A Systematic Review of Electrophysiological Findings in Binge-Purge Eating Disorders: A Window Into Brain Dynamics.

Binge-purge eating disorders (BP-ED), such as bulimia nervosa and binge eating disorder, may share some neurobiological features. Electroencephalography (EEG) is a non-invasive measurement modality that may aid in research and diagnosis of BP-ED. We conducted a systematic review of the literature on EEG findings in BP-ED, seeking to summarize and analyze the current evidence, as well as identify shortcomings and gaps to inform new perspectives for future studies. Following PRISMA Statement recommendations, the PubMed, Embase, and Web of Science databases were searched using terms related to "electroencephalography" and "binge-purge" eating disorders. Of 555 articles retrieved, 15 met predefined inclusion criteria and were included for full-text analysis. Eleven studies investigated EEG by means of event-related potentials (ERP) in BP-ED individuals: 7 using eating disorder-related stimuli (i.e., food, body image) and 4 using non-eating disorder-related stimuli (i.e., facial expressions or auditory clicks). These studies found significant differences in the N200, P200, P300, and LPP components in BP-ED participants compared to controls, indicating that this population exhibits impairments in selective attention, attentional allocation/processing, and allocation of motivational or emotion-based attention. Five studies investigated EEG using frequency analysis; reporting significant differences in beta activity in fronto-temporal and occipito-temporo-parietal areas in BP-ED individuals compared to controls, revealing a dysfunctional brain network. However, the small number of studies, the heterogeneity of samples, study paradigms, stimulus types, and the lack of an adequate assessment of neuropsychological parameters are some limitations of the current literature. Although some EEG data are promising and consistent with neuroimaging and neuropsychological findings in individuals with BP-ED, future studies need to overcome current methodological shortcomings.

Virtual Reality as a Promising Strategy in the Assessment and Treatment of Bulimia Nervosa and Binge Eating Disorder: A Systematic Review.

Several lines of evidence suggest that Virtual Reality (VR) has a potential utility in eating disorders. The objective of this study is to review the literature on the use of VR in bulimia nervosa (BN) and binge eating disorder (BED). Using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement for reporting systematic reviews, we performed a PubMed, Web of Knowledge and SCOPUS search to identify studies employing VR in the assessment and treatment of BN and BED. The following search terms were used: "virtual reality", "eating disorders", "binge eating", and "bulimia nervosa". From the 420 articles identified, 19 were selected, nine investigated VR in assessment and 10 were treatment studies (one case-report, two non-controlled and six randomized controlled trials). The studies using VR in BN and BED are at an early stage. However, considering the available evidence, the use of VR in the assessment of those conditions showed some promise in identifying: (1) how those patients experienced their body image; and (2) environments or specific kinds of foods that may trigger binge-purging cycle. Some studies using VR-based environments associated to cognitive behavioral techniques showed their potential utility in improving motivation for change, self-esteem, body image disturbances and in reducing binge eating and purging behavior.

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.

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.

Assessment of interpersonal skills in obese women with binge eating disorder.

Based upon interpersonal theory that suggests an association between binge eating disorder (BED) and interpersonal problems, the present study examined empathy and other social skills of obese women with BED. The findings showed that five social skills were statistically associated with the chance of presenting BED. Obese women with less assertiveness, lower ability to express feelings, lower capacity to deal with strangers, lower ability to understand the perspective of others, and with higher levels of distress in interpersonal situations had a higher probability of presenting the diagnosis of BED. These results highlight an association between social skills deficits and BED.

Assessment of executive functions in obese individuals with binge eating disorder.

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

Review of literature of attention-deficit/hyperactivity disorder with comorbid eating disorders: [review] / Revisão da literatura sobre a comorbidade do transtorno do déficit de atenção e hiperatividade com transtornos alimentares: [revisão]

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

OBJETIVO: De acordo com os estudos de prevalência de comorbidades, até 70 por cento dos adultos com transtorno do déficit de atenção e hiperatividade apresentam pelo menos uma comorbidade psiquiátrica, ocasionando dificuldades diagnósticas e terapêuticas, bem como um maior prejuízo funcional. Existem poucos estudos sobre a comorbidade entre transtorno do déficit de atenção e hiperatividade e transtornos alimentares. O objetivo deste estudo foi realizar uma revisão da literatura sobre a comorbidade transtorno do déficit de atenção e hiperatividade/transtornos alimentares, realizando uma análise crítica dos dados encontrados. MÉTODO: Procedeu-se a uma revisão sistemática da literatura por meio de pesquisa bibliográfica de artigos publicados no período de 1980 a 2008, utilizando as bases de dados Medline, Lilacs, SciELO, ISI e PsycINFO. RESULTADOS: Foram identificados 14 artigos, sendo cinco estudos de prevalência de comorbidades, quatro relatos de casos, três estudos caso-controle, um estudo de avaliação de sintomas de transtorno do déficit de atenção e hiperatividade e de transtornos alimentares e um sobre as possíveis causas da associação entre transtorno do déficit de atenção e hiperatividade e transtornos alimentares. Os artigos identificados evidenciaram maior risco de desenvolvimento de transtornos alimentares, especialmente bulimia nervosa, em mulheres portadoras de transtorno do déficit de atenção e hiperatividade. As taxas de bulimia nervosa encontradas nos grupos com transtorno do déficit de atenção e hiperatividade variaram de 1 por cento a 12 por cento, enquanto que nos grupos controle foram de 0 por cento a 2 por cento. CONCLUSÕES: Embora pareça existir uma relação entre transtorno do déficit de atenção e hiperatividade e transtornos alimentares, a escassez de trabalhos existentes, com metodologias variadas e pequenas amostras avaliadas não permitem a generalização dos resultados.

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

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

Double-blind, randomized, placebo-controlled trial of topiramate plus cognitive-behavior therapy in binge-eating disorder.

OBJECTIVE: To evaluate the efficacy and tolerability of adjunctive topiramate compared to placebo in reducing weight and binge eating in obese patients with binge-eating disorder (BED) receiving cognitive-behavior therapy (CBT). METHOD: A double-blind, randomized, placebo-controlled trial of 21 weeks' duration was conducted at 4 university centers. Participants were 73 obese (body mass index >or= 30 kg/m(2)) outpatients with BED (DSM-IV criteria), both genders, and aged from 18 to 60 years. After a 2- to 5-week run-in period, selected participants were treated with group CBT (19 sessions) and topiramate (target daily dose, 200 mg) or placebo (September 2003-April 2005). The main outcome measure was weight change, and secondary outcome measures were binge frequencies, binge remission, Binge Eating Scale (BES) scores, and Beck Depression Inventory (BDI) scores. RESULTS: Repeated-measures random regression analysis revealed a greater rate of weight reduction associated with topiramate over the course of treatment (p < .001), with patients taking topiramate attaining a clinically significant weight loss (-6.8 kg) compared to patients taking placebo (-0.9 kg). Although rates of reduction of binge frequencies, BES scores, and BDI scores did not differ between groups during treatment, a greater number of patients of the topiramate plus CBT group (31/37) attained binge remission compared to patients taking placebo (22/36) during the trial (p = .03). No difference between groups was found in completion rates; 1 patient (topiramate group) withdrew for adverse effect. Paresthesia and taste perversion were more frequent with topiramate, and insomnia was more frequent with placebo (p < .05). CONCLUSIONS: Topiramate added to CBT improved the efficacy of the later, increasing binge remission and weight loss in the short run. Topiramate was well tolerated, as shown by few adverse events during treatment. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov identifier NCT00307619.

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.

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 percent 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.

OBJETIVO: Avaliar a efetividade da terapia cognitivo-comportamental baseada em um manual adaptado para o formato de grupo em uma amostra brasileira de obesos com transtorno da compulsão alimentar periódica. MÉTODO: Em um estudo aberto, 21 pacientes obesos com transtorno da compulsão alimentar periódica participaram de um programa da terapia cognitivo-comportamental em grupo. A freqüência da compulsão alimentar, o peso corporal, o grau de satisfação com a forma corporal e os sintomas depressivos foram avaliados no início do tratamento e no final do estudo. RESULTADOS: Houve uma redução estatisticamente significativa da freqüência média de episódios de compulsão alimentar entre a linha de base e o final do tratamento (p < 0,001), com uma taxa de remissão de episódios no final do estudo de 76,1 por cento. Foi observada, também, uma redução significativa dos sintomas depressivos e da insatisfação com a forma corporal (p < 0,001). Adicionalmente, a perda de peso foi clínica e estatisticamente significativa. CONCLUSÃO: A utilização de terapia cognitivo-comportamental baseada em um manual adaptado para o transtorno da compulsão alimentar periódica resultou em melhora significativa da compulsão alimentar, do peso corporal, da preocupação com a forma corporal e dos sintomas depressivos associados ao transtorno da compulsão alimentar periódica nessa amostra.

Transtorno do déficit de atenção e hiperatividade: contribuição diagnóstica de avaliação computadorizada de atenção visual / Attention-deficit/hyperactivity disorder: diagnostic contribution of a computerized assessment of visual attention

OBJETIVO: Identificar se o desempenho num teste de atenção visual permite diferenciar crianças e adolescentes portadoras de TDAH de indivíduos normais. MÉTODOS: 102 crianças e adolescentes com diagnóstico de TDAH, segundo os critérios do DSM-IV, submeteram-se ao Teste de Atenção Visual (TAVIS-III) e tiveram seus desempenhos comparados a 678 controles pareados de um grupo controle. Os indivíduos foram selecionados de duas escolas particulares e uma escola pública, de modo seqüencial com autorização dos pais. RESULTADOS: Uma análise com curvas ROC revelou que os índices tempo médio de reação na tarefa de atenção seletiva, número de erros por omissão na tarefa de atenção alternada e número de erros por ação na tarefa de atenção sustentada, quando comprometidos simultaneamente, revelaram sensibilidade e especificidade elevadas, com um valor preditivo positivo de 87,5 por cento. O valor preditivo negativo da associação de escores normais naqueles três índices foi de 99 por cento. CONCLUSÃO: TAVIS-III revelou-se eficiente para discriminar indivíduos normais de portadores de TDAH nesta amostra.

OBJECTIVE: To investigate if performances in a visual attention test could discriminate between children and adolescents with ADHD and normal subjects. METHODS: 102 children and adolescents diagnosed with ADHD according to DSM-IV were submitted to the Test of Visual Attention (TAVIS-III) and had their performance compared to 678 normal paired subjects who comprised a control comparison group. All of the subjects were sequentially recruited from one public and two private schools, following parents’ authorization. RESULTS: ROC curves analysis have shown that simultaneous impairment in hit reaction time of focused attention, omission errors in shifted attention and commission errors in sustained attention revealed high sensibility and specificity, with positive predictive value of 87.5 percent. The negative predictive value was of 99 percent when the aforementioned indexes occurred simultaneously within normal range. CONCLUSION: The Test of Visual Attention (TAVIS-III) was efficient to discriminate persons with ADHD and normal persons in this non clinical sample.

Evidências sobre a terapia cognitivo-comportamental no tratamento de obesos com transtorno da compulsão alimentar periódica / Evidence of cognitive-behavioral therapy in the treatment of obese patients with binge eating disorder

OBJETIVOS: Avaliar as evidências sobre a eficácia da terapia cognitivo-comportamental no tratamento de obesos com transtorno da compulsão alimentar periódica. MÉTODOS: Nesta revisão, foram incluídos ensaios clínicos e metanálises publicados entre janeiro de 1980 e fevereiro de 2006, em todas as línguas. Foram excluídos estudos que investigassem a eficácia da terapia cognitivo-comportamental com uso concomitante de medicação, terapia cognitivo-comportamental no formato de manuais de auto-ajuda, relatos ou série de casos e cartas ao editor. As bases eletrônicas de dados consultadas foram: MEDLINE, PsycINFO, Embase, LILACS e Cochrane Library. A estratégia de busca incluiu também a checagem manual das referências bibliográficas dos artigos selecionados e de capítulos de livros sobre o tema. RESULTADOS: Foram encontrados dois ensaios clínicos abertos e 15 controlados. O desfecho primário na maioria desses estudos é a compulsão alimentar. No geral, os ensaios clínicos avaliados sugerem que o uso da terapia cognitivo-comportamental resulta numa melhora significativa da compulsão alimentar e dos sintomas psicopatológicos associados ao transtorno da compulsão alimentar periódica, sem resultar em perda de peso substancial. CONCLUSÕES: As evidências disponíveis sugerem que a terapia cognitivo-comportamental é um método de tratamento eficaz para o transtorno da compulsão alimentar, em relação aos componentes psicológicos dessa condição. Entretanto, sua eficácia na redução do peso corporal e na manutenção dos seus efeitos no longo prazo ainda precisa ser melhor investigada.

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.

Distribuição de transtornos alimentares em indivíduos com diabetes melito do tipo 1 e do tipo 2: descrição de dois casos / Distribution of eating disorders in subjects with type 1 and type 2 diabetes mellitus: a description of two cases

A presença de alterações do comportamento alimentar parece estar aumentada no diabetes melito (DM). Entretanto, a distribuição das diversas categorias de transtornos alimentares tende a se distinguir de acordo com a fisiopatologia do diabetes. O objetivo dessa apresentação é discutir dois casos distintos de ocorrência de transtornos alimentares no DM do tipo 1 (DM1) e no DM do tipo 2 (DM2). A paciente A é do sexo feminino, tem 19 anos e apresenta DM1 desde os 13 anos. Evidenciava sintomas depressivos proeminentes e, há 2 anos, passou a apresentar episódios de compulsão alimentar seguidos de vômitos auto-induzidos e omissão das doses de insulina com o objetivo de evitar ganho de peso. Em função desse comportamento, apresentou diversas internações associadas a uma piora do controle glicêmico. Após o uso de fluoxetina, houve remissão da psicopatologia alimentar e melhora do controle do DM. A paciente B possui 42 anos e é portadora do DM2 há 6 anos. Apresenta obesidade grau II e vinha exibindo, antes mesmo do diagnóstico do DM2, episódios de compulsão alimentar na ausência de comportamentos compensatórios, que prejudicavam o controle metabólico do diabetes. Foi iniciada fluoxetina até a dose de 60 mg/dia, com remissão do descontrole alimentar, perda ponderal e redução da hemoglobina glicosilada. A incidência de transtornos alimentares no DM1 estaria associada com um aumento da preocupação com a forma corporal e a possibilidade da omissão do uso da insulina como comportamento compensatório. No DM2, a obesidade seria um dos fatores associados ao desenvolvimento da psicopatologia alimentar.

The presence of changes in eating behavior seems to be increased in diabetes mellitus (DM). However, the distribution of varied categories of eating disorders tends to be distinguished according to the physiopathology of diabetes. The objective of this report is to discuss two distinct cases of eating disorders in type 1 (T1DM) and type 2 diabetes mellitus (T2DM). Patient A is a 19-year-old female who has had T1DM since she was 13 years old. She presented prominent depressive symptoms and 2 years ago she started presenting binge eating episodes followed by self-induced vomits and insulin omission to avoid weight gain. Due to this behavior, she had several hospitalizations associated with worse glycemic control. After treatment with fluoxetine, there was remission of eating psychopathology and improvement in DM control. Patient B is a 42-year-old female who has had T2DM for 6 years. She has grade II obesity and had been showing, even before the diagnosis of T2DM, binge eating episodes in the absence of compensatory behaviors that jeopardized the metabolic control of DM. She started a treatment with fluoxetine up to 60 mg/day, with remission of binge eating, weight loss and reduction in glycosylated hemoglobin. The incidence of eating disorders in T1DM seems to be associated with an increase in concern with body shape and the possibility of insulin omission as a compensatory behavior. In T2DM, obesity seems to be one of the factors associated with the development of eating psychopathology.

Transtornos alimentares comórbidos em uma amostra clínica de adultos com transtorno do déficit de atenção com hiperatividade / Comorbid eating disorders in a Brazilian Attention-Deficit/Hyperactivity Disorder adult clinical sample

A comorbidade de transtornos alimentares (TA) com o transtorno do déficit de atenção com hiperatividade (TDAH) é pouco investigada, apesar de relevante para o tratamento clínico. MÉTODOS: 86 adultos com transtorno do déficit de atenção com hipeartividade segundo o DSM-IV de uma amostra inicial de 107 indivíduos auto-referidos para um centro especializado em TDAH foram entrevistados com o SCID-P para avaliar a presença de transtornos alimentares e outros transtornos comórbidos. RESULTADOS: Nove pacientes apresentavam transtornos alimentares, sendo o transtorno da compulsão alimentar periódica (TCAP) o diagnóstico mais comum. O grupo com transtornos alimentares revelou maior número de comorbidades (p=0,02), não foram observadas, entretanto, diferenças quanto ao sexo, idade na avaliação atual, escolaridade e tipo de transtorno do déficit de atenção com hiperatividade entre os grupos. CONCLUSÃO: Amostras clínicas de transtorno do déficit de atenção com hiperatividade podem apresentar elevada prevalência de comorbidade com transtorno da compulsão alimentar periódica. Pacientes com transtorno do déficit de atenção com hiperatividade e transtornos alimentares podem apresentar um perfil diferente de comorbidades.

[Neuropsychology of eating disorders: a systematic review of the literature]. / Neuropsicologia dos transtornos alimentares: revisão sistemática da literatura.

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

Neuropsicologia dos transtornos alimentares: revisão sistemática da literatura / Neuropsychology of eating disorders: a systematic review of the literature

ANTECEDENTES: A etiologia dos transtornos alimentares (TA) ainda não se encontra estabelecida. Dentre os diversos fatores envolvidos, a hipótese de uma disfunção do sistema nervoso central tem sido explorada de diversas maneiras. Assim, a avaliação neuropsicológica de pacientes com TA tem por finalidade investigar a ocorrência de déficits cognitivos associados a estas patologias. OBJETIVOS: O objetivo deste artigo é avaliar o estado atual das investigações sobre a avaliação neuropsicológica em pacientes com TA. MÉTODOS: Foi realizada uma pesquisa bibliográfica - utilizando as seguintes bases de dados como estratégias de procura: MedLINE, PsychoINFO, LILACS e Cochrane Data Bank -, procurando artigos relacionados ao tema e publicados até o ano de 2004. RESULTADOS: A anorexia nervosa é o transtorno alimentar que conta com mais estudos neuropsicológicos e, de uma forma geral, os resultados apontam para déficits de atenção, déficits viso-espaciais e de viso-construção. Na bulimia nervosa, as alterações mais encontradas são déficits de atenção seletiva e das funções executivas. O transtorno da compulsão alimentar periódica ainda não conta com estudos neuropsicológicos até o momento. Após um tratamento bem-sucedido do transtorno alimentar, embora haja uma diminuição dos déficits cognitivos, algumas alterações cognitivas parecem persistir. CONCLUSÕES: Os transtornos alimentares parecem estar associados a algum grau de disfunção neuropsicológica, muito embora as funções específicas que se apresentam deficitárias variem entre os estudos encontrados, talvez em decorrência de variações metodológicas. O fato de que, após o tratamento, alguns pacientes apresentem uma melhora no funcionamento cognitivo poderia indicar que, em alguns casos, os déficits seriam funcionais. A ausência de melhora no funcionamento cognitivo de alguns pacientes, após diversas formas de intervenção, pode sugerir que estes déficits antecederiam o desenvolvimento dos transtornos alimentares, podendo, assim, contribuir para seu desenvolvimento ou para um pior prognóstico. O melhor delineamento do perfil cognitivo dos pacientes com transtorno alimentar torna-se importante para orientar abordagens terapêuticas mais seletivas.

[Comorbid eating disorders in a Brazilian attention-deficit/hyperactivity disorder adult clinical sample]. / Transtornos alimentares comórbidos em uma amostra clínica de adultos com transtorno do déficit de atenção com hiperatividade.

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

Terapia cognitivo-comportamental dos transtornos alimentares / Cognitive-behavioural therapy of eating disorders

A terapia cognitivo-comportamental é uma intervençäo breve, semi-estruturada e orientada para metas, que tem sido amplamente utilizada nos centros de pesquisa e tratamento de transtornos alimentares. O presente artigo tem por objetivo descrever as principais estratégias cognitivas e comportamentais utilizadas no tratamento ambulatorial dos transtornos alimentares. Vários ensaios clínicos avaliaram a eficácia da terapia cognitivo-comportamental, indicando que ela favorece a remissäo ou diminuiçäo da freqüência de episódios de compulsäo alimentar, dos comportamentos purgativos e da restriçäo alimentar. Tem sido relatada também melhora do humor, do funcionamento social, e diminuiçäo da preocupaçäo com peso e formato corporal

O consenso latino-americano em obesidade / The latin-american obesity consensus

A obesidade é fator de risco para várias patologias e sua prevalência vem aumentando em vários países. Ela foi considerada um grave problema de saúde pública pela Organização Mundial de Saúde e diversas modalidades de tratamento têm sido propostas para a obtenção de redução de peso. Esse fato levou à necessidade de sistematizar as estratégias de tratamento da obesidade cujos resultados foram adequadamente testados. Com esta finalidade, foi elaborado o Consenso Latino-Americano em Obesidade, um documento que descreve as estratégias eficazes e éticas que devem ser utilizadas no tratamento do obeso. O objetivo deste artigo é descrever a metodologia utilizada para a elaboração do Consenso Latino-Americano em Obesidade, seu conteúdo e as políticas governamentais que estão sendo desenvolvidas para diminuir a prevalência de obesidade (AU)