Terapia de remediación cognitiva en bulimia nerviosa: Un estudio de caso / Cognitive remediation therapy in bulimia nervosa: A case study

Resumen El objetivo de este estudio fue realizar una evaluación preliminar de la terapia de remediación cognitiva (TRE) en una paciente con bulimia nerviosa (BN). Bajo un diseño pre-post-tratamiento, la paciente (20 años de edad e índice de masa corporal [IMC] de 22.41) completó cuatro pruebas neuropsicológicas, tres medidas de síntomas de BN y dos de sintomatología psiquiátrica (depresión y ansiedad). Con base a las puntuaciones pre y post TRE fue calculado el cambio clínico objetivo (CCO). Los principales efectos neuropsicológicos se registraron en: flexibilidad de pensamiento, proceso visocontructivo, coherencia central y planificación (CCO = 0.39-0.99). También se identificaron cambios relevantes en las medidas de sintomatología psiquiátrica y de BN (CCO = 0.53-0.88), no así en el IMC. Este estudio suma evidencias respecto a la utilidad de la CRT en el tratamiento multidisciplinario, ya no solo de la anorexia nerviosa, sino que extiende su aplicabilidad a la BN.

Abstract The aim of this study was to perform a preliminary evaluation of cognitive remediation therapy (CRT) in a patient with bulimia nervosa (BN). The participant was 20 years old with a 22.41kg/m2 body mass index (BMI). Under a pre-post treatment design, the patient was administered four neuropsychological tests, three measures of BN symptoms and two of psychiatric symptomatology (depression and anxiety). Based on the pre and post CRT scores, the objective clinical change (OCC) was calculated. The main neuropsychological effects were observed in cognitive flexibility, visoconstructive processing (memory and central coherence) and working memory (OCC = 0,39-0,99). Relevant changes were also identified in the measures of psychiatric symptomatology and BN (OCC = 0,53-0,88), with no change in BMI. This study adds evidence regarding the usefulness of CRT in the multidisciplinary treatment not only of anorexia nervosa, but also extends its applicability to another eating disorder, BN.

Cognitive remediation therapy in Mexico as a treatment for Anorexia Nervosa: A case study.

The purpose of this study was to conduct a preliminary evaluation of cognitive remediation therapy (CRT) as part of the treatment of a patient with anorexia nervosa (AN) from Mexico. The participant was a 21-year-old woman with a body mass index (BMI) of 14.7, who had suffered from the disorder for 10 years. Using a pre-post treatment design, changes were evaluated using four neuropsychological tests, two tests to measure the AN symptoms and two to measure psychological distress (depression and anxiety). BMI was also evaluated before and after the intervention. The results of the present study were similar to those reported for patients from English-speaking countries. The average percentage of favorable change in the different measures was higher than 30%, except for BMI, which increased by only 21%. The results suggest that the inclusion of CRT in AN treatment programs in Mexico is a potentially viable option.

Funciones ejecutivas y sintomatología asociada con los trastornos de la conducta alimentaria / Executive functions and symptoms associated with eating disorders

Estudios recientes coinciden en que las pacientes con trastornos de la conducta alimentaria (TCA) presentan ineficiencias en las funciones ejecutivas secundarias al padecimiento. Así, el objetivo de este trabajo fue explorar la posibilidad de que tales ineficiencias formen parte del endofenotipo de los TCA y que no sean únicamente consecuencias de los mismos. Para ello, se evaluaron 69 mujeres: 23 con TCA, 23 con sintomatología asociada a los TCA y 23 sin sintomatología de riesgo a desarrollarlas. Todas las participantes respondieron el cuestionario de actitudes hacia la alimentación, la entrevista diagnóstica de trastornos alimentarios-IV, la Torre de Londres y la prueba de clasificación de tarjetas de Wisconsin. Los resultados mostraron ineficiencias en las funciones ejecutivas, específicamente en la planeación y en la flexibilidad de pensamiento, en el grupo con sintomatología asociada a los TCA similares a las que presentaron las participantes con TCA; hallazgos que abren la posibilidad de que las dificultades sean previas al establecimiento y que incluso pudiesen constituirse como un factor de riesgo.

Recent studies agree in that patients with Eating Disorders (ED) suffer from inefficiencies in Executive Functions as a consequence of the disease. In order to determine whether or not such inefficiencies make part of the endophenotype of ED-not that they result as a mere consequence of ED-69 women were evaluated: 23 diagnosed with ED, 23 with symptoms associated to ED and 23 women without any ED or risks for developing them. All participants were administered the Eating Attitude Test (EAT -40), the Interview for Diagnosis of Eating Disorders-IV (IDED -IV), the Tower of London Test and the Wisconsin Card Sorting Test. The results showed inefficiencies in executive functions-specifically in planning and cognitive flexibility for both the analogous symptoms group and the diagnosed ED group. The findings suggest that these alterations could be present prior to the establishment of the ED, and that they can actually constitute a risk factor.

Visoconstructive deficits and risk of developing eating disorders.

In order to explore if neuropsychological deficits on visual constructional ability could be related to risk eating behaviors, a total of 102 women were evaluated, 51 of the participants had been formally diagnosed with eating disorders and 51 did not. All participants were given the Eating Attitude Test (EAT-40), The Rey-Osterrieth Complex Figure and The Tower of London Task. Results revealed the existence of a deficit on visual integration similar to those observed in other studies with diagnosed patients. The group at risk showed a comparatively reduced ability on the tasks and the control participants' execution was on the average. Findings revealed the need for designing studies to evaluate neuropsychological processes as possible risk factors which predict eating disorders.

Visoconstructive Deficits and Risk of Developing Eating Disorders

In order to explore if neuropsychological deficits on visual constructional ability could be related to risk eating behaviors, a total of 102 women were evaluated, 51 of the participants had been formally diagnosed with eating disorders and 51 did not. All participants were given the Eating Attitude Test (EAT-40), The Rey-Osterrieth ComplexFigure and The Tower of London Task. Results revealed the existence of a deficit on visual integration similar to those observed in other studies with diagnosed patients. The group at risk showed a comparatively reduced ability on the tasks and the control participants’ execution was on the average. Findings revealed the need for designing studies to evaluate neuropsychological processes as possible risk factors which predict eating disorders (AU)

A fin de explorar si las deficiencias neuropsicológicas en el proceso visoconstructivo están relacionadas con conductas alimentarias de riesgo, se evaluó un total de 102 mujeres, 51 presentaban conductas de riesgo y 51 no las presentaban. A todas las participantes se les aplicó el Cuestionario de Actitudes hacia la Alimentación (EAT-40); la Figura Compleja de Rey-Osterrieth y la Torre de Londres. Los resultados revelaron la existencia de un déficit en la integración visual similar al observado en otros estudios realizados con pacientes diagnosticadas. El grupo con riesgo mostró una reducción en tales habilidades en comparación con el desempeño de los participantes sin riesgo, mismo que estuvo dentro del promedio. Los hallazgos revelan la necesidad de diseñar estudios que evalúen los procesos neuropsicológicos como posibles factores predictores de los trastornos de la conducta alimentaria (AU)