The manifestation of emotional distress: Correlations between self-compassion and self-mutilation in Brazilian women with disordered eating behavior.

BACKGROUND: The functions or motives for self-mutilation behavior (SMB) in Eating Disorders are diverse, and the relationship with self-compassion is unclear. Objectives This study aims to evaluate the relationship between SMB and Self-compassion. METHODS: 251 women aged 25.8 years (SD=5.94) and 73.54kg (SD=19.33) completed measures for Binge Eating (BE), Self-Compassion, and SMB. RESULTS: In the total evaluated, 83.27% (n=209) presented BE and 94.02% (n=236) presented at least 1 type of SMB. In comparison between groups, the BE-purging one's reached higher values for BE, and less self-compassion, while BE group presented higher self-compassion values. For the BE-purging group, the behaviors "Cut or carving skin", "Hitting self", "Pulling out one's hair", "Burning skin" and "Picking areas of the body to the point of drawing blood" showed inverse correlations with self-compassion. CONCLUSION: There is an inverse correlation between self-compassion and SMB, and SMB seems to have different functions between BE-purging group vs. BE group.

The body asks and the mind judges: Food cravings in eating disorders.

BACKGROUND: Food Craving (FC) is a construct influenced by cognitive, emotional, physiological and external components, severely altered in Eating Disorders (EDs). OBJECTIVES: To investigate how FC was measured in EDs. METHODS: A search was conducted (PubMed, Scopus and PsycINFO databases) for studies that have investigated FC in EDs published in the last thirty years. RESULTS: The studies found (n=37) demonstrated that FC is a predictor of binge eating in individuals with Bulimia Nervosa and Binge Eating Disorder, which are more sensitive to the environment and emotional factors, whereas, in individuals with Anorexia Nervosa, FC levels are lower. DISCUSSION: FC is a physiological component of eating behavior, as well as the craving/urge that arises associated with thirst during dehydration, and food restriction is a crucial mechanism for the restriction-binge cycle to hold. Further studies are needed to see if FC increases in response to treatment for Anorexia Nervosa, recognizing that individuals without Anorexia Nervosa have higher FC levels and greater motivational orientation towards food. CONCLUSIONS: It is necessary to understand the physiological role of FC and also consider the significance of each food in an individual eating context (eating attitudes) and whether it is treated like a "drug" or just as a desired tasty food and future studies should verify possible neural changes involved in FC after nutritional treatment.

Eating attitudes of anorexia nervosa, bulimia nervosa, binge eating disorder and obesity without eating disorder female patients: differences and similarities.

The objective was to compare eating attitudes, conceptualized as beliefs, thoughts, feelings, behaviors and relationship with food, of anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED) patients and a group of obese (OBS) without eating disorders (ED). Female patients from an Eating Disorder (ED) Unit with AN (n=42), BN (n=52) and BED (n=53) and from an obesity service (n=37) in Brazil answered the Disordered Eating Attitude Scale (DEAS) which evaluate eating attitudes with 5 subscales: relationship with food, concerns about food and weight gain, restrictive and compensatory practices, feelings toward eating, and idea of normal eating. OBS patients were recruited among those without ED symptoms according to the Binge Eating Scale and the Questionnaire on Eating and Weight Patterns. ANOVA was used to compare body mass index and age between groups. Bonferroni test was used to analyze multiple comparisons among groups. AN and BN patients presented more dysfunctional eating attitudes and OBS patients less dysfunctional (p<0.001). For DEAS total score, AN and BN patients were similar and all other were different (p<0.001). Similarities suggested between BN and BED were true just for the "Relationship with food" and "Idea of normal eating." BED patients were worst than OBS for "Relationship with food" and as dysfunctional as AN patients - besides their behavior could be considered the opposite. Differences and similarities support a therapeutic individualized approach for ED and obese patients, call attention for the theoretical differences between obesity and ED, and suggest more research focused on eating attitudes.

Psychometric evaluation of the "Body Checking and Avoidance Questionnaire--BCAQ" adapted to Brazilian Portuguese.

OBJECTIVE: Adapt and validate the Brazilian Portuguese version of the Body Checking and Avoidance Questionnaire (BCAQ). METHODS: The study consisted of: translation and back translation; technical review and assessment of semantic equivalences, factor analysis and discriminant and concurrent validity in a sample of subjects with and without eating disorders. RESULTS: The instrument was adapted and was found to be easy to understand (mean scores higher than 3.4; maximum score: 5.0) and showed excellent concordance (Cronbach's alpha: 0.94). Factor analysis identified five components with eigenvalues greater than 1. It was able to discriminate the two groups (p<0.001) and correlated with the Eating Attitudes Test (EAT) (r=0.50), body shape questionnaire (BSQ) (r=0.68) and Beck Depression Inventory (BDI) scales (0.51). DISCUSSION: The Brazilian Language version showed suitable internal consistency and external validation, and was easy to understand. The results were similar to the original version and its use is recommended for evaluation of body checking in the Brazilian population in subjects with or without eating disorders.

Body image dissatisfaction and eating symptoms in mothers of adolescents with eating disorders.

The purpose of the present study was to assess body dissatisfaction and eating symptoms in mothers of eating disorder (ED) female patients and to compare results with those of a control group. The case group consisted of 35 mothers of female adolescents (aged between 10 and 17 yrs) diagnosed with ED who attended the Interdisciplinary Project for Care, Teaching and Research on Eating Disorders in Childhood and Adolescence (PROTAD) at Clínicas Hospital Institute of Psychiatry of the Universidade de São Paulo Medical School. Demographic and socioeconomic data were collected. Eating symptoms were assessed using the Eating Attitudes Test (EAT-26) and body image was assessed by the Body Image Questionnaire (BSQ) and Stunkard Figure Rating Scale (FRS). The case group was compared to a control group consisting of 35 mothers of female adolescents (between 10 and 17 years) who attended a private school in the city of São Paulo, southeastern Brazil. With regard to EAT, BSQ and FRS scores, we found no statistically significant differences between the two groups. However, we found a positive correlation between BMI and BSQ scores in the control group (but not in the case group) and a positive correlation between EAT and FRS scores in the case group (but not in the control group). It appears to be advantageous to assess body image by combining more than one scale to evaluate additional components of the construct.

Validation of the Portuguese version of the Social Adjustment Scale on Brazilian samples.

BACKGROUND: Social dysfunction is reported in several psychiatric diseases and its evaluation is becoming an important measure of treatment outcome. The aim of this study was to obtain normative data, to test the validity and the ability of the Portuguese version of the Self-Report Social Adjustment Scale (SAS-SR) to detect different clinical conditions. METHODS: The Portuguese version of the SAS-SR was applied to a carefully selected non-psychiatric sample, and to depressed, panic, bulimic and cocaine-dependent patients. Depressed and panic patients were evaluated in two different clinical conditions: acutely symptomatic and in remission. RESULTS: SAS overall and sub-scale scores of the normal sample were consistently lower than all patient groups, indicating better social adjustment in all areas. Panic patients were impaired to a lower level than depressed and cocaine-dependent patients in overall adjustment. Depressed patients in remission, although in better condition, were still impaired in relation to normal subjects in overall social functioning, leisure time and marital areas. In panic patients in remission, normalization was not achieved in overall functioning, work and marital areas. LIMITATIONS: Sample size was small in some groups and the evaluation was cross-sectional. CONCLUSIONS: The Portuguese version of SAS-SR is a useful instrument for detecting differences between psychiatric patients and normal subjects and for the evaluation of different clinical conditions, recommending its use in outcome studies.

A dose-finding and discontinuation study of clomipramine in panic disorder.

Eighty-one panic disorder patients with or without agoraphobia were treated with flexible doses of clomipramine under single-blind conditions. Fifty-seven (70.3%) reached operational criteria for full remission in 16.2 +/- 6.5 weeks, with a mean dose of 89.1 +/- 8.2 mg/day. Fifty-four (81%) of them received a continuous post-remission maintenance treatment at full doses of clomipramine for 4-6 months. No patient relapsed during the clomipramine maintenance phase. Their medication was then tappered and discontinued with placebo substitution under double-blind conditions. Fifty-one (63%) patients were followed-up until relapse or recurrence for up to 3 years, with periodic assessments. Three different outcome groups were identified: the first (n = 19, 19; 37.2%) experienced an early/immediate relapse (5.2 +/- 4.9 weeks after drug discontinuation); the second group (n = 22, 22; 43.1%) experienced recurrence after 42.9 +/- 35 weeks following discontinuation; and the third group (n = 10, 10; 19.6%) remained assymptomatic and functionally well throughout the follow-up. Predictors of early relapse were: (1) higher baseline score in the Beck Depression Inventory; (2) higher global score on the phobic avoidance scale after the full remission criteria; and (3) the need for higher clomipramine doses to reach full remission. The need for long-term or intermittent maintenance for most patients is emphasized.

Quetiapina: nova alternativa para o tratamento da esquizofrenia / Quetiapine: a new alternative in the treatment of schiwphrenia

Nos últimos anos houve um desenvolvimento sem precedentes de novas medicaçöes antipsicóticas. Como com as medicaçöes clássicas, elas apresentam eficácia na reduçäo de delírios e alucinaçöes. Porém os novos compostos apresentam menos efeitos colaterais e uma expectativa de maior eficácia. Os autores revisam os dados de um novo antipsicótico atipico, a quetiapina

[Adolescent-onset anorexia nervosa] / Anorexia nervosa na adolescência.

OBJECTIVE: This paper is a review on the topic of adolescent-onset anorexia nervosa. According to the literature, this disorder presents high morbidity and mortality, with increasing incidence over the last decades, thus enhancing the importance of scientific investigation on the subject. METHODS: The authors performed a non-systematic review of the related literature and also reported their clinical experience. RESULTS: Age and gender are important risk factors. The peak of incidence occurs in adolescence and the prevalence is 9 times higher in females. It was initially believed that anorexia nervosa manifested itself only in higher socioeconomic levels, which are more highly exposed to the demands of western beauty standards. More recent studies have identified similar incidence of this disorder also in lower socioeconomic levels, rural areas and Asian communities. The clinical features are: refusal to maintain weight at or above a minimal normal weight for age; high, intense fear of gaining weight or becoming fat, even though underweight; disturbance in the way of experiencing one s body weight or shape, and amenorrhea. The most common physical complications are similar to those of chronic malnutrition and depression is the main comorbidity. CONCLUSIONS: Treatment should be multidisciplinary, taking into account the plurality of etiological factors. Family therapy plays an important role, particularly when this disorder manifests itself during adolescence.

Clinical characteristics and course of anorexia nervosa in Latin America, a Brazilian sample.

The authors present the clinical description of a sample of anorexic patients from an eating disorder program from a non-English developing country. The patients were diagnosed according to DSM-III-R criteria and treated with a multidisciplinary approach. Similarities to and differences from other Western patient studies are discussed.

Seasonal affective disorder in a tropical country: a case report.

Seasonality and affective disorders in the Southern Hemisphere were investigated in populations living in latitudes (40 degrees S) equivalent to those of the studies conducted in the Northern Hemisphere. The authors describe a patient with bipolar II affective disorder who was living in a low-latitude area (São Paulo, latitude: 23 degrees 39' S). The patient experienced five episodes of affective disorder that began in the summer and were characterized by symptoms typical of an autumn-winter depression. During the last two depressive episodes, the symptoms remitted after a 4-week course of evening light therapy. The case calls attention to the possibility that seasonality may influence the natural history of affective disorders even in lower latitude regions.

Childhood sexual abuse and bulimia nervosa: a comparison of American, Austrian, and Brazilian women.

OBJECTIVE: This study was designed to assess the prevalence of childhood sexual abuse among women with bulimia nervosa in three countries: the United States, Austria, and Brazil. In addition, it assessed whether bulimic subjects might have experienced more severe sexual abuse than women in the general population and whether bulimic subjects who report abuse might display greater psychopathology than those who do not report abuse. METHOD: Thirty-three university students in Innsbruck, Austria, 33 university students in Boston, and 25 women in São Paulo, Brazil, all meeting DSM-III-R criteria for bulimia nervosa, were recruited by advertisement. Detailed histories of sexual abuse, obtained at the conclusion of a comprehensive evaluation interview, were prepared, translated into English, and rated by an investigator who was blind to the nationality of the subject. Subjects were compared on frequency of eating binges, history of major depression, body mass index, and satisfaction with body image. RESULTS: Narrowly defined childhood sexual abuse was reported by 24%-36% of women in the three countries, although only 15%-32% of women reported abuse before the onset of bulimia nervosa. There were no significant differences between countries in rates of abuse. Overall, these rates appear no greater than those reported in comparable studies of women in the general population. The data also did not support the hypothesis that bulimic subjects had endured more severe sexual abuse than other women, nor was there a significant association between history of childhood sexual abuse and severity of bulimic symptoms. CONCLUSIONS: These findings add to the weight of evidence suggesting that childhood sexual abuse is not a risk factor for bulimia nervosa.

Clomipramine, a better reference drug for panic/agoraphobia. I. Effectiveness comparison with imipramine.

An 8-week, double-blind, flexible-dose trial comparing low doses of clomipramine (mean=50 mg) with moderate doses of imipramine (mean=113.8 mg and propanteline (active placebo), was carried out in 60 out-patients with panic disorder with or without agoraphobia. Efficacy evaluation included global, anxiety and depression rating scales, and the determination of rates of relapse over up to 10 weeks of single-blind placebo follow-up. Both tricyclics were significantly more effective than propanteline, but clomipramine tended to act faster and more consistently than imipramine on most measures. Given the degree of blindness achieved and the significantly lower doses of clomipramine, this seems a better reference drug than imipramine for clinical trials in panic/agoraphobia.

Linhas gerais do tratamento farmacológico das doenças afetivas no idoso / An overview on pharmacological treatment of affective disorders in the aged

Os autores salientam a importância do diagnóstico de depressäo na populaçäo idosa e as peculiaridades do seu tratamento com as diferentes drogas antidepressivas, principalmente, em relaçäo à farmacocinética e efeitos colaterais das mesmas

[Mitral valve prolapse and panic disorder]. / Prolapso valvar mitral e transtorno do pânico.

PURPOSE: To determine the incidence of mitral valve prolapse (MVP), using echocardiographic and auscultatory criteria, in cases of panic disorder (complicated or not with agoraphobia). PATIENTS AND METHODS: Sixty-five patients (37 women) with panic disorder and without known cardiac disease, mean age 39.8 years (range 19-67) were studied. MVP was diagnosed when there was a typical auscultatory click or when the echocardiographic study (echo) registered one mitral lacinea 2 mm behind the C-D line at the "M" study or a systolic billowing of mitral leaflets in two views to the two-dimensional study. RESULTS: MVP was found in 29 (44.6%) of the patients, 12 (42.7) men and 17 (49.5%) women. A click was found in 19 (24%) of the cases and the Echo was positive in 24 (39.6%) of the patients. Click and a positive Echo finding were identified in 14 patients. CONCLUSION: MVP was found in panic cases, in incidence greater than in the general population.

Linhas gerais do tratamento farmacologico das doencas afetivas no idoso

O autores salientam a importancia do diagnostico de depressao na populacao idosa e as peculiaridades do seu tratamento com as diferentes drogas antidepressivas, principalmente, em relacao a farmacocinetica e efeitos colaterais das mesmas.

[Electroencephalographic study of patients with panic disorders]. / Estudo eletroencefalográfico em pacientes com transtorno do pânico.

Electroencephalographic changes were studied in 27 patients with panic disorder and agoraphobia with panic attacks due to some clinical similarities between panic disorder and temporal lobe epilepsy. The EEG records, obtained with sleep deprivation, photostimulation and hyperventilation showed no abnormalities.