Increased waist circumference is associated with an increased prevalence of mood disorders and depressive symptoms in obese women.

OBJECTIVE: There is growing evidence suggesting that obese patients may be more prone to develop certain psychiatric diseases, especially mood disorders. However, no studies have already determined which indicator of fat distribution best explains these comorbidities. The aim of this study is to investigate which anthropometric indicator of overweight (i.e. body mass index [BMI], waist circumference [WC] or waist/hip ratio [WHR]) best correlates with the presence of current mood disorders and the severity of depressive symptoms in obese women. METHODS: Two hundred seventeen (217) obese women (BMI> or =30 kg/m2) between 18 and 75 years old were selected to participate in the study. All participants had anthropometrical data registered. The diagnosis of current mood disorders was assessed according to the Portuguese version of the Structured Clinical Interview for DSM-IV [SCID]. The severity of depressive symptoms was assessed using the Beck Depression Inventory (BDI). RESULTS: A statistically significant association was found between BDI scores and BMI (r=0.16; p=0.018) and WC (r=0.20; p=0.004), but not WHR (r=0.10; p=0.15) or any socio-demographic variable. An increased prevalence of mood disorders was observed in the fourth quartile of WC, but not BMI or WHR, in comparison with the first and the second ones (p<0.05). DISCUSSION: In conclusion, obesity, per se, seems to be an independent variable associated with the severity of depressive symptoms and the prevalence of current mood disorders in obese women. Waist circumference, and not BMI or WHR, seems to be the anthropometric indicator of overweight and fat distribution that best explains these findings.

Comorbidity of psychiatric disorders and symmetric distal polyneuropathy among type II diabetic outpatients.

The objective of the present study was to establish the frequency of psychiatric comorbidity in a sample of diabetic patients with symmetric distal polyneuropathy (SDPN). Sixty-five patients with type 2 diabetes mellitus were selected consecutively to participate in the study at Instituto Estadual de Diabetes e Endocrinologia. All patients were submitted to a complete clinical and psychiatric evaluation, including the Portuguese version of the structured clinical interview for DSM-IV, the Beck Depression Inventory, the Neuropathy Symptom Score, and Neuropathy Disability Score. SDPN was identified in 22 subjects (33.8%). Patients with and without SDPN did not differ significantly regarding sociodemographic characteristics. However, a trend toward a worse glycemic control was found in patients with SDPN in comparison to patients without SDPN (HbA1c = 8.43 +/- 1.97 vs 7.48 +/- 1.95; P = 0.08). Patients with SDPN exhibited axis I psychiatric disorders significantly more often than those without SDPN (especially anxiety disorders, in general (81.8 vs 60.0%; P = 0.01), and major depression--current episode, in particular (18.2 vs 7.7%; P = 0.04)). The severity of the depressive symptoms correlated positively with the severity of SDPN symptoms (r = 0.38; P = 0.006), but not with the severity of SDPN signs (r = 0.07; P = 0.56). In conclusion, the presence of SDPN seems to be associated with a trend toward glycemic control. The diagnosis of SDPN in diabetic subjects seems also to be associated with relevant psychiatric comorbidity, including anxiety and current mood disorders.

Comorbidity of psychiatric disorders and symmetric distal polyneuropathy among type II diabetic outpatients

The objective of the present study was to establish the frequency of psychiatric comorbidity in a sample of diabetic patients with symmetric distal polyneuropathy (SDPN). Sixty-five patients with type 2 diabetes mellitus were selected consecutively to participate in the study at Instituto Estadual de Diabetes e Endocrinologia. All patients were submitted to a complete clinical and psychiatric evaluation, including the Portuguese version of the structured clinical interview for DSM-IV, the Beck Depression Inventory, the Neuropathy Symptom Score, and Neuropathy Disability Score. SDPN was identified in 22 subjects (33.8 percent). Patients with and without SDPN did not differ significantly regarding sociodemographic characteristics. However, a trend toward a worse glycemic control was found in patients with SDPN in comparison to patients without SDPN (HbA1c = 8.43 ± 1.97 vs 7.48 ± 1.95; P = 0.08). Patients with SDPN exhibited axis I psychiatric disorders significantly more often than those without SDPN (especially anxiety disorders, in general (81.8 vs 60.0 percent; P = 0.01), and major depression - current episode, in particular (18.2 vs 7.7 percent; P = 0.04)). The severity of the depressive symptoms correlated positively with the severity of SDPN symptoms (r = 0.38; P = 0.006), but not with the severity of SDPN signs (r = 0.07; P = 0.56). In conclusion, the presence of SDPN seems to be associated with a trend toward glycemic control. The diagnosis of SDPN in diabetic subjects seems also to be associated with relevant psychiatric comorbidity, including anxiety and current mood disorders.

An empirical comparison of atypical bulimia nervosa and binge eating disorder.

The International Classification of Diseases, 10th edition (ICD-10) defines atypical bulimia nervosa (ABN) as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED). We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES), the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90). Individuals fulfilling criteria for both ABN and BED (N = 18), ABN without BED (N = 16), and obese controls (N = 19) were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 +/- 7.7 and 30.05 +/- 5.5, respectively), which were significantly higher than those found in the obese controls (18.32 +/- 8.7; P < 0.001 and P < 0.001, respectively). When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02) and increased scores in the somatization (1.97 +/- 0.85 vs 1.02 +/- 0.68; P = 0.001), obsessive-compulsive (2.10 +/- 1.03 vs 1.22 +/- 0.88; P = 0.01), anxiety (1.70 +/- 0.82 vs 1.02 +/- 0.72; P = 0.02), anger (1.41 +/- 1.03 vs 0.59 +/- 0.54; P = 0.005) and psychoticism (1.49 +/- 0.93 vs 0.75 +/- 0.55; P = 0.01) dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.

An empirical comparison of atypical bulimia nervosa and binge eating disorder

The International Classification of Diseases, 10th edition (ICD-10) defines atypical bulimia nervosa (ABN) as an eating disorder that encompasses several different syndromes, including the DSM-IV binge eating disorder (BED). We investigated whether patients with BED can be differentiated clinically from patients with ABN who do not meet criteria for BED. Fifty-three obese patients were examined using the Structured Clinical Interview for DSM-IV and the ICD-10 criteria for eating disorders. All volunteers completed the Binge Eating Scale (BES), the Beck Depression Inventory, and the Symptom Checklist-90 (SCL-90). Individuals fulfilling criteria for both ABN and BED (N = 18), ABN without BED (N = 16), and obese controls (N = 19) were compared and contrasted. Patients with ABN and BED and patients with ABN without BED displayed similar levels of binge eating severity according to the BES (31.05 ± 7.7 and 30.05 ± 5.5, respectively), which were significantly higher than those found in the obese controls (18.32 ± 8.7; P < 0.001 and P < 0.001, respectively). When compared to patients with ABN and BED, patients with ABN without BED showed increased lifetime rates of agoraphobia (P = 0.02) and increased scores in the somatization (1.97 ± 0.85 vs 1.02 ± 0.68; P = 0.001), obsessive-compulsive (2.10 ± 1.03 vs 1.22 ± 0.88; P = 0.01), anxiety (1.70 ± 0.82 vs 1.02 ± 0.72; P = 0.02), anger (1.41 ± 1.03 vs 0.59 ± 0.54; P = 0.005) and psychoticism (1.49 ± 0.93 vs 0.75 ± 0.55; P = 0.01) dimensions of the SCL-90. The BED construct may represent a subgroup of ABN with less comorbities and associated symptoms.

An open trial of reboxetine in obese patients with binge eating disorder.

BACKGROUND: The objective of this study was to evaluate the effectiveness and safety of reboxetine, a selective noradrenaline reuptake inhibitor, in the treatment of obese patients with binge eating disorder (BED). METHOD: Nine outpatients with BED and obesity received reboxetine 8 mg/day for 12 weeks. The number of days with binge eating episodes per week was considered the primary outcome measure. Body weight, body mass index (BMI), Binge Eating Scale (BES), Clinical Global Impression Severity (CGI-S) and the World Health Organization Quality of Life Assessment Scale (WHOQOL-BREF) scores were used as secondary outcome measures. Paired t-test with the last observation carried forward was used to analyze changes from baseline to endpoint. RESULTS: Five patients completed the study and showed a complete remission of BED. The mean binge days per week was significantly reduced from 4.6+/-1.8 to 0.2+/-0.6, at the end of the study (p=0.0002). Mean BES scores were decreased from 32.3+/-6.3 to 9.3+/-6.8 (p=0.0003). There was also a statistically significant decrease in BMI (from 36.5+/-4.48 to 35.06+/-4.49; p=0.01), and in CGI-S (from 5.1+/-0.9 to 1.4+/-1.01; p=0.0002). Quality of life, assessed using the WHOQOL-BREF was significantly improved on overall quality of life and general health (p=0.02) and on psychological (p=0.03) domain. No serious adverse events were observed. CONCLUSION: Reboxetine may be an effective and well-tolerated agent in the treatment of BED in obese patients.

Alteracoes psiquiatricas no hipertireoidismo: revisao da literatura e apresentacao de casos

A importancia do estudo das relacoes entre o cerebro e o sistema endocrino e o seu impacto sobre o comportamento e um dos objetivos principais da nova disciplina chamada psiconeuroendocrinologia. Dentre os varios hormonios estudados, aqueles provenientes do eixo tireoidiano tem recebido uma atencao especial. Os autores apresentam uma revisao da literatura referente aos aspectos psiquiatricos dos transtornos tireoidianos e apresentam cinco casos de hipertireoidismo (Doenca de Basedow-Graves) que cursaram com transtorno mental organico. Dois destes casos apresentaram-se como 'delirium'e os outros tres foram diagnosticados como sindrome organico do humor (maniaco). A evolucao e a conduta terapeutica dos casos sao discutidas de acordo com literatura revista.

Alteraçöes psiquiátricas no hipertireoidismo: revisäo da literatura e apresentaçäo de casos / Psychiatric changes in hyperthyroidism: literature review and report of cases

A importância do estudo das relaçöes entre o cérebro e o sistema endócrino e o seu impacto sobre o comportamento é um dos objetivos principais da nova disciplina chamada psiconeuroendocrinologia. Dentre os vários hormônios estudados, aqueles provenientes do eixo tireoidiano têm recebido uma atençäo especial. Os autores apresentam uma revisäo da literatura referente aos aspectos psiquiátricos dos transtornos tireoidianos e apresentam cinco casos de hipertireoidismo (Doença de Basedow-Graves) que cursaram com transtorno mental orgânico. Dois destes casos apresentaram-se como "delirium" e os outros três foram diagnosticados como síndrome orgânica do humor (maníaco). A evoluçäo e a conduta terapêutica dos casos säo discutidas de acordo com literatura revista.