression model was employed to predict binge eating behavior. RESULTS Obese ADHD patients had a larger number of psychiatric comorbidities (p<0.001), especially Substance Abuse Disorders, and higher scores on psychopathology rating scales (p<0.05). The highest prediction for binge eating in the regression model was the presence of depressive symptoms, followed by ADHD inattention symptoms and trait-impulsivity. CONCLUSION ADHD should be routinely evaluated in obese since it is related with more severe psychopathology. Depressive symptoms can predict the presence of binge eating in obese patients.

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.

Terapia cognitivo-comportamental dos transtornos alimentares

The cognitive-behavioural therapy is a brief, semi-structured and goal oriented intervention, which has been largely used in research and treatment centers specialized on eating disorders. The present article describes the main cognitive and behavioral strategies used in the outpatient treatment of eating disorders. Several clinical studies assessed the effectiveness of cognitive-behavioural therapy, indicating the remission or the reduction of the frequency of binge eating episodes, purgative behaviours and food restriction. Social and mood improvement, as well as reduction of weight and body shape concerns, have also been reported.

The use of a manual-driven group cognitive behavior therapy in a Brazilian sample of obese individuals with binge-eating disorder.

OBJECTIVE To assess the effectiveness of a manual-based cognitive behavior therapy adapted to a group format in a sample of Brazilian obese subjects with binge-eating disorder. METHOD In an open trial, 21 obese subjects with binge-eating disorder received a group cognitive-behavioral therapy program. Changes in binge-eating frequency, weight, body shape concerns, and depressive symptoms were compared between baseline and the end of the study. RESULTS The mean frequency of binge-eating episodes significantly decreased from baseline to post-treatment (p < 0.001), with a binge eating remission rate of 76.1% at the end of the trial. Depressive symptoms and body shape concern also improved (p < 0.001). In addition, weight loss was statistically and clinically significant. CONCLUSION The use of this adapted manual-based cognitive behavior therapy in this sample resulted in a marked improvement in binge-eating, weight, body shape concern, and depressive symptoms related to binge-eating disorder.

ADHD Rate in Obese Women With Binge Eating and Bulimic Behaviors From a Weight-Loss Clinic.

Objective: Few studies have demonstrated a possible association between ADHD and obesity in adults. The aim of this study was to investigate the prevalence of ADHD in a sample of obese women seeking treatment, and its relations with binge eating and bulimic behaviors. Method: We performed a cross-sectional study in a clinical sample of one hundred fifty-five women, with a mean age of 38.9 (+10.7) years and a mean body mass index (BMI) of 39.2 (+5.29). Participants were evaluated with semistructured interviews and completed self-report psychiatric rating scales. Results: The rate of ADHD in the sample was of 28.3%. The presence of ADHD was significantly correlated with more severe binge eating, bulimic behaviors, and depressive symptomatology. Conclusion: Similar to previous studies, a higher than expected rate of ADHD was observed among obese women. ADHD in obese individuals may be a risk factor for greater severity of disordered eating patterns.

Normatização de um teste computadorizado de atenção visual: (TAVIS)

The authors present the normative data of a computerized test (TAVIS) that address visual attention in children and adolescents being the first neuropsychological instrument as such devised and developed in Brazil. Selective, alternate and sustained attention aspects are evaluated through three different tasks. Omission and action errors as well as time reaction are evaluated. The advantages and limitations of the test are commented.