International consensus on patient-centred outcomes in eating disorders.

The effectiveness of mental health care can be improved through coordinated and wide-scale outcome measurement. The International Consortium for Health Outcomes Measurement has produced collaborative sets of outcome measures for various mental health conditions, but no universal guideline exists for eating disorders. This Position Paper presents a set of outcomes and measures for eating disorders as determined by 24 international experts from professional and lived experience backgrounds. An adapted Delphi technique was used, and results were assessed through an open review survey. Final recommendations suggest outcomes should be tracked across four domains: eating disorder behaviours and cognitions, physical health, co-occurring mental health conditions, and quality of life and social functioning. Outcomes are collected using three to five patient-reported measures. For children aged between 6 years and 12 years, the measures include the Children's Eating Attitude Test (or, for those with avoidant restrictive food intake disorder, the Eating Disorder in Youth Questionnaire), the KIDSCREEN-10, and the Revised Children's Anxiety and Depression Screener-25. For adolescents aged between 13 years and 17 years, the measures include the Eating Disorder Examination Questionnaire (EDE-Q; or, for avoidant restrictive food intake disorder, the Nine-Item Avoidant Restrictive Food Intake Disorder Screener [NIAS]), the two-item Patient Health Questionnaire (PHQ-2), the nine-item Patient Health Questionnaire (PHQ-9), the two-item Generalised Anxiety Disorder (GAD-2), the seven-item Generalised Anxiety Disorder (GAD-7), and the KIDSCREEN-10. For adults older than 18 years, measures include the EDE-Q (or, for avoidant restrictive food intake disorder, the NIAS), the PHQ-2, the PHQ-9, the GAD-2, the GAD-7, the Clinical Impairment Assessment, and the 12-item WHO Disability Assessment Schedule 2.0. These questionnaires should be supplemented by information on patient characteristics and circumstances (ie, demographic, historical, and clinical factors). International adoption of these guidelines will allow comparison of research and clinical interventions to determine which settings and interventions work best, and for whom.

Saúde mental dos profissionais da saúde na pandemia do coronavírus (Covid-19) / Mental health of health care professionals in the coronavirus pandemic (Covid-19)

Introdução: A pandemia do coronavírus (Covid-19) impôs desafios adicionais aos profissionais da saúde (PS), potencializando o risco de sofrimento psíquico. Objetivo: Avaliar o perfil sociodemográfico e a saúde mental de uma amostra de PS do Brasil durante a pandemia do Covid-19. Métodos: Estudo transversal online realizado durante 1 mês, entre maio e junho de 2020. Sintomas depressivos foram avaliados pelo Patient Health Questionnaire 9 (PHQ-9) e o nível de burnout pelo Copenhagen Burnout Inventory (CBI). Resultados: 1054 PS foram incluídos, sendo 34,5% médicos, 19,1% técnicos de enfermagem, 14,2% enfermeiros e 11,9% psicólogos. Mais da metade da amostra total apresentou escores ≥ 50 no domínio de burnout pessoal (PB) da CBI, indicativo de alto nível de burnout, e escores no PHQ-9 sugestivos de depressão clinicamente significativa, sendo estes índices mais elevados entre os técnicos de enfermagem (68,2% com PB ≥ 50 e 68,7% com PHQ-9 ≥ 9) e os PS da linha de frente (61,3% com PB ≥ 50 e 58% com PHQ-9 ≥ 9). Os técnicos de enfermagem apresentaram escores PB (58,4 ± 20,9) e do domínio de burnout relacionado ao trabalho (WB = 51,0 ± 21,1) superiores aos dos médicos (PB= 48,2 ± 19,9 e WB= 44,2 ± 19,1) e dos psicólogos (PB= 44,2 ± 17,4 e WB= 41,2 ± 16,7) p < 0,001. Conclusão: Os elevados níveis de burnout e depressão, mais preocupantes entre os técnicos de enfermagem, corroboram a vulnerabilidade dos PS ao sofrimento emocional no contexto do atendimento à Covid-19, demonstrando a urgência de intervenções específicas.(AU)

Introduction: The coronavirus pandemic (Covid-19) posed additional challenges to health care professionals (PS), increasing the risk of psychological distress. Objective: To evaluate the sociodemographic profile and mental health of a sample of PS in Brazil during the Covid-19 pandemic. Methods: Cross-sectional online study conducted during 1 month, between May and June 2020. Depressive symptoms were assessed by the Patient Health Questionnaire 9 (PHQ-9) and the level of burnout by the Copenhagen Burnout Inventory (CBI). Results: 1054 PS were included, being 34.5% physicians, 19.1% nursing technicians, 14.2% nurses and 11.9% psychologists. More than half of the total sample had scores ≥ 50 in the the personal burnout (PB) domain of CBI, indicative of a high level of burnout, and PHQ-9 scores suggestive of clinically significant depression, these rates being higher among nursing technicians (68.2% with BP ≥ 50 and 68.7% with PHQ-9 ≥ 9) and frontline PS (61.3% with BP ≥ 50 and 58% with PHQ-9 ≥ 9). Nursing technicians had PB scores (58.4 ± 20.9) and work-related burnout domain scores (WB = 51.0 ± 21.1) higher than those of physicians (PB = 48.2 ± 19.9 and WB = 44.2 ± 19.1) and psychologists (PB = 44.2 ± 17.4 and WB = 41.2 ± 16.7) p <0.001. Conclusion: The high levels of burnout and depression, most worrying among nursing technicians, corroborate the vulnerability of the PS to emotional suffering in the context of the Covid-19 pandemic. Specific interventions are urgent.(AU)

Introducción: La pandemia de coronavirus (Covid-19) planteó desafíos adicionales a los profesionales de la salud (PS), aumentando el riesgo de angustia psicológica. Objetivo: Evaluar el perfil sociodemográfico y la salud mental de una muestra de PS en Brasil durante la pandemia Covid-19. Métodos: Estudio transversal en línea realizado durante 1 mes, entre mayo y junio de 2020. Los síntomas depresivos fueron evaluados por el Patient Health Questionnaire 9 (PHQ-9) y el nivel de burnout por el Copenhagen Burnout Inventory (CBI). Resultados: Se incluyeron 1054 PS, siendo 34,5% médicos, 19,1% técnicos de enfermería, 14,2% enfermeras y 11,9% psicólogos. Más de la mitad de la muestra total tuvo puntajes ≥ 50 en el dominio de Burnout personal (PB) de CBI, indicativo de un alto nivel de Burnout, y puntajes PHQ-9 sugestivos de depresión clínicamente significativa, siendo estas tasas más altas entre los técnicos de enfermería (68,2% con PB ≥ 50 y 68,7% con PHQ-9 ≥ 9) y el PS de primera línea (61,3% con PB ≥ 50 y 58% con PHQ-9 ≥ 9). Los técnicos de enfermería tuvieron puntuaciones de PB (58,4 ± 20,9) y el dominio de burnout laboral (WB = 51,0 ± 21,1) superior al de los médicos (PB = 48,2 ± 19,9 y WB = 44,2 ± 19,1) y psicólogos (PB = 44,2 ± 17,4 y WB = 41,2 ± 16,7) p <0,001. Conclusión: Los altos niveles de burnout y depresión, que son más preocupantes entre los técnicos de enfermería, corroboran la vulnerabilidad del PS al sufrimiento emocional en el contexto de la atención al Covid-19, demostrando la urgencia de intervenciones específicas.(AU)

Cross-cultural adaptation and translation into Brazilian Portuguese of the instruments Sick Control One Stone Fat Food Questionnaire (SCOFF), Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment Questionnaire (CIA).

INTRODUCTION: Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA. METHOD: The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales' items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors. RESULTS: The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use. CONCLUSION: This study provides important tools for the ED research field in Brazil.

Cross-cultural adaptation and translation into Brazilian Portuguese of the instruments Sick Control One Stone Fat Food Questionnaire (SCOFF), Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment Questionnaire (CIA)

Abstract Introduction Eating disorders (EDs) affect up to 13% of young people and are associated with significant morbidity and mortality. Nevertheless, important, internationally recognized instruments for brief ED screening (Sick Control One Stone Fat Food Questionnaire [SCOFF]), symptom severity assessment and diagnosis (Eating Disorder Examination Questionnaire [EDE-Q]) and assessment of ED-associated psychosocial impairment (Clinical Impairment Assessment Questionnaire [CIA]) were not yet available in Brazilian Portuguese. Our objective was to perform the cross-cultural adaptation and translation into Brazilian Portuguese of the instruments SCOFF, EDE-Q and CIA. Method The process involved a series of standardized steps, as well as discussions with experts. First, the relevance and adequacy of the scales' items to our culture and population were extensively discussed. Then, two independent groups translated the original documents, creating versions that were compared. With the participation of external ED experts (i.e., who did not take part in the translation process), synthesized versions were produced. The syntheses were then applied to a focal group of patients with ED (n = 8). After that step, a preliminary version of the three scales in Brazilian Portuguese was produced and sent for back-translation by two English native speakers, who worked independently. A synthesis of the back-translations, along with the preliminary versions in Brazilian Portuguese, were sent to the original authors. Results The Brazilian Portuguese versions of SCOFF, EDE-Q and CIA were approved by the original authors and are now available for use. Conclusion This study provides important tools for the ED research field in Brazil.

Impairment in psychosocial functioning in patients with different subtypes of eating disorders.

OBJECTIVE: To examine psychosocial functioning in eating disorder (ED) patients with restrictive and purgative subtypes. METHOD: Forty-four adult female patients with a diagnosis of ED were divided into restrictive (RP) and purgative (PP) groups according the presence of purgative symptoms. Functioning was assessed using the Functioning Assessment Short Test (FAST) and the Global Assessment of Functioning Scale (GAF). RESULTS: No differences were found in total FAST scores or in specific domains between the RP (39.58±11.92) and PP (45.75±11.75) groups (p = 0.19). However, PP showed more severe functional impairment than RP in the financial domain (p < 0.01). There were no differences in comorbidity with mood disorders, depressive symptoms, or general psychiatric symptoms between the two ED subtypes. CONCLUSIONS: The similarities found between PP and PR in overall functioning and in autonomy, cognition, work, interpersonal relationships, and leisure seem to reflect the use of an objective scale that corresponds to the clinical impression. In fact, the assessment of psychosocial functioning in ED patients using self-report instruments requires careful consideration because results may reflect the egosyntonic nature of symptoms commonly observed in these patients, particularly in the restrictive subtype.

Impairment in psychosocial functioning in patients with different subtypes of eating disorders / O prejuízo no funcionamento psicossocial de pacientes com diferentes subtipos de transtorno alimentar

OBJECTIVE: To examine psychosocial functioning in eating disorder (ED) patients with restrictive and purgative subtypes. METHOD: Forty-four adult female patients with a diagnosis of ED were divided into restrictive (RP) and purgative (PP) groups according the presence of purgative symptoms. Functioning was assessed using the Functioning Assessment Short Test (FAST) and the Global Assessment of Functioning Scale (GAF). RESULTS: No differences were found in total FAST scores or in specific domains between the RP (39.58±11.92) and PP (45.75±11.75) groups (p = 0.19). However, PP showed more severe functional impairment than RP in the financial domain (p < 0.01). There were no differences in comorbidity with mood disorders, depressive symptoms, or general psychiatric symptoms between the two ED subtypes. CONCLUSIONS: The similarities found between PP and PR in overall functioning and in autonomy, cognition, work, interpersonal relationships, and leisure seem to reflect the use of an objective scale that corresponds to the clinical impression. In fact, the assessment of psychosocial functioning in ED patients using self-report instruments requires careful consideration because results may reflect the egosyntonic nature of symptoms commonly observed in these patients, particularly in the restrictive subtype

OBJETIVO: Avaliar o funcionamento psicossocial de pacientes com subtipos restritivo e purgativo de transtorno alimentar (TA). MÉTODOS: Quarenta e quatro pacientes adultas com TA foram divididas em grupos restritivo (RP) e purgativo (PP) conforme a presença de sintomas purgativos. O funcionamento foi avaliado com a Functioning Assessment Short Test (FAST) e a Global Assessment of Functioning Scale (GAF). RESULTADOS: Não houve diferenças nos escores totais nem nos domínios da FAST entre os grupos RP (39,58±11,92) e PP (45,75±11,75) (p = 0,19). No entanto, o grupo PP demonstrou maior prejuízo funcional no domínio finanças (p < 0,01). RP e PP foram semelhantes em comorbidade com transtornos de humor, sintomas depressivos e sintomas psiquiátricos em geral. CONCLUSÕES: As semelhanças encontradas entre os grupos PP e RP no funcionamento geral e nos domínios autonomia, cognição, trabalho, relacionamentos interpessoais e lazer parecem refletir o uso de uma escala objetiva que corresponde à impressão clínica. De fato, é necessário cautela ao avaliar funcionamento psicossocial em pacientes com TA com escalas autoaplicáveis, porque estas costumam refletir a natureza egossintônica dos sintomas comumente observados nesses pacientes, especialmente no subtipo restritivo

Compreensão psicodinâmica da bulimia nervosa e suas manifestações na transferência-contratransferência / Psychodynamic understanding of the bulimia nervosa and its manifestations in transference and countertransference

A Bulimia Nervosa tem sido um transtorno de difícil manejo psicoterápico devido à sua complexa etiologia. Uma abordagem psicodinâmica parece ser fundamental para entender as funções do comportamento bulímico e ajudaro paciente a elaborar a sua história única e pessoal. Contudo, é imprescindível compreender algumas particularidades do transtorno e suas manifestações prototípicas que originam configurações transferenciais-contratransferenciais intensas e peculiares. O trabalho apresenta as principais teorias psicodinâmicassobre a bulimia, discute as manifestações na transferência-contratransferência resultantes do tratamento destas pacientes e apresenta um exemplo clínico para ilustrar tais aspectos

Bulimia Nervosa has been a disorder of difficult psychotherapeutic treatmentdue to its complex etiology. A psychodynamic approach seems to be fundamental to understand the functions of bulimic behavior and to help the patient to elaborate her personal and unique history. However, it is essential to understand some particularities of the disorder and its manifestations, whichoriginate intense and peculiar transference-countertransference configurations. This article presents the main psychodynamic theories of bulimia, discusses some aspects of transference-countertransference manifestations in the treatment of these patients, presenting as illustration, a clinical example

Compreensão psicodinâmica da bulimia nervosa e suas manifestações na transferência-contratransferência / Psychodynamic understanding of the bulimia nervosa and its manifestations in transference and countertransference

A bulimia nervosa tem sido um transtorno de difícil manejo psicoterápico devido à sua complexa etiologia. Uma abordagem psicodinâmica parece ser fundamental para entender as funções do comportamento bulímico e ajudar o paciente a elaborar a sua história única e pessoal. Contudo, é imprescindível compreender algumas particularidades do transtorno e suas manifestações prototípicas que originam configurações transferenciais-contratransferenciais intensas e peculiares. O trabalho apresenta as principais teorias psicodinâmicassobre a bulimia, discute as manifestações na transferência-contratransferência resultantes do tratamento destas pacientes e apresenta um exemplo clínico para ilustrar tais aspectos

Bulimia Nervosa has been a disorder of difficult psychotherapeutic treatment due to its complex etiology. A psychodynamic approach seems to be fundamental to understand the functions of bulimic behavior and to help the patient to elaborate her personal and unique history. However, it is essential to understand some particularities of the disorder and its manifestations, which originate intense and peculiar transference-countertransference configurations. This article presents the main psychodynamic theories of bulimia, discusses some aspects of transference-countertransference manifestations in the treatment of these patients, presenting as illustration, a clinical example

Evidências da eficácia da eletroconvulsoterapia na prática psiquiátrica / Evidence of the effectiveness of electroconvulsive therapy in the psychiatric practice

A eletroconvulsoterapia (ECT) consiste em tratamento biológico ainda não amplamente utilizado na prática psiquiátrica, devido aos inúmeros fatores que contribuem para uma resistência acerca do método. Objetivando sustentar, com embasamento científico, o emprego da ECT, agregamos evidências de sua eficácia, indicações, contra-indicações e efeitos adversos, advindas dos principais ensaios clínicos randomizados e meta-análises disponíveis na literatura médica atual sobre o tema (PubMed/MEDLINE, Cochrane).