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

A Group’s Level of Defensive Functioning Affects Individual Outcomes in Group Psychodynamic-Interpersonal Psychotherapy

We used an actor–partner interdependence model (APIM) to study the association between the individual group member and other group therapy members’ defensive functioning on an individual group member’s treatment outcome. We hypothesized that (a) more adaptive individual defensive functioning at pretreatment will be significantly related to better treatment outcomes (i.e., lower binge eating and interpersonal distress) at 6 months post-treatment; and (b) more adaptive other group members’ defensive functioning at pretreatment will be significantly related to better treatment outcomes at 6 months post-treatment. Participants (N = 136) were individuals with BED enrolled in group psychodynamic-interpersonal psychotherapy (GPIP). Participants completed attachment interviews and were assessed on interpersonal distress and days binged at pre-treatment and 6 months post-treatment. The interview audio recordings were transcribed and used to code defensive functioning. We found that individual overall defensive functioning (ODF) scores at pretreatment were not significantly associated with binge-eating frequency or interpersonal distress at 6 months post treatment. Other group members’ mean ODF scores at pretreatment were significantly associated with individual interpersonal distress at 6 months post-treatment. However, the other group members’ mean ODF scores were not significantly associated with individual binge-eating outcomes at 6 months post treatment. Defensive functioning of other members of a therapy group may be particularly important for improving interpersonal functioning in individuals with BED.

Emotion Dysregulation and Eating Disorder Symptoms: Examining Distinct Associations and Interactions in Adolescents

Emotion dysregulation has been posited as a key transdiagnostic factor of mental health difficulties, including eating disorders. However, how this transdiagnostic factor interacts with the disorder-specific factor of weight and shape concerns remains unclear. The current study examined whether emotion dysregulation is associated with eating disorder behaviors over and above the association between weight and shape concerns and whether these two factors interacted. The current study used data from two samples, a community sample of high school students (n = 2699), and a clinical sample of adolescents receiving outpatient treatment for an eating disorder (n = 149). Participants completed self-report measures on their eating behaviors, weight/shape concerns, and emotion dysregulation. Findings showed that emotion dysregulation had a unique association with engaging in binge eating and purging (community sample only). Weight and shape concerns were found to have a unique association with engaging in binge eating, fasting, purging, and driven exercise (community sample only). Additionally, weight and shape concerns moderated the association between emotion dysregulation and the probability of engaging in binge eating and driven exercise, whereby the strongest association between emotion dysregulation and these behaviors were observed among adolescents with the lowest levels of weight and shape concerns. Regarding the frequency of eating disorder behaviors, emotion dysregulation had a unique association with severity of binge eating and fasting. Weight and shape concerns were uniquely associated with severity of fasting and driven exercise (community sample only). Findings suggest that emotion dysregulation is a distinct factor of eating disorder behaviors among adolescents.

The effects of lisdexamfetamine dimesylate on eating behaviour and homeostatic, reward and cognitive processes in women with binge-eating symptoms: an experimental medicine study

Lisdexamfetamine dimesylate (LDX) is the only drug currently approved by the FDA for the treatment of Binge-Eating Disorder (BED), but little is known about the behavioural mechanisms that underpin the efficacy of LDX in treating BED. We examined the behavioural and neural effects of an acute dose of LDX (50 mg) in 22 women with binge-eating symptomatology using a randomised, crossover, double-blind, placebo-controlled experimental medicine design. LDX reduced self-reported appetite ratings and intake of both a pasta meal and a palatable cookie snack. LDX also decreased the eating rate of pasta but not of cookies and reduced self-reported liking ratings for pasta at the end of the meal. When viewing food pictures during an fMRI scan, LDX reduced activity bilaterally in the thalamus. LDX enhanced sustained attention and reduced impulsive responding in a continuous performance task but had no effect on emotional bias or working memory. These results suggest the observed effects of LDX on food intake (and by implication the efficacy of LDX in treating BED) may be related to the actions of the drug to enhance satiety, reduce food-related reward responding when full and/or increase cognitive control. Novel pharmacotherapies for BED might be most effective if they have a broad spectrum of effects on appetite, reward and cognition.

Bli venn med maten: evaluering av et lavterskel kurstilbud for personer med overspisingsproblematikk

This study evaluates a mindful eating-based program for people with self-reported binge eating problems. The study was initiated by a non-governmental eating disorder interest organization. Participants met once a week over eight weeks. The Eating Disorder Questionnaire (EDE-Q) and three subscales of the Self-Compassion Scale (SCS) were used to measure eating pathology, self-compassion and mindfulness before, after, and six-months after the program. Results: Significant improvements in EDE-Q and SCS scores were found, and results remained stable at the six-month follow-up. The number of binge eating days decreased significantly during the study, both from before to after program participation, and from post-program participation to six-month follow-up. Conclusion: Future studies investigating the current program are clearly needed. These preliminary results are nonetheless encouraging and illustrate that mindful eating-based interventions as an interesting treatment avenue for individuals with binge eating pathology, a group which currently has few treatment options available to them.

Instrumentos utilizados na avaliação psicológica no tratamento da obesidade: revisão integrativa

Os instrumentos utilizados na avaliação psicológica no tratamento clínico ou cirúrgico da obesidade tem grande relevância no resultado e processo da avaliação. Identificar personalidade, ansiedade, depressão e compulsão alimentar é fundamental, pois são fatores que podem afetar diretamente na manutenção do peso e adesão ao tratamento. O objetivo desta pesquisa foi analisar a literatura científica sobre instrumentos utilizados na avaliação psicológica da pessoa obesa. Trata-se de uma revisão integrativa realizada nas bases de dados: BVS, Medical Subject Headings (MeSH), da National Library, com os seguintes descritores controlados: "psychometrics”, "psychological test", “Psychological Assessment”, "psychologist", "obesity", "overweight" e o descritor não controlado "psychological assessment” e os operadores booleanos “OR” e “AND”. Ao final das buscas, 14 publicações atenderam aos critérios de análise e foram selecionadas para o estudo. Diante dos estudos selecionados, encontramos 52 ferramentas utilizadas na avaliação, dentre eles, os mais utilizados nos programas de perda de peso foram respectivamente o Beck Depression Inventory – BDI (Inventário de Depressão de Beck); o Binge Eating Scale - BES (Escala de Compulsão Alimentar Periódica - TCAP); e a Escala Hospitalar de Ansiedade e Depressão – HADS. Essa pesquisa nos dá evidências importantes para elaboração instrumentos específicos do tratamento da obesidade no Brasil.