Charakteristika schwer essgestörter Patientinnen in einer universitären Einrichtung und therapeutische Richtlinien

Patientinnen und Patienten mit einer schweren Essstörung (Anorexie, Bulimie, weitere) finden einerseits selten Eingang in systematische Studien, sind andererseits aber häufig auf ein stationäres Behandlungssetting in einem tertiären Zentrum angewiesen. Die kürzlich veröffentlichte S3-Leitlinie zur Behandlung von Essstörungen erlaubt eine klarere Einschätzung der Hospitalisationsbedürftigkeit schwer Essgestörter als bisher. In der vorliegenden Arbeit wurden 26 Patientinnen und Patienten mit einer schweren Essstörung, die konsekutiv auf einer spezialisierten psychosomatisch/internistischen universitären Einrichtung hospitalisiert wurden, retrospektiv hinsichtlich ihrer biologischen, psychologischen und sozialen Merkmale charakterisiert und in Bezug zur S3-Leitlinie gestellt. Die biopsychosozialen Charakteristika der untersuchten Population zeigen, dass die Hospitalisierung schwer Essgestörter im tertiärmedizinischen Setting mit einem multiprofessionellen Behandlungsteam evidenzbasiert erfolgt.

Intermediate results of health related quality of life after vertical banded gastroplasty

OBJECTIVES: The purpose of this study is to evaluate (a) health-related quality of life (HRQL) after vertical banded gastroplasty (VBG) (Mason) and (b) predictors of HRQL. SUBJECTS: Eighty-two consecutive patients were assessed preoperatively and then after 6, 12 and 24 months. Patients filled out questionnaires for subjective appraisal of HRQL (physical well-being, mood, physical performance, perceived health, social support and coping/adjustment). RESULTS: The greatest improvement in weight and HRQL was seen within 6 months of surgery. Twenty-four months after VBG weight reduction (P<0.05), perceived health (P<0.05), physical well-being (P<0.05), physical performance (P<0.05), mood (P<0.05), coping/adjustment (P<0.05) continued to be better than before surgery. Preoperative binge eating was the most important predictor of HRQL. CONCLUSION: Two years after VBG weight loss and a significant improvement of HRQL can be found. HRQL and weight loss are not associated in terms of outcome, indicating that weight loss alone may not be enough to improve HRQL.

Behavioral responses to catecholamine depletion in unmedicated, remitted subjects with bulimia nervosa and healthy subjects

BACKGROUND: Bulimia nervosa (BN) has been associated with dysregulation of the central catecholaminergic system. An instructive way to investigate the relationship between catecholaminergic function and psychiatric disorder has involved behavioral responses to experimental catecholamine depletion (CD). The purpose of this study was to examine a possible catecholaminergic dysfunction in the pathogenesis of bulimia nervosa. METHODS: CD was achieved by oral administration of alpha-methyl-para-tyrosine (AMPT) in 18 remitted female subjects with BN (rBN) and 31 healthy female control subjects. The study design consisted of a randomized, double blind, placebo-controlled crossover, single-site experimental trial. The main outcome measures were bulimic symptoms assessed by the Eating Disorder Examination-Questionnaire. Measures were assessed before and 26, 30, 54, 78, 102 hours after the first AMPT or placebo administration. RESULTS: In the experimental environment (controlled environment with a low level of food cues) rBN subjects had a greater increase in eating disorder symptoms during CD compared with healthy control subjects (condition × diagnosis interaction, p < .05). In the experimental environment, rBN subjects experienced fewer bulimic symptoms than in the natural environment (uncontrolled environment concerning food cues) 36 hours after the first AMPT intake (environment × diagnosis interaction, p < .05). Serum prolactin levels increased significantly, and to a comparable degree across groups, after AMPT administration. CONCLUSIONS: This study suggests that rBN is associated with vulnerability for developing eating disorder symptoms in response to reduced catecholamine neurotransmission after CD. The findings support the notion of catecholaminergic dysfunction as a possible trait abnormality in BN.

Individual differences in the sensory perception of fats

Excessive consumption of dietary fat is acknowledged to be a widespread problem linked to a range of medical conditions. Despite this, little is known about the specific sensory appeal held by fats and no previous published research exists concerning human perception of non-textural taste qualities in fats. This research aimed to address whether a taste component can be found in sensory perception of pure fats. It also examined whether individual differences existed in human taste responses to fat, using both aggregated data analysis methods and multidimensional scaling. Results indicated that individuals were able to detect both the primary taste qualities of sweet, salty, sour and bitter in pure processed oils and reliably ascribe their own individually-generated taste labels, suggested that a taste component may be present in human responses to fat. Individual variation appeared to exist, both in the perception of given taste qualities and in perceived intensity and preferences. A number of factors were examined in relation to such individual differences in taste perception, including age, gender, genetic sensitivity to 6-n-propylthiouracil, body mass, dietary preferences and intake, dieting behaviours and restraint. Results revealed that, to varying extents, gender, age, sensitivity to 6-n-propylthiouracil, dietary preferences, habitual dietary intake and restraint all appeared to be related to individual variation in taste responses to fat. However, in general, these differences appeared to exist in the form of differing preferences and levels of intensity with which taste qualities detected in fat were perceived, as opposed to the perception of specific taste qualities being associated with given traits or states. Equally, each of these factors appeared to exert only a limited influence upon variation in sensory responses and thus the potential for using taste responses to fats as a marker for issues such as over-consumption, obesity or eating disorder is at present limited.

Is maternal psychopathology related to obesigenic feeding practices at 1 year?

Objective: To investigate the relationship between maternal psychopathological symptomatology during pregnancy and at 6 and 12 months postnatally and maternal use of controlling and restrictive feeding practices at 1 year. Research Methods and Procedures: Eighty-seven women completed a measure of psychological distress during pregnancy and at 6 and 12 months postpartum, and at 12 months postnatally these women reported their usage of controlling and restrictive feeding practices and were observed feeding their infants. Results: General psychological distress, particularly anxious psychopathology, during pregnancy and at 6 and 12 months postnatally was significantly associated with maternal use of restrictive feeding practices at 1 year, even when controlling for length of breast-feeding and the infants' weights at 1 year. Contrary to expectations, depression and eating psychopathology as measured by the SCOFF eating disorder measure during pregnancy or at 6 or 12 months postnatally were not associated with the use of controlling or restrictive feeding practices at 1 year. Discussion: These findings indicate that anxious maternal psychopathology may partially explain the development of maternal use of restriction when feeding. Copyright © 2005 NAASO.

A Study of the Behavioural and Affective Profile of Inpatient Adolescent Girls Presenting a Restrictive Anorexia Nervosa

Essai doctoral d'intégration présenté à la Faculté des Études Supérieures et Postdoctorales en vue de l'obtention du grade de Docteur en psychologie (D.Psy.), en psychologie clinique

A Study of the Behavioural and Affective Profile of Inpatient Adolescent Girls Presenting a Restrictive Anorexia Nervosa

Essai doctoral d'intégration présenté à la Faculté des Études Supérieures et Postdoctorales en vue de l'obtention du grade de Docteur en psychologie (D.Psy.), en psychologie clinique

De Invloed van Mentale Veerkracht op Copingstrategieën bij Eetproblematiek

Dit onderzoek bestudeerde het verband tussen probleemgerichte- en emotiegerichte coping en eetproblematiek en onderzocht daarnaast of mentale veerkracht de relaties tussen probleemgerichte en emotiegerichte coping enerzijds en eetproblematiek anderzijds beïnvloedt. Het doel van dit onderzoek was het verkrijgen van meer inzicht in de rol van mentale veerkracht als mogelijke moderator van de relatie tussen coping en eetproblematiek. Er is een eenmalige meting verricht bij jong volwassen vrouwen van 18 t/m 30 jaar uit de algemene populatie. Via e-mail en sociale media zijn online vragenlijsten verspreid die bruikbare gegevens opleverden van in totaal 188 vrouwen. Meetinstrumenten. Coping is gemeten middels de Utrechtse Coping Lijst (UCL) (Schreurs, Willige, van de Tellegen & Brosschot, 1988; Schreurs, Willige, van de Tellegen & Brosschot, 1993); mentale veerkracht is gemeten met behulp van de Resilience Scale-Nederlandse versie (RS-nl) (Portzky, 2008); en de mate van eetproblematiek is gemeten met de Eating Disorder Examination Questionnaire (EDE-Q) (Fairburn & Beglin, 1994). De resultaten hebben aangetoond dat er een significant negatief verband bestaat tussen probleemgerichte coping en mate van eetproblematiek en een significant positief verband tussen emotiegerichte coping en eetproblematiek. De negatieve samenhang tussen probleemgerichte coping en eetproblematiek bleek sterker bij een lagere mate van mentale veerkracht. De positieve samenhang tussen emotiegerichte coping en eetproblematiek bleek eveneens sterker bij een lagere mentale veerkracht. Personen met een lage mentale veerkracht en een ineffectieve (emotiegerichte of weinig probleemgerichte) copingstijl bleken de meeste eetproblemen te ervaren, bij een hoge mentale veerkracht werd de minste eetproblematiek gerapporteerd, ongeacht de gehanteerde copingstijl.

Prevalência e Sintomatologia Associada a Doenças do Comportamento Alimentar em Adolescentes

As Doenças do Comportamento Alimentar apresentam-se como um problema de saúde proeminente e, como tal, devem ser entendidas como multidimensionais e complexas, que interagem com factores biológicos, psicológicos e sócio-culturais e, que podem ocorrer devido a comportamentos alimentares de carácter patológico e com consequências sérias na qualidade de vida presente e futura. Este trabalho de investigação teve como principal objectivo avaliar a prevalência das Doenças do Comportamento Alimentar numa população não clínica de estudantes, assim como caracterizar o perfil socio-demográfico e familiar dos estudantes e, determinar a relação entre a sintomatologia associada a perturbações do comportamento alimentar e o sexo, idade, IMC, tipo de família, vinculação aos pais e ano de escolaridade dos adolescentes. No intuito de concretizar os objectivos, realizámos um estudo não experimental, transversal e correlacional. A amostra foi constituída por 326 estudantes do 3º Ciclo e do Ensino Secundário da zona centro de Portugal. Foram aplicados um questionário anónimo composto por dados socio-demográficos, antropométricos e clínicos, o Eating Disorder Inventory 2 (EDI 2) e o Questionário de Vinculação ao Pai e à Mãe (QVPM). De acordo com os critérios presentes no DSM-IV-TR não encontramos qualquer caso de Bulimia Nervosa em ambos os sexos. Nas raparigas, constatamos 1,5% de casos prováveis de Anorexia Nervosa tipo Restritivo, 0% de casos prováveis de Anorexia Nervosa tipo Purgativa, 17,3% de casos prováveis de Anorexia Nervosa Restritiva Parcial e 6,1% de casos prováveis de Anorexia Nervosa Purgativa Parcial. Quanto aos rapazes, relatam-se 0,8% de casos prováveis de Anorexia Nervosa tipo Restritivo, 0% de casos prováveis de Anorexia Nervosa tipo Purgativa, 5,2% de situações parciais de Anorexia Nervosa Restritiva e 1,8% de situações parciais de Anorexia Nervosa Purgativa. Foram observadas também, correlações entre a sintomatologia associada a perturbações do comportamento alimentar consoante o sexo, idade, IMC, tipo de família, vinculação aos pais e ano de escolaridade dos inquiridos. Concluímos que todo o sistema familiar e escolar, especialmente pais e professores, devem estar alerta para os sinais manifestados pelos adolescentes no sentido de dar à prevenção um papel fulcral.

O Efeito da Terapia Cognitivo Comportamental na Anorexia Nervosa: uma meta-análise

Introdução: A Anorexia Nervosa (AN) é a perturbação do comportamento alimentar (PCA) com a maior taxa de mortalidade de todos os transtornos psiquiátricos. Carateriza-se pela recusa em manter um peso corporal normal mínimo, pela distorção da imagem corporal e por um obsessivo medo de ganhar peso. Os comportamentos patológicos a ela associados podem levar a uma semi-inanição que necessita de cuidados médicos pluridisciplinares, muitas vezes, em regime de internamento. Vários ensais clínicos avaliaram a eficácia da Terapia Cognitivo- Comportamental (TCC), indicando que ela favorece a remissão ou a diminuição da frequência de episódios de compulsão alimentar, dos comportamentos purgativos e da restrição alimentar. Objetivo: Combinar os resultados da melhor evidência científica de forma a avaliar a eficácia da TCC em comparação com outras terapias utilizadas no tratamento da AN. Métodos: A pesquisa realizou-se nas bases de dados eletrónicas da MEDLINE, Psyc-Info, Embase, CCTR e de forma manual, incluindo ensaios clínicos controlados randomizados que comparam a TCC com qualquer outro tipo de intervenção no tratamento da AN. Resultados: Foram incluídos 10 estudos que envolveram 957 pacientes: dos quais 571 (59,7%) foram submetidos a tratamento com Terapia cognitivo comportamental e 556 (49,3%) a outras terapias. Não se registaram diferenças significativas nos resultados obtidos em diversos outcomes, exceto nas subescalas Restrições (z=3,03; p=0,02), Preocupações alimentares (z=2,98; p=0,002) e Preocupações com a forma (z=1,71; p=0,09) do EDE e nos scores da escala GAF (z=1,87; p=0,06). Registaram-se diferenças estatisticamente significativas no número de episódios bulímicos (z=2,61; p=0,009), número de episódios de indução de vómito (z=2,11; p=0,03) e no número de episódios de uso indevido de laxantes (z=3,04; p=0,002). Conclusão: A utilização da Terapia Cognitivo-Comportamental no tratamento de doentes com AN parece melhorar bastante os sintomas da doença, revelando-se particularmente eficaz nos resultados obtidos na Eating Disorder Examination Scale. A sua utilização parece levar a uma melhoria no scores da GAF, evidenciando uma melhoria geral do estado de saúde dos pacientes (redução dos episódios de vómito, bulimia e uso de laxantes). / Página | viii ABSTRACT Background: Anorexia Nervosa is an eating disorder with the highest mortality rate of all psychiatric disorders. It is characterized by refusal to maintain a minimally normal body weight, the distortion of body image and obsessive fear of gaining weight. The pathological behaviors associated with it can lead to semi-starvation, requiring medical treatment and multidisciplinary inpatient care. Several clinical trials evaluated the efficacy of Cognitive Behavioral Therapy (CBT) in lead to remission or reduction of the frequency of bingue eating episodes, purgative behaviors and food restriction. Objective: Combining the results of the best scientific evidence to assess the efficacy of CBT in comparison with other therapies used in the treatment of AN. Methods: The research was carried out in electronic databases of MEDLINE, Psyc- Info, Embase, CCTR and manually, including randomized controlled trials that compared CBT with any other type of intervention in the treatment of AN. Results: Of which 571 (59.7%) were treated with cognitive behavioral therapy and 556 (49.3%) to other therapies: 10 studies involving 957 patients were included. No significant differences in the results obtained in different outcomes, except subscales Restrictions (z = 3.03, p = 0.02), Eating Concerns (z = 2.98, p = 0.002) and Shape Concerns (z = 1.71, p = 0.09) in the scores of EDE and the GAF scale (z = 1.87, p = 0.06). There were statistically significant differences in the number of bulimic episodes (z = 2.61, p = 0.009), number of episodes of induced vomiting (z = 2.11, p = 0.03) and the number of occurrences of use misuse of laxatives (z = 3.04, p = 0.002). Conclusion: The use of cognitive-behavioral therapy in the treatment of patients with AN seems to greatly improve the symptoms of the disease, revealing particularly effective results in the Eating Disorder Examination Scale. Its use seems to lead to an improvement in the GAF scores, showing a general improvement of the health status of patients (reduction of episodes of vomiting, bulimia and laxative use).

Imagem do corpo, perturbações alimentares e traços de personalidade

Este estudo tem como objetivo investigar a relação entre a imagem do corpo, perturbações alimentares e traços de personalidade. 254 estudantes do ensino superior, 191 raparigas (Idade média = 21,53) e 63 rapazes (Idade média = 22,87) responderam a: Questionário sobre a Imagem do Corpo (Bruchon-Schweitzer, 1992), Eating Disorder lnventory (Garner, Olmstead & Polivy, 1983) e o NEO-FFI-20 (Bertoquini & Ribeiro, 2006). Os resultados obtidos revelaram uma correlação positiva entre a imagem corporal e o comportamento alimentar. As dimensões de personalidade Extroversão e Conscienciosidade estão correlacionadas positivamente com a imagem corporal, enquanto que a dimensão Abertura à Experiência correlaciona-se de modo negativo com a imagem corporal e com o comportamento alimentar. /ABSTRACT: This study aims to investigate the relationship between body image, eating disorders and personality traits. 254 higher education students, 191 girls (mean age = 21.53) and 63 boys (mean age = 22.87) answered: Questionnaire on Body lmage (Bruchon-Schweitzer, 1992), Eating Disorder lnventory (Garner, Olmstead & Polivy, 1983) and the NEO-FFI-20 (Bertoquini & Ribeiro, 2006). The results revealed a positive correlation between body image and eating behaviors. The personality dimensions Extraversion and Conscientiousness was positively correlated with body image, while the dimension Openness to Experience correlated negatively with body image and eating behavior.

L’objectif de modifier ou de contrôler son poids chez les adolescents : vecteur de promotion des saines habitudes de vie ou facteur de risque à la santé ?

L’objectif de modifier son poids est associé à certains comportements potentiellement dangereux, mais ses retombées sur les saines habitudes de vie des adolescents sont peu connues. L’objectif du mémoire est de quantifier les associations entre l’objectif relatif au contrôle du poids et la consommation de fruits et légumes, de boissons sucrées et d’aliments de restauration rapide, la prise du déjeuner et la pratique d’activité physique. Des régressions logistiques ont été effectuées sur les données de l’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011. Respectivement, 25 %, 34 %, 12 % et 29 % des adolescents essayaient de perdre, maintenir, gagner du poids et ne rien faire à propos de leur poids. Chez les garçons et les filles, essayer de perdre du poids était associé à une probabilité plus faible de déjeuner quotidiennement (RC garçons = 0,72 ; 95%IC = 0,61 - 0,84, RC filles = 0,61 ; 95%IC = 0,56 -0,70) et chez les filles, cela était aussi associé à une probabilité plus élevée de consommer au moins cinq portions de fruits et légumes par jour (RC = 1,20 ; 95%IC = 1,04 - 1,37) et une probabilité plus faible de consommer des boissons sucrées quotidiennement (RC = 0,77 ; 95%IC = 0,66 - 0,90). Essayer de maintenir son poids et de gagner du poids étaient minimalement associés à une habitude plus délétère. L’objectif de contrôler son poids n’est donc pas strictement positif ou négatif. Il semble plus prudent de promouvoir directement les saines habitudes de vie plutôt que d’encourager l’adoption d’un objectif de contrôle du poids.

L’objectif de modifier ou de contrôler son poids chez les adolescents : vecteur de promotion des saines habitudes de vie ou facteur de risque à la santé ?

L’objectif de modifier son poids est associé à certains comportements potentiellement dangereux, mais ses retombées sur les saines habitudes de vie des adolescents sont peu connues. L’objectif du mémoire est de quantifier les associations entre l’objectif relatif au contrôle du poids et la consommation de fruits et légumes, de boissons sucrées et d’aliments de restauration rapide, la prise du déjeuner et la pratique d’activité physique. Des régressions logistiques ont été effectuées sur les données de l’Enquête québécoise sur la santé des jeunes du secondaire 2010-2011. Respectivement, 25 %, 34 %, 12 % et 29 % des adolescents essayaient de perdre, maintenir, gagner du poids et ne rien faire à propos de leur poids. Chez les garçons et les filles, essayer de perdre du poids était associé à une probabilité plus faible de déjeuner quotidiennement (RC garçons = 0,72 ; 95%IC = 0,61 - 0,84, RC filles = 0,61 ; 95%IC = 0,56 -0,70) et chez les filles, cela était aussi associé à une probabilité plus élevée de consommer au moins cinq portions de fruits et légumes par jour (RC = 1,20 ; 95%IC = 1,04 - 1,37) et une probabilité plus faible de consommer des boissons sucrées quotidiennement (RC = 0,77 ; 95%IC = 0,66 - 0,90). Essayer de maintenir son poids et de gagner du poids étaient minimalement associés à une habitude plus délétère. L’objectif de contrôler son poids n’est donc pas strictement positif ou négatif. Il semble plus prudent de promouvoir directement les saines habitudes de vie plutôt que d’encourager l’adoption d’un objectif de contrôle du poids.

Ingestão compulsiva na obesidade: O peso do comportamento e da satisfação com o suporte numa realidade insular e continental

Dissertação de Mestrado apresentada no ISPA – Instituto Universitário para obtenção do grau de Mestre em Psicologia especialidade em Psicologia da Saúde