bluuebunny/crossref_metadata_2025 huggingface dataset:
Bariatric surgery is associated with reduced psychological distress and improved sexual function in obese female patients
Authors: Assimakopoulos K. , Karaivazoglou K. , Hyphantis T. , Iconomou G. , Panayiotopoulos S. , Goula P. , Kalfarentzos F.
Published: May 2011

Introduction

Obesity is a serious health issue, associated with significant medical and psychosocial co-morbidity. Bariatric surgery is a promising treatment modality however, few studies have so far investigated its impact on patients’ sexuality.

Aims

The present study's aim was to determine bariatric surgery's effect on female patients’ Body Mass Index (BMI), psychological and sexual functioning.

Methods

59 obese female patients, scheduled to undergo weight loss operation, completed the study. Psychological functioning was measured by the Hospital Anxiety and Depression Scale (HADS), while sexual functioning was assessed by the Female Sexual Functioning Index (FSFI). All participants were evaluated in two consecutive time intervals, one week before surgery (T1) and one year after (T2).

Results

Statistical analysis revealed a significant reduction in BMI (p < 0.001) and depression (p < 0.001) scores, a significant improvement in sexual desire (p = 0.005), arousal (p = 0.001), lubrication (p = 0.003), satisfaction (p = 0.012) and total sexual function (p = 0.003) and a decrease in the levels of pain during intercourse (p = 0.014) postoperatively.

Postoperative total sexual functioning was correlated with baseline BMI (p = 0.030) and BMI decrease (p = 0.037).

Conclusions

Bariatric surgery appears as an effective way to control weight and improve psychological and sexual functioning in female obese patients. Patients, who ceased to be obese postoperatively, reported the greatest level of sexual improvement, indicating that obesity treatment should focus on BMI normalization.
Screening of disordered eating in 12 year old girls and boys: Psychometric analysis of the German versions of SCOFF and EAT-26
Authors: Berger U. , Wick K. , Hölling H. , Schlack R. , Bormann B. , Brix C. , Sowa M. , Schwartze D. , Strauß B.
Published: May 2011

To detect eating disorders and risky eating behaviour in early stages, screening tests are used. In order to examine as many adolescents as possible, these tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D) and the German version of the SCOFF test (which contains only five Yes-no questions) in a sample of 425 twelve year old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of rtt = .73 and a maximum accuracy of 82% (area under the ROC curve). In reference to the EAT-26D (20 point cut-off) the sensitivity of the SCOFF was 78%, specificity 75%, positive predictive value 28%, and the negative predictive value, which is more relevant for screenings, was 96%. The construct validity reached r = .52.
Preliminary retrospective analysis of a refeeding program in a psychiatric intensive care unit for patients suffering from extreme severe anorexia nervosa
Authors: Born C. , de la Fontaine L.
Published: May 2011

Introduction

Anorexia nervosa (AN) is showing the highest mortality in psychiatric illness, especially because of its somatic consequences. A special program for refeeding patients with extreme severe underweight has been established in Munich.

Methods

From 2000–2010 about 80 patients with any eating disorder were admitted. Data of 53 patients with AN were analysed. After admission most of the patients (n = 43) received a percutaneous gastric feeding tube. A high caloric solution (Fresubin energy) was administered adjusted to bodyweight aiming a weight gain of 700–1000 g per week. After reaching BMI 17 most patients were send for illness specific psychotherapy to a specialized clinic.

Results

The sample consists of 50 (94.3%) females. Patients were diagnosed as having AN restrictive subtype in 25 cases (47.2%), AN binge/purge subtype in 24 cases (45,2%) and AN purging subtype in 4 cases (7.6%). Mean age at admission was 25.4 years (SD 7.0) and mean duration of illness until admission was 8.4 years (SD 5.7). Average length of stay in the intensive care unit was 135 days (SD 79.4). Mean BMI at admission was 12.3 (SD 1.6) and mean BMI at discharge 16.6 (SD 1.6). Thus, mean weight increase was 11.4 kg (SD 5.4).

Discussion

This intensive care program was established to enable patients with extreme severe AN to participate in psychotherapeutic programs afterwards as it was reported that cognitive function changed in regard to bodyweight. Further evaluation has to consider the occurrence of a refeeding syndrome.
Psychopathologic aspects of obesity: Psychodiagnostic evaluations of bariatric surgery applicants
Authors: Chiappini S. , Righino E. , Ciciarelli C. , Pettorruso M. , Conte G.
Published: May 2011

Introduction

Psychiatrists play an important role as members of the bariatric surgery team. A preoperative psychiatric evaluation is considered as part of a mandatory workup before approving surgery.

Aims

This evaluation focuses on the identification of any pre-existing psychiatric disorders among candidates for TOGa[1], a new experimental technique of bariatric surgery, and their correlations with post surgical weight loss.

Method

45 obese patients underwent a psychiatric interview and several psycho diagnostic questionnaires (SCL-90; HAM-D; HAM-A; EDI; TAS).

A follow-up was set each 3 months.

Results

We found that 34.1% of surgery candidates had a current diagnosis of depression; the majority showed anxiety symptoms. We also documented dissatisfaction about body shape, desire of slimness, fear of maturity, perfectionism, bulimia and binge eating disorder. Other frequent psychiatric symptoms were somatization, sensitivity, obsession and compulsion. After 3 months from surgery we found that the best weight loss was associated to low score in HAM-A, high score in hanger-hostility item (SCL-90) and low score in sensitiveness item (SCL-90).

Conclusion

The diagnosis of a psychiatric pathology during the pre-surgical evaluation can be considered a predictive negative factor for the outcome of the surgery. The predictive positive factors are firstly the nonexistence of psychiatric symptoms, secondly the high score in sensitiveness-insight item (SCL-90) and the high score in the ability to express feelings. [1] (TransOral Gastroplasty)
Organic eating disorders of pica, hperphagia, and severe food restriction: Presentation and prevalence after acquired brain injury
Authors: Faruqui R. , El-Kadi K. , Rowell A.
Published: May 2011

Introduction

Persistent Hyperphagia, Pica, and Severe Food Restriction are rare but potentially life threatening complications following acquired brain injury. These disorders are not formally coded in disease classification systems though do present with significant management challenges in both inpatient and outpatient settings.

Objectives

To inform treatment and management strategies and service development for complex neuropsychiatric conditions

Aims

To study presentation and prevalence of organic eating disorders following acquired brain injury.

Methods

Systematic review of medical literature on Medline, PsychInfo, CINAHL, Embase, Cochrane database of systematic reviews, using terms eating disorders, organic eating disorders, binge eating, bulimia, anorexia nervosa, atypical eating disorders, food restriction, pica, head injury, acquired brain injury, traumatic brain injury.

Service consultations and identification of grey literature

Results

Systematic review identified case reports, case series, and case studies relevant to these disorders. It also identified lack of research in this area and absence of well structured longitudinal studies that can identify true prevalence in a representative sample. Persistent Hyperphagia has been reported in 2–3% of adult cases requiring inpatient post acute rehabilitation. Pica has been reported in young children after acquired brain injury only. Two reports identified this condition in post neurosurgery period. Severe food restriction, at times also described as atypical anorexia, has been reported following acquired brain injury. However, it remains rather difficult to estimate prevalence in different patient populations.

Conclusions

Organic eating disorders present with significant levels of challenges in patient management and do carry identifiable mortality risk.
Prevalence and risk factors of eating disorders in Greek undergraduate students
Authors: Fragkos K.C. , Frangos C.C. , Sotiropoulos I. , Giovanis A.N. , Tilikidou I. , Manolopoulos I.
Published: May 2011

Aims

To estimate the prevalence of eating disorders (EDs) and associated risk factors in a sample of undergraduate students.

Methods

This is a cross-sectional study. We used a questionnaire consisting of the following sections: demographics, SCOFF questionnaire for screening EDs, the Achievement Anxiety Test (AAT) and the Depression, Anxiety and Stress Scale (DASS). Our sample was selected randomly. Sample size was 535 students (44% men, 56% women), and 33% of students were between 18 and 20 years old (age range 16–28).

Results

SCOFF's reliability measured by Cronbach's alpha was 0.542; AAT's alpha for its facilitating scale was 0.682 and debilitating scale 0.821; finally, DASS's depression, anxiety and stress sections’ alpha were 0.923, 0.896 and 0.876 respectively. The prevalence of EDs was 42.2%. The associated factors with the presence of EDs was gender (62% women, 38% men; X2 = 5.007, p = 0.025) and personal family status (X2 = 18.862, p = 0.002), while having divorced parents was a borderline association (OR = 1.53, 95% CI 0.97–2.42). Mann-Whitney’s U test showed that there was a significant difference in the scale of stress between those with an ED and those without (p = 0.026) but not for depression and anxiety. According to multiple logistic regression, risk factors for having an eating disorder were depression, stress, female gender, being married and searching for a romantic relationship (overall model fit p < 0.0001).

Conclusion

This is the first study on EDs from Greece. Depression and stress were significant predictors of EDs, which shows the importance of these two factors in the pathogenesis of EDs.
Anorexia nervosa in males
Authors: Freire Lucas R.M.
Published: May 2011

Eating disorders are far more prevalent in women than men, with only 10% of cases occurring in males. This discrepancy may be partially explained by biological and cultural factors, but it also suggests diagnostic difficulties.

Introduced by the description of a clinical case of Anorexia Nervosa (AN) in a male patient, this work reviews and compares diagnostic features of eating disorders, namely AN, in both genders, emphasizing the most common pitfalls to its recognition in men, in order to reduce the number of undiagnosed cases.

We searched for scientific articles about this topic on the databases MEDLINE, LILACS and PsycINFO, using the search words “eating disorder”, “anorexia nervosa” and “male”. We chose to preferentially include original articles and recent reviews.
Implicit associations in eating disorders: An experimental study with the “self-esteem” implicit associations test
Authors: Fronza S. , Galimberti E. , Fadda E. , Fanini F. , Bellodi L.
Published: May 2011

Introduction

Greenwald et al. (1998) developed The implicit Association Test (IAT) to measure automatic concept-attribute associations. Several evidences showed that Eating Disorders (EDs) were charactterized by a low explicit self-esteem.

Objectives

The first aim was the evaluation of implicit self-esteem in a sample of patients with EDs. Second aim was to verify the correlation between implicit and explicit self-esteem, hypothesizing that they could represent two independent constructs.

Methods

A IAT modeled to assess self-esteem (Self-esteem IAT) has been administered to 17 Anorexia Nervosa (AN), 14 Bulimia Nervosa (BN), 17 Binge Eating (BED) patients and 32 healthy controls (HC). In IAT, the target categories were represented by the words «SELF / OTHER» and «agreeable / disagreeable». A positive IAT effect suggest a negative implicit self esteem, instead a negative IAT effect suggest a positive implicit self-esteem. Traditional self reports were used to evaluate explicit self-esteem to all participants.

Results

Results showed a significant difference between HC and clinical groups in implicit self-esteem. HC and BED showed positive IAT effect, instead AN and BN shows a negative IAT effect. No correlations between implicit and explicit self-esteem were found.

Conclusion

Results showed that HC has a much more positively implicit self-esteem compared to clinical samples. An interesting result concerns the absence of any significant correlation between the implicit and explicit self-esteem, that could suggests that the implicit self-esteem is an independent construct respect to the explicit one.
Implicit associations in eating disorders: An experimental study using implicit associations test
Authors: Ricceri A. , Fronza S. , Galimberti E. , Bellodi L.
Published: May 2011

Introduction

Greenwald et al. (1998) developed The implicit Association Test (IAT) to measure automatic concept-attribute associations. The assumption of the test is that strongly associated (compatible) attribute-concept pairs should be easier to classify together than are weakly associated or opposed (incompatible) attribute concepts. Ease of classifying is measured by the response times and errors in performing such categorizations.

Objectives

The aim of this study was the evaluation, at an implicit level, of the attitude concerning fat people in a sample of Eating Disorders (ED).

Methods

A IAT modeled to assess self-esteem the attitude concerning fat and slim persons has been administered to 17 Anorexia Nervosa (AN), 14 Bulimia Nervosa (BN), 17 Binge Eating (BED) patients and 32 healthy controls (HC). In IAT, the target categories were represented by the words «FAT-SLIM» and «good / bad». Stimuli were images of faces of overweight and normal weight people and positive/negative word. A positive IAT effect underline an implicit tendency to associate the category «FAT» with positive attributes, instead a negative IAT effect suggest an implicit tendency to associate the same category with negative attributes.

Results

Results showed a significant difference between HC and clinical groups in implicit attitude concerning overweight persons. HC showed positive IAT effect, instead AN, BN and BED showed a negative IAT effect. No correlations between implicit attitude and clinical variables were found.

Conclusion

These results suggest a common implicit tendency in ED’s groups, compared with controls, to negatively judge overweight persons.
Relationships between eating disorders and personality disorders in adolescents
Authors: Gaudio S. , Bufacchi C. , Andreotti M. , Gregorini N. , Montecchi F.
Published: May 2011

Introduction

Several research studies have investigated Personality Disorder (PD) comorbidity in adult with Eating Disorders (ED), which showed an association between the two types of disorder.

Objective

The aim of this study is to examine the relationships between ED and PD in a sample of adolescents between 14 to 18 years of age.

Method

Sixty-seven adolescents with ED treated in an outpatients setting [23 Anorexia Nervosa (AN), 17 Bulimia Nervosa (BN) and 27 Eating Disorder Not Otherwise Specified (EDNOS)] were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II), the Beck Depression Inventory (BDI) and the Eating Attitudes Test (EAT).

Results

Overall, 13 (19.4%) of ED patients had one or more PD. Cluster C PDs were the most common specific PDs. No significant difference was found between AN and BN based on the general presence of PDs. EDNOS patients had a lower prevalence of PDs compared to AN and BN patients. ED patients with a PD had an higher BDI rates compared to ED patients without PDs. No significant difference was observed in EAT rates between ED patients with and without PDs.

Conclusions

Cluster C PDs were the most frequent PDs found in ED adolescent patients. The prevalence of PDs is similar in AN and BN patients, whilst EDNOS patients have a lower prevalence of PDs compared to AN and BN patients. ED adolescent patients with current PD comorbidity show higher depression scores.
Characteristics of suicide attempts in anorexia and bulimia nervosa : A case-control study
Authors: Guillaume S. , Jaussent I. , Olié E. , Genty C. , Bringer J. , Courtet P. , Schmidt U.
Published: May 2011

Objective

People with eating disorders (ED) are at high risk for suicidal behavior. Among different ED, anorexia nervosa (AN) has the highest rates of completed suicide whereas suicide attempt rates are similar or lower than in bulimia nervosa (BN). Attempted suicide is a key predictor of completed suicide, thus this mismatch is intriguing. We sought to explore whether the clinical characteristics of suicidal acts differ between suicide attempters with AN, BN or without an ED.

Method

Case-control study in cohort of suicide attempters (n = 1563). Forty-four patients with AN and 71 with BN were compared with 235 non-ED attempters matched for sex, age and education, using interview measures of suicidal intent and severity.

Results

AN patients were more likely to have made a serious attempt (OR = 3.4, 95% CI 1.4–7.9), with a higher expectation of dying (OR = 3.7, 95% CI 1.1–13.5), and an increased risk of lethality (OR = 3.4, 95% CI 1.2–9.6). BN patients did not differ from the control group.

Conclusion

There are distinct features of suicide attempts in AN. This may explain the higher suicide rates in AN. Deaths from suicide in AN may not be the result simply of their greater physical frailty.
Depression and life quality in patients with eating disorders - A two year follow up
Authors: Debska E. , Janas A. , Steposz A. , Bablok R. , Krysta K. , Janas-Kozik M. , Krupka-Matuszczyk I.
Published: May 2011

Introduction

The symptoms of depression are often found in patients suffering from eating disorders.

Aims

The aims of this research were to find out if depression in patients with eating disorders (ED) like anorexia nervosa (AN) or bulimia nervosa (BN) is an additional condition accompanying the ED diagnose, or if it is an integral element being part of emotional problems related to maturation. The estimation of patients’ social condition is also considered in comparison to matched group with no ED diagnose.

Methods

Subjects: Group B - 19 females diagnosed, age 12 – 24; group C - matched control group of 30 healthy females, group F - 19 patients out of group B examined in a follow up research two years after hospital treatment. Tools used: Beck Depression Inventory (BDI), Life Quality Questionnaire (Q), Body Mass Index measurement (BMI).

Results

BDI results: depression symptoms are more intense in the early phase of the treatment of ED (group B) than in the follow up -group F (two years after hospitalization) and also more intense than in group C (controls). Q Questionnaire shows no differences between groups B, C, and F.

Conclusions

Depression is an additional condition in patients diagnosed with ED mostly in the early phase of the treatment. No differences have been found in the social condition between groups B, C, and F.
Eating disorder in a male psychotic patient
Authors: Maner F. , Şahmelikoğlu Ö. , Girit Ö. , Hısım Ö. , Emin Ceylan M.
Published: May 2011

Introduction

Eating disorders are associated with two or four comorbid diagnoses especially mood, anxiety, obsessive compulsive, substance abuse and personality disorders.

Objectives

Psychotic disorders are seen rarely with eating disorders which have been reported as case reports.

Methods

40 years old male patient suffering for vomiting after eating and drinking large amounts of water and then purge. Recently vomiting has became habituation; he felt dysphoria after eating and forced himself to vomit. He didn’t want to be thin and wanted to gain weight. He didn’t think that condition could be a disease.

In his childhood he had bizarre behaviours. For instance he pulled up the paints of walls and then ate the pieces of paints. He teared off the skin nearby his nails. Since adolescence he was social isolated, introverted, affective flattened. His self appearance was poor. He couldn’t perform his grooming and cleaning by himself. He didn’t want to take a bath. Eight years ago with his mother's death he developed binge eating and vomiting problems.

Results

He was hospitalized in internal clinics for two times due to losing weight. Then he was admitted to psychiatry clinic. The level of plasma potassium was 2.4 mEq/lt during hospitalization. The patient was treated both for weight restoration, electrolite regulation and psychiatric condition. Olanzapine 20 mg/day, ketiapine 600 mg/day was administered. Within 1 month his medical condition was remitted but he couldn’t gain weight, his negative symptoms.

Conclusions

This case is a male diagnosed as schizophrenia comorbid with atypic eating.
Characteristic prefrontal blood volume patterns when imaging body type, high-calorie food, and mother-child attachment in childhood anorexia nervosa: A near infrared spectroscopy study
Authors: Nagamitsu S. , Matsuoka M. , Ohzono S. , Yamashita Y. , Matsuishi T.
Published: May 2011

Introduction

The risk for developing and preserving symptoms of anorexia nervosa (AN) in children seems to be multifactorial: individual, familial, socio-cultural, and biological factors interact within the developmental framework. A disruption of attachment processes with the mother in an early stage of child development has been proposed as a contributing factor; however, the evidence is controversial.

Objectives

To address the research question of how childhood AN patients recognize disorder-specific provocative factors such as body type, high-calorie food, and attachment between mother and child.

Aims

The aim of this study was to investigate the prefrontal activation in childhood AN patients when imaging those symptom-provocative factors.

Methods

The prefrontal activations during each task, in terms of blood volume changes, were measured by near infrared spectroscopy. Twelve females with childhood AN (mean age, 14.4 years old) and 13 age-matched healthy female controls participated in this study.

Results

Both groups showed increased prefrontal blood volume when viewing images of each symptom-provocative factor. Unexpectedly, there was no significant difference in the prefrontal blood volume increases between the control group and the childhood AN group when viewing images of slender and obese body types and high-calorie food. On the other hand, images of mother-child attachment resulted in significantly greater increases in prefrontal blood volume in the childhood AN group than in the control group.

Conclusions

These results indicated that prefrontal activation in AN might be associated with imaging attachment between mother and child, but not associated with imaging body type or high-calorie food.
Reconsidering food avoidance emotional disorder through discussion of four cases
Authors: Pellicciari A. , Di Pietro E. , Sacrato L. , Iero L. , Franzoni E.
Published: May 2011

Objectives

The Authors investigate the conceptualization of a group of patients with the same clinical and psychological patterns, affected by eating disturbances arisen during the age of latency.

Methods

Four cases are presented and discussed. Each subject was diagnosed as Food Avoidance Emotional Disorder (FAED).

Results

The described subjects present some of the typical features of eating disorders of adolescence. Moreover, regressive aspects, obligingness, dichotomyc behaviors and thoughts were noticed. The Authors observed that parental expectations and needs were transmitted to their sons.

Conclusions

Through the refusal of food the dochotomyc and fearful thoughts are crystallized. The child cannot comprehend the existence of a false Self built on the Other's expectations. The Authors believe that FAED can be a precursor of Anorexia nervosa in the affected children, who show a less organized cognitive structure due to their young age.
A portuguese experience of multiple family day treatment
Authors: Ribeiro A.E. , Martins A.P. , Timóteo S. , Brandão I.
Published: May 2011

Families universally agree that Anorexia Nervosa takes over almost every aspect of their lives, becoming the central organizing principle of the family's life.

Over the last years focus for family interventions has been the Multiple Family Day Treatment approach (MFDT), which has a strong focus on helping families to maximize their strengths and resources, in order to help their patient member to recover. An important goal of MFDT is to help break the interconnections that have developed between the symptom and family interactions, and help overcome the sense of being unable to move and communicate freely about the problems. When families come together they witness each other, revealing their narratives about developed rules, roles, rituals and myths. The differences in the way that individual families have coped, allows for the possibility to look for alternative ways of managing the problem within the family.

The authors describe their first experience with MFDT, which occurred in a Portuguese hospital with 17 families of anorectic patients.

The shared experience of what it is like for families to live with anorexia quickly helps to create group cohesion and a supportive atmosphere in which difficulties can be tackled. Hearing how other families have overcome problems helps families to broaden their own time frame and consider trying new things.

The MFDT has attracted considerable interest has an innovative and effective treatment, and feedback received from families has been very positive emphasizing in particular the collaborative nature of the treatment.
Psychoeducational manual for treating binge eating disorder (BED) patients: A controlled trial
Authors: Stefano S.C. , Devoraes A.M.R. , Souza A.M.R. , Kaio M.H. , Blay S.L.
Published: May 2011

Objective

To evaluate the efficacy of a psychoeducational manual as first intervention when treating BED.

Method

It was conducted a 8-week controlled trial (before-after) without a control group. Twenty BED patients were enrolled at an outpatient service specialized in eating disorders (PROATA).

After being submitted to a psychiatric evaluation and responding to the following instruments: MINI-PLUS, QEWP-R, BES, BDI, HAM-A, SF-36, and BSQ, the subjects signed a consent term and they received explanations about the manual. After eight weeks the patients were re-evaluated by trained examiners.

The main outcome criterion was the BED evolution (evaluated through QEWP-R and BES). The secondary criteria were evaluated through the other instruments plus a semi-structured interview.

Results

Most patients presented a slight improvement of BED symptoms, although these symptoms are still present. The secondary criteria show that the most relevant aspect was that the information presented in the manual allowed the patients to acknowledge they had a condition and to see themselves with less guilt and prejudice, making it easier to look for a more comprehensive treatment.

Conclusions

There are indications that using the psychoeducational manual can reduce the symptoms, and that it can be useful in identifying the condition and allowing the patients to look for treatment. Also, since the instrument can be used as part of a stepped-care program, a broader, controlled and randomized study enrolling a larger number of patients must be conducted in order to better clarify the results.
Non-alcoholic steatosis and eating disorders
Authors: Strangio A.M. , Focà F. , Blanco P. , Luci G. , Rinaldi L. , Grieco A. , Miele L.
Published: May 2011

Introduction

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide. Prolonged fasting and excessive caloric intake are possible nutritional causes of NAFLD incurred by patients with eating disorders (ED).

Aims

Aims of this study are: identifying if eating disorders are associated with NAFLD; evaluating possible improvements of the risk of NAFLD and of psychopathology determined by integrated multidisciplinary treatment (behavioral therapy, dietary assessment and treatment, clinical care overall).

Methods

78 patients with ED received the integrated multidisciplinary treatment. Psychopathology and eating symptoms were assessed before and after treatment through Eating Disorder Inventory and Questionnaire of Eating Behaviours (QEB). The risk of NAFLD was evaluated by Fatty liver index (FLI) based on values of γGT, BMI, triglycerides and waist circumference.

Results

54% of patients with binge eating disorder in our sample has a 60-FLI, indicating a risk of NAFLD higher than 85%.

FLI (p: 0.003) and yGT (p: 0.006) were significantly lower after treatment, thus indicating an improvement in the risk of NAFLD. Four of the eight EDI's subscales improved: Drive for thinness (p: 0.008), Interoceptive awareness (p < 0.001), Bulimia (p: 0.001), Ineffectiveness (p: 0.014). Two of the three SCA's subscales improved: Binge Eating (p: 0.001) and Food Restriction (p: 0.016).

Conclusions

the association between NAFLD and eating disorders was shown together with the efficacy of the multidisciplinary treatment. The risk index FLI and γGT were reduced by the therapy but should be monitorized over time.
Psychological recommendations in the massive weight loss for patients after bariatric surgery in public service outpatient in Southeast Brazil
Authors: Magdaleno R. , Chaim E.A. , Turato E.R. ,   Laboratory of Clinical-Qualitative Research
Published: May 2011

Introduction

Bariatric surgery is a procedure that results in a complex network of emotional experiences. One of the objectives of surgery is to bring about an improvement in the quality of life. Many patients fail because of psychological difficulties, a fact that reinforces the need for specific studies on the psychological dynamic.

Objective

to understand the meanings for patients when undergoing bariatric surgery.

Method

Clinical-qualitative method.

Results

The main emotional experiences are social re-insertion, personal acceptance, the risk of disillusion with the results of surgery, recovery of self esteem, improvement in quality of life and in body image.

Conclusions

It is important to identify those aspects of a patients’ psychological make-up which would be expected to improve or worsen their prognosis, and to provide the necessary pre- and post-operative psychosocial counselling. We offer some markers to assist the health professionals, which will allow an appropriate psychosocial plan to be developed and help the health team to identify factors that may affect prognosis. We propose some recommendations for a better psychological evolution: psychotherapy focusing on improving self-esteem; identifying feelings of shame related to a greater exposure; identifying how patients deal with feelings of competitiveness, envy and jealousy; assessing if obesity has defensive function; providing realistic parameters with regards the results of surgery; distinguishing between realistic necessity for plastic surgery and unreal expectations; observation of deviations to other compulsions; acceptance of skin folds and scars; clarifying the misunderstanding between emotional and physical hunger; confidence in own ability to adopt new behavioural models.
The eating impulse after bariatric surgery: A clinical-qualitative study in a public outpatient service in Southeast Brazil
Authors: Magdaleno R. , Chaim E.A. , Turato E.R.
Published: May 2011

Introduction

Bariatric surgery provokes post-operative experiences which the patients are unprepared to deal with. This study aims at understanding the alteration of the eating impulse and how patients try to reorganize themselves emotionally after bariatric surgery.

Method

Clinical-qualitative method.

Results

After surgery, hunger starts to be experienced in a different way, as an emptiness, a pain, a weakness, that are attempts to describe primitive emotional sensations. The compulsive eating impulse is still present after the surgery. Areas of symbolic deficiency in obese patients brings serious mental consequences and limits the capacity of the morbidly obese to deal with the impact of the drive demand, leaving only the direct path of the discharge through the ingestion of food. Satiety is altered by the surgery, whereas satiation is not.

Conclusions

The hunger of operated patients is diminished; however, the sensation of satiation is not achieved, leading to feelings of anguish, emptiness and weakness, which often end in the patients seeking alternative means to obtain satisfaction. That which the patients referred to as hunger before the surgery is a complex of physical and emotional sensations. These are transformed into vague sensations, through lack of psychic elements that could make an elaboration of the anguish possible, keep the patient imprisoned in a vicious circle of dissatisfaction and seeking of food. It is crucial to provide to patients psychosocial guidance, clinical and psychiatric care. In these patients we have to deal with mental representation's emptiness and therefore help them in the task of creating symbols.
Body contouring following bariatric surgery: emotional meanings for patients of a public outpatient service in the Southeast Brazil
Authors: Magdaleno R. , Chaim E.A. , Turato E.R.
Published: May 2011

Introduction

Morbid obesity is accompanied by impairment of the body image. Bariatric surgery is seen like a solution for the problems concerning body image. An element that contributes to disillusions with the results is when patients realize that their bodies, even though thinner, still maintain the sequel of obesity, flaccidity and excess skin. Once weight loss has been achieved, the body image is not infrequently cosmetically unacceptable. To complete treatment, body contouring procedures are performed.

Aim of this study

To understand the emotional meaning of body contouring after bariatric surgery.

Method

Clinical-qualitative method, semi-directed interviews with open-ended questions.

Results

Shame that had previously been attributed to obesity is attributed to the sequel of obesity that contributes to the frustrated expectations of having a beautiful and healthy body. The risk of isolation and lose interest to fulfil the objectives of surgery is great. Plastic surgery takes the place occupied by bariatric surgery, that is, the hope of achieving acceptance.

Conclusion

Body contouring following significant weight loss can re-establish a good psychosocial functioning because of the perception of improved body image. The plastic surgery is accompanied by a substantial normalization of the self esteem. It could gradually lead to the cessation of distressing and pathological body-related behaviour. The psychosocial benefits of plastic surgery are: increase self-esteem, improved self-confidence, more intense social activities, better interpersonal relationships, relief from depression and anxiety, improvement in emotional stability, better relationship with colleagues and partner, less stigmatization, better sexual performance and fewer physical limitations during sexual intercourse.
Psychological characteristics of anorexic patients’ mothers in the Southeast Brazil: Implications for treatment and prognosis of anorexia nervosa in a public service
Authors: Campos L.K.S. , Sampaio A.B.R.F. , Garcia C. , Magdaleno R. , Battistoni M.M.D.M. , Turato E.R.
Published: May 2011

Introduction

Considering both the complexity of factors that composes the anorexia nervosa (AN) and the recommendation of important organizations related to health, it becomes fundamental the reflection on psychotherapeutic interventions proposed to patient's relatives.

Objectives

Expand the knowledge about the mother-daughter relationship in AN in order to develop a conceptual framework that improves the way to handle with this disorder, to reduce the factors that maintain it and to improve the prognosis.

Method

Clinical method, through clinical observation regarding a group of patients’ relatives with eating disorders at an outpatient service at a university hospital in the Southeast Brazil.

Results

We have identified common characteristics in the mother-daughter relationship in AN, that maintain the structure of anorexic patients, influencing directly on the severity of each case and therapeutic possibilities. The mutual control: anorexic's mothers showed the need of controlling their daughters, denying the daughter's individuality, trying to become tutors of their actions and thus also become controlled by them; The dialectic between omnipotence and impotence: sense of powerlessness in face of numerous failed attempts to help their daughters, with feelings of guilt, as if they were fully responsible for the daughter's disorder; The relationship of devotion, passion and hostility between mother and daughter: with a fused attitude with her daughter, the mother is even more limited to understand their real needs, invading their personal space.

Conclusions

The findings allowed to identify important aspects of mother-daughter relationship in AN, that can improve clinical interventions for the treatment.
Group therapy during the post-surgery period for bariatric patients from a public service in the Southeast Brazil: Main aspects
Authors: Pegoraro L.F.L. , Magdaleno R. , Chaim E.A. , Turato E.R.
Published: May 2011

Introduction

With the worldwide increase of severe obesity, the demand for and performance of bariatric surgery has increased.

Objective

To show the importance of the group therapy approach in the research and treatment of the surgery's psychological consequences.

Method

Clinical method of research, through weekly open therapeutic groups with patients that have undergone bariatric surgery.

Results

After the surgery the patients: feel empty, which leads them to search for alternative routes to give their lives meaning, some healthy, such as exercising intensely, others unhealthy, such as addictions, especially the consumption of alcohol; they are divided between the control of impulses sensation that the surgery provides and the food temptation that generates anguish, conflicts and fears of failing and gaining weight again; they experience the presence of new identity elements that arise with the weight loss and that lead to feelings of strangeness in relation to themselves and their personality; they are not stigmatized anymore and assume new social roles, with an important improvement of their self-esteem and social functioning; they may experience conflicts that are hard to handle in parental and marital relationships, especially due to jealousy and competitiveness.

Conclusions

Despite the undeniable benefits that the bariatric surgery provides to the patients, psychological conflicts arise. The bariatric surgery is a procedure that causes, in addition to massive weight loss, deep changes in the patients’ psychic structure that, if well conducted in what concerns psychotherapy, lead to a significant improvement of the patient's life quality.
Psychological life experiences facing chronic diseases for patients with metabolic syndrome and impacts reported about health promotion in the Southeast Brazil: A clinical qualitative study
Authors: Vieira C.M. , Chvatal V.L.S. , Cordeiro S.N. , Turato E.R.
Published: May 2011

Introduction

Receiving and understanding the psychological and sociocultural aspects associated to both health problems and difficulties to make the eating behaviour changes are relevant issues when treating individuals with Metabolic Syndrome.

Objective and aims

The reports given by chronic individuals in the present study allowed for analyzing the subjective expressions related to food, treatment management and patient adherence to self care propositions.

Methods

In-depth semi-directed interviews with open-ended questions, with psychodynamic orientation in the conducting dialogues were performed with nine patients from the endocrinology outpatient service of a public university hospital located in Southeast Brazil. From this broader objective, a selection was made of some experiences reported by the subjects, which were related to the process of managing treatment and eating behaviour, implied in chronic metabolic disorders.

Results

In this work, elements that mediate the process of developing autonomy in eating habits, living with the illnesses and vulnerability factors experiences by Metabolic Syndrome patients are identified in this study.

Conclusion

The interdisciplinary character of the present study promoted the valorisation of the practice of listening to the psychological and cultural meanings of eating behaviours, hence offering contributions regarding the nutritional care of individuals with Metabolic Syndrome.
Cognitive behavior therapy in patients with binge eating disorder
Authors: Vaidya V.
Published: May 2011

Introduction

With the growing epidemic of obesity many treatments are aimed at reducing weight like diets, exercise, pharmacotherapy and bariatric surgery. All of these can reduce weight at least for a period; however none of them adequately address the behavior of binge eating/eating disorder.

Aim

assessed the role of Cognitive Behavior therapy in reducing disordered eating behavior.

Method

The subjects were enrolled in 12 weeks CBT. They were all obese and had a score of > 20 on the BES. They completed a BDI, MBSRQ, and BES before and after the groups. Their weight was recorded before and after the 12 weeks. 79 patients were enrolled in groups over a period of 3 years. Of those 56 patients completed the groups and questionnaires. Most groups consisted of 6–8 patients.

Discussion

70% of patients had psychiatric symptoms psychotropic medications like antidepressants. More than 70% felt their eating habits were more in control and felt more informed about themselves since attending CBT groups. All of the patients who stayed and attended groups felt that the connection helped them sustain better eating habits. 67% of patients had lost 4–30 lbs during the 12 weeks of CBT, none had gained weight.

Conclusion

CBT helps the patient reduce disordered eating behaviors by understanding the cause of their self sabotage. CBT addresses the core of the problem i.e. disordered behavior as opposed to its consequences (viz. obesity and its multiple medical comorbidities); while affecting weight indirectly.
Cognitive behavioral therapy focused upon communicational skills enhancement in anorexia nervosa- a case series
Authors: Vasile D. , Vasiliu O. , Mangalagiu A.G. , Tudor C. , Bogdan V. , Paraico I.
Published: May 2011

Introduction

Anorexia nervosa (AN) has been approached from multiple medical, social and psychological perspectives, but it still stands as a major challenge for the clinician, due to its resistance to treatment, low therapeutic compliance and severe complications.

Objective

To asses the efficacy of an interpersonal focused cognitive-behavioral therapy (CBT) in patients diagnosed with AN.

Methods

We enrolled in 12 weeks, 3 sessions a week, CBT program a number of three patients, females, admitted successively in our departments, diagnosed with AN, who didn’t have previously any kind of psychotherapy. The first patient was 22, diagnosed with AN-restricting type, had a BMI of 14.5 and a score on Eating Attitudes Test (EAT) of 34. The second patient was 19, presented AN-binge eating-purging, had a BMI of 14 and an EAT score of 35. The third patient was 25, had also AN-binge eating-purging, a BMI of 15 and an EAT score of 32.

Results

The first two patients responded well to the CBT program, but the first signs of recovery (EAT decreases of at least 5 points and increases of at least 1 unit on BMI) appeared after 10 weeks (15 sessions). The third patient discontinued rather fast the psychological treatment. The follow up (12 weeks after endpoint) showed relapse in one CBT-treated patient and a severe status of the patient that discontinued psychotherapy.

Conclusion

The CBT focused on communicational skills enhancement is beneficial in patients with AN, but responses appear rather late and need to be boosted by frequent follow-up sessions.
Psychiatric co-morbidity in patients with eating disorders
Authors: von Hausswolff-Juhlin Y.L. , Högdahl L. , Birgegård A.
Published: May 2011

Background

Co-morbidity is common among patients with eating disorders (ED) and some previous studies have reported a prevalence of over 80%. However, research in the area has been sparse and no previous studies include both children and adults, and both genders.

Methods

Data from the Stepwise quality control database, a large-scale Internet based data collection system for specialized ED care in Sweden, were used. The database includes data from children and adults and both genders. Stepwise contains structured diagnostic interviews for ED- and other DSM-IV Axis I diagnostics (the Structured Eating Disorder Interview and the M.I.N.I.Kid and SCID-I interviews). Part one is performed by trained staff and contains SEDI and SCID-I. Part two is made up of self-rating questionnaires and contains EDE-Q, and CPRS. The system is used in 32 treatment units (in and out patients) and comprises up to date1917 patients from all over Sweden.

Results

96,4% of the patients with ED was women and 3,6% were men. 74,8% of the patients with ED also had at least one other Axis I disorder. The most common type of diagnosis was anxiety (61%) followed by mood disorder (56%). 19% had substance use disorders. No gender differences regarding co-morbidity or specific ED diagnosis were observed.

Conclusion

This study confirms previous results showing that the prevalence in co-morbidity is high among patients with ED. The high level of co-morbidity in patients with ED may change the approach in treatment and calls for more tailored treatment programs.
Food preferences and taste perception in anorexia nervosa
Authors: Woeckel L. , Glass F. , Sungurtekin I. , Zepf F.D. , Poustka F. , Herpertz-Dahlmann B.
Published: May 2011

Objective

Restrictive and selective eating behavior with food preferences and aversions is a characteristic symptom in anorexia nervosa (AN). Typically fat-containing food is avoided. Furthermore, very often patients with AN replace food which is rich in calories by fruits and vegetable. The aim of the present study was to evaluate if there is a relationship between food preferences and taste perception in AN.

Methods

15 female patients with acute AN (ANacute) (BMI 16.5 ± 1.3 kg/m2, 20.4 ± 4.7 yrs.), 21 remitted female patients with AN (ANrem) (BMI 21.4 ± 2.9 kg/m2, 24.2 ± 3.2 yrs., remission period 6 ± 2.6 yrs.) and 15 female healthy controls (HC) (BMI 21.6 ± 3.1 kg/m2, 24.9 ± 2.7 yrs.) were included. Taste perception was evaluated using taste strips (sweet, sour, salty, bitter). Food practice and choice were assessed by self-report. Several blood parameters including hormones and leptin were analyzed. The number of fungiform papillae was quantified using digital photography and image processing.

Results

In ANacute bitter tasting foods were significantly consumed more often when compared with ANrem and HC. Sensoric taste perception for salty and bitter was reduced in ANacute (n.s.). Hedonic taste perception for sour, salty and bitter was increased in ANacute (n.s.). The number of fungiform papillae was significantly decreased in ANacute compared with ANrem and HC. Taste perception for bitter tastes within a range of concentrations correlated with serum estrogen and leptin.

Conclusions

Our results indicate a relationship between food selection and biological factors which can influence taste perception during the underweight stage of ANacute.