ABSTRACT
A teoria psicanalítica postula que as raízes emocionais dos transtornos alimentares (TAs) remontam à relação precoce mãe-filha. Este estudo qualitativo teve como objetivo investigar os significados atribuídos por mães de pacientes com anorexia e bulimia às experiências de gravidez, parto, puerpério e cuidados básicos oferecidos às filhas nos primeiros anos de vida. Participaram sete mães cujas filhas encontravam-se em seguimento em um serviço especializado para TAs. Os dados foram coletados por meio de entrevista aberta e organizados em categorias de acordo com a análise temática reflexiva. Os resultados foram discutidos à luz da Teoria do Amadurecimento Emocional de Winnicott. As experiências relacionadas à maternidade e aos cuidados maternos foram marcadas por frustrações e emoções negativas, com poucas recordações de vivências gratificantes advindas da assunção ao papel de mãe. São discutidas as repercussões emocionais da não elaboração de conflitos transgeracionais recebidos das gerações anteriores e transmitidos sem transformação pelas mães, o que contribui para inibir o amadurecimento emocional das filhas, guardando possível relação com a vulnerabilidade aos sintomas de TAs. (AU)
Psychoanalytic theory postulates that the emotional foundations of eating disorders (EDs) rest in the early mother-daughter relationship. This qualitative study aimed to investigate the meanings attributed by mothers of patients with anorexia and bulimia to the experiences of pregnancy, childbirth, puerperium, and basic care provided to their daughters in the first years of life. Participants included 7 mothers whose daughters were being treated in a specialized service for EDs. Data were collected by open interviews and organized into categories according to reflexive thematic analysis. Results were discussed in light of Winnicott's Theory of Human Maturation. The experiences related to motherhood and maternal care were marked by frustrations and negative emotions, with few memories of rewarding experiences with the assumption of the maternal role. The potential repercussions arising from the non-elaboration of intergenerational conflicts inherited and transmitted without transformation by mothers were discussed. These implications could potentially hinder the emotional maturation of daughters, establishing a close relation with the symptoms of EDs. (AU)
La teoría psicoanalítica postula que las bases emocionales de los trastornos alimentarios (TAs) descansan en la relación temprana madre-hija. Este estudio cualitativo tuvo como objetivo investigar los significados atribuidos por madres de pacientes con anorexia y bulimia a las vivencias del embarazo, parto, puerperio y cuidados básicos brindados a sus hijas en los primeros años de vida. Participaron siete madres cuyas hijas estaban siendo atendidas en un servicio especializado en TAs. Los datos fueron recolectados por entrevista abierta y organizados en categorías de acuerdo con el análisis temático reflexivo. Los resultados fueron discutidos a la luz de la Teoría del Desarrollo Emocional de Winnicott. Las experiencias relacionadas con la maternidad y el cuidado materno estuvieron marcadas por frustraciones y emociones negativas, con pocos recuerdos de experiencias gratificantes con la asunción del rol materno. Se discuten las posibles repercusiones de la no elaboración de conflictos transgeneracionales recibidos y transmitidos sin transformación por parte de las madres, lo que contribuye a inhibir la maduración emocional de las hijas, guardando una estrecha relación con los síntomas de los TAs. (AU)
Subject(s)
Humans , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Breast Feeding , Feeding and Eating Disorders , Socioeconomic Factors , Infant, Newborn , Pregnancy , Surveys and Questionnaires , Qualitative Research , Data Analysis , Infant , Mother-Child RelationsABSTRACT
Objetivo: Analizar las conductas alimentarias de riesgo, en relación al estado nutricional y actividad física en jóvenes adultos durante la pandemia COVID-19 en las comunas de Chillán y Chillán Viejo. Método: Diseño observacional y transversal. Se obtuvo una muestra de 184 adultos jóvenes de ambos sexos, que residían en dos comunas de la región de Ñuble (Chile) durante el periodo de confinamiento por la pandemia COVID-19. Se les aplicó un cuestionario de antecedentes personales y la escala SCOFF que evalúa el riesgo de trastornos de la conducta alimentaria (TCA). Resultados: Se encontró un 37,16% de riesgo para TCA (IC 95%: 30,23 - 44,63%). El riesgo de trastornos de la conducta alimentaria tuvo relación con las variables: actividad física (p = 0,01 análisis bivariante) y estado nutricional (p = 0,03, análisis ajustado). Conclusión: Se logró identificar una proporción superior a la registrada en la literatura y los factores asociados a TCA eran los que se esperaban encontrar.
Objective: To analyze risky eating behaviors in relation to nutritional status and physical activity in young adults during the COVID-19 pandemic in the communes of Chillán and Chillán Viejo. Methods: Observational and cross-sectional design. A sample of 184 young adults of both sexes, who lived in two communes in the Ñuble region (Chile) during the period of confinement due to COVID-19 pandemic, was obtained. A personal history questionnaire and the SCOFF scale that assesses the risk of eating behavior disorders (EDs) were applied. Results: A 37.16% risk for ED was found (95% CI: 30.23 - 44.63%). The risk of eating behavior disorders was related to the variables: physical activity (p=0.01 bivariate analysis) and nutritional status (p=0.03, adjusted analysis). Conclusion: It was possible to identify a higher proportion than that recorded in the literature and the factors associated with eating disorders were those that were expected to be found.
ABSTRACT
Los trastornos de conducta alimentaria tienen efectos importantes sobre la salud oral destacándose entre estos por su alta prevalencia la anorexia y bulimia. Evaluar los efectos de la anorexia y bulimia sobre la periodontitis. Se realizó una búsqueda electrónica entre 2017 y 2021 en las bases datos Medline a través de Pubmed, Dentistry & Oral Sciences Source, Scopus, Springer y Biblioteca Virtual en Salud, donde con la estrategia de búsqueda "Anorexia OR Bulimia AND periodontal disease". Se recuperaron 101 registros potencialmente elegibles de los cuales luego de aplicar los criterios de elegibilidad se seleccionaron tres estudios de diseño observacional, cuyos resultados mostraron una asociación de la bulimia y anorexia con la incidencia de complicaciones orales en pacientes ambulatorios, donde la condición periodontal parece ser significativamente peor comparada con pacientes sanos emparejados por sexo y edad, siendo estos hallazgos de alta calidad metodológica o bajo riesgo de sesgo. La anorexia y la bulimia generan un alto impacto sobre la calidad de vida relacionada a la salud oral específicamente sobre el desarrollo de periodontitis. Sin embargo, se requieren de nuevos estudios que logren explicar en su totalidad esta posible relación.
Eating disorders have important effects on oral health, anorexia and bulimia standing out among them due to their high prevalence. To evaluate the effects of ano- rexia and bulimia on periodontitis. An electronic search was carried out between 2017 and 2021 in the Medline databases through Pubmed, Dentistry & Oral Sciences Source, Scopus, Springer and Virtual Health Library, where with the search strategy "Anorexia OR Bulimia AND periodontal disease". 101 potentially eligible records were retrieved from which, after applying the eligibility criteria, three observational design studies were selected, whose results showed an association of bulimia and anorexia with the incidence of oral complications in outpatients, where periodontal condition appears to be significantly worse compared to healthy patients matched for sex and age, these results being of high methodological quality or low risk of bias. Anorexia and bulimia have a high impact on health-related quality of life oral specifically on the development of periodontitis.However, it is required They want new studies that fully explain this possible relationship.
ABSTRACT
Introduction: the evidence on the health problem-related prevalence of COVID-19 is an emergency. Case report: we present the case of a 28-year-old woman who had had a behavioral eating disorder (BED) since age 12. Her body mass index (BMI) was 13.6 kg/m2. She was hospitalized for a respiratory condition (bronchospasm) due to COVID-19, with supplementary oxygen at two liters. During her stay, she refused food and was started on standard enteral nutrition via a naso-gastric tube. She developed refeeding syndrome (RFS), which was managed with electrolytes, and her enteral diet was changed to a low-carbohydrate high-protein diet. She received psychological therapy through video calls, recovered, and was discharged to home. Discussion: refeeding complications increase when a high caloric rate is begun. The standard enteral formula has 54% carbohydrates, which contributes to the risk of developing RFS. The consequences of BED and COVID-19 are unknown, and it is likely to become more evident over time. (Acta Med Colomb 2022; 48. DOI:https://doi.org/10.36104/amc.2023.2626).
ABSTRACT
Objetivo: avaliar os sintomas de transtornos alimentares em estudantes do Curso de Medicina do Centro Universitário Christus. Métodos: o estudo foi realizado com acadêmicos do quarto semestre do curso de Medicina. Utilizou-se um questionário sociodemográfico e antropométrico e os instrumentos Eating Atitudes Test (EAT-26); Binge Eating Scale (BES); e Sick Control One Stone Fat Food Questionnaire (SCOFF). Resultados: participaram do estudo 78 alunos, sendo 54 pessoas do sexo feminino (69,23%). A média de idade dos participantes foi de 22 (±4,7) anos, e o IMC médio foi de 24,33 (±4,11) kg/m2. Quanto ao SCOFF, 38,46% dos participantes apresentaram elevada probabilidade de transtorno alimentar, 14,10% apresentaram alto risco para desenvolverem transtornos alimentares segundo o EAT-26, e 12,82% apresentaram escores sugestivos de presença de compulsão alimentar moderada mediante o uso da BES. Conclusão: os transtornos alimentares e os comportamentos alimentares alterados foram identificados entre os acadêmicos de medicina. Assim, são necessárias intervenções de educação em saúde e de apoio psicológico para esta população, objetivando reduzir o risco de desenvolvimento de transtornos alimentares.
Objective: this study aimed to evaluate the symptoms of eating disorders in medical students at Centro Universitário Christus. Methods: the study was carried out with fourth-semester medical students. A sociodemographic and anthropometric questionnaire was used, the Eating Attitudes Test (EAT-26) instruments; Binge Eating Scale (BES); and Sick Control One Stone Fat Food Questionnaire (SCOFF). Results: 78 students participated in the study, 54 of whom were female (69.23%). The mean age of the participants was 22 (±4.7) years and the mean BMI was 24.33 (±4.11) kg/m2. As for the SCOFF, 38.46% of the participants had a high probability of having an eating disorder, 14.10% had a high risk of developing eating disorders according to the EAT-26, and 12.82% had scores suggestive of the presence of moderate binge eating using BES. Conclusion: eating disorders and altered eating behaviors were identified among medical students. Thus, health education and psychological support interventions are needed for this population, aiming to reduce the risk of developing eating disorders.
Subject(s)
Feeding Behavior , Anorexia Nervosa , Bulimia NervosaABSTRACT
Objetivo: analisar a atuação da Enfermagem junto a pacientes com transtornos alimentares em filmes sobre o assunto. Método: trata-se de um estudo descritivo-exploratório desenvolvido a partir de dados secundários. Utilizaram-se a base de dados cinematográfica Internet Move Database e descritores em português e inglês, que foram: "anorexia", "bulimia" e/ou "transtornos alimentares". Adotaram-se como critérios de inclusão: criações audiovisuais produzidas entre 1998 e 2020; o conteúdo estar disponível nas plataformas de streaming elencadas; as criações terem áudio e/ou legendas em português; e o filme ter alguma cena com o profissional de Enfermagem. Seis mídias atenderam a esses critérios e foram analisadas a partir de um roteiro que investiga a abordagem da Enfermagem no tratamento dos transtornos alimentares. Para elencar a produção mais indicada para finalidade didática, foram considerados seis critérios objetivos. Resultados: a maioria dos enredos veiculou a Enfermagem de modo estereotipado e com pouca autonomia, além de atribuir uma postura de "mau" ou "bom ajudante do médico" a esses profissionais. Embora nenhum enredo tenha atendido a todos os critérios objetivos de maneira satisfatória, a produção audiovisual que correspondeu à maior parte dos critérios foi aquela indicada para a finalidade didática. Conclusão: as produções, de um modo geral, condizem mais com o modelo médico assistencialista, na qual o enfermeiro desenvolve ações de prevalência tecnicistas, de supervisão e desintegradas da equipe multiprofissional em detrimento do modelo biopsicossocial, o qual demanda raciocínio clínico, pensamento crítico e conhecimento científico fundamentado.(AU)
Objective: to analyze the performance of Nursing with patients with eating disorders in films about the subject. Method: this is a descriptive-exploratory study developed from secondary data. The film database Internet Move Database and descriptors in Portuguese and English were used, which were: "anorexia", "bulimia" and/or "eating disorders". The following inclusion criteria were adopted: audiovisual creations produced between 1998 and 2020; the content is available on the listed streaming platforms; the creations have audio and/or subtitles in Portuguese; and the film has a scene with the Nursing professional. Six media met these criteria and were analyzed based on a script that investigates Nursing's approach to the treatment of eating disorders. To list the most suitable production for didactic purposes, six objective criteria were considered. Results: most plots conveyed Nursing in a stereotyped way and with little autonomy, in addition to attributing a "bad" or "good doctor's helper" attitude to these professionals. Although no plot met all the objective criteria satisfactorily, the audiovisual production that met most of the criteria was the one indicated for didactic purposes. Conclusion: the productions, in general, are more in line with the medical care model, in which the nurse develops actions that are technical, supervisory, and disintegrated from the multidisciplinary team to the detriment of the biopsychosocial model, which demands clinical reasoning, critical thinking and grounded scientific knowledge.(AU)
Objetivo: analizar los cuidados de enfermería frente a pacientes con trastornos alimentarios en películas sobre el tema. Método: se trata de un estudio descriptivo-exploratorio desarrollado a partir de datos secundarios. Se utilizó la base de datos cinematográfica "Internet Move Database" y las palabras clave en portugués e inglés, las cuales fueron: "anorexia", "bulimia" y/o "trastornos alimentarios". Fueron adoptados los siguientes criterios de inclusión: creaciones audiovisuales producidas entre los años 1998 y 2020; el contenido estar disponible en las plataformas de streaming listadas; tener audio y/o subtítulos en portugués; y alguna escena con el profesional de Enfermería. Seis medios cumplieron estos criterios y fueron analizados a...(AU)
Subject(s)
Humans , Male , Female , Adult , Feeding and Eating Disorders/nursing , Nurse's Role/psychology , Nurse PractitionersABSTRACT
Diversas condições psiquiátricas apresentam influência de fatores genéticos, e dentre essas condições encontram-se os distúrbios alimentares: anorexia nervosa, bulimia nervosa e transtorno de compulsão alimentar. Os distúrbios previamente citados apresentam influência genética ligadas à hereditariedade, sendo que cada um deles apresenta características distintas quanto às suas manifestações clínicas, tratamento e diagnóstico. A importância da investigação deste tema e seu objetivo relaciona-se com o propósito de contribuir para elucidar quanto às características gerais dos principais distúrbios alimentares e seus fatores genéticos através da: etiologia, sinais e sintomas, diagnóstico e tratamento e que venha a possibilitar, futuramente, novos estudos com resultados para novas medidas terapêuticas. Como base da pesquisa, foi levantada a seguinte problemática: "Quais as características gerais dos principais distúrbios psiquiátricos, etiologia, sinais e sintomas, diagnóstico e tratamento?". Portanto, realizou- se uma uma busca ativa através dos descritores: "transtorno de compulsão alimentar"; "distúrbios alimentares"; "bulimia nervosa" e "anorexia nervosa", adquiriu-se material pelas fontes: SciELO, ELSEVIER, GOOGLE ACADÊMICO, PUBMED, MEDSCAPE e pelo periódico Arquivos e Ciências da Saúde da UNIPAR. Com isso, foi adquirido material suficiente para concluir a influência genética perante tais distúrbios, além de elucidar suas principais características, tendo assim caráter educativo e científico.
Several psychiatric conditions have genetic factors influence, and among these conditions are eating disorders: anorexia nervosa, bulimia nervosa and binge eating disorder. The previously mentioned disorders have a genetic influence linked to heredity, each one of them having different characteristics as to their clinical manifestations, treatment and diagnosis. The importance of research on this topic and its objective is related to the purpose of contributing to elucidate the general characteristics of the main eating disorders and their genetic factors through: etiology, signs and symptoms, diagnosis and treatment and that will make possible, in the future, new studies with results for new therapeutic measures. As a basis for the research, the following issue was raised: "What are the general characteristics of the main psychiatric disorders, etiology, signs and symptoms, diagnosis and treatment?". Therefore, an active search was carried out through the descriptors: "binge eating disorder"; "eating disorders"; " nervous bulimia" and " nervous anorexia", material was acquired by the sources: SciELO, ELSEVIER, GOOGLE ACADEMIC, PUBMED, MEDSCAPE and by UNIPAR's Archives and Health Sciences. With this, sufficient material was acquired to conclude the genetic influence in the face of such disturbances, besides elucidating its main characteristics, thus having an educational and scientific character.
Varios trastornos psiquiátricos tienen factores genéticos que influyen, y entre estos trastornos se encuentran los trastornos de la alimentación: anorexia nerviosa, bulimia nerviosa y trastorno por atracón. Los trastornos mencionados tienen una influencia genética vinculada a la herencia, cada uno de ellos con características diferentes en cuanto a sus manifestaciones clínicas, tratamiento y diagnóstico. La importancia de la investigación sobre este tema y su objetivo se relaciona con el propósito de contribuir a dilucidar las características generales de los principales trastornos de la conducta alimentaria y sus factores genéticos a través de: etiología, signos y síntomas, diagnóstico y tratamiento y que posibilitarán, en el futuro, nuevos estudios con resultados para nuevas medidas terapéuticas. Como base para la investigación se planteó la siguiente cuestión: "¿Cuáles son las características generales de los principales trastornos psiquiátricos, etiología, signos y síntomas, diagnóstico y tratamiento?". Por lo anterior, se realizó una búsqueda activa a través de los descriptores: "trastorno por atracón"; "trastornos de la conducta alimentaria"; "bulimia nerviosa" y "anorexia nerviosa", material adquirido por las fuentes: SciELO, ELSEVIER, GOOGLE ACADEMIC, PUBMED, MEDSCAPE y por Archivos y Ciencias de la Salud de UNIPAR. Con ello, se adquirió material suficiente para concluir la influencia genética ante tales alteraciones, además de dilucidar sus principales características, teniendo así un carácter educativo y científico.
ABSTRACT
O objetivo deste estudo foi compreender como mulheres adultas (acima de 30 anos) diagnosticadas com transtornos alimentares (TAs) vivenciam o adoecer. Trata-se de um estudo qualitativo, descritivo e exploratório, desenvolvido com base no referencial teórico-metodológico da Análise Fenomenológica Interpretativa (AFI). Participaram seis mulheres, com idades entre 34 e 65 anos, atendidas em um serviço especializado. Os dados foram coletados por meio de entrevista aberta, de inspiração fenomenológica, na modalidade remota. As entrevistas foram audiogravadas, transcritas e analisadas seguindo os passos da AFI. Duas categorias temáticas foram identificadas: "Vivendo antes do adoecer" e "Encontrando-se doente." Constatou-se que os sintomas tiveram início anteriormente à vida adulta e que houve dificuldade na confirmação do diagnóstico. Na perspectiva das participantes, conviver com a sintomatologia ficou mais complicado em função de particularidades de manejo dos sintomas na vida adulta, e a idade é percebida como um fator que impacta e dificulta ainda mais a recuperação. As participantes relataram desesperança em relação ao futuro, apesar de a maioria reconhecer melhoras no quadro clínico ao longo do tempo e de valorizar a relação de confiança estabelecida com a equipe multiprofissional.(AU)
This study aimed to understand the experience of illness of adult women (over 30 years) diagnosed with eating disorders (ED). This is a qualitative, descriptive, and exploratory study, using Interpretative Phenomenological Analysis (IPA) as theoretical and methodological framework. A sample of six women aged 34-64 years, assisted in a specialized service, were recruited to complete a phenomenological in-depth open interview. The data were remotely collected. Interviews were audio-recorded, transcribed and analyzed following the IPA. Two thematic categories were identified: "Living before the illness" and "Finding about the illness." It was found that the symptoms started before adulthood and that there was difficulty establishing the diagnosis. Living with the symptoms became more complicated due to particularities of symptom management in adulthood and age is perceived as a factor that impacts recovery and makes it even more difficult. The participants reported hopelessness about the future, although most recognized improvements in the clinical condition over time and valued the trusting relationship they established with the multiprofessional team.(AU)
El objetivo de este estudio fue comprender las experiencias de las mujeres adultas (mayores de 30 años) diagnosticadas con trastornos alimentarios (TA) respecto a la enfermedad. Se trata de un estudio cualitativo, descriptivo y exploratorio, desarrollado a partir del marco teórico y metodológico del Análisis Fenomenológico Interpretativo (AFI). Participaron seis mujeres, con edades de entre 34 y 65 años, atendidas en un servicio especializado. Los datos se recogieron mediante entrevistas abiertas, de inspiración fenomenológica, en la modalidad a distancia. Las entrevistas fueron grabadas en audio, transcritas y analizadas siguiendo los pasos del AFI. Se identificaron dos categorías temáticas: "Vivir antes de enfermar" y "Encontrarse enfermo." Se constató que los síntomas comenzaron antes de la edad adulta y que hubo dificultades de establecer el diagnóstico. La convivencia con síntomas se complicó debido a las particularidades del manejo de los síntomas en la vida adulta y la edad se percibe como un factor que influye y dificulta aún más la recuperación. Los participantes manifestaron desesperanza sobre el futuro, aunque reconocieron mejoras en el cuadro clínico con el paso del tiempo y valoraron la relación de confianza establecida con el equipo multiprofesional.(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Anorexia Nervosa , Feeding and Eating Disorders , Bulimia Nervosa , Pandemics , Anxiety , Perceptual Distortion , Appetite , Personal Satisfaction , Psychiatry , Psychology , Psychopathology , Quality of Life , Self-Assessment , Shame , Stomach Diseases , Stress, Psychological , Therapeutics , Thinness , Beauty Culture , Vomiting , Nutrition Rehabilitation , Body Weight , Aging , Menopause , Weight Loss , Family , Comorbidity , Mental Health , Mortality , Interview , Cultural Factors , Dehydration , Transcription Factors, General , Malnutrition , Depressive Disorder , Diagnosis , Diet , Diet Therapy , Emotions , Nutritional Sciences , Laxatives , Feeding Behavior , Binge-Eating Disorder , Bullying , Social Stigma , Physical Appearance, Body , Self-Control , Applied Behavior Analysis , Food Addiction , Rumination, Digestive , Mental Health Recovery , Body-Weight Trajectory , Embarrassment , Avoidant Restrictive Food Intake Disorder , Body-Shaming , Social Representation , Orthorexia Nervosa , Social Status , Guilt , Health Promotion , Mass Media , Mental Disorders , Metabolism , ObesityABSTRACT
ABSTRACT Objectives: to analyze subjective experiences related to adaptation to remote care by users with eating disorders during the COVID-19 pandemic. Methods: a descriptive study with a qualitative approach conducted with users of an eating disorders outpatient clinic. A semi-structured remote interview was applied using the Google Meet application. The data were submitted to lexical analysis using ALCESTE software and discussed in the light of scientific evidence. Results: the remote appointment is a positive strategy but not a substitute for the face-to-face modality. The research cited financial savings, closer contact with professionals, and flexibility of service schedules as advantages. It pointed out the difficulty in clinical evaluation concerning weight, vital signs, and poor mastery of technology as limitations. Final Considerations: the study induces discussion about the systematization of remote care, which, during the COVID-19 pandemic, were responsible for providing a greater sense of support to people with eating disorders.
RESUMEN Objetivos: analizar experiencias subjetivas relacionadas a la adaptación a la atención remota por usuarios con trastornos alimenticios durante la pandemia de COVID-19. Métodos: estudio descriptivo de abordaje cualitativo realizado con usuarios de un ambulatorio especializado en trastornos alimenticios. Fue aplicada una entrevista semiestructurada remota, utilizándose el aplicativo Google Meet. Los datos fueron sometidos al análisis lexical mediante software ALCESTE y discutidos a la luz de las evidencias científicas. Resultados: la consulta remota es una estrategia positiva, pero no substitutiva de la presencial. Ventajas como economía financiera, mayor contacto con los profesionales y flexibilización de horarios de atenciones fueron citadas. Dificultad de evaluación clínica en relación al peso, signos vitales y poco dominio de tecnología fueron apuntados como limitaciones. Consideraciones Finales: el estudio induce la discusión sobre sistematización de atenciones remotas, las cuales, durante la pandemia de COVID-19, fueron responsables por fornecer mayor sensación de soporte a personas con trastornos alimenticios.
RESUMO Objetivos: analisar as experiências subjetivas relacionadas à adaptação ao atendimento remoto por usuários com transtornos alimentares durante a pandemia de COVID-19. Métodos: estudo descritivo de abordagem qualitativa realizado com usuários de um ambulatório especializado em transtornos alimentares. Foi aplicada uma entrevista semiestruturada remota, utilizando-se o aplicativo Google Meet. Os dados foram submetidos à análise lexical por meio do software ALCESTE e discutidos à luz das evidências científicas. Resultados: a consulta remota é uma estratégia positiva, mas não substitutiva da modalidade presencial. Vantagens como economia financeira, maior contato com os profissionais e flexibilização de horários de atendimentos foram citadas. Dificuldade de avaliação clínica em relação ao peso, sinais vitais e pouco domínio da tecnologia foram apontados como limitações. Considerações Finais: o estudo induz a discussão sobre sistematização dos atendimentos remotos, os quais, durante a pandemia de COVID-19, foram responsáveis por fornecer maior sensação de suporte às pessoas com transtornos alimentares.
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RESUMO Objetivo: Avaliar o perfil dos pacientes com transtornos alimentares (TAs) atendidos por um serviço especializado e investigar os fatores associados ao desfecho do tratamento. Métodos: Estudo retrospectivo, realizado com dados de pacientes com TAs que fizeram seguimento em um serviço especializado, desde a sua criação, em 1982, até 2019. Foram coletadas informações, nos prontuários médicos, referentes ao primeiro atendimento, de natureza sociodemográfica, clínica e antropométrica, e ao desfecho do tratamento. Resultados: Foram incluídos 271 pacientes. A amostra foi predominantemente do sexo feminino (89,7%), com idade média de 21,5 ± 9 anos, sem companheiro (86,9%) e diagnóstico de anorexia nervosa (AN) (65,7%), e o índice de massa corporal mais frequente foi de magreza (53,9%). A metade dos indivíduos tinha comorbidades psiquiátricas (50,6%), e 88,5% dos pacientes (n = 100) dos 113 prontuários com essa informação realizaram tratamento anterior. O tempo médio de tratamento foi de 2,16 ± 3,25 anos (1 mês a 40 anos). O abandono foi o desfecho terapêutico mais prevalente na amostra (68,3%). O maior tempo de tratamento e a realização de tratamento anterior reduziram a taxa de abandono, de forma significativa (p = 0,0001 e p = 0,0101, respectivamente). Para os pacientes com diagnóstico de transtorno de personalidade, a média de encaminhamento/inassistência foi 4,47 vezes maior (p = 0,0003). Conclusões: O perfil dos pacientes foi composto por mulheres adultas jovens, estudantes, sem companheiro, com AN, magreza e comorbidades psiquiátricas. A taxa de abandono foi elevada, e os fatores associados foram o tempo de tratamento e a realização de tratamento anterior. Além disso, transtornos de personalidade foram associados a encaminhamento para outro serviço e alta por inassistência.
ABSTRACT Objective: To evaluate the profile of patients with eating disorders (ED) treated by a specialized service and to investigate the factors associated with the treatment outcome. Methods: Retrospective study, with data from patients with ED who were followed up at a specialized service, since its creation, in 1982, until 2019. Information of a sociodemographic, clinical, anthropometric nature and the outcome of the treatment were collected from the medical records regarding the first consultation. Results: Two hundred and seventy one patients were included. The sample was predominantly female (89.7%), with a mean age of 21.5 ± 9 years, without a partner (86.9%), diagnosis of anorexia nervosa (AN) (65.7%) and the most frequent body mass index was thinness (53.9%). Half of the individuals had psychiatric comorbidities (50.6%) and 88.5% (n = 100) of the 113 medical records with this information had undergone previous treatment. The mean treatment time was 2.16 ± 3.25 years (1 month to 40 years). Dropout was the most prevalent therapeutic outcome in the sample (68.3%). Longer treatment time and having undergone previous treatment significantly reduced the dropout rate (p = 0.0001 and p = 0.0101, respectively). For patients diagnosed with a personality disorder, the mean referral/lack of assistance was 4.47 times higher (p = 0.0003). Conclusions: The patients' profile consisted of young adult women, students, single, with AN, thinness and psychiatric comorbidities. The dropout rate was high, and the predictors associated with this outcome were treatment time and previous treatment for ED. In addition, personality disorders were associated with referral to another service and discharge due to lack of assistance.
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RESUMEN Introducción: Los trastornos de la conducta alimentaria (TCA) son afecciones complejas de origen multifactorial que tienen como principal característica la preocupación excesiva por el peso y la forma del cuerpo, que causa gran malestar y afectación física llevando a una disminución de la calidad de vida y alteraciones de la funcionalidad del paciente y su entorno social. El objetivo de este estudio es describir los síntomas de orden emocional y conductual de los adolescentes que consultan en la ciudad de Bogotá a un programa especializado en TCA. Métodos: Estudio observacional y descriptivo de corte transversal, para el que se reclutó a pacientes de 11-19 arios con diagnóstico de TCA. Resultados: Se incluyeron 40 pacientes con diagnóstico de TCA, el 92% mujeres. El promedio de edad de los pacientes fue 16,6 ± 1,9 años. El 57% de los pacientes viven en hogar biparental y el 30%, en hogar monoparental. El 72% de la población tenía un rendimiento académico excelente. El 50% de los pacientes estaban moderadamente enfermos. El 60% estaba en tratamiento farmacológico con ISRS. El 65% de los pacientes cumplían criterios clínicos de trastorno de ansiedad; el 30%, de trastorno depresivo; el 22,5%, de problemas de agresividad, y el 17,5%, de conducta delictiva. El 72,5% de la muestra muestra criterios clínicos de síntomas internalizantes y el 42,5%, de síntomas externalizantes, y la mayoría de ellos son pacientes con diagnóstico de bulimia nerviosa. Conclusiones: Los pacientes con bulimia nerviosa obtuvieron en los diferentes síntomas de orden emocional y conductual puntuaciones superiores que con los demás trastornos alimentarios. Esta entidad ofrece mayor psicopatología, la cual se debe examinar rigurosamente al momento de la atención clínica, buscando disminuir el impacto funcional que estos síntomas generan en el individuo.
ABSTRACT Introduction: Eating disorders (EDs) are complex conditions of multifactorial origin. Their main characteristic is excessive concern about body weight and shape, which causes great discomfort and physical problems and leads to a decrease in quality of life and alterations in the patient's functionality social environment. The objective of this study is to describe the emotional and behavioural symptoms of adolescents who consult a specialised ED programme in the city of Bogota. Methods: Observational, descriptive, cross-sectional study, for which patients between 11 and 19 years old with an ED diagnosis were recruited. Results: Forty patients with an ED diagnosis were included, of which 92% were female. The mean age of the patients was 16.6 ± 1.9 years; 57% of patients live in a two-parent home and 30% in a single-parent home; 72% of the sample had excellent academic performance; 50% were moderately ill; 60% received pharmacological management with SSRIs; 65% of patients met clinical criteria for anxiety disorder, 30% for depressive disorder; 22.5% had aggression problems; 17.5% criminal behaviour; 72.5% of the sample met clinical criteria for internalising symptoms and 42.5% for externalising symptoms, the majority being patients with a diagnosis of bulimia nervosa. Conclusions: Patients with bulimia nervosa obtained higher scores in the different emotional and behavioural symptoms than those with other eating disorders. This condition is associated with greater psychopathology, which must be examined rigorously at the time of clinical care, seeking to reduce the functional impact that these symptoms generate on the individual.
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RESUMEN Introducción: La anorexia nerviosa es un trastorno grave que causa tasas elevadas de morbilidad y mortalidad. La aplicación de una intervención no voluntaria solo es legalmente admisible si el paciente no es competente. Sin embargo, la evaluación de su capacidad puede ser extremadamente compleja. Ello conlleva que la decisión final pueda verse influida por las actitudes individuales del facultativo. Objetivo: Crear y validar empíricamente un cuestionario en español que permita medir la actitud hacia la capacidad y el internamiento no voluntario y comparar entre grupos categóricos. Métodos: Formaron la muestra 338 profesionales de salud mental. Los ítems fueron validados por grupos de expertos. Se realizaron un análisis factorial exploratorio y comparaciones grupales. Resultados: Se obtuvo un modelo de 13 ítems formado por 3 factores: prointervención, ausencia de capacidad y cronicidad. Los profesionales tienden a creer en la ausencia de capacidad y la necesidad de la intervención no voluntaria, así como en la idoneidad diferencial en virtud de la cronicidad. El respaldo previo a intervenciones involuntarias se relacionó significativamente con los factores prointervención y ausencia de capacidad y la formación en bioética, con la cronicidad. Conclusiones: El instrumento resultante es válido y fiable. Puede ser útil a profesionales, pacientes y sociedad.
ABSTRACT Introduction: Anorexia nervosa is a serious disorder that causes high rates of morbidity and mortality. Involuntary treatments are only legally admissible if the patient is not competent. However, assessing their capacity can be really complex. This implies that the final decision might be influenced by the individual attitudes of the physician. Objective: To create and empirically validate a questionnaire in Spanish that makes it possible to measure the attitude towards capacity and involuntary commitment and compare between categorical groups. Methods: The sample consisted of 338 mental health professionals. The items were validated by groups of experts. An exploratory factor analysis and group comparisons were carried out. Results: Favourable evidence was obtained of a 13-item model consisting of three factors: pro-intervention, lack of capacity and chronicity. Professionals tend to believe in the lack of capacity and the need for involuntary interventions, as well as differential suitability due to chronicity. Having ever supported involuntary interventions was significantly related to the pro-intervention and lack of capacity factors, and training in bioethics to chronicity. Conclusions: The resulting instrument is valid and reliable. Its use can be useful to professionals, patients and society.
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RESUMEN Introducción: Las recomendaciones de las guías vigentes están basadas en evidencia de baja calidad. Se requiere su actualización periódica considerando la evidencia reciente. Objetivo: Sintetizar la mejor evidencia clínica disponible sobre eficacia y seguridad de antidepresivos y antipsicóticos de segunda generación en pacientes con anorexia nerviosa. Métodos: Revisión sistemática (CRD42020150577). Se buscaron en PubMed, SCOPUS, Ovid(Cochrane), EMBASE y LILACS los ensayos clínicos aleatorizados realizados en pacientes con anorexia nerviosa que evaluasen el uso de antipsicóticos de segunda generación o antidepresivos orales a cualquier dosis y por cualquier tiempo en el tratamiento ambulatorio y/u hospitalario tomando como resultados el peso (índice de masa corporal), las entidades psicopatológicas y la seguridad. Resultados: Se incluyeron 5 estudios, 4 catalogados como con alto riesgo de sesgo. La evidencia indica que los pacientes que reciben tratamiento con olanzapina o fluoxetina tienden a mantenerse por más tiempo dentro de los programas de tratamiento. La olanzapina mostró resultados favorables (un estudio) en cuanto al aumento de peso, pero no mostró los mismos resultados en psicopatología, donde la evidencia es contradictoria. Conclusiones: En concordancia con las revisiones anteriores, nuestro trabajo permite concluir que hay información contradictoria sobre la eficacia de los psicofármacos para la anorexia nerviosa. El trabajo futuro debe enfocarse en desarrollar ensayos clínicos de alta calidad metodológica.
ABSTRACT Introduction: The recommendations of the current guidelines are based on low quality evidence. Periodic updating is required, taking recent evidence into consideration. Objective: To synthesise the best available clinical evidence on the efficacy and safety of second-generation antidepressants and antipsychotics in patients with anorexia nervosa. Methods: Systematic review (CRD42020150577). We searched PubMed, SCOPUS, Ovid(Cochrane), EMBASE and LILACS for randomised clinical trials performed in patients with anorexia nervosa that evaluated the use of second-generation antipsychotics or oral antidepressants, at any dose and for any length of time, in outpatient and/or hospital treatment, taking weight (body mass index), psychopathological entities and safety as results. Results: Five studies were included, with four assessed as having a high risk of bias. The evidence indicates that patients receiving treatment with olanzapine or fluoxetine tend to stay in treatment programmes for longer. Olanzapine showed favourable results (one study) in terms of weight gain, but did not show the same results in psychopathology, where the evidence is contradictory. Conclusions: In accordance with previous reviews, our work allows us to conclude that there is contradictory information on the efficacy of psychotropic drugs in the treatment of anorexia nervosa. Future work should focus on developing clinical trials of high methodological quality.
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Resumen: Antecedentes: se ha observado baja calidad de vida relacionada con la salud en pacientes con trastornos de la conducta alimentaria, pero poco se sabe acerca de cómo inciden los tratamientos, tal como la terapia cognitivo conductual, desde las percepciones y experiencias de los pacientes. Objetivo: explorar la calidad de vida relacionada con la salud en jóvenes diagnosticados con trastornos de la conducta alimentaria que reciben terapia cognitivo conductual. Materiales y métodos: estudio cualitativo con metodología de casos múltiples y muestreo intencional de cinco jóvenes que recibían terapia cognitivo conductual para trastornos de la conducta alimentaria en dos programas de tratamiento de la ciudad de Medellín, a los cuales se les realizó una entrevista a profundidad relacionada con la calidad de vida respecto a la salud. Resultados: aunque la terapia cognitivo conductual generó restricciones en la vida de los participantes al inicio del tratamiento, se observaron mejoras en diferentes ámbitos de la calidad de vida relacionada con la salud a medida que este avanzaba: capacidad para hacer cosas, moverse o cuidarse a sí mismo; habilidades cognitivas y académicas; estado emocional; relaciones sociales; percepción de sí mismo y percepción del estado de salud, incluyendo la salud mental. Conclusión: los participantes mejoraron su calidad de vida relacionada con la salud progresivamente, como resultado de la terapia cognitivo conductual, tanto por la reducción de las problemáticas asociadas a trastornos de la conducta alimentaria como por el incremento de habilidades para la vida.
Abstract: Background: Low health-related quality of life has been observed in patients with eating disorders, but little is known about how treatments, such as cognitive behavioral therapy, impact the perceptions and experiences of patients. Objective: To explore the health-related quality of life in youth diagnosed with eating disorders receiving cognitive behavioral therapy. Materials and Methods: Qualitative study with multiple case methodology and intentional sampling of five youth receiving cognitive behavioral therapy for eating disorders in two treatment programs in the city of Medellín. These youth were given an in-depth interview related to health-related quality of life. Results: Although cognitive behavioral therapy created restrictions in the lives of the participants at the beginning of the treatment, improvements were observed in different areas of health-related quality of life, as treatment progressed: the ability to do things, move or take care of oneself; cognitive and academic skills; emotional state; social relationships; self-perception and health status perception, including mental health. Conclusion: The participants progressively improved their health-related quality of life as a result of cognitive behavioral therapy, both by reducing the problems associated with eating disorders and by increasing life skills.
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Resumen El perfil cognitivo de los pacientes con anorexia nerviosa se caracteriza por dificultades en la flexibilidad mental y en la coherencia central. El objetivo de este trabajo fue analizar si los familiares de primer grado no afectados de los pacientes presentan estas dificultades cognitivas, que podrían representar rasgos endofenotípicos de la enfermedad. Fueron estudiadas 34 mujeres: 17 familiares de primer grado (madres y hermanas) de pacientes con anorexia nerviosa y 17 controles sanos agrupados por edad y escolaridad. Se consideraron el índice de masa corporal, la ansiedad, la depresión, los síntomas obsesivo-compulsivos y los relacionados con los trastornos alimentarios. Se evaluó la coherencia central, mediante la copia de la Figura Compleja de Rey, y la flexibilidad mental, mediante el test de Stroop, el test de los trazos B y el test de fluencia fonológica. Los familiares de pacientes con anorexia nerviosa presentaron un menor rendimiento en las medidas de coherencia central (p < .05) y en fluencia fonológica (p < .05) que los controles sanos. Se observó una correlación entre el test de Stroop y los síntomas de depresión y trastornos alimentarios (p < .05). Los familiares de primer grado no afectados de pacientes con anorexia nerviosa presentaron dificultades en la coherencia central y, en menor grado, en la flexibilidad mental. Los resultados en los familiares indican que este perfil podría ser mediado genéticamente, constituyendo un rasgo característico de la anorexia nerviosa y, por ende, un posible candidato a endofenotipo neuropsicológico de esta enfermedad.
Abstract The cognitive profile of patients with anorexia nervosa is characterized by difficulties in central coherence and mental flexibility. Central coherence is defined by the ability to integrate incoming information in its own context, and weakness in central coherence is characterized by poor overall processing and superior detail processing. Mental flexibility is defined by the ability to change the course of a thought or action according to the demands of the environment. Alterations in this cognitive domain generate rigid and inflexible behavior. An open question in the literature is whether these cognitive characteristics are a transient state derived from the disease or whether they are stable traits associated with anorexia nervosa and endophenotypical features of this disease. The concept of endophenotype refers to the internal phenotype that is not clinically appreciable but can be observed indirectly through deficits that arise in the performance of certain neuropsychological tests. In recent years the search for endophenotypes has been renewed in the field of psychiatry as they would constitute an important route for the understanding of the biological and genetic bases of mental illnesses, constituting markers that allow a diagnosis before the onset of clinical symptomatology. For a cognitive marker to be considered an endophenotype it must meet a series of characteristics such as being measurable, inherited, found in patients with and without active disease and in first-degree relatives not affected by the disease. The aim of the present study was to assess whether difficulties in central coherence and mental flexibility are shared by unaffected first-degree relatives of patients with anorexia nervosa and thus constitute an endophenotypical feature of this disease. This is a cross-sectional, descriptive-comparative study in which 34 women participated: 17 unaffected first-degree relatives of patients with anorexia nervosa (mothers and sisters) and 17 healthy controls matched by age and education. For the study of central coherence the copy of Rey's Complex Figure was used and to assess set-shifting the Stroop test, the Trail Making Test B and the Phonological Fluency test were used. Demographic and clinical aspects such as age, educational level, body mass index, anxiety, depression, obsessive-compulsive and eating disorder related symptoms were also evaluated. First-degree relatives of patients with anorexia nervosa showed lower performance on measures of central coherence (p < .05) and phonological fluency (p < .05) than healthy controls. A correlation was observed between the Stroop test and depression and eating disorders symptoms (p < .05). The results of this study show that unaffected first-degree relatives of patients with anorexia nervosa presented alterations in central coherence and, to a lesser degree, in mental flexibility. These results, in addition to previous research in which difficulties persisted even after recovery, indicate that these alterations could be genetically mediated, constituting a characteristic trait of anorexia nervosa and therefore a possible candidate for neuropsychological endophenotype of this disease. Regarding practical implications of the study, the findings reinforce the importance of cognitive remediation treatments not only for patients with anorexia nervosa but also emphasize that they could be useful for unaffected family members. Taking into account that family intervention is a widely used tool in the psychological treatment of anorexia, improving the perception of the patient and his relatives about cognitive biases, could contribute to raising awareness of the disease, something that patients with anorexia nervosa do not usually have, and generate a positive impact on the response to treatment as a whole.
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Objective: To systematically review the literature focusing on obstetric and perinatal outcomes in women with previous or current eating disorders (EDs) and on the consequences of maternal EDs for the offspring. Methods: The study was performed following the systematic review and meta-analysis (PRISMA) statement. PubMed, SciELO, and Cochrane databases were searched for non-interventional studies published in English or Portuguese from January 1980 to December 2020. Risk of bias was assessed using the Methods guide for effectiveness and comparative effectiveness reviews (American Agency for Healthcare Research and Quality). Results: The search yielded 441 records, and 30 articles were included. The psychiatric outcome associated with EDs in women was mainly perinatal depression. The most prevalent obstetric outcomes observed in women with EDs were vomiting, hyperemesis, bleeding, and anemia. Most studies found maternal anorexia nervosa and bulimia nervosa to be associated with low birth weight and slow fetal growth. Women with binge EDs delivered children with increased birth weight. Of the 30 studies included, methodological quality was good in seven, fair in eight, and poor in 15 studies. Conclusion: A considerable body of evidence was reviewed to assess obstetric and perinatal outcomes in EDs. Acute and lifetime EDs, especially if severe, correlated with poor perinatal, obstetric, and neonatal outcomes. Obstetricians and general practitioners should be vigilant and screen for EDs during pregnancy.
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Introdução:aanorexia nervosa caracteriza-se por um transtorno alimentar com quadro clínico típico de restrição dietética e desnutrição. Objetivo:verificar a eficácia do uso dos fármacos antipsicóticos olanzapina, quetiapina, risperidonano aumento ponderal de pacientes com tal patologia.Metodologia:utilizou-se de 9 Ensaios Clínicos Randomizados anexados na plataforma Medical Literature Analysis and Retrieval System Online/PubMed, sendo todos analisados a partir de critérios de inclusão e exclusão feitos aos pares para a realização de uma Revisão Sistemática de Literatura.Os artigos foram avaliados através do sistema Grading of Recommendatons AssessmentDevelopment and Evaluaton/GRADE. Resultadose discussão:Percebeu-se a prevalência da olanzapina sobre o aumento do peso entre os pacientes com anorexia comparado ao placebo. Pouca eficácia sobre o ganho ponderal com relação a quetiapina. A risperidona não demonstroualteração do peso ao utilizá-ladurante o tratamento da anorexia nervosa.Conclusões:Os achados sugeriram que aolanzapina, apresentou oefeito mais significativo sobre o ganho de peso em um menor intervalo de tempo (AU).
Introduction:Anorexia nervosa is characterized by an eating disorder with a typical clinical of food restriction and malnutrition. Objective:to verify the effectiveness of the use of the antipsychotic drugs olanzapine, quetiapine, risperidone in the weight gain of patients with this pathology. Methodology:9 Randomized Clinical Trials (RCT) were used attached to the Medical Literature Analysis andRetrieval System Online/PubMed/MEDLINE platform, all of which were analyzed based oninclusion and exclusion criteria made in pairs to carry out a Systematic Literature Review. Results and discussion:It was noticed the prevalence of olanzapine on weight gain among patients with anorexia compared to placebo. Little diligence on weight gain with regard to quetiapine. Risperine showed no weight change when used during the treatment of anorexia nervosa. Conclusions:The findings suggest that olanzapine had the most significant effect on weight gain in a short period (AU).
Introducción: La anorexia nerviosa se caracteriza por un trastorno alimentario con un cuadro clínico típico de restricción alimentaria y desnutrición. Objetivo: verificar la efectividad del uso de los medicamentos antipsicóticos olanzapina, quetiapina, risperidonaem el aumento de peso de pacientes con esta patología.Metodología: Se utilizaron 9 Ensayos Clínicos Aleatorizados (RCT) adjuntos a la plataforma Medical Literature Analysis and Retrieval System Online / PubMed (MEDLINE), todos fueron analizados en base a criterios de inclusión y exclusión realizados en pares para realizar una Revisión Sistemática de la Literatura. Resultados y discusión:Se notó la prevalencia de la olanzapina en la ganancia de peso entre pacientes con anorexia en comparación con el placebo. Poca diligencia en la ganancia de peso con respecto a la quetiapina. Risperine no mostró cambios de peso cuando se usó durante el tratamiento de la anorexia nerviosa. Conclusiones:Los hallazgos sugieren que la olanzapina tuvo el efecto más significativo sobre el aumento de peso en un lapso de tiempo más corto (AU).
Subject(s)
Antipsychotic Agents/therapeutic use , Antipsychotic Agents/pharmacology , Anorexia Nervosa/diagnosis , Feeding and Eating Disorders/drug therapy , Feeding Behavior , Brazil/epidemiology , Anorexia , Risperidone , Quetiapine Fumarate , Olanzapine/therapeutic useABSTRACT
Abstract Family relationships seem to have a relevant contribution to the etiopathogenesis of eating disorders (EDs), which makes the international treatment guidelines recommend family participation. This study aimed to synthesize and reinterpret the findings of primary qualitative studies about the perception of family of people with EDs about treatment. The search strategy was organized using the SPIDER tool, and the analyzes were carried out by two independent reviewers. From 1115 studies originally retrieved from six databases (CINAHL, LILACS, PsycINFO, PubMed, Scopus and Web of Science), 19 articles were selected. The results converge to the recognition that the family is part of the process and also needs to be considered as a care recipient, not just as a coadjuvant/companion for the patient. Since family dynamics have a relevant contribution in the development and maintenance of EDs, it is necessary to invest in the transformation of family relationships so that more effective and lasting gains in treatment can be obtained.
Resumo Relações familiares parecem ter uma contribuição relevante na etiopatogenia dos transtornos alimentares (TAs), o que faz com que as diretrizes internacionais de tratamento recomendem a participação da família. Esta metassíntese teve como objetivo sintetizar e reinterpretar os resultados de estudos qualitativos primários sobre a percepção de familiares de pessoas com TAs acerca do tratamento. A estratégia de busca foi organizada utilizando-se a ferramenta SPIDER e as análises foram realizadas por dois revisores independentes. A partir de 1.115 estudos originariamente recuperados de 6 bases de dados (CINAHL, LILACS, PsycINFO, PubMed, Scopus e Web of Science), foram selecionados 19 artigos. Os resultados convergem para o reconhecimento de que a família é parte do processo saúde-doença e precisa ser considerada como destinatária de cuidados, não apenas como coadjuvante/acompanhante no cuidado à pessoa acometida. Como a dinâmica familiar tem contribuição relevante no desenvolvimento e na manutenção dos TAs, é necessário investir na transformação das relações familiares para que se possam obter ganhos mais efetivos e duradouros no tratamento.
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ABSTRACT Objective: To evaluate the prevalence and severity of malocclusion and its impact on oral health-related quality of life (OHRQoL) and self-reported satisfaction of patients with anorexia and bulimia nervosa. Methods: The sample consisted of sixty women who attended a specialized mental health clinic of a Brazilian medical school. Participants were distributed into two groups: patients with anorexia and bulimia nervosa (ABN; n=30) and control patients without eating disorders (CN; n=30). The dental occlusion was evaluated by the Dental Aesthetic Index; the OHRQoL was assessed using the OHIP-14 questionnaire; and the self-reported satisfaction with the appearance of teeth, speech ability and chewing was obtained by interviews. Results: Severe and very severe malocclusion were observed in 26.67% and 46.67% of patients in the ABN group, respectively, while the CN group showed 80.00% of patients without abnormality/mild malocclusion. ABN group showed a higher proportion of patients (p < 0.05) with tooth loss, spacing in the region of incisors, maxillary misalignment, and mandibular misalignment in relation to CN group. ABN group presented lower (p< 0.05) OHRQoL and self-reported satisfaction with the appearance of teeth, speech ability and chewing, compared to the CN group. There was a significant positive correlation (p< 0.05) between the Dental Aesthetic Index and OHIP-14 scores in the ABN group. Conclusions: The prevalence of severe malocclusion in ABN group was high, with a negative impact on OHRQoL and self-reported satisfaction with the chewing ability, speech ability and appearance of teeth.
RESUMO Objetivo: Avaliar a prevalência e gravidade da má oclusão e seu impacto na qualidade de vida relacionada à saúde bucal (QVRSB) e a satisfação autorreferida de pacientes com anorexia e bulimia nervosa. Métodos: A amostra foi composta por 60 mulheres que compareceram a uma clínica especializada em saúde mental de uma faculdade brasileira de Medicina. Os participantes foram distribuídos em dois grupos: pacientes com anorexia e bulimia nervosa (ABN; n=30) e pacientes sem distúrbios alimentares (CN; n=30). A oclusão dentária foi avaliada pelo Índice de Estética Dental; a QVRSB foi avaliada usando o questionário OHIP-14; e a satisfação autorreferida com a aparência dos dentes, capacidade de fala e mastigação foi avaliada por meio de entrevistas. Resultados: Má oclusão grave e muito grave foi observada em 26,67% e 46,67% dos pacientes no grupo ABN, respectivamente, enquanto o grupo CN apresentou 80,00% dos pacientes sem anormalidade/má oclusão leve. O grupo ABN apresentou maior proporção de pacientes (p<0,05) com perda dentária, espaçamento na região dos incisivos, desalinhamento maxilar e desalinhamento mandibular, em relação ao grupo CN. O grupo ABN apresentou menor (p<0,05) QVRSB e satisfação autorreferida com a aparência dos dentes, capacidade de fala e mastigação, em comparação ao grupo CN. Houve uma correlação positiva (p<0,05) entre o Índice de Estética Dental e o escore do OHIP-14 no grupo ABN. Conclusões: A prevalência de má oclusão grave no grupo ABN foi alta, com impacto negativo na QVRSB e satisfação autorreferida com a aparência dos dentes, capacidade de fala e mastigação.
ABSTRACT
Introdução: Este estudo tem como objeto avaliar as consequências geradas pelas medidas de isolamento social na saúde mental de pessoas com transtornos alimentares atendidas em um ambulatório especializados no município do Rio de Janeiro. Objetivos: descrever características sociodemográficas e clínicas de pessoas com transtornos alimentares em um ambulatório especializado; analisar as consequências da pandemia de COVID-19 na saúde mental de pessoas com transtornos alimentares em acompanhamento ambulatorial; discutir as ferramentas de acompanhamento em saúde mental no período de isolamento social em um ambulatório especializado em transtornos alimentares. Método: Pesquisa descritiva de caráter qualitativo com usuários de 18 a 60 anos diagnosticados com anorexia nervosa, bulimia nervosa ou transtorno de compulsão alimentar e suas formas subclínicas, em tratamento especializado durante a pandemia de COVID-19. O cenário foi o ambulatório do Grupo de Obesidade e Transtornos Alimentares (GOTA) de um Instituto de Psiquiatria universitário. Foram utilizados dados retrospectivos sobre características clínicas e demográficas dos usuários, coletados nos prontuários clínicos e de entrevistassemi-estruturadas aplicadas de forma remota. Os dados foram analisados através dos softwares ALCESTE e Microsoft Excel 2019 e discutidos a partir da literatura científica sobre o tema. As análises realizadas pelo ALCESTE evidenciaram 4 classes de palavras predominantes, sendo a de impactos socioeconômicos a mais relevante, seguida da classe referente ao suporte profissional em saúde mental recebido durante a pandemia, da classe referente aos impactos na autoestima e autopercepção dos participantes e por fim, da classe referente aos impactos na rotina de alimentação. Resultados: A amostra foi constituída de 16 mulheres com predomínio da cor branca, com faixa etária de 18 à 30 anos, sendo o diagnóstico de transtorno de compulsão alimentar o mais frequente. A pandemia resultou em sensação de perda de controle devido a modificações na rotina, tendo culminado em piora do comportamento alimentar e aumento de mecanismos compensatórios. Em alguns casos, o isolamento social foi considerado pelos participantes como ferramenta para reestruturação emocional. Os impactos socioeconômicos ocorreram de maneira indiferente a estrato social. A introdução do atendimento remoto no serviço foi considerado um fator protetor na manutenção do tratamento, com vantagens como economia financeira e maior flexibilidade de horário. Foram apontadas desvantagens como dificuldade de monitoramento de dados antropométricos e exame físico. Conclusão: Os desdobramentos do isolamento social refletiram em diferentes campos da vida dos participantes, tais como saúde física, mental, convivência intradomiciliar, impactos socioeconômicos e modificações no suporte profissional para o transtorno alimentar. O atendimento remoto foi apontado como uma estratégia promissora para prestação de assistência a esse público, necessitando melhor sistematização para o futuro, com potencial de permanência não somente em períodos pandêmicos. Para os profissionais de saúde, a pesquisa indica que os usuários com transtornos alimentares reconhecem o valor do atendimento no ambulatório, o que requer capacitação e maior participação da enfermagem na equipe interdisciplinar.
Introduction: This research has as aim to evaluate the consequences caused by social restriction measures in the mental health of clients with eating disorders attended in a specialized ambulatory in the city of Rio de Janeiro. Objectives: to describe sociodemographic and clinical characteristics of people with eating disorders in a specialized ambulatory; to analyse the consequences of the COVID-19 pandemic in the mental health of people with eating disorders; to discuss tools of mental health support during the social isolation in an ambulatory specialized on eating disorders. Methods: Descriptive study with qualitative design including clients between 18-60 years old diagnosed with anorexia nervosa, bulimia nervosa or binge eating disorders and its subclinical presentations in specialized treatment during the pandemic. The place of the study it was the Grupo de Obesidade e Transtornos Alimentares (GOTA) ambulatory of an academic psychiatric institute. It was used restropective data about clinical and demographical characteristics collected of the medical records and it was applied a semi-structured interview by remote mode. Data was analysed by the softwares ALCESTE and Microsoft Excel 2019, and discussed by the cientific literature about the subject. The analysis presented 4 classes of predominant words, within the socioeconomical impacts one being the most relevant, followed by the class referring to the professional mental health support during the pandemic, by the class referring to the impacts on self steem and self perception of the participants and finally, by the class referring to impacts on the food routine. Results: The sample was constituted by 16 women, with white skin color predominance, ages between 18 to 30 years old, with binge eating disorder being the most frequent diagnose. The pandemic resulted in a sense of loss of controle because of changes in the routine, resulting in worsening of food behaviour and increasing in compensatory behaviour. In some cases, social restriction was considered by participants as a tool for emotional reestructuration. The socioeconomical impacts existed regardless of social stratum. The introduction of the remote consultation was considered a protective factor on the treatment maintenance, including benefits such as financial economy and greater time flexibility. It were considered disadvantagens such as difficulty on monitoring anthropometric data and physical examination. Conclusion: The outspread of social restriction reflected in diverse life fields of the participants, such as physical health, mental health, household coexistency and changes on the professional support to eating disorders. The remote consultation was pointed as a promissory strategy to provide assistance to this public, and it needs better systematization to the future, within potential of implementation not only in pandemic periods. To healthcare professionals, the study indicates that users with eating disorders recognize the value of an ambulatory assistance, which requires training courses and a bigger participation of nursing on interdisciplinary teams.