Transtornos alimentares

Instituto Estadual de Diabetes e Endocrinologia Grupo de Obesidade e Transtornos AlimentaresUniversidade Federal do Rio de Janeiro Instituto de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Comorbidade entre transtorno dismórfico corporal e bulimia nervosa

CONTEXTO: Insatisfação com a imagem corporal (IIC) é uma característica psicopatológica proeminente dos transtornos alimentares (TA), estando incluída nos critérios diagnósticos para anorexia nervosa e bulimia nervosa (BN). Portadores de TA podem apresentar IIC não relacionada ao peso, mas com a pele, os dentes e o nariz, entre outras. A presença de IIC não relacionada ao peso em portadores de TA pode levantar a possibilidade da existência de dois diagnósticos: o TA e o transtorno dismórfico corporal (TDC). RELATO DE CASO: Relatamos neste artigo o caso de uma paciente portadora de BN que apresentou incômodo significativo com a aparência de seu rosto, chegando a afetar seu funcionamento social mais que o TA. CONCLUSÃO: Embora os sistemas classificatórios atuais sugiram que o TDC seja diagnosticado na presença de queixas relacionadas a defeitos corporais que não sejam mais bem explicadas por outra condição, alguns autores relacionam essas queixas características intrínsecas dos TAs. Esse caso ilustra a necessidade de melhor entendimento das queixas relacionadas à IIC não relacionadas ao peso em pacientes portadores de TA e/ou eventual ocorrência de TDC nesses pacientes.BACKGROUND: Body image dissatisfaction (BID) is a relevant psychopatological feature of eating disorders (ED), being one of the diagnostic criteria for both anorexia nervosa and bulimia nervosa (BN). Patients with ED may present BID not related to their weight, such as dissatisfaction with their skin, teeth and nose amongst others. The presence of BDI not related to weight raises the possibility of the presence of two diagnostics: ED and body dysmorphic disorder (BDD). CASE REPORT: In this article the case of a female with BN, who presented a significant distress with the appearance of her face, which compromised her social functioning in a larger extent than the ED, is reported. DISCUSSION: Although present diagnostic systems indicate that BDD should be diagnosed in the presence of BID (which can not be explained by other condition) some authors support that these symptoms are intrinsic characteristics of ED. This case report illustrates the need of a better understanding of these BID non-weight related complaints in eating disordered patients, and the occurrence of BDD as a comorbid condition in those individuals

Comorbidade entre transtorno dismórfico corporal e bulimia nervosa

CONTEXTO: Insatisfação com a imagem corporal (IIC) é uma característica psicopatológica proeminente dos transtornos alimentares (TA), estando incluída nos critérios diagnósticos para anorexia nervosa e bulimia nervosa (BN). Portadores de TA podem apresentar IIC não relacionada ao peso, mas com a pele, os dentes e o nariz, entre outras. A presença de IIC não relacionada ao peso em portadores de TA pode levantar a possibilidade da existência de dois diagnósticos: o TA e o transtorno dismórfico corporal (TDC). RELATO DE CASO: Relatamos neste artigo o caso de uma paciente portadora de BN que apresentou incômodo significativo com a aparência de seu rosto, chegando a afetar seu funcionamento social mais que o TA. CONCLUSÃO: Embora os sistemas classificatórios atuais sugiram que o TDC seja diagnosticado na presença de queixas relacionadas a defeitos corporais que não sejam mais bem explicadas por outra condição, alguns autores relacionam essas queixas características intrínsecas dos TAs. Esse caso ilustra a necessidade de melhor entendimento das queixas relacionadas à IIC não relacionadas ao peso em pacientes portadores de TA e/ou eventual ocorrência de TDC nesses pacientes.BACKGROUND: Body image dissatisfaction (BID) is a relevant psychopatological feature of eating disorders (ED), being one of the diagnostic criteria for both anorexia nervosa and bulimia nervosa (BN). Patients with ED may present BID not related to their weight, such as dissatisfaction with their skin, teeth and nose amongst others. The presence of BDI not related to weight raises the possibility of the presence of two diagnostics: ED and body dysmorphic disorder (BDD). CASE REPORT: In this article the case of a female with BN, who presented a significant distress with the appearance of her face, which compromised her social functioning in a larger extent than the ED, is reported. DISCUSSION: Although present diagnostic systems indicate that BDD should be diagnosed in the presence of BID (which can not be explained by other condition) some authors support that these symptoms are intrinsic characteristics of ED. This case report illustrates the need of a better understanding of these BID non-weight related complaints in eating disordered patients, and the occurrence of BDD as a comorbid condition in those individuals

Comorbidade entre transtorno dismórfico corporal e bulimia nervosa

CONTEXTO: Insatisfação com a imagem corporal (IIC) é uma característica psicopatológica proeminente dos transtornos alimentares (TA), estando incluída nos critérios diagnósticos para anorexia nervosa e bulimia nervosa (BN). Portadores de TA podem apresentar IIC não relacionada ao peso, mas com a pele, os dentes e o nariz, entre outras. A presença de IIC não relacionada ao peso em portadores de TA pode levantar a possibilidade da existência de dois diagnósticos: o TA e o transtorno dismórfico corporal (TDC). RELATO DE CASO: Relatamos neste artigo o caso de uma paciente portadora de BN que apresentou incômodo significativo com a aparência de seu rosto, chegando a afetar seu funcionamento social mais que o TA. CONCLUSÃO: Embora os sistemas classificatórios atuais sugiram que o TDC seja diagnosticado na presença de queixas relacionadas a defeitos corporais que não sejam mais bem explicadas por outra condição, alguns autores relacionam essas queixas características intrínsecas dos TAs. Esse caso ilustra a necessidade de melhor entendimento das queixas relacionadas à IIC não relacionadas ao peso em pacientes portadores de TA e/ou eventual ocorrência de TDC nesses pacientes.BACKGROUND: Body image dissatisfaction (BID) is a relevant psychopatological feature of eating disorders (ED), being one of the diagnostic criteria for both anorexia nervosa and bulimia nervosa (BN). Patients with ED may present BID not related to their weight, such as dissatisfaction with their skin, teeth and nose amongst others. The presence of BDI not related to weight raises the possibility of the presence of two diagnostics: ED and body dysmorphic disorder (BDD). CASE REPORT: In this article the case of a female with BN, who presented a significant distress with the appearance of her face, which compromised her social functioning in a larger extent than the ED, is reported. DISCUSSION: Although present diagnostic systems indicate that BDD should be diagnosed in the presence of BID (which can not be explained by other condition) some authors support that these symptoms are intrinsic characteristics of ED. This case report illustrates the need of a better understanding of these BID non-weight related complaints in eating disordered patients, and the occurrence of BDD as a comorbid condition in those individuals

Comorbidade entre transtorno dismórfico corporal e bulimia nervosa

CONTEXTO: Insatisfação com a imagem corporal (IIC) é uma característica psicopatológica proeminente dos transtornos alimentares (TA), estando incluída nos critérios diagnósticos para anorexia nervosa e bulimia nervosa (BN). Portadores de TA podem apresentar IIC não relacionada ao peso, mas com a pele, os dentes e o nariz, entre outras. A presença de IIC não relacionada ao peso em portadores de TA pode levantar a possibilidade da existência de dois diagnósticos: o TA e o transtorno dismórfico corporal (TDC). RELATO DE CASO: Relatamos neste artigo o caso de uma paciente portadora de BN que apresentou incômodo significativo com a aparência de seu rosto, chegando a afetar seu funcionamento social mais que o TA. CONCLUSÃO: Embora os sistemas classificatórios atuais sugiram que o TDC seja diagnosticado na presença de queixas relacionadas a defeitos corporais que não sejam mais bem explicadas por outra condição, alguns autores relacionam essas queixas características intrínsecas dos TAs. Esse caso ilustra a necessidade de melhor entendimento das queixas relacionadas à IIC não relacionadas ao peso em pacientes portadores de TA e/ou eventual ocorrência de TDC nesses pacientes.BACKGROUND: Body image dissatisfaction (BID) is a relevant psychopatological feature of eating disorders (ED), being one of the diagnostic criteria for both anorexia nervosa and bulimia nervosa (BN). Patients with ED may present BID not related to their weight, such as dissatisfaction with their skin, teeth and nose amongst others. The presence of BDI not related to weight raises the possibility of the presence of two diagnostics: ED and body dysmorphic disorder (BDD). CASE REPORT: In this article the case of a female with BN, who presented a significant distress with the appearance of her face, which compromised her social functioning in a larger extent than the ED, is reported. DISCUSSION: Although present diagnostic systems indicate that BDD should be diagnosed in the presence of BID (which can not be explained by other condition) some authors support that these symptoms are intrinsic characteristics of ED. This case report illustrates the need of a better understanding of these BID non-weight related complaints in eating disordered patients, and the occurrence of BDD as a comorbid condition in those individuals

Systematic review and meta-analysis of the use of prokinetics in gastroesophageal reflux and in gastroesophageal reflux disease in Pediatrics

OBJECTIVE: To evaluate, by systematic review and meta-analysis, randomized studies comparing the prokinetics (domperidone, bromopride, metoclopramide and bethanechol) to placebo in the treatment of gastroesophagic reflux (GER) and gastroesophagic reflux disease (GERD) in children. METHODS: Bibliographic search for randomized clinical trials (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). The primary outcome was the modification of reflux symptoms. Other outcomes were: GER-related complications, alterations in control exams, life quality, adverse events and abandon of treatment. RESULTS: The metanalysis included four studies on domperidone, two on metoclopramide, and one on bethanechol. No study of bromopride was retrieved. The risk of non-response to the treatment was significantly smaller in children that received prokinetics in comparison to placebo (RR 0.35, 95%CI 0.14-0.88). Individual therapeutic advantage regarding placebo was related to domperidone (n=126; RR 0.27; 95%CI 0.14-0.52, NNT 3; I2 0%) and bethanechol (n=44; RR 0.19; 95%CI 0.05-0.55; NNT 2), but not to metoclopramide (n=71; RR 0.63; 95%CI 0.07-5.71; I2 92.2%). CONCLUSIONS: The evidence for prokinetic use in GER and GERD in children is limited because the few studies report preliminary trials that evaluate short-term responses and show methodological limitations.OBJETIVO: Avaliar, por meio de revisão sistemática e metanálise, estudos randomizados que comparam os procinéticos domperidona, bromoprida, metoclopramida e betanecol ao placebo no tratamento do refluxo gastroesofágico (RGE) e da doença do refluxo gastroesofágico (DRGE) em crianças. MÉTODOS: BUsca bibliográfica de ensaios clínicos randomizados (Medline, EMBASE, Biological Abstracts, ISI/Web of Science, CINAHL, Lilacs e Cochrane). O desfecho primário foi eficácia na modificação dos sintomas de refluxo, conforme definição de autores das fontes primárias. Outras variáveis de interesse foram: complicações relacionadas ao RGE, alterações nos exames laboratoriais de controle, qualidade de vida, eventos adversos e abandono do tratamento. RESULTADOS: Foram incluídos quatro estudos com domperidona, dois com metoclopramida, um com betanecol. Nenhum estudo com bromoprida foi localizado. O risco de não resposta ao tratamento foi significativamente menor para os procinéticos quando comparados ao placebo (RR 0,35; IC95% 0,14-0,88). A vantagem terapêutica individual em relação ao placebo se manteve para a domperidona (n=126; RR 0,27; IC95% 0,14-0,52; NNT 3; I2 0%) e betanecol (n=44, RR 0,19, IC95% 0,05-0,55, NNT 2), mas não para metoclopramida (n=71; RR 0,63; IC95% 0,07-5,71, I2 92,2%). CONCLUSÕES: A evidência para o uso de procinéticos no RGE e na DRGE em crianças é limitada, pois os poucos estudos são ensaios preliminares de resposta em curto prazo e com limitações metodológicas.UFPel Centro de Medicina Baseada em EvidênciasHospital de Clínicas de Porto Alegre Instituto Nacional de Ciência e Tecnologia Translacional em MedicinaUFRJ Instituto de PsiquiatriaUNIFESP Departamento de PsiquiatriaUNIFESP, Depto. de PsiquiatriaSciEL

Long-acting injectable risperidone in partially adherent and nonadherent patients with schizophrenia

Background: Long-acting injectable antipsychotics may improve medication adherence, thereby improving overall treatment effectiveness. This study aimed to evaluate the effectiveness, safety, and tolerability of risperidone long-acting injection in schizophrenic patients switched from oral antipsychotic medication. Methods: In a 12-month, multicenter, open-label, noncomparative study, symptomatically stable patients on oral antipsychotic medication with poor treatment adherence during the previous 12 months received intramuscular injections of risperidone long-acting injection (25 mg starting dose) every 2 weeks. The primary endpoint was the change in Positive and Negative Syndrome Scale (PANSS) total score. Results: Of the 60 patients who were screened, 53 received at least one injection (safety population), and 51 provided at least one postbaseline assessment. Mean PANSS total scores improved significantly throughout the study and at endpoint. Significant improvements were also observed in Clinical Global Impression of Severity, Personal and Social Performance, and Drug Attitude Inventory scales. Risperidone long-acting injection was safe and well-tolerated. Severity of movement disorders on the Extrapyramidal Symptom Rating Scale was reduced significantly. The most frequently reported adverse events were insomnia (22.6%), increased prolactin (17.0%), and weight gain (13.2%). Conclusion: Risperidone long-acting injection was associated with significant symptomatic improvements in stable patients with schizophrenia following a switch from previous antipsychotic medications.Janssen-Cilag Farmaceutica Ltda, Brazi

Effects of Aerobic Exercise on Anxiety Symptoms and Cortical Activity in Patients with Panic Disorder: A Pilot Study

Background: The effects of the aerobic exercise on anxiety symptoms in patients with Panic Disorder (PD) remain unclear. Thus, the investigation of possible changes in EEG frontal asymmetry could contribute to understand the relationship among exercise, brain and anxiety. Objective: To investigate the acute effects of aerobic exercise on the symptoms of anxiety and the chronic effects of aerobic exercise on severity and symptoms related to PD, besides the changes in EEG frontal asymmetry. Methods: Ten PD patients were divided into two groups, Exercise Group (EG; n=5) and Control Group (CG; n=5), in a randomized allocation. At baseline and post-intervention, they submitted the psychological evaluation through Panic Disorder Severity Scale (PDSS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), EEG frontal asymmetry, and maximal oxygen consumption (VO2max). On the second visit, the patients of EG being submitted to the aerobic exercise (treadmill, 25 minutes, and 50-55% of heart rate reserve) and the CG remained seated for the same period of time. Both groups submitted a psychological evaluation with Subjective Units of Distress Scale (SUDS) at baseline, immediately after (Post-0), and after 10 minutes of the rest pause (Post-10). The patients performed 12 sessions of aerobic exercise with 48-72 hours of interval between sessions. Results: In EG, SUDS increased immediately after exercise practice and showed chronic decrease in BAI and BDI-II as well as increased in VO2max (Post-intervention). Conclusion: Aerobic exercise can promote increase in anxiety acutely and regular aerobic exercise promotes reduction in anxiety levels.Eduardo Lattari acknowledges the financial support of the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)Peer Reviewe

Serological study of vaccinia virus reservoirs in areas with and without official reports of outbreaks in cattle and humans in São Paulo, Brazil

Vaccinia virus (VACV), the etiological agent of an exanthematic disease, has been associated with several bovine outbreaks in Brazil since the end of the global vaccination campaign against smallpox. It was previously believed that the vaccine virus used for the WHO global campaign had adapted to an unknown wild reservoir and was sporadically re-emerging in outbreaks in cattle and milkers. At present, it is known that Brazilian VACV is phylogenetically different from the vaccinia virus vaccinal strain, but its origin remains unknown. This study assessed the seroprevalence of orthopoxviruses in domestic and wild animals and farmers from 47 farms in three cities in the southwest region of the state of São Paulo with or without official reports of outbreaks in cattle or humans. Our data indicate a low seroprevalence of antibodies in wild animals and raise interesting questions about the real potential of wild rodents and marsupials as VACV reservoirs, suggesting other routes through which VACV can be spread