Long Term Remission of Anorexia Nervosa: Factors Involved in the Outcome of Female Patients

Background: Anorexia nervosa (AN) is usually marked by difficult recovery.Objective: To elicit, describe and characterize factors involved in successful AN remission for at least five years and post-recovery life.Methods: A qualitative study design using semi-structured interviews according to grounded theory methodology was used. An intentional sample of 15 information rich AN patients was selected using two sampling procedures: the criterion and snowball techniques. Qualitative interviews were audiotaped, transcribed, and entered into a content analysis. Researchers coded transcripts and developed themes.Results: Four core parameters were found to be associated with remission: (i) 'motivation to change/stimuli'; (ii) 'empowerment/autonomy'; (iii) 'media related factors'; (iv) 'treatment factors'. Clinical remission can be associated with residual symptoms.Conclusions: the recovery model involves not only one, but rather a set of inter-active variables, each one can partially explain remission. Media factors can take a new role on recovery. Remission, however, can be followed by remnants of the disease and functional limitations.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilFAPESP: 07/50739CNPq: 306156/2011-3Web of Scienc

Bulimia and binge eating disorder: systematic review and metasynthesis

OBJECTIVE: The aim of this systematic review is to identify the scope of qualitative investigations on the life experience of patients with bulimia and binge eating disorder. METHODOLOGY: Searches were conducted using the following databases: PubMed, ISI, PsycInfo, Embase, LILACS and Scielo, for articles published between 1990 and 2005. Inclusion criteria were: 1) articles with main focus on bulimia or binge eating disorders; 2) original research reported in English, Spanish, French or Portuguese; 3) use of any qualitative method, such as interview, focal group or field observation. Exclusion criteria were exclusively theoretical articles and those assessing children or elderly subjects. A meta-ethnographic approach was used to synthesize the data. Each study was carefully read, and their thematic categories were interpreted and compared to the categories of all other studies. RESULTS: Fifteen studies were included of a total of 3,415 articles. Seven overlapping main themes were identified: illness representation; negative feelings (fear, guilt, anger, loneliness, loss of control); positive feelings (self-control, power); symptom function; interpersonal relationships; sociocultural context; recovery. CONCLUSIONS: Although many issues were negative, the overall experience was not reported as being only bad. Some aspects of eating disorders were considered beneficial by the patients.OBJETIVO: Esta revisão sistemática teve como objetivo organizar o conjunto das informações disponibilizadas pelos estudos qualitativos sobre a vivência dos pacientes portadores de bulimia e transtorno da compulsão alimentar periódica. METODOLOGIA: Pesquisas foram conduzidas nas seguintes bases de dados: PubMed, ISI, PsycINFO, EMBASE, LILACS e SciELO, no período de 1990 a 2005. Critérios de inclusão: 1) artigos com foco principal na bulimia ou transtorno da compulsão alimentar periódica; 2) pesquisas originais em inglês, espanhol, francês ou português; 3) uso de qualquer método qualitativo, como entrevista, grupo focal ou observação de campo. Critérios de exclusão: artigos exclusivamente teóricos ou que utilizam população infantil ou da terceira idade. Utilizou-se a abordagem meta-etnográfica para sintetizar os dados. Cada estudo foi lido, e as categorias centrais de cada um foram comparadas e interpretadas com as categorias de todos os outros estudos. RESULTADOS: Foram incluídos 15 estudos de um total de 3.415 artigos. Sete temas centrais que se sobrepõem foram identificados: representação da doença; sentimentos negativos (medo, culpa, raiva, solidão, perda de controle); sentimentos positivos (auto-controle; poder; função do sintoma; relacionamentos interpessoais; história pessoal; contexto sociocultural; recuperação). CONCLUSÕES: Embora muitos aspectos sejam negativos, a experiência, como um todo, não é referida apenas como má. Alguns aspectos dos transtornos alimentares são sentidos como benéficos, segundo os pacientes.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

Associação dos fatores físicos, psiquiátricos e socioeconômicos e os escores do WHOQOL-Bref

The aim of this study is to investigate the impact of psychiatric morbidity, depression, cognitive deficit, number of self-reported illnesses and socio-demographic variables on the WHOQOL-Bref domain scores. WHOQOL-Bref domain scores are substantially affected by psychiatric morbidity and income. Depression, the number of self-reported illnesses and the female gender also explain the variability of other domains to a lesser extent.O objetivo deste estudo é o de investigar o impacto da morbidade psiquiátrica, depressão, comprometimento cognitivo, número de doenças autorreferidas e variáveis sociodemográficas nos escores do WHOQOL-Bref. Os escores dos domínios do WHOQOL-Bref estão associados à morbidade psiquiátrica e renda. A depressão, o número de doenças autorreferidas e o sexo feminino também explicam a variabilidade nos outros domínios, porém em menor grau.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Universidade Federal de São Paulo (UNIFESP) Departamento de PsiquiatriaCentro Universitário Hermínio OmettoUNIFESP, Depto. de PsiquiatriaSciEL

Public perception of depression in the city of São Paulo

OBJECTIVE: To assess how the population identifies symptoms of depression as well as its causes. METHODS: A household survey with a probabilistic sample of 500 individuals, residing in the city of São Paulo and aged between 18 and 65 years, was conducted in 2002. A structured questionnaire including sociodemographic data and a vignette presentation describing a person with depression, according to the Diagnostic and Statistical Manual of Mental Disorders-IV and the International Classification of Diseases-10 was used during the in-person interviews carried out by trained, qualified interviewers. Two questions about the vignette's symptom identification were subsequently asked. The results were analyzed by means of logistic regression and variance analysis. RESULTS: Symptoms presented were identified as depression by less than half of the sample. About 20% of respondents believed it was a mental illness. Low level of education was the only variable associated with identification as mental illness (OR=2.001, 95% CI: 1.275; 3.141, p=0.003). The most relevant causes were unemployment and isolation. Biological, spiritual and moral causes were considered to be less relevant. Factors that most influenced the responses about causes were level of education, gender, personal experience with mental problems and identification as mental illness. CONCLUSIONS: The population of the city of São Paulo in general, especially those with a higher level of education, views depression in terms of a psychosocial model that somewhat differs from the biomedical model.OBJETIVO: Avaliar como a população identifica os sintomas de depressão e suas causas. MÉTODOS: Foi realizado inquérito domiciliar em 2002 com amostra probabilística de 500 indivíduos residentes em São Paulo, com idade entre 18 e 65 anos. Foi aplicado questionário estruturado que incluía dados sociodemográficos e apresentação de vinheta que descrevia uma pessoa com depressão, segundo o Diagnostic and Statistical Manual of Mental Disorders-IV e a Classificação Internacional de Doenças-10. A seguir, eram respondidas duas questões sobre a identificação dos sintomas da vinheta. A atribuição de causas foi avaliada mediante apresentação de 18 possíveis causas. Os resultados foram analisados por meio de regressão logística e análise de variância. RESULTADOS: Os sintomas apresentados foram identificados como depressão por menos da metade da amostra. Cerca de 20% dos entrevistados acreditaram tratar-se de doença mental. Baixa escolaridade foi a única variável associada à identificação como doença mental (OR=2,001, IC 95%: 1,275;3,141, p=0,003). As causas consideradas mais relevantes foram desemprego e isolamento. Causas biológicas, espirituais e morais foram tidas como menos relevantes. Os determinantes associados às respostas sobre causas foram escolaridade, sexo, experiência pessoal com problemas mentais e identificação como doença mental. CONCLUSÕES: A população de São Paulo em geral e as pessoas com maior escolaridade em particular apresentam um modelo psicossocial de depressão que se afasta do modelo biomédico.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaSciEL

A percepção popular sobre a dependência alcoólica

OBJECTIVE: To describe how the population of the city of São Paulo identifies alcohol dependence, which causes they attribute to this disorder and what is reported regarding stigma perception, risk of violence and emotional reactions. METHOD: Cross sectional study involving a probabilistic sample of 500 individuals in São Paulo aged 18 to 65 years. A structured questionnaire was used and started with a vignette describing an individual with alcohol dependence according to the DSM-IV and ICD-10, followed by a questionnaire divided into various sections examining the causes, stigma, risk of violence and emotional reactions to the case presented in the vignette. RESULTS: Less than 20% of the subjects reported to believe this was a mental illness. The causes considered most relevant were psychosocial ones, followed by moral causes. Alcohol dependence was associated with a high risk of violence and stigma by the part of others. In contrast, reactions declared by the subjects about their probable attitude were mostly positive. CONCLUSION: Alcohol dependence is seen as a psychosocial and moral problem. Negative images predominate regarding individuals with this disorder.OBJETIVO: Descrever como a população da cidade de São Paulo identifica a dependência alcoólica, quais causas atribui para explicar esse transtorno, e avaliar o que é percebido em relação ao estigma, risco de violência e as reações emocionais. MÉTODO: Foi realizado estudo de corte transversal com uma amostra probabilística de 500 indivíduos residentes em São Paulo, com idade entre 18 e 65 anos. Utilizou-se um questionário estruturado que se iniciava com a apresentação de uma vinheta descrevendo um indivíduo com dependência alcoólica (segundo o DSM-IV e a CID 10), seguido de um questionário dividido em várias seções examinando as causas, estigma, risco de violência e as reações emocionais ao caso apresentado na vinheta. RESULTADOS: Menos de 20% dos entrevistados disseram acreditar se tratar de uma doença mental. As causas consideradas mais relevantes foram de natureza psicossocial, seguidas por causas de natureza moral. A dependência alcoólica foi associada a elevado risco de violência e a estigma por parte de outros indivíduos. Em contraste, as reações declaradas pelos próprios entrevistados sobre as suas atitudes foram principalmente de natureza positiva. CONCLUSÕES: A dependência alcoólica é vista como um problema de natureza psicossocial e moral. Predominam imagens negativas em relação aos indivíduos com este transtorno.Universidade Federal de São Paulo (UNIFESP) Department of PsychiatryUNIFESP, Department of PsychiatrySciEL

Quality of life and eating disorders: a systematic review

This article provides a systematic review of articles on quality of life (QoL) among individuals with eating disorders. A literature search was conducted using six databases. Manual searches were also performed in two specialized journals, covering the period from January 1975 to June 2008. The search strategies identified a total of 29,537 articles. Forty-one studies met the inclusion criteria, and 36 were analyzed in the present review. Patients with eating disorders showed reduced QoL as compared to normal controls and individuals with other psychiatric disorders. The mental health component of QoL showed greater impairment than the physical component. Patients with binge eating disorders showed reduced physical and psychological QoL. We identified few studies on QoL in bulimia nervosa-only patients. QoL assessment of anorexia nervosa patients showed a modest impact on the physical domain. However, this finding should be interpreted with caution, since it may be due to an artifact in the disorder's psychopathology rather than better health status per se.O objetivo foi fazer uma revisão sistemática dos estudos que avaliam qualidade de vida em pessoas com transtornos alimentares. Foram realizadas buscas bibliográficas em seis bases de dados e buscas manuais em duas revistas, abrangendo o período de janeiro de 1975 até junho de 2008. As estratégias de busca forneceram um total de 29.537 referências. Quarenta e um estudos preencheram os critérios de inclusão desta revisão e 36 foram analisados no presente trabalho. De modo geral, os estudos revelam prejuízos na qualidade de vida de pacientes com transtornos alimentares quando comparados a grupos normais ou outras patologias psiquiátricas. O aspecto mental da qualidade de vida mostra-se mais prejudicado. A avaliação da qualidade de vida em sujeitos com transtorno da compulsão alimentar periódica revela prejuízos nos aspectos físico e mental da qualidade de vida. Há pouca evidência e discussão para indivíduos com bulimia nervosa isoladamente. Em sujeitos com anorexia nervosa, a avaliação requer cautela, já que o aparente menor impacto físico pode ser reflexo da psicopatologia específica deste transtorno e não do funcionamento saudável.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Prevalence and Concomitants of Arthritis in the Elderly in Rio Grande do Sul, Brazil

Objectives: Information on the prevalence and concomitants of arthritis in developing countries is sparse. It is unclear whether they are comparable to findings in developed countries. To ascertain the prevalence, demographic characteristics, and health-related concomitants of arthritis in older persons in the southern state of Rio Grande do Sul, Brazil, a middle income country.Methods: the state of Rio Grande do Sul, Brazil, was subdivided into nine regions. Stratified random sampling was used to identify 880 community residents age >= 60 years in each region. One region with suspect data was excluded. of 7040 community residents contacted in eight regions, 6963 participated (1.1% refusal rate). in 1995, trained, monitored interviewers, using structured questionnaires, conducted in-home interviews gathering information on demographic characteristics (age, sex, race/ethnicity, education, income, living arrangements, employment status), health behaviors (physical activity, tobacco use, social activity), functional limitations, depression, and 15 self-reported health conditions, including arthritis. Data were analyzed using descriptive statistics and logistic regression.Results: Arthritis, reported by 43% of the sample, was more prevalent in women, among the less educated, those with lower income, and higher age. Severity, but not prevalence, differed by race/ethnicity. Controlled analyses indicated significant association with female gender, lower education, and less social activity. Arthritis was associated with reduced odds of stroke, but increased odds of hypertension, varicosities, bronchitis, renal problems, headache, gastrointestinal disorders, and depression. Arthritis was not significantly associated with age or functional limitations, and associations did not differ by gender.Conclusions: the prevalence, demographic and health characteristics associated with self-reported arthritis in this southern state in Brazil are similar to findings elsewhere in Brazil, and in developed countries.Conselho Estadual do Idoso, Secretaria do Trabalho, Cidadania e Assistencia SocialGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological DevelopmentNational Institute on AgingUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAVet Adm Med Ctr, Geriatr Res Educ & Clin Ctr, Durham, NC USAProject Sci Comm, Porto Alegre, RS, BrazilUniversidade Federal de São Paulo, Dept Psychiat, Escola Paulista Med UNIFESP, São Paulo, BrazilGoverno do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 470724/2011-0Governo do Estado do Rio Grande do Sul, the National Council for Scientific and Technological Development: 306156/2011-3National Institute on Aging: 1P30 AG028716-02Web of Scienc

Prevalence and Correlates of Physical Inactivity among Older Adults in Rio Grande do Sul, Brazil

BackgroundCurrent information on the epidemiology of physical inactivity among older adults is lacking, making it difficult to target the inactive and to plan for interventions to ameliorate adverse effects.ObjectivesTo present statewide representative findings on the prevalence of physical inactivity among older community residents, its correlates and associated health service use.MethodsA representative non-institutionalized random sample of 6963 individuals in Rio Grande do Sul, Brazil, aged >= 60 years, was interviewed face-to-face. Information was obtained on demographic characteristics, social resources, health conditions and behaviors, health service use, and physical inactivity. Controlled logistic regression was used to determine the association of physical inactivity with these characteristics.ResultsOverall, 62% reported no regular physical activity. Physical inactivity was significantly more prevalent among women, older persons, those with lower education and income, Afro-Brazilians (73%; White: 61%; other: 64%), those no longer married, and was associated with multiple individual health conditions and impaired activities of daily living (ADL). in adjusted analyses, associations remained for sociodemographic characteristics, social participation, impaired self-rated health, ADL, vision, and depression (odds ratios (OR) 1.2-1.7). Physically inactive respondents were less likely to report outpatient visits (OR 0.81), but more likely to be hospitalized (OR 1.41).ConclusionsPhysical inactivity is highly prevalent, particularly among Afro -Brazilians. It is associated with adverse sociodemographic characteristics; lack of social interaction; and poor self-rated health, ADL, vision, and depression; although not with other health conditions. Self-care may be neglected, resulting in hospitalization.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Bolsista de Produtividade em PesquisaNational Institute on AgingUniversidade Federal de São Paulo, Escola Paulista Med, Dept Psychiat, São Paulo, BrazilDuke Univ, Med Ctr, Ctr Study Aging & Human Dev, Durham, NC 27710 USAUniversidade Federal de São Paulo, Escola Paulista Med, Dept Psychiat, São Paulo, BrazilBolsista de Produtividade em Pesquisa: 306156/2011-3National Institute on Aging: 1P30 AG028716Web of Scienc

Homeless adolescent mothers: a systematic review of the literature

Little is known about adolescent mothers who are homeless during pregnancy and motherhood. This study is a review of the epidemiological literature about this increasing phenomenon. Articles were identified by searching the following electronic databases: MEDLINE, Lilacs, SciELO, PsychINFO, CINHAL, ERIC and Sociological Abstracts; 19 studies were retrieved. The studies showed a wide heterogeneity of objectives and methods, and mainly revealed that the teenagers have high rates of substance abuse, mental disorders, lack of social support, sexual behavior, physical and sexual violence, and troublesome pregnancy and mother-child interaction. Our methodological review found few articles about this population. Homeless adolescent mothers are extensively exposed to violence, drug abuse, and risk of physical and mental health problems. Further studies are needed about this topic, mainly involving culturally different populations, focusing on stigma and intervention methods for this group of women.Pouco se sabe sobre mães adolescentes que passam por gravidez ou maternidade fora de casa. Este estudo é uma revisão da literatura epidemiológica sobre esse fenômeno crescente. Os artigos foram identificados através de pesquisa nas seguintes bases de dados eletrônicas: MEDLINE, Lilacs, SciELO, PsychINFO, CINHAL, ERIC e Sociological Abstracts; 19 referências foram recuperadas. Os estudos mostram ampla heterogeneidade dos objetivos e dos métodos e revelam principalmente que as adolescentes têm elevadas taxas de abuso de substâncias, transtornos mentais, falta de apoio social, comportamento sexual, violência física e sexual; gravidez e interação mãe-criança problemáticas. Poucos artigos resultaram da revisão metodológica realizada sobre essa população. As mães adolescentes de rua têm grande exposição à violência, abuso de drogas e risco de problemas de saúde física e mental. Mais estudos centrados no estigma e em métodos de intervenção para esse grupo de mulheres são necessários nesta área, especialmente em populações culturalmente distintas.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PsiquiatriaUNIFESP-EPM Departamento de PsiquiatriaUNIFESP, EPM, Depto. de PsiquiatriaUNIFESP, EPM Depto. de PsiquiatriaSciEL

Polycystic ovary syndrome and mental disorders: a systematic review and exploratory meta-analysis

Background: The association between depression, anxiety, and polycystic ovary syndrome (PCOS) is still unclear. Therefore, a systematic review and meta-analysis was conducted to assess the rates of comorbid psychiatric disorders among women with PCOS compared to women without it. Methods: PubMed/MEDLINE, Embase, PsycINFO, and Web of Science databases were searched from inception to November 27, 2015. Studies were eligible for inclusion if they were original reports in which the rates of mood (bipolar disorder, dysthymia, or major depressive disorder), obsessive-compulsive spectrum disorders, trauma- and stressor-related disorders, anxiety disorders or psychotic disorders, somatic symptom and related disorders, or eating disorders had been investigated among women with an established diagnosis of PCOS and compared with women without PCOS. Psychiatric diagnosis should have been established by means of a structured diagnostic interview or through a validated screening tool. Data were extracted and pooled using random effects models. Results: Six studies were included in the meta-analysisof these, five reported the rates of anxiety and six provided data on the rates of depression. The rate of subjects with anxiety symptoms was higher in patients with PCOS compared to women without PCOS (odds ratio (OR) =2.7695% confidence interval (CI) 1.26 to 6.02Log OR = 1.013P=0.011). The rate of subjects with depressive symptoms was higher in patients with PCOS compared to women without PCOS (OR = 3.5195% CI 1.97 to 6.24Log OR =1.255P < 0.001). Conclusion: Anxiety and depression symptoms are more prevalent in patients with PCOS.National Council for Scientific and Technological Development (CNPqConselho Nacional de Desenvolvimento Cientifico e Tecnologico) [305274/2014-7]Department of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina – UNIFESP), São Paulo, SP, BrazilDepartment of Psychiatry, Fortaleza University, Fortaleza, Ceará, BrazilLaboratory of Molecular Psychiatry Federal University of Rio Grande do Sul, Rio Grande do Sul, BrazilDepartment of Psychiatry, Federal University of Rio Grande do Sul, Rio Grande do Sul, BrazilDepartment of Psychiatry, Federal University of São Paulo (Escola Paulista de Medicina – UNIFESP), R Borges Lagoa 570, BR-04038020 Sao Paulo, SP, Brazil.CNPq: 305274/2014-7Web of Scienc