Silvia Freitas

Instrumentos para a avaliação dos transtornos alimentares

This article describes the most useful instruments and methods that measure general and specific psychopathological features of the eating disorders. Thirteen self-report measures and two interviewer-based instruments are reviewed. The authors present, for each instrument, a brief description of its structure, their preferential utilization and the availability of a Portuguese version. At the end, a proposal of a psychometric protocol for the assessment of anorexia nervosa, bulimia nervosa and binge eating disorder is suggested.

Depression, glycemic control and type 2 diabetes

BackgroundComorbid depression in diabetes has been suggested as one of the possible causes of an inadequate glycemic control. The purpose of this study was to investigate the association between major depression and the glycemic control of type 2 diabetes mellitus (T2DM).MethodsSeventy T2DM patients were evaluated. They underwent a psychiatric examination using the following instruments: Structured Clinical Interview for DSM-IV and Beck Depression Inventory. The diabetes status was assessed in the short-term (glycemia, glycated hemoglobin) clinical control.ResultsThe presence of current depression was observed in 18.6% (13/70). In addition, type 2 diabetes patients who displayed depression evidenced higher levels of glycated hemoglobin (8.6 ± 2.0 vs. 7.5 ± 1.8; p = 0.05) when compared to those who did not exhibit a mood disorder.ConclusionsIn our sample, the presence of depression seems to impact on the short-term control of T2DM. The authors discuss the clinical utility of these findings in the usual treatment of diabetes.

Psychiatric comorbidity in a Brazilian sample of patients with binge-eating disorder

We compared sociodemographic characteristics and psychiatric status in obese Brazilian patients who did (n=32) and did not (n=33) meet DSM-IV criteria for binge-eating disorder (BED). The samples mean age was 35.0 years (+/-10.5), with 92.3% of individuals being female and 41.5% having some higher education. Obese binge eaters (OBE) were significantly more likely than obese non-binge eaters to meet criteria for a current diagnosis of any axis I disorder, any mood disorder and any anxiety disorder. Specifically, OBE patients were characterized by significantly higher rates of current and lifetime histories of major depressive disorder. Similar to patients from developed countries, Brazilian patients with BED display increased rates of psychiatric comorbidity, particularly mood and anxiety disorders.

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.

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.

Análise combinada de fatores genéticos e ambientais na hipertensão essencial em um município da região Amazônica

OBJECTIVE In the present study, we evaluated the contribution of six genetic polymorphisms of the Renin-Angiotensis-Aldosterone system (RAAS) and clinical risk factors in the development of essential hypertension in a Brazilian rural population in the Amazon region. METHODS Eighty-two hypertensive patients and seventy-eight normotensive individuals were evaluated. Genotyping for renin (REN G1051A), angiotensinogen (AGT) M235T, insertion/deletion of angiotensin-converting enzyme (ACE I/D), angiotensin II type 1 receptor (AGTR1) A1166C and aldosterone synthase (CYP11B2) C344T polymorphisms were performed using polymerase chain reaction, with further restriction analysis when required. The influence of genetic polymorphisms and clinical risk factors on blood pressure variation was assessed by stepwise linear regression. RESULTS We report the co-occurrence of clinical risk factors and angiotensin-converting enzyme (ACE) gene polymorphism in a Brazilian rural population in the Amazon region. Our results indicate that increase of systolic blood pressure (SBP) is favored by ACE I/D- D allele and advanced age, while alcohol consumption and aging are associated with high diastolic blood pressure (DBP). CONCLUSION These findings suggest that in the Santa Isabel do Rio Negro population, the residents that carry ACE-D allele or have an alcohol consumption habit present higher values of SBP and DBP, respectively, with the passing of years.

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.

Evidências sobre a terapia cognitivo-comportamental no tratamento de obesos com transtorno da compulsão alimentar periódica

OBJECTIVES: To investigate evidence of the efficacy of cognitive-behavioral therapy in the treatment of obese patients with binge eating disorder. METHOD: This review included clinical trials and meta-analyses published in all languages from January 1980 to February 2006. Studies assessing the efficacy of cognitive-behavioral therapy associated with medication, cognitive-behavioral therapy in self-help manuals, case reports or series and letters to editors were excluded. The following electronic databases were used: MEDLINE, PsycINFO, Embase, LILACS and Cochrane Library. Search strategies also included consulting the references of selected articles and chapters of specialized books. RESULTS: Two open and 15 controlled clinical trials were included. The primary outcome in most studies was binge eating. In general, the clinical trials suggest that cognitive-behavioral therapy results in significant improvement in binge eating and other psychopathological symptoms related to binge eating disorder. However, no substantial weight loss was reported. CONCLUSIONS: Available evidence suggests that cognitive-behavioral therapy is an effective intervention method for psychological aspects of binge eating disorder, although its efficacy in body weight reduction and long-term maintenance of results still needs further investigation.

Misuse of sibutramine and bulimia nervosa: a dangerous combination

Although sibutramine was withdrawn from the U.S. and European markets, it is still widely prescribed in many countries, such as Brazil, and is available worldwide as an over-the-counter drug. There are many descriptions of the psychiatric side effects of sibutramine; however, there is scant information about sibutramine misuse as a compensatory behavior in bulimia nervosa (BN) and its potential consequences. In this letter, we report a case of a patient with BN who misused sibutramine and developed severe, recurrent psychotic symptoms. A 51-year-old single woman with a diagnosis of BN (assessed by the Structured Clinical Interview for DSMIV, Patient Version [SCID-P], adapted for DSM-5 criteria) was referred to our Eating Disorders Unit for treatment about 5 years ago. She reported feeling fat since adolescence, when she started dieting. About 30 years before referral, she developed severe binge-eating episodes and, to compensate and control them and to avoid weight gain, started taking amphetamines without a prescription. Twenty years later, the patient sought medical advice in order to lose weight (at the time, her BMI was normal or occasionally borderline overweight). Sibutramine 10 mg/day was prescribed in substitution of the amphetamines, but she increased the sibutramine dosage progressively to 180 mg/day. Three years ago, the patient developed psychotic symptoms. She had persecutory delusions involving her neighbors, whose voices she could hear even when they were not around; she also had tactile hallucinations, including ‘‘pins-and-needles’’ and recurrent feelings that someone had touched her genitals, which resulted in orgasms in embarrassing situations. Considering the severity of her condition, she was weaned off sibutramine in an inpatient psychiatric unit and risperidone up to 4 mg/ day was prescribed. The psychotic symptoms remitted quickly. However, a few months later, the patient started to take sibutramine again; the psychotic symptoms reappeared, and became more severe with increasing doses of the drug. Since then, the patient has alternated periods of psychotic symptoms during the course of sibutramine usage with periods in which she discontinues sibutramine and psychosis remits, but the binge-eating episodes and her body-shape dissatisfaction increase. Currently, the patient is being treated with cognitivebehavioral therapy, nutritional counseling, and topiramate 800 mg/day plus quetiapine 100 mg/day. With this approach she has achieved longer periods of sibutramine abstinence, remission of psychotic symptoms, fewer bulimic episodes, and less weight fluctuations. However, she still has problems with her eating patterns and body image. This case brings an important and rarely discussed issue to the fore: the dangerous combination between sibutramine and BN. It suggests that patients with BN may occasionally take high doses of sibutramine as a compensatory behavior, which can place them at added risk of developing neuropsychiatric adverse effects (considered rare when the medication is used properly). We highlight two critical points for clinical practice: 1) it is important to consider sibutramine misuse when patients with eating disorders present with atypical psychiatric symptoms; and 2) as many bulimic individuals are overweight or obese, and since weight loss is the main motivation for them to seek for medical care, it is important to actively investigate eating patterns, body image complaints, and engagement in compensatory behaviors before prescribing sibutramine.