The Authors investigate the conceptualization of a group of patients with the same clinical and psychological patterns, affected by eating disturbances arisen during the age of latency.

Four cases are presented and discussed. Each subject was diagnosed as Food Avoidance Emotional Disorder (FAED).

The described subjects present some of the typical features of eating disorders of adolescence. Moreover, regressive aspects, obligingness, dichotomyc behaviors and thoughts were noticed. The Authors observed that parental expectations and needs were transmitted to their sons.

Through the refusal of food the dochotomyc and fearful thoughts are crystallized. The child cannot comprehend the existence of a false Self built on the Other's expectations. The Authors believe that FAED can be a precursor of Anorexia nervosa in the affected children, who show a less organized cognitive structure due to their young age.

Pharmacological therapy for anorexia nervosa is not enough successful. Mild to moderate anorexia nervosa is very prevalent in Iran. We wondered whether combination of antidepressants with appetizers (to block multiple neurotransmitters) could reverse the disease course.

Twenty seven patients with mild (8), moderate (12) and severe anorexia nervosa (7) were treated with escalating doses of three drugs (Olanzapine, Citalopram and Vitamin B6 in combination). The initial doses were 2.5 mg at night, 10 mg at noon and 40 mg TID and the increments were 2.5, 10 and 40 mg every 4 days, respectively. All patients were studied by way of the MCMI-III and clinical interview at admission and 6 weeks later. Additional behavior and cognitive therapy were used in compliant cases.

Almost all patients responded (overall response rate of 100%) and complete response of around 67%. Five and two partial responses were among the severe and moderate group. Weight gain was between 3–16% of primary body weights with a mean of 9% at 6 weeks. Depression and anxiety scores were reduced substantially studied by way of the MCMI-III and clinical interview. Maximal tolerated doses were 12.5, 40 and 360 mg respectively and most could be maintained with 5, 20 and 240 mg.

This combination regimen is extremely effective, well tolerated and without major side effects. Scheduled escalation increases compliance. High dose VitB6 has been used by us in the content of many psychological and auto immune disorders with much success. Longer follow up and larger studies are recommended.

To evaluate the efficacy of a psychoeducational manual as first intervention when treating BED.

It was conducted a 8-week controlled trial (before-after) without a control group. Twenty BED patients were enrolled at an outpatient service specialized in eating disorders (PROATA).

After being submitted to a psychiatric evaluation and responding to the following instruments: MINI-PLUS, QEWP-R, BES, BDI, HAM-A, SF-36, and BSQ, the subjects signed a consent term and they received explanations about the manual. After eight weeks the patients were re-evaluated by trained examiners.

The main outcome criterion was the BED evolution (evaluated through QEWP-R and BES). The secondary criteria were evaluated through the other instruments plus a semi-structured interview.

Most patients presented a slight improvement of BED symptoms, although these symptoms are still present. The secondary criteria show that the most relevant aspect was that the information presented in the manual allowed the patients to acknowledge they had a condition and to see themselves with less guilt and prejudice, making it easier to look for a more comprehensive treatment.

There are indications that using the psychoeducational manual can reduce the symptoms, and that it can be useful in identifying the condition and allowing the patients to look for treatment. Also, since the instrument can be used as part of a stepped-care program, a broader, controlled and randomized study enrolling a larger number of patients must be conducted in order to better clarify the results.

Non-alcoholic fatty liver disease (NAFLD) is becoming the most common liver disease worldwide. Prolonged fasting and excessive caloric intake are possible nutritional causes of NAFLD incurred by patients with eating disorders (ED).

Aims of this study are: identifying if eating disorders are associated with NAFLD; evaluating possible improvements of the risk of NAFLD and of psychopathology determined by integrated multidisciplinary treatment (behavioral therapy, dietary assessment and treatment, clinical care overall).

78 patients with ED received the integrated multidisciplinary treatment. Psychopathology and eating symptoms were assessed before and after treatment through Eating Disorder Inventory and Questionnaire of Eating Behaviours (QEB). The risk of NAFLD was evaluated by Fatty liver index (FLI) based on values of γGT, BMI, triglycerides and waist circumference.

54% of patients with binge eating disorder in our sample has a 60-FLI, indicating a risk of NAFLD higher than 85%.

FLI (p: 0.003) and yGT (p: 0.006) were significantly lower after treatment, thus indicating an improvement in the risk of NAFLD. Four of the eight EDI's subscales improved: Drive for thinness (p: 0.008), Interoceptive awareness (p < 0.001), Bulimia (p: 0.001), Ineffectiveness (p: 0.014). Two of the three SCA's subscales improved: Binge Eating (p: 0.001) and Food Restriction (p: 0.016).

the association between NAFLD and eating disorders was shown together with the efficacy of the multidisciplinary treatment. The risk index FLI and γGT were reduced by the therapy but should be monitorized over time.

Bariatric surgery is a procedure that results in a complex network of emotional experiences. One of the objectives of surgery is to bring about an improvement in the quality of life. Many patients fail because of psychological difficulties, a fact that reinforces the need for specific studies on the psychological dynamic.

to understand the meanings for patients when undergoing bariatric surgery.

Clinical-qualitative method.

The main emotional experiences are social re-insertion, personal acceptance, the risk of disillusion with the results of surgery, recovery of self esteem, improvement in quality of life and in body image.

It is important to identify those aspects of a patients’ psychological make-up which would be expected to improve or worsen their prognosis, and to provide the necessary pre- and post-operative psychosocial counselling. We offer some markers to assist the health professionals, which will allow an appropriate psychosocial plan to be developed and help the health team to identify factors that may affect prognosis. We propose some recommendations for a better psychological evolution: psychotherapy focusing on improving self-esteem; identifying feelings of shame related to a greater exposure; identifying how patients deal with feelings of competitiveness, envy and jealousy; assessing if obesity has defensive function; providing realistic parameters with regards the results of surgery; distinguishing between realistic necessity for plastic surgery and unreal expectations; observation of deviations to other compulsions; acceptance of skin folds and scars; clarifying the misunderstanding between emotional and physical hunger; confidence in own ability to adopt new behavioural models.

Bariatric surgery provokes post-operative experiences which the patients are unprepared to deal with. This study aims at understanding the alteration of the eating impulse and how patients try to reorganize themselves emotionally after bariatric surgery.

Clinical-qualitative method.

After surgery, hunger starts to be experienced in a different way, as an emptiness, a pain, a weakness, that are attempts to describe primitive emotional sensations. The compulsive eating impulse is still present after the surgery. Areas of symbolic deficiency in obese patients brings serious mental consequences and limits the capacity of the morbidly obese to deal with the impact of the drive demand, leaving only the direct path of the discharge through the ingestion of food. Satiety is altered by the surgery, whereas satiation is not.

The hunger of operated patients is diminished; however, the sensation of satiation is not achieved, leading to feelings of anguish, emptiness and weakness, which often end in the patients seeking alternative means to obtain satisfaction. That which the patients referred to as hunger before the surgery is a complex of physical and emotional sensations. These are transformed into vague sensations, through lack of psychic elements that could make an elaboration of the anguish possible, keep the patient imprisoned in a vicious circle of dissatisfaction and seeking of food. It is crucial to provide to patients psychosocial guidance, clinical and psychiatric care. In these patients we have to deal with mental representation's emptiness and therefore help them in the task of creating symbols.

Morbid obesity is accompanied by impairment of the body image. Bariatric surgery is seen like a solution for the problems concerning body image. An element that contributes to disillusions with the results is when patients realize that their bodies, even though thinner, still maintain the sequel of obesity, flaccidity and excess skin. Once weight loss has been achieved, the body image is not infrequently cosmetically unacceptable. To complete treatment, body contouring procedures are performed.

To understand the emotional meaning of body contouring after bariatric surgery.

Clinical-qualitative method, semi-directed interviews with open-ended questions.

Shame that had previously been attributed to obesity is attributed to the sequel of obesity that contributes to the frustrated expectations of having a beautiful and healthy body. The risk of isolation and lose interest to fulfil the objectives of surgery is great. Plastic surgery takes the place occupied by bariatric surgery, that is, the hope of achieving acceptance.

Body contouring following significant weight loss can re-establish a good psychosocial functioning because of the perception of improved body image. The plastic surgery is accompanied by a substantial normalization of the self esteem. It could gradually lead to the cessation of distressing and pathological body-related behaviour. The psychosocial benefits of plastic surgery are: increase self-esteem, improved self-confidence, more intense social activities, better interpersonal relationships, relief from depression and anxiety, improvement in emotional stability, better relationship with colleagues and partner, less stigmatization, better sexual performance and fewer physical limitations during sexual intercourse.

Considering both the complexity of factors that composes the anorexia nervosa (AN) and the recommendation of important organizations related to health, it becomes fundamental the reflection on psychotherapeutic interventions proposed to patient's relatives.

Expand the knowledge about the mother-daughter relationship in AN in order to develop a conceptual framework that improves the way to handle with this disorder, to reduce the factors that maintain it and to improve the prognosis.

Clinical method, through clinical observation regarding a group of patients’ relatives with eating disorders at an outpatient service at a university hospital in the Southeast Brazil.

We have identified common characteristics in the mother-daughter relationship in AN, that maintain the structure of anorexic patients, influencing directly on the severity of each case and therapeutic possibilities. The mutual control: anorexic's mothers showed the need of controlling their daughters, denying the daughter's individuality, trying to become tutors of their actions and thus also become controlled by them; The dialectic between omnipotence and impotence: sense of powerlessness in face of numerous failed attempts to help their daughters, with feelings of guilt, as if they were fully responsible for the daughter's disorder; The relationship of devotion, passion and hostility between mother and daughter: with a fused attitude with her daughter, the mother is even more limited to understand their real needs, invading their personal space.

The findings allowed to identify important aspects of mother-daughter relationship in AN, that can improve clinical interventions for the treatment.

With the worldwide increase of severe obesity, the demand for and performance of bariatric surgery has increased.

To show the importance of the group therapy approach in the research and treatment of the surgery's psychological consequences.

Clinical method of research, through weekly open therapeutic groups with patients that have undergone bariatric surgery.

After the surgery the patients: feel empty, which leads them to search for alternative routes to give their lives meaning, some healthy, such as exercising intensely, others unhealthy, such as addictions, especially the consumption of alcohol; they are divided between the control of impulses sensation that the surgery provides and the food temptation that generates anguish, conflicts and fears of failing and gaining weight again; they experience the presence of new identity elements that arise with the weight loss and that lead to feelings of strangeness in relation to themselves and their personality; they are not stigmatized anymore and assume new social roles, with an important improvement of their self-esteem and social functioning; they may experience conflicts that are hard to handle in parental and marital relationships, especially due to jealousy and competitiveness.

Despite the undeniable benefits that the bariatric surgery provides to the patients, psychological conflicts arise. The bariatric surgery is a procedure that causes, in addition to massive weight loss, deep changes in the patients’ psychic structure that, if well conducted in what concerns psychotherapy, lead to a significant improvement of the patient's life quality.

Receiving and understanding the psychological and sociocultural aspects associated to both health problems and difficulties to make the eating behaviour changes are relevant issues when treating individuals with Metabolic Syndrome.

The reports given by chronic individuals in the present study allowed for analyzing the subjective expressions related to food, treatment management and patient adherence to self care propositions.

In-depth semi-directed interviews with open-ended questions, with psychodynamic orientation in the conducting dialogues were performed with nine patients from the endocrinology outpatient service of a public university hospital located in Southeast Brazil. From this broader objective, a selection was made of some experiences reported by the subjects, which were related to the process of managing treatment and eating behaviour, implied in chronic metabolic disorders.

In this work, elements that mediate the process of developing autonomy in eating habits, living with the illnesses and vulnerability factors experiences by Metabolic Syndrome patients are identified in this study.

The interdisciplinary character of the present study promoted the valorisation of the practice of listening to the psychological and cultural meanings of eating behaviours, hence offering contributions regarding the nutritional care of individuals with Metabolic Syndrome.

Anorexia nervosa and bulimia have the highest mortality rates among psychiatric disorders. High dropout rates 30 to 50% stand obstacle to outcomes.

To search and to analyze articles based on studies about inpatients and outpatients dropout in AN and BN.

The search was conducted through PubMed/Medline, Lilacs, PsycINFO and Cochrane databases. The selection included all the articles about AN/BN focused on dropout. Furthermore, cited articles were included when related. The articles were fully summarized, classified and submitted to categorization.

Most of the articles came from Europe; scarce results from Latin America. dropout-rates are not significantly different between inpatients and outpatients; lower rates among adolescents. Emerging categories are discussed: socio-demographic, clinical and psychological characteristics; family; therapeutic alliance. Impulsive/compulsive behaviour is the strongest predictor explaining the higher dropout rate for AN purging-subtype. The correlation with lower educational level and family background are also supported. The correlation between depression and lower dropout risk founded by some studies was not confirmed by others. Age, previous hospitalizations, length of illness, symptoms severity, weight/BMI are emerging as not consistent predictors. Dropout is not always a negative outcome.

The common discrepant results are attributed to the difficulty in composing adequate samples and to the lack of standardization of the term “dropout”. The focus on patient characteristics in research was questioned; this tendency is changing toward to take into account the answer to treatment process. Highlights: patient's difficulty in intrapersonal relationships, the therapeutic alliance and its management to adherence and continuation of treatment.

With the growing epidemic of obesity many treatments are aimed at reducing weight like diets, exercise, pharmacotherapy and bariatric surgery. All of these can reduce weight at least for a period; however none of them adequately address the behavior of binge eating/eating disorder.

assessed the role of Cognitive Behavior therapy in reducing disordered eating behavior.

The subjects were enrolled in 12 weeks CBT. They were all obese and had a score of > 20 on the BES. They completed a BDI, MBSRQ, and BES before and after the groups. Their weight was recorded before and after the 12 weeks. 79 patients were enrolled in groups over a period of 3 years. Of those 56 patients completed the groups and questionnaires. Most groups consisted of 6–8 patients.

70% of patients had psychiatric symptoms psychotropic medications like antidepressants. More than 70% felt their eating habits were more in control and felt more informed about themselves since attending CBT groups. All of the patients who stayed and attended groups felt that the connection helped them sustain better eating habits. 67% of patients had lost 4–30 lbs during the 12 weeks of CBT, none had gained weight.

CBT helps the patient reduce disordered eating behaviors by understanding the cause of their self sabotage. CBT addresses the core of the problem i.e. disordered behavior as opposed to its consequences (viz. obesity and its multiple medical comorbidities); while affecting weight indirectly.

Anorexia nervosa (AN) has been approached from multiple medical, social and psychological perspectives, but it still stands as a major challenge for the clinician, due to its resistance to treatment, low therapeutic compliance and severe complications.

To asses the efficacy of an interpersonal focused cognitive-behavioral therapy (CBT) in patients diagnosed with AN.

We enrolled in 12 weeks, 3 sessions a week, CBT program a number of three patients, females, admitted successively in our departments, diagnosed with AN, who didn’t have previously any kind of psychotherapy. The first patient was 22, diagnosed with AN-restricting type, had a BMI of 14.5 and a score on Eating Attitudes Test (EAT) of 34. The second patient was 19, presented AN-binge eating-purging, had a BMI of 14 and an EAT score of 35. The third patient was 25, had also AN-binge eating-purging, a BMI of 15 and an EAT score of 32.

The first two patients responded well to the CBT program, but the first signs of recovery (EAT decreases of at least 5 points and increases of at least 1 unit on BMI) appeared after 10 weeks (15 sessions). The third patient discontinued rather fast the psychological treatment. The follow up (12 weeks after endpoint) showed relapse in one CBT-treated patient and a severe status of the patient that discontinued psychotherapy.

The CBT focused on communicational skills enhancement is beneficial in patients with AN, but responses appear rather late and need to be boosted by frequent follow-up sessions.

Co-morbidity is common among patients with eating disorders (ED) and some previous studies have reported a prevalence of over 80%. However, research in the area has been sparse and no previous studies include both children and adults, and both genders.

Data from the Stepwise quality control database, a large-scale Internet based data collection system for specialized ED care in Sweden, were used. The database includes data from children and adults and both genders. Stepwise contains structured diagnostic interviews for ED- and other DSM-IV Axis I diagnostics (the Structured Eating Disorder Interview and the M.I.N.I.Kid and SCID-I interviews). Part one is performed by trained staff and contains SEDI and SCID-I. Part two is made up of self-rating questionnaires and contains EDE-Q, and CPRS. The system is used in 32 treatment units (in and out patients) and comprises up to date1917 patients from all over Sweden.

96,4% of the patients with ED was women and 3,6% were men. 74,8% of the patients with ED also had at least one other Axis I disorder. The most common type of diagnosis was anxiety (61%) followed by mood disorder (56%). 19% had substance use disorders. No gender differences regarding co-morbidity or specific ED diagnosis were observed.

This study confirms previous results showing that the prevalence in co-morbidity is high among patients with ED. The high level of co-morbidity in patients with ED may change the approach in treatment and calls for more tailored treatment programs.

Restrictive and selective eating behavior with food preferences and aversions is a characteristic symptom in anorexia nervosa (AN). Typically fat-containing food is avoided. Furthermore, very often patients with AN replace food which is rich in calories by fruits and vegetable. The aim of the present study was to evaluate if there is a relationship between food preferences and taste perception in AN.

15 female patients with acute AN (ANacute) (BMI 16.5 ± 1.3 kg/m2, 20.4 ± 4.7 yrs.), 21 remitted female patients with AN (ANrem) (BMI 21.4 ± 2.9 kg/m2, 24.2 ± 3.2 yrs., remission period 6 ± 2.6 yrs.) and 15 female healthy controls (HC) (BMI 21.6 ± 3.1 kg/m2, 24.9 ± 2.7 yrs.) were included. Taste perception was evaluated using taste strips (sweet, sour, salty, bitter). Food practice and choice were assessed by self-report. Several blood parameters including hormones and leptin were analyzed. The number of fungiform papillae was quantified using digital photography and image processing.

In ANacute bitter tasting foods were significantly consumed more often when compared with ANrem and HC. Sensoric taste perception for salty and bitter was reduced in ANacute (n.s.). Hedonic taste perception for sour, salty and bitter was increased in ANacute (n.s.). The number of fungiform papillae was significantly decreased in ANacute compared with ANrem and HC. Taste perception for bitter tastes within a range of concentrations correlated with serum estrogen and leptin.

Our results indicate a relationship between food selection and biological factors which can influence taste perception during the underweight stage of ANacute.

Restraints is the ultimate method of behavior control, which should be used when patients may be harmful to themselves or others, or when they remain agitated and noncompliant, and violence seems imminent. When used with a compassionate, humanistic approach, restraint can achieve a therapeutic outcome for the patient while protecting the safety of others. But how do we use restraints?

To asses restraint practice in our Clinic.

We assessed consecutively every restrained patient in period of 92 days (from 9.7. to 7.10. 2009.) and noted age, sex, duration, and time of beginning and ending of restraints, number of restraints, diagnoses, therapy, and reasons for restraints.

We found that male patients were more often restrained. Also age span was pretty wide (from 14 to 70 years of age). Some periods of restraints were very long, the longest were 120 h. We also found interesting results considering time of beginning and ending of restraints.

The practice is different from theory. There are areas, in our restraints practice, that should be improved.

Acute psychosis can represent a diagnosis challenge. Several disorders can be implicated, and some representing a life threatening condition. We report a rare case of acute psychosis with persistent soft neurological signs as a primary presentation of a central nervous system vasculitis.

A 23 year old man, with antecedent of depression, previous history of cocaine and marijuana abuse, admitted to an acute psychiatric ward with three days evolution of disturbed behavior, mainly isolation and immobility. On the psychiatric ward he appeared vague, with negativism, inattentiveness, and elementary and incoherent speech. He had unsystematised delusions. His neurological examination revealed a slight ataxic gait and discoordination, and signs of frontal lobe release. Initial extensive complementary study, including brain CT, EEG, and urine toxicology were negative. He began treatment with risperidone and clomipramine, with improvement of his mental condition, and by the second week he was able maintain a coherent speech. The neurological signs did not improve, and frequent falls appeared. We performed a brain MRI who revealed lesions compatible with vasculitis. The extensive liquor study was negative, with exception of proteins levels (56 md/dl). He was transferred to an internal medicine ward, treated with corticoesteroid. His condition improved in the following weeks and on discharge from Hospital he had recovered his mental status and was autonomous.

Psychosis is an uncommon presentation of central nervous system vasculitis. In cases of persistence or progression of the soft neurological signs, further complementary study is essential to exclude organic pathology.

This poster explores how Psychiatric Intensive Care Units can be designed using “green” technology in order to be environment-friendly whilst also meeting patient needs.

Analysis of the new PICU at Hellesdon Hospital, Norfolk and Waveney Mental Health NHS Foundation Trust, United Kingdom. We describe how the architecture has been adapted from the standard mental health unit model to facilitate more intensive supervision. We will also examine the building design features that have been incorporated to ensure the lowest possible carbon footprint.

Rollesby Ward (PICU) at Hellesdon Hospital won the Broadland design award 2009. It is a new, purpose built, building that provides a safe, user-friendly unit with en-suite accommodation; and rooms for seclusion, therapeutic activities and one to one sessions. The use of key cards and the layout of the bedrooms and lounge areas maintain patient privacy and dignity. A number of technologies have been used to minimise the building's carbon footprint. These include maximising usage of natural light and ventilation, underground rainwater tanks for flushing toilets, photovoltaic roof panels, and ground source heat pumps. Since the PICU has opened, 62.63 mwh of energy (35.57 tons of carbon) has been saved.

New build psychiatric units can successfully incorporate design features that deliver a better patient and therapeutic environment whilst also minimising the consumption of energy and the size of the carbon footprint.