Knowledge and perceived confidence of Brazilian psychiatrists about eating disorders´ diagnosis and treatment recommendations.

OBJECTIVE: To investigate Brazilian psychiatrists ́ knowledge and perceived confidence, both in diagnosis and in evidence-based treatments for eating disorders (ED). METHODS: In this cross-sectional study, 259 psychiatrists filled out an online form including: sociodemographic data, questions about ED diagnosis and management based on standard guidelines. Descriptive statistics described sample characteristics and levels of ED knowledge and perceived confidence. RESULTS: Sample was composed mainly by women (65,64%), with mean age of 42.86, from the Southeast of Brazil (56,37%), working predominantly in private practice (59,85%), with less than ten years of experience in Psychiatry (51,74%). We found that 33.21% of participants correctly chose diagnostic criteria for anorexia nervosa (AN); 29.73% for bulimia nervosa (BN), and 38.22% for binge eating disorder (BED). Correct answers for therapeutic options were similar in BN and BED (20.8%), being considerably lower for AN (2.7%). Additionally, reported ED training were: 15.1% during medical school; 59.8% during medical residency/postgraduate studies; 58.7% as complementary training. Only 8.89% felt satisfied with their ED training; 50.97% felt confident diagnosing ED and 37.07% in managing ED patients. CONCLUSION: These results demonstrated an important gap in ED knowledge of Brazilian psychiatrists, and its consequences on their confidence and competence in managing ED patients.

Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery.

BACKGROUND: Weight regain (WR) after bariatric surgery (BS) is frequent. OBJECTIVE: The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. METHODS: Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. RESULTS: Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). CONCLUSION: Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. LEVEL III: Evidence obtained from well-designed cohort or case-control analytic studies.

Binge eating disorder is not predictive of alcohol abuse disorders in long-term follow-up period after Roux-en-Y gastric bypass surgery.

INTRODUCTION: Some studies have shown an increase in alcohol use disorders (AUD) after Roux-en-Y gastric bypass surgery (RYGB), but its relationship with binge eating disorder (BED) has not been fully explored. The purpose of this study was to determine the prevalence of AUD and BED after RYGB and also to evaluate if BED is predictive of late postoperative occurrence of AUD or BED. METHODS: Patients (n = 46) submitted to RYGB, in a tertiary outpatient weight management service at a Federal University of Sao Paulo, Brazil, were tested for BED and AUD using the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R) and AUDIT, respectively. BED was tested before surgery, while both disorders were evaluated with a follow-up period of 12 ± 1.6 years after RYGB. RESULTS: No patients reported AUD before RYBP. After a mean period of 12 years from surgery, ten patients (21.7%) were diagnosed with AUD. Before surgery, BED was present in 24 patients (52.2%) and it was detected in seven out of these 24 patients (29.2%) after RYGB. Thirteen new cases of BED (28.2%) were detected after surgery; total of 20 patients (43.5%) with BED. No association was found between pre- and postsurgery BED (p = 0.148). After RYGB, four out of 24 patients (16.6%) with presurgery BED developed AUD, and no association was found between presurgery BED and postsurgery AUD (p = 0.384). Seven out of ten patients (70%) with AUD after RYGB also developed BED, but no statistical significance was found between these two disorders (p = 0.061). CONCLUSION: The presence of BED before RYGB did not predict AUD and BED after RYGB. Nevertheless, factors involved in a possible association between BED and AUD after surgery remain to be determined. LEVEL OF EVIDENCE: Level III, cohort study.

Transtorno alimentar e cirurgia bariátrica: relato de caso / Eating disorder and bariatric surgery: a case report

OBJETIVO: Os autores discutem, a partir de um relato de caso e de uma revisão da literatura, as implicações de uma operação bariátrica sobre o comportamento alimentar. MÉTODO: É apresentado o caso clínico de uma paciente submetida a uma operação bariátrica e que apresentou alterações comportamentais alimentares semelhantes às de uma anorexia nervosa, mas não apresentando peso abaixo do normal, o que levou a um diagnóstico de transtorno alimentar não especificado. Este caso é analisado em comparação com situações semelhantes na literatura. DISCUSSÃO: Os dados da literatura são discutidos de acordo com aqueles apresentados no caso relatado e procura-se, a partir daí, obter uma conduta prudente frente aos candidatos à cirurgia bariátrica e no seguimento pós-operatório, analisando os possíveis riscos envolvidos.

Post-surgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? A case series.

Speculation concerning the role of psychiatric disorders in patients undergoing bariatric surgery is abundant in the literature. Psychiatric factors predicting the success or failure of bariatric surgery have not been adequately described. However, an increasing number of cases of eating disorders in the postoperative period are being reported. A concise literature review and 5 cases are presented with the purpose of studying the specific pathological eating habits of these patients. The criteria for Anorexia or Bulimia Nervosa were not fulfilled in most of the reports studied and were not met by the 5 patients described. The criteria for a new eating disorder (Post-Surgical Eating Avoidance Disorder, PSEAD) are proposed.

[Eating disorder and bariatric surgery: a case report]. / Transtorno alimentar e cirurgia bariátrica: relato de caso.

OBJECTIVE: The authors discuss, based on a case report and on a literature review, the implications of a bariatric surgery for obesity on the eating behavior. METHOD: A case report is presented in which a patient was submitted to a bariatric surgery and show altered eating behavior like in anorexia nervosa, but without low weight, leading to the diagnostic of an otherwise unspecified eating disorder. This case is compared with the literature review. DISCUSSION: Literature information is discussed according to data from the present case and based on this, aiming to establish a prudent conduct with bariatric surgery candidates and their follow up, analyzing the possible risks involved.

Indicações e contra-indicações para realização das operações bariátricas / Bariatric surgery indications and contraindications

A obesidade, condiçäo cuja prevalência vem aumentando em níveis de epidemia no mundo inteiro, compartilha com os transtornos psiquiátricos de pesado preconceito tanto entre a populaçäo leiga quanto entre os profissionais de Saúde. Quando se considera a associaçäo entre estas patologias, observa-se uma pobreza de dados quer em termos caracterizaçäo desta associaçäo quer em termos de tratamentos específicos. Neste artigo, tópicos relativos à interface entre estes aspectos e a realizaçäo de operações bariátricas, assim como um breve resumo de suas indicações seräo abordados, à luz da literatura mundial e da experiência dos autores

Bariatric surgery in a patient with possible psychiatric contraindications.

Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.

Aspectos psicossociais e psiquiatricos da obesidade / Obesity: psychosocial and psychiatric aspects

A obesidade esta comprovadamente associada a maior mortalidade geral e a maior morbidez com doencas como hipertensao arterial, diabetes melito, aterosclerose, insuficiencia coronariana, doenca cerebrovascular, osteoartrose, colecistopatia, gota, apneia obstrutiva do sono e outras. Dados da...

Bulimia nervosa I: aspectos clínicos / Bulimia nervosa I: clinical aspects

Os autores fazem uma revisäo bibliográfica a respeito do conceito, quadro clínico, diagnóstico, aspectos etiopatogênicos e do curso da Bulimia Nervosa, associada à experiência clínica adquirida ao longo dos quatro anos de funcionamento do AMBULIM.

Bulimia nervosa II: tratamento / Bulimia nervosa II: treatment

Os autores iniciam o artigo com uma revisäo bibliográfica, enfatizando aspectos multiprofissionais do tratamento de Bulimia Nervosa, e, em seguida, descrevem o tratamento oferecido no AMBULIM aos pacientes que apresentam esta entidade.

Bulimia nervosa III: transtornos e avaliaçäo de personalidade em pacientes com bulimia nervosa / Bulimia nervosa III: disorders and personality evaluation in patients with bulimia nervosa

Os autores fazem uma revisäo bibliográfica a respeito dos conceitos de personalidade, transtornos de personalidade e bulimia nervosa e a respeito dos métodos utilizados para a obtençäo de diagnósticos de Transtornos de Personalidade, com ênfase para o Teste de Rorschach. Em seguida, a experiência clínica sobre o assunto no AMBULIM é resumidamente descrita.