An empirical evaluation of the translation to Brazilian Portuguese of the Loss of Control over Eating Scale (LOCES)

Background Loss of control over eating is a key feature of the most prevalent eating disorders. The Loss of Control over Eating Scale (LOCES) enables a thorough assessment of loss of control over eating. Objective This study empirically evaluated the translation of the LOCES from English to Brazilian Portuguese. Methods The scale was translated to Brazilian Portuguese and back translated to English in order to check accuracy of the translation. Two hundred and ninety-three medicine and nursing students, 60 males and 233 females, 18-55 years old, with mean body mass index (BMI) 23.2 kg/m2 (SD 4.1), recruited between August and December 2014, answered the Brazilian Portuguese LOCES. An exploratory factor analysis was performed. Results Exploratory factor analysis of the Brazilian Portuguese LOCES showed three distinct factors of the loss of control over eating (disgust/negative sensations, cognitive experiences/dissociation, and “positive” effects) as well as moderate consistency with previous reports of exploratory factor analysis of the English version. Discussion This study showed satisfactory translation of the LOCES from English to Brazilian Portuguese, which is now ready for further validation

Physical and mental health outcomes of an integrated cognitive behavioural and weight management therapy for people with an eating disorder characterized by binge eating and a high body mass index : a randomized controlled trial

Background: Bulimia nervosa (BN) and binge eating disorder (BED) are eating disorders (EDs) characterized by recurrent binge eating. They are associated with medical complications, impaired adaptive function and often a high BMI, for which a multidisciplinary treatment approach may be needed. This study explored the efficacy of a novel intervention integrating Cognitive Behavioural Therapy- Enhanced (CBT-E) and weight management for people with recurrent binge eating episodes and high BMI with respect to physical, psychopathological and quality of life outcomes. Methods: Ninety-eight adults diagnosed with BN, BED, or Other Specified/Unspecified Feeding or Eating Disorder (OSFED/UFED) and BMI ≥ 27 to <40 kg/m2 were randomized to a multidisciplinary approach, the Healthy APproach to weIght management and Food in Eating Disorders (HAPIFED) or to CBT-E. Metabolic parameters, health-related quality of life, general psychological and ED symptoms and ED diagnostic status outcomes are reported. Data were analyzed with mixed effects models adopting multiple imputed datasets where data were missing. Results: Both HAPIFED and CBT-E showed statistical significance for the time effect, with reduction in stress (p < 0.001), improvement in mental health-related quality of life (p = 0.032), reduction in binge eating severity (p < 0.001), and also in global ED symptoms scores (p < 0.001), with the significant changes found at end of treatment and sustained at 12-month follow-up. However, no statistical significance was found for differences between the interventions in any of the outcomes measured. Despite a high BMI, most participants (> 75%) had blood test results for glucose, insulin, triglycerides and cholesterol within the normal range, and 52% were within the normal range for the physical component of quality of life at baseline with no change during the trial period. Conclusion: Integrating weight and ED management resulted in comparable outcomes to ED therapy alone. Although adding weight management to an ED intervention had no adverse effects on psychological outcomes, it also had no beneficial effect on metabolic outcomes. Therefore, more intense weight management strategies may be required where indicated to improve metabolic outcomes. Safety will need to be concurrently investigated. Trial registration: US National Institutes of Health clinical trial registration number NCT02464345, date of registration 08/06/2015. Changes to the present paper from the published protocol paper (Trials 18:578, 2015) and as reported in the Trial registration (clinicaltrials.gov) are reported in Supplementary File 1

Teachers’ perceptions, difficulties, and actions facing drugs at the school environment

Objetivou-se avaliar a percepção dos professores de ensino médio sobre suas atitudes em relação à abordagem da temática do uso de álcool e outras drogas em seu trabalho. Trata se de um estudo qualitativo, através de perguntas semiestruturadas. Os participantes responderam a um questionário semiestruturado e os dados obtidos foram inseridos no software Atlas.ti, desenvolvendo-se uma análise de conteúdo do tipo temática. Produziram-se três categorias de análise: a compreensão dos professores a respeito de seu papel na discussão sobre substâncias psicoativas; dificuldades na abordagem sobre as substâncias psicoativas no âmbito do trabalho; ações e necessidades destinadas ao trabalho com a temática das substâncias psicoativas na escola. Alguns desses educadores, em sua percepção, não compreendem que discutir o tema álcool e drogas deva fazer parte de suas atribuições por não considerarem ser papel da escola. Os educadores percebem a necessidade de capacitação para trabalhar de forma interdisciplinar com a problemática, não apenas direcionada às suas próprias atuações, mas também em relação às redes de apoio e legislações sobre álcool e drogas. É necessário criar formas práticas de oferecimento de capacitações específicas sobre o uso de substâncias psicoativas aos gestores escolares e educadores, investir na implementação de espaços de discussão e reflexão dentro da escola entre docente e discentes e construir um trabalho em rede intersetorial, visando melhor enfrentamento da problemática em âmbito escolar.We aimed to evaluate the perception of high school teachers about their attitudes when approaching the topic of use of alcohol and other drugs in their work. This is a qualitative study, performed by semi-structured questions. Participants answered to a semi-structured questionnaire and the obtained data were entered into the Atlas.ti software, and thus we developed a thematic content analysis. We produced three categories of analysis: understanding the teachers regarding their role when discussing psychoactive substances; difficulties in approaching psychoactive substances in the work environment; actions and needs aimed at work with the theme of psychoactive substances at school. Some of these educators, in their perception, do not understand that discussing alcohol and drugs should be part of their work because they do not consider it as part of the role of the school. Educators realize the need for training for them to work in an interdisciplinary way with these problems not just directed to their own performances, but also concerning support networks and legislation on alcohol and drugs. It is necessary to create practical ways of providing specific training on the use of psychoactive substances to school managers and educators, investing in the implementation of spaces for discussion and reflection at the school environment between staff and students, and creating an intersectoral networking aimed at better addressing such issue

Pharmacological treatments in anorexia nervosa and binge eating disorder

BV UNIFESP: Teses e dissertaçõe

Bulimia nervosa

INTRODUCTION: Up to 1% of young women may have bulimia nervosa, characterised by an intense preoccupation with body weight, uncontrolled binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa may be of normal weight, making it difficult to diagnose. After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms. METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for bulimia nervosa in adults? What are the effects of discontinuing treatment in people with bulimia nervosa in remission? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review).We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria.We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy (CBT; alone or plus exposure/response prevention enhancement), cognitive orientation therapy, dialectical behavioural therapy, discontinuing fluoxetine in people with remission, guided self-help cognitive behavioural therapy, hypnobehavioural therapy, interpersonal psychotherapy, mirtazapine, monoamine oxidase inhibitors (MAOIs), motivational enhancement therapy, pharmacotherapy plus psychotherapy, pure or unguided self-help cognitive behavioural therapy, reboxetine, selective serotonin reuptake inhibitors (SSRIs), topiramate, tricyclic antidepressants (TCAs), and venlafaxine

Considerações diagnósticas na anorexia nervosa: análise a partir de 7 casos clínicos

BV UNIFESP: Teses e dissertaçõe

Evidence-based treatment for the eating disorders

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa(BN), binge eating disorder(BED), and eating disorder not otherwise specified(EDNOS), and discusses the role of primary care and presents treatment algorithms

Bulimia nervosa : online interventions

Introduction: Up to 1% of young women may have bulimia nervosa, characterised by an intense preoccupation with body weight, uncontrolled binge-eating episodes, and use of extreme measures to counteract the feared effects of overeating. People with bulimia nervosa may be of normal weight, making it difficult to diagnose. After 10 years, about half of people with bulimia nervosa will have recovered fully, one third will have made a partial recovery, and 10% to 20% will still have symptoms. Methods and Outcomes: We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments for bulimia nervosa in adults? What are the effects of discontinuing treatment in people with bulimia nervosa in remission? We searched: Medline, Embase, The Cochrane Library, and other important databases up to January 2010 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review).We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS: We found 27 systematic reviews, RCTs, or observational studies that met our inclusion criteria.We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions: In this systematic review we present information relating to the effectiveness and safety of the following interventions: cognitive behavioural therapy (CBT; alone or plus exposure/response prevention enhancement), cognitive orientation therapy, dialectical behavioural therapy, discontinuing fluoxetine in people with remission, guided self-help cognitive behavioural therapy, hypnobehavioural therapy, interpersonal psychotherapy, mirtazapine, monoamine oxidase inhibitors (MAOIs), motivational enhancement therapy, pharmacotherapy plus psychotherapy, pure or unguided self-help cognitive behavioural therapy, reboxetine, selective serotonin reuptake inhibitors (SSRIs), topiramate, tricyclic antidepressants (TCAs), and venlafaxine