Estudio comparativo de psicoterapia cognitivo-conductual y terapia nutricional en pacientes con diferentes tipos de trastornos de la conducta alimentaria / Comparative study of cognitive-behavioral psychotherapy and nutritional support in patients with different types of eating disorders

Fundamento y objetivo: Existen varios enfoques psicológicos para el tratamiento de la disfunción eréctil con eficacia siendo revelado por la investigación empírica; sin embargo ninguno de ellos es universalmente aceptada. El objetivo fue comparar la respuesta a la terapia cognitivo-conductual en pacientes con diferentes formas clínicas de trastornos de la alimentación. Material y método: Setenta y cuatro pacientes con diagnóstico de trastornos de la alimentación, 32 con anorexia nerviosa (AN), 19 con bulimia nerviosa (BN) y 23 con trastornos no especificados (TCANE) Comer fueron incluidos. Se trata de un estudio prospectivo y comparativo. Los pacientes fueron tratados con psicoterapia, el tratamiento nutricional y farmacológico. Resultados:Las tasas de recuperación en los grupos de pacientes con AN, BN y TCANE fueron 14 (43,7%), 8 (42,1%), 10 (43,4%), respectivamente, p> 0,05. Las tasas de mejoría fueron 14 (43,7%), 10 (52,6%), 12 (52,1%) para la AN, BN y TCANE, respectivamente, p> 0,05. Por último, la tasa de pacientes que tuvieron un mal resultado fueron 3 (9,3%), 1 (5,2%), y 1 (4,3%), p> 0,05, para AN, BN y TCANE, respectivamente. El análisis de regresión de Cox mostró que la edad de inicio de la enfermedad y no uso de drogas psicotrópicas predijeron una buena respuesta en los pacientes con disfunción eréctil. Conclusiones: La respuesta al tratamiento con terapia cognitivo-conductual, el apoyo nutricional y las drogas psicotrópicas en la mayoría de los pacientes fue favorable y similar en la mayoría de los pacientes con diferentes tipos de trastornos de la alimentación. Por otra parte, una edad temprana y no uso de drogas psicotrópicas predicen un resultado favorable en los pacientes con disfunción eréctil (AU)

Background and objective: There are several psychological approaches to treat ED with efficacy being revealed by empirical research; however none of them are universally accepted. The objective was to compare response to Cognitive Behavioral Therapy in patients with different clinical forms of Eating Disorders. Material and method: Seventy-four patients diagnosed with eating disorders, 32 with Anorexia nervosa (AN), 19 with Bulimia nervosa (BN) and 23 with Eating disorders not otherwise specified (EDNOS) were included. This is a prospective and comparative study. Patients were treated by psychotherapy, nutritional treatment and pharmacotherapy. Results: The recovery rates in the groups of patients with AN, BN and EDNOS were 14 (43.7%), 8 (42.1%), 10 (43.4%), respectively, p > 0.05. The rates of improvement were 14 (43.7%), 10 (52.6%), 12 (52.1%) for AN, BN and EDNOS, respectively, p > 0.05. Finally, the rate of patients who had poor outcome were 3 (9.3%), 1 (5.2%), and 1 (4.3%), p > 0.05, for AN, BN, and EDNOS, respectively. Cox regression analysis showed that the age of disease onset and no use of psychotropic drugs predicted a good response in patients with ED. Conclusions: The treatment response to Cognitive Behavioral Therapy, nutritional support and psychotropic drugs in the majority of patients was favorable and similar in most patients with different types of Eating Disorders. Furthermore, a young age and no use of psychotropic drugs predict a favorable outcome in patients with ED (AU)

Comparative study of cognitive-behavioral psychotherapy and nutritional support in patients with different types of eating disorders.

BACKGROUND AND OBJECTIVE: There are several psychological approaches to treat ED with efficacy being revealed by empirical research; however none of them are universally accepted. The objective was to compare response to Cognitive Behavioral Therapy in patients with different clinical forms of Eating Disorders. MATERIAL AND METHOD: Seventy-four patients diagnosed with eating disorders, 32 with Anorexia nervosa (AN), 19 with Bulimia nervosa (BN) and 23 with Eating disorders not otherwise specified (EDNOS) were included. This is a prospective and comparative study. Patients were treated by psychotherapy, nutritional treatment and pharmacotherapy. RESULTS: The recovery rates in the groups of patients with AN, BN and EDNOS were 14 (43.7%), 8 (42.1%), 10 (43.4%), respectively, p>0.05. The rates of improvement were 14 (43.7%), 10 (52.6%), 12 (52.1%) for AN, BN and EDNOS, respectively, p>0.05. Finally, the rate of patients who had poor outcome were 3 (9.3%), 1 (5.2%), and 1 (4.3%), p>0.05, for AN, BN, and EDNOS, respectively. Cox regression analysis showed that the age of disease onset and no use of psychotropic drugs predicted a good response in patients with ED. CONCLUSIONS: The treatment response to Cognitive Behavioral Therapy, nutritional support and psychotropic drugs in the majority of patients was favorable and similar in most patients with different types of Eating Disorders. Furthermore, a young age and no use of psychotropic drugs predict a favorable outcome in patients with ED.

Factors influencing the outcome of patients with incidental papillary thyroid microcarcinoma.

Objective. To analyze some factors that could influence the outcome of patients with PTMC. Material and Methods. This is a longitudinal observational study. All patients diagnosed and treated for papillary thyroid microcarcinoma at the University Hospital of Vigo, between January 1994 and December 2003, were included in the present study. Demographic characteristics, tumour characteristics, TNM stage, rate of recurrence, and treatment with (131)I were the study variables. Results. Ninety-one patients (75 females) with an average age of 47.7 ± 13.4 years, range 19-81, were studied. Initial tumour staging was T1 in 90 patients and T4a in 1 case. Initial lymph node involvement was present in 4 cases (4.4%). We only found one case with distant metastases at diagnosis. Postsurgical evaluation of thyroid specimens revealed that 28 (30.7%) tumours were multifocal. The average size of the tumour was 0.44 ± 0.25 cm, range 0.1-1. Univariate analysis reveals a statistically significant association between tumour multifocality and postsurgical (131)I therapy with the recurrence rate. In the multivariate analysis only multifocality (P = 0.037, HR 5.7) was a significant risk factor for the recurrence rate. Conclusions. Our results indicate that tumour multifocality is an independent predictor of relapse but neither the tumour size nor postsurgical (131)I therapy.

High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study.

PURPOSE: To determine the incidence and prevalence of eating disorder and its clinical forms. METHODS: All new ED cases of both genders, ≥15 years old, diagnosed from January 2005 to December 2009 were included. All patients who suffered from ED in December 2009 were included in the prevalence study. This is a prospective, population-based study. Cumulative incidence rates and 20-year prevalence were calculated. RESULTS: The ED incidence was 14.1 (95% CI 11.4-16.1) cases per 100,000 inhabitants per year, for AN, BN and EDNOS 3.1 (95% CI 2.00-4.1), 4.4 (95% CI 3.0-8.00) and 6.5 (95% CI 4.8-7.9), respectively. The incidence of ED at the four age-intervals, 15-24, 25-34, 35-45 and >45 years, revealed that the 25-34-year interval had the highest incidence; moreover, new cases were observed even in the >45-year interval. The prevalence of ED was 82.8 (95% CI 69.4-94.5) per 100,000 inhabitants, being for AN, BN and EDNOS 18.6 (95% CI 12.5-24.4), 25.7 (95% CI 18.5-32.5) and 38.3 (95% CI 29.4-46.5), respectively. CONCLUSIONS: The incidence and prevalence of EDNOS are the highest in the ED cases; furthermore, new cases of ED are observed above the age of 45, which are remarkable data.

Disordered eating behaviors in type 1 diabetic patients.

Patients with type 1 diabetes mellitus are at high risk for disordered eating behaviors (DEB). Due to the fact that type 1 diabetes mellitus is one of the most common chronic illnesses of childhood and adolescence, the coexistence of eating disorders (ED) and diabetes often affects adolescents and young adults. Since weight management during this state of development can be especially difficult for those with type 1 diabetes, some diabetics may restrict or omit insulin, a condition known as diabulimia, as a form of weight control. It has been clearly shown that ED in type 1 diabetics are associated with impaired metabolic control, more frequent episodes of ketoacidosis and an earlier than expected onset of diabetes-related microvascular complications, particularly retinopathy. The management of these conditions requires a multidisciplinary team formed by an endocrinologist/diabetologist, a nurse educator, a nutritionist, a psychologist and, frequently, a psychiatrist. The treatment of type 1 diabetes patients with DEB and ED should have the following components: diabetes treatment, nutritional management and psychological therapy. A high index of suspicion of the presence of an eating disturbance, particularly among those patients with persistent poor metabolic control, repeated episodes of ketoacidosis and/or weight and shape concerns are recommended in the initial stage of diabetes treatment, especially in young women. Given the extent of the problem and the severe medical risk associated with it, more clinical and technological research aimed to improve its treatment is critical to the future health of this at-risk population.

Treatment of Graves' hyperthyroidism with thionamides-derived drugs: review.

Thionamide-derived antithyroid drugs (ATD) have been in use for over half a century and much is now known about their mechanism of action, pharmacokinetics and clinical pharmacology. Candidates for first option ATD therapy are young adults, without large goitre. The recommended initial dose for patients without big goitre and mild hyperthyroidism is 20 mg of MMI/CBZ. The recommended maintenance doses are 5-10 mg of MMI/CBZ. In cases of big goitre and/or severe hyperthyroidism the recommended initial dose is 30 to 40 mg/day. PTU use should be restricted to first trimester of pregnancy, doses should be as low as possible (150 to 200 mg/day) and then changing to MMI is recommended. Treatment Duration should be of 12-18 months. ATD plus thyroxine combination therapy have not advantage on ATD alone. ATD plus L-Thyroxine regimens should be used to avoid hypothyroidism when patients are with maintenance doses of ATD drugs in order to relax monitoring. In this case a low dose of T4 50-75 µg per day is used. Breast feeding women with hyperthyroidism can be treated with MMI/CBZ. ATD will not stop until serum stimulating TSH-receptors antibodies values are within the normal range. We are waiting for results of ongoing studies of biochemical and/or genetic markers that will permit us to predict the outcome of these patients after ATD treatment is stopped.

Prevalencia e incidencia de la enfermedad de Crohn en Galicia / Prevalence and incidence of Crohn¿s disease in Galicia, Spain

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Psicoterapia cognitiva conductual en el tratamiento de la obesidad / Psychotherapy cognitive conductual in the obesity treatment

La obesidad es una enfermedad crónica. Entre los tratamientos existentes, tienen mayor efectividad a largo plazo, aquellos que implican un cambio de hábitos alimentarios y de actividad física, un cambio de estilo de vida. La modificación de estos hábitos requiere el uso de técnicas psicológicas específicas. En el presente artículo proponemos la inclusión de psicoterapia cognitivo-conductual dentro del tratamiento multidisciplinar de la obesidad con el objetivo de conseguir el mantenimiento a largo plazo del peso perdido.

Obesity is a chronic disease. The treatment adult obesity is difficult and long-term results often are disappointing. Current management of this disease is based in the modification of the lifestyle, mainly regarding to eating habits and physical activity. Modification of any habit requires the use of specific psychological methods. In the present article we propose the use of cognitive-behavioural therapy as adjuvant in the regular therapy of obese patients, in order to maintain the loss weight.

[Psychological treatment for obesity]. / Tratamiento psicológico de la obesidad.

Obesity is a chronic disease. Current management is based in the modification of the lifestyle, mainly regarding to eating habits and physical activity. Eating habits are acquired during the childhood and kept through the entire life. Modification of any habit requires the use of specific psychological methods such as cognitive-behavioural therapy, which is based on first notions of learning theories. Very often, obese patients and therapist think that the obesity is a problem not related to other aspects of their lives. Thus the objective of the treatment is only weight loss, instead of looking for a modification of patient's behaviour. In the present review we try to update the treatment of obesity in adult patients mainly regarding to the psychological approach.

Tratamiento psicológico de la obesidad / Psychological treatment for obesity

La obesidad es una enfermedad crónica. Entre los tratamientos existentes, tienen mayor efectividad a largo plazo aquellos que implican un cambio de hábitos alimentarios y de actividad física, es decir, un cambio de estilo de vida. Los hábitos alimentarios los aprendemos en la infancia, en la primera década de la vida; esas conductas quedarán fuertemente fijadas y tenderemos a ejecutarlas a lo largo de la vida. La modificación de estos hábitos requiere el uso de técnicas psicológicas específicas como las incluidas en la psicoterapia cognitivo-conductual. Muchos obesos acuden a consulta con la idea de que la obesidad es un problema independiente de las demás áreas de su vida. Muchas veces esta actitud se ve reforzada por la conducta del terapeuta, que centra la pérdida rápida de peso como objetivo único de tratamiento más que el cambio profundo de la conducta. En la presente revisión pretendemos poner al día el manejo del paciente obeso, especialmente en lo referente al tratamiento psicológico

Obesity is a chronic disease. Current management is based in the modification of the lifestyle, mainly regarding to eating habits and physical activity. Eating habits are acquired during the childhood and kept through the entire life. Modification of any habit requires the use of specific psychological methods such as cognitive-behavioural therapy, which is based on first notions of learning theories. Very often, obese patients and therapist think that the obesity is a problem not related to other aspects of their lives. Thus the objective of the treatment is only weight loss, instead of looking for a modification of patient's behaviour. In the present review we try to update the treatment of obesity in adult patients mainly regarding to the psychological approach