Instrumentos para avaliação da compulsão alimentar em adultos : uma revisão sistemática

Objective: The aim of this study was to systematically review the methodologies used for BE evaluation/identification diagnosis in clinical trials (CT) with adults. Methods: The search was performed on PUBMED until July 2018. The PRISMA statement was used to improve the reporting of results. Results: 93 CTs were included among the 225 studies retrieved. The main BE evaluation/identification methods used in studies were: Binge Eating Scale; Diagnostic and Statistical Manual of Mental Disorders; Eating Disorder Diagnostic Scale; Eating Disorder Examination; Eating Disorder Examination Questionnaire; Eating Disorder Inventory; Loss of Control Over Eating Scale and Three-Factor Eating Questionnaire. Overlaps between methods were observed in studies, 61 used both DSM and an evaluation instrument, 06 only DSM and 26 only standardized questionnaires to assess BE disorder. Conclusions: The DSM-5 diagnostic criterion for binge eating disorder is considered excellent and widely used, however, when the objective of the study is to identify emotional, nutritional and qualitative issues, a questionnaire or interview about subjective perceptions can be used in a complementary way.Objetivo: O objetivo deste estudo foi revisar sistematicamente as metodologias utilizadas para avaliação/identificação da compulsão alimentar em ensaios clínicos com pacientes adultos. Métodos: A busca foi realizada no PUBMED até julho de 2018. Foi utilizado o protocolo PRISMA para reportar os resultados. Resultados: Foram incluídos 93 ensaios clínicos dentre os 225 que foram encontrados na busca da literatura. Os principais métodos de avaliação / identificação da compulsão alimentar utilizados nos estudos foram: Binge Eating Scale; Manual Diagnóstico e Estatístico de Transtornos Mentais; Escala de Diagnóstico de Transtorno Alimentar; Exame de Transtorno Alimentar; Questionário de Exame de Transtorno Alimentar; Inventário de Desordens Alimentares; Escala de Perda de Controle sobre a Alimentação e Questionário de Alimentação de Três Fatores. Foram observadas sobreposições entre os métodos nos estudos, 61 utilizaram o DSM e outro instrumento de avaliação, seis estudos utilizaram apenas o DSM e 26 apenas questionários padronizados para avaliar o transtorno de compulsão alimentar. Conclusão: O critério diagnóstico do DSM-5 para o transtorno de compulsão alimentar é considerado excelente e utilizado amplamente, entretanto, quando o objetivo do estudo é identificar questões emocionais, nutricionais e qualitativas, pode ser utilizado de forma complementar um questionário ou entrevista sobre percepções subjetivas

Childhood trauma and resilience : vulnerabilities to develop crack/cocaine dependence

Background: Crack cocaine dependence is a health problem of epidemic proportions and there is lack of evidence concerning vulnerability factors that could lead to crack cocaine use. The aim of this study is to investigate characteristics of resilience in a group of crack cocaine users and its association with childhood trauma and PTSD. Method: This is a case-control study in which we evaluated 218 crack cocaine inpatients users and 215 healthy controls, recruited from the capital city of the southern State of Brazil. Childhood Trauma was evaluated with the Childhood Trauma Questionnaire; resilience was evaluated with the Resilience Scale; and post-traumatic stress disorder (PTSD) was evaluated with the Mini-International Neuropsychiatric Interview. Results: Childhood trauma was significantly higher among crack cocaine users in all trauma domains (p<0.001), except for sexual abuse. Most resilience scores was lower among crack cocaine users (p<0.01). Having higher scores of childhood trauma and lower scores of resilience increase the odds to become a crack cocaine user (p<0.001), despite the diagnosis of PTSD. Discussion: Childhood trauma appears to be a risk factor to become a crack cocaine user while resilience features may be a protection factor. To understand factors of vulnerabilities in this population is important for the development of more efficacious treatment and preventive strategies

Crack-cocaine users have less family cohesion than alcohol users

Objective: Many studies correlate characteristics of family functioning and the development of drug addiction. This study sought to evaluate and compare the family environment styles of two groups of psychoactive substance users: 1) alcohol-only users and 2) crack-cocaine users. Methods: Three hundred and sixty-four users of alcohol, crack-cocaine, and other drugs, recruited from research centers in four Brazilian capitals participated in this study. Subjects were evaluated through the Family Environment Scale and the Addiction Severity Index, 6th version (ASI-6). ASI-6 t-scores were compared by analysis of variance (ANOVA) and post-hoc tests. A final model was obtained using a logistic regression analysis. All analyses were adjusted for partner, age, and psychiatric t-score. Results: We found a significant difference between groups in the cohesion subscale (p = 0.044). The post-hoc test revealed a difference of 1.06 points (95%CI 0.11-2.01) between groups 1 (6.4560.28) and 2 (5.3860.20). No significant between-group differences were observed in the other subscales. However, categorical analyses of variables regarding family dynamic showed that crack users more often reported that sometimes people in their family hit each other (30.4% vs. 13.2%, p = 0.007) and that people in their family frequently compared each other regarding work and/or school achievement (57.2% vs. 42.6%, p = 0.041). Conclusion: These results suggest that families of crack-cocaine users are less cohesive than families of alcohol users. This type of family environment may affect treatment outcome, and should thus be adequately approached