Fatores preditivos de desistência em um programa para adolescentes com sobrepeso ou obesidade: estudo MERC / Predictive factors of dropout from a program for overweight or obese adolescents: MERC study / Factores predictivos de desistimiento en un programa para adolescentes con sobrepeso u obesidad: estudio MERC

O objetivo deste estudo foi identificar fatores potenciais de impacto sobre a desistência em um ensaio clínico randomizado. Para participar das 12 semanas de intervenção, foram selecionados adolescentes com sobrepeso ou obesidade (IMC percentil ≥ 85), dos sexos masculino e feminino, com média de idade 16,44±1,09. Utilizou-se regressão logística binária para responder pelo desfecho de não conclusão. As regressões foram realizadas por blocos e as variáveis estudadas foram características demográficas e antropométricas, marcadores metabólicos, aspectos motivacionais, funcionamento psicológico e percepção das práticas alimentares parentais. Foi constatada uma taxa de desistência de 48,8%. A maior chance de desistência foi explicada no modelo final de regressão pela autoeficácia para mudança de estilo de vida (OR: 0,732; IC95%: 0,581-0,921; p=0,008), pelo suporte familiar (OR: 0,807; IC95%: 0,685-0,950; p=0,010), pela HbA1c (OR: 11,366; IC95%: 3,123-37,702; p=0,010) e por fatores relacionados às práticas alimentares parentais. Concluiu-se que a família e os aspectos relacionados à motivação para mudança podem ser determinantes de desistência em programas para perda de peso para adolescentes.

The number of overweight or obese adolescents has increased, but the rate of dropping out in programs for this population is high. The objective of this study was to identify potential factors of impact on dropping out in a randomized clinical trial. To take part in a 12-week intervention, overweight or obese adolescents (BMI percentile ≥ 85), males and females, with mean age 17.99±1.09 were selected. Binary logistic regression was used to account for the non-completion outcome. Regressions were performed by blocks and the variables studied were demographic and anthropometric traits, metabolic markers, motivational aspects, psychological functioning, and perception of parental food practices. The drop-out rate was 48.8%. The highest chance of withdrawal was explained in the final regression model by self-efficacy to change lifestyle (OR: 0.732; IC95%: 0.581-0.921; p=0.008), by family support (OR: 0.807; IC95%: 0.685-0.950; p=0.010), by HbA1c (OR: 11.366; IC95%: 3.123-37.702; p=0.010), and by factors associated with parental food practices. It was concluded that the family and aspects related to motivation for change can be determinants of dropping-out in weight-loss programs for teenagers.

El objetivo de este estudio fue identificar factores potenciales del impacto sobre la desistencia en un ensayo clínico aleatorizado. Se seleccionaron para participar en 12 semanas de intervención, adolescentes con sobrepeso u obesidad (IMC percentil ≥ 85), del sexo masculino y femenino con media de edad 16,44±1,09. Se utilizó regresión logística binaria para responder por el resultado de conclusión incompleta. Las regresiones fueron realizadas por bloques y las variables estudiadas fueron características demográficas y antropométricas, marcadores metabólicos, aspectos motivacionales, funcionamiento psicológico y percepción de las prácticas alimentarias parentales. La tasa de desistimiento fue de 48,8%. La mayor probabilidad de desistimiento fue explicada en el modelo final de regresión por auto-eficacia para el cambio de estilo de vida (OR: 0,732, IC95%: 0,581-0,921, p=0,008), por el soporte familiar (OR: 0,807, IC95%: 0,685-0,950; p=0,010), por la HbA1c (OR: 11,366, IC95%: 3,123-37,702; p=0,010) y por factores relacionados con las prácticas alimentarias parentales. Se concluyó que la familia y los aspectos relacionados con la motivación para el cambio pueden ser determinantes de la desistencia de programas para la pérdida de peso para los adolescentes.

Transtheoretical model for change in obese adolescents: MERC randomized clinical trial.

The randomized controlled trial evaluated the effectiveness of an intervention based on the Transtheoretical Model of Change on anthropometric, metabolic and motivational outcomes in obese adolescents. A total of 135 male and female adolescents were randomized to two groups: intervention group (n = 65) and control group (n = 70). The adolescents were evaluated 1 week before the interventions began and at the end of 12 weeks. There was no statistically significant difference between groups in the outcome variables. Intervention group reported magnitude of effect more expressive on body mass index percentile, waist circumference, waist-to-hip ratio, readiness to change diet and readiness to start exercise.

The efficacy of milnacipran in panic disorder: an open trial.

The aim of this study is to evaluate the efficacy of milnacipran in the acute treatment of patients with panic disorder. Thirty-one patients who met Diagnostic and statistical manual of mental disorders-IV criteria for panic disorder with or without agoraphobia were included in the study. Patients were initially treated with milnacipran 25 mg twice daily and then 50 mg twice daily until the 10th week. The treatment outcome and panic disorder severity were determined by the Panic Disorder Severity Scale, Panic Inventory, Clinical Global Impression and Hamilton Anxiety Scale, all of which were applied during every evaluation interview. Quality of life (WHOQOL-bref) was evaluated at baseline and at the end of the study. Missing data were handled by using the last observation carried forward for all participants who had taken at least one dose of study medication. Intention-to-treat was used in the analyses. Pharmacological treatment resulted in a clinically and statistically significant mean reduction in all severity measures. Remission (Clinical Global Impression < or = 2) was obtained in 58.1% of the sample. Regarding WHOQOL, we found a significant improvement (P<0.05) across treatment in all the domains studied. Although results may be influenced by the open design of this pilot study and by the small sample size, our findings suggest that milnacipran may be effective for the treatment of panic disorder and justify further research.

Trauma and defense style as response predictors of pharmacological treatment in panic patients.

BACKGROUND: As panic disorder (PD) has a chronic course, it is important to identify predictors that might be related to non-remission. The aim of this study is to verify whether history of trauma and defense style are predictors to pharmacological treatment response in PD patients. METHOD: The sample was composed by 47 PD patients according to DSM-IV who were treated with sertraline for 16 weeks. Evaluations were assessed by the C.G.I. (Clinical Global Impression), the Hamilton-Anxiety Scale, the Hamilton-Depression Scale, the Panic Inventory and the DSQ-40 (Defense Style Questionnaire) at baseline and after treatment. RESULTS: Full remission was observed in 61.7% of the sample. The predictors significantly associated with non-remission were: severity of PD (p=0.012), age of onset (p=0.02) and immature defenses (p=0.032). In addition, the history of trauma was associated with early onset of PD (p=0.043). CONCLUSION: Panic patients had as predictors of worse response to pharmacological treatment the early onset and the severity of PD symptoms as well as the use of immature defenses at baseline. This finding corroborates the relevance of the evaluation of factors that might affect the response so as to enable the development of appropriate treatment for each patient.

Do defense mechanisms vary according to the psychiatric disorder?

OBJECTIVE: The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. METHOD: The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. RESULTS: Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. CONCLUSIONS: Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions.

Do defense mechanisms vary according to the psychiatric disorder? / Os mecanismos de defesa se modificam de acordo com o transtorno psiquiátrico?

OBJECTIVE: The aim of this study was to evaluate the defense mechanisms used by depressive and anxious patients without comorbidities compared to those used by controls and to determine whether these patterns differ between diagnoses. METHOD: The sample was composed of 167 psychiatric patients and 36 controls that were evaluated using the Defense Style Questionnaire 40. All subjects were evaluated through a clinical interview, and each evaluation was confirmed through the application of the Mini International Neuropsychiatric Interview, a structured psychiatric interview. We used ANOVA and discriminant analysis to assess differences between groups. RESULTS: Neurotic defense mechanisms discriminated controls from all patients except those with social anxiety. Immature defense mechanisms differentiated controls from all patients, as well as distinguished depressive patients from panic disorder and obsessive disorder patients. The discriminant analysis indicated that depressive patients are characterized by projection, panic disorder patients by sublimation and obsessive-compulsive patients by acting out. CONCLUSIONS: Depressive and anxious patients differ from other individuals in their use of defense mechanisms, and each diagnosis has a particular pattern. These findings could lead to the development of specific psychotherapeutic interventions.

OBJETIVO: O objetivo do estudo é avaliar o uso dos mecanismos de defesa utilizados por pacientes deprimidos e ansiosos sem comorbidades comparados com aqueles utilizados por pacientes-controle e se esses padrões de defesa podem ser diferenciados entre os diagnósticos. MÉTODO: 167 pacientes psiquiátricos e 36 controles foram avaliados pelo Defense Style Questionnaire 40. Todos os indivíduos foram avaliados por uma entrevista clínica que foi confirmada pelo Mini International Neuropsychiatric Interview, uma entrevista psiquiátrica estruturada. Para detectar diferenças entre os grupos, os dados foram submetidos à análise discriminante e ANOVA. RESULTADOS: As defesas neuróticas discriminam os controles de todos pacientes, exceto dos pacientes com ansiedade social. As defesas imaturas diferenciam os controles de todos pacientes, além de discriminar os pacientes deprimidos dos pacientes com transtorno do pânico e obsessivo. A análise discriminante indica que a projeção diferencia pacientes deprimidos, sublimação diferencia pacientes com transtorno do pânico, e acting-out diferencia pacientes obsessivos-compulsivos. CONCLUSÕES: Os pacientes diferem dos controles no uso dos mecanismos de defesa, e cada patologia tem seu padrão particular. Esses achados podem permitir o desenvolvimento de intervenções específicas no tratamento psicoterápico.