REVISÃO DA LITERATURA SOBRE O TRATAMENTO FARMACOLÓGICO DOS TRANSTORNOS ALIMENTARES

Os distúrbios alimentares são doenças de caráter psicopatológico e quando não tratadas corretamente prejudicam o indivíduo afetando-o socialmente, mentalmente e biologicamente. Dentro desse contexto, o trabalho avaliou, com base na literatura, os fármacos utilizados no tratamento dos transtornos alimentares. A metodologia utilizada foi a revisão integrativa da literatura com apoio da análise documental de Bardin. Para a busca das literaturas foram utilizados descritores, contidos nos DECs: [Transtornos da compulsão alimentar/Binge-Eating Disorder], [Tratamento Farmacológico/Drug therapy], [Bulimia/bulimia] e [Anorexia/anorexia]. Para coleta de dados, foram utilizadas literaturas encontradas na base de dado MEDLINE, na biblioteca do SCIELO e em repositórios. Foram selecionadas 22 literaturas, sendo que 63,6% (14) são da biblioteca do SCIELO, 18,2% (4) da base de dados MEDLINE e 18,2% (4) de repositórios de Ensino Superior. Foi observado que o uso de medicamento é essencial quando a terapia não medicamentosa não surtir efeito, uso de fármacos a Fluoxetina, Imipramina e Sibutramina são as principais medicações para o tratamento. Além disso, o tratamento dos transtornos alimentares exige uma equipe multidisciplinar para auxiliar no processo, com isto, o profissional farmacêutico exerce uma função primordial que garante um diagnóstico favorável e um tratamento adequado. Portanto, medicamento como o dimesilato de lisdexanfetamina, utilizado no tratamento de lúpus, entre outros fármacos para tratar outras doenças podem ser de suma importância para o tratamento dos transtornos alimentares, quando associados a outras terapias não farmacológica e do acompanhamento com profissionais especializados

Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review

Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual−5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED), obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases (MEDLINE, PubMed and Embase) which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical (i.e., ED, obese or bariatric surgery) population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature (such as, age, gender, income, etc.) and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology (including emotional eating and loss of control eating) and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder (BED; an ED subtype which is also comorbid with obesity) patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome.

Psychosocial profile of candidates for bariatric surgery and its association with Binge-Eating Disorder

Objective: To describe the psychosocial profile of candidates for bariatric surgery, verify the prevalence of Binge-Eating Disorder (BED) and analyze the correlation between psychosocial variables in patients with or without BED. Methods: Cross-sectional study. Data collection was based on information from 125 patients, and the Periodic Binge-Eating Scale (BES) was applied by the Psychology section of a general hospital in southern Minas Gerais from July 2019 to March 2020. Candidates were separated into groups with and without BED, and psychosocial variables were correlated with groups. Results: The BED prevalence was 41.6% (52). Most patients were women (101; 80.8%), between 30 and 49 years (68; 54.4%), had a paid job (80; 64%), had completed or incomplete high school (51; 48.8%), reported memories of "remarkable facts" in the child's family environment (78; 62.4%). Anxiety disorders were reported in 37.6% (47) and depressive disorders in 17.6% (22) of the sample. As for weight-loss treatments, 62.4% (78) tried at least three types; 58.4% (73) reported the perception of weight gain in childhood or adolescence. A statistically significant association was observed between BED and a low education (p = 0.009). Conclusion: It was possible to characterize the studied population. It was observed that education can be considered a protective factor for the occurrence of BED.

Executive Functions of Adults with Binge-Eating Disorder: The Role of Weight Status and Psychopathology

Findings on executive functions (EFs) in binge-eating disorder (BED) are inconsistent and possibly biased by associated comorbidities. This study aimed to identify whether distinct levels of physical and mental comorbidity are related to EFs in BED. General and food-specific EFs in n = 77 adults with BED were compared to population-based norms and associations with weight status, depressive symptoms, and eating disorder psychopathology were analyzed. To detect within-sample patterns of EF performance, k-means clustering was applied. The results indicated that participants’ general EFs were within the average range with slight deficits in alertness. While depression and eating disorder psychopathology were unrelated to EFs, weight status was associated with food-specific attentional bias that was significantly higher in obesity class 2 than in overweight/obesity class 1 and obesity class 3. Four meaningful clusters with distinct strengths and impairments in general and food-specific EFs but without differences in clinical variables were identified. Altogether, adults with BED showed few specific deficits compared to normative data. Performance was unrelated to depression and eating disorder psychopathology, while weight status was associated with food-specific EFs only. The results highlight the need for longitudinal studies to evaluate the relevance of EFs in BED development and maintenance in neurologically healthy adults.

EEG Neurofeedback in the Treatment of Adults with Binge-Eating Disorder: a Randomized Controlled Pilot Study

Specific alterations in electroencephalography (EEG)-based brain activity have recently been linked to binge-eating disorder (BED), generating interest in treatment options targeting these neuronal processes. This randomized-controlled pilot study examined the effectiveness and feasibility of two EEG neurofeedback paradigms in the reduction of binge eating, eating disorder and general psychopathology, executive functioning, and EEG activity. Adults with BED and overweight (N = 39) were randomly assigned to either a food-specific EEG neurofeedback paradigm, aiming at reducing fronto-central beta activity and enhancing theta activity after viewing highly palatable food pictures, or a general EEG neurofeedback paradigm training the regulation of slow cortical potentials. In both conditions, the study design included a waiting period of 6 weeks, followed by 6 weeks EEG neurofeedback (10 sessions à 30 min) and a 3-month follow-up period. Both EEG neurofeedback paradigms significantly reduced objective binge-eating episodes, global eating disorder psychopathology, and food craving. Approximately one third of participants achieved abstinence from objective binge-eating episodes after treatment without any differences between treatments. These results were stable at 3-month follow-up. Among six measured executive functions, only decision making improved at posttreatment in both paradigms, and cognitive flexibility was significantly improved after food-specific neurofeedback only. Both EEG neurofeedback paradigms were equally successful in reducing relative beta and enhancing relative theta power over fronto-central regions. The results highlight EEG neurofeedback as a promising treatment option for individuals with BED. Future studies in larger samples are needed to determine efficacy and treatment mechanisms.

Case Report: Repeated Transcranial Magnetic Stimulation Improves Comorbid Binge Eating Disorder in Two Female Patients With Treatment-Resistant Bipolar Depression

Introduction: Binge eating disorder (BED) is the most common eating disorder, affecting a large population worldwide. It is characterized by recurrent episodes of binge eating, with no compensatory behaviors. BED is often associated with psychiatric comorbidities, and still represents a challenge in terms of treatment strategies. In the last years, neuromodulation has represented a promising approach in the treatment of BED. We report the cases of two women, affected by Bipolar Disorder Type II (BD-II) and comorbid BED, whose BED symptoms improved after a course of accelerated intermittent Theta Burst Stimulation (iTBS).Methods: We carried out a clinical study, involving neurostimulation on six patients with a treatment-resistant depressive episode. The trial consisted of a 3-week accelerated iTBS treatment, delivered to the left dorsolateral pre-frontal cortex. Clinical evaluation scales (Hamilton Rating Scale for Depression, Montgomery-Åsberg Depression Rating Scale, and Young Mania Rating Scale) were administered at baseline, after 2 weeks, and at the end of the stimulation cycle. Pharmacotherapy was maintained unchanged during iTBS treatment. Patients gave their informed consent both for the protocol and for the publication.Results: The treatment was well-tolerated. Depressive symptoms only slightly improved; however, patients' binge episodes remitted completely, which was a serendipitous finding. BED symptomatology complete remission lasted up to 12 weeks follow-up.Discussion: This is the first study regarding iTBS use in BED in comorbidity with BD-II. Further research is still needed to assess the efficacy of this technique in BED treatment.