1,721,112 research outputs found
Check del corpo nei disturbi dell'alimentazione: validazione italiana del Body Checking Questionnaire (BCQ)
No full textIl Body Checking Questionnaire (BCQ) è uno strumento recentemente validato nella versione italiana ideato per misurare il costrutto del check del corpo. La validazione italiana del BCQ è stata effettuata in una popolazione di pazienti con disturbo dell’alimentazione, usando degli studenti di psicologia come controlli. 573 donne (422 controlli e 151 pazienti affetti da disturbi dell’alimentazione) hanno compilato il BCQ, il Body Image Avoidance Questionnaire, il Body Uneasiness Test e l’Eating Attitude Test–40. L’analisi fattoriale confermatoria ha evidenziato che il BCQ misura il costrutto globale del check del corpo e tre sotto-fattori correlati. Il BCQ ha una validità concorrente, un’affidabilità test-retest e una consistenza interna buone. Il test discrimina i pazienti con disturbi dell’alimentazione dai controlli e i controlli a dieta da quelli non a dieta. Il BCQ può essere usato in ambito clinico, per la valutazione il check del corpo dei pazienti affetti da disturbi dell’alimentazione, e in ambito di ricerca per studiare l’immagine corporea in campioni clinici e non clinici
Personalized multistep cognitive behavioral therapy for obesity
Full text linkRiccardo Dalle Grave, Massimiliano Sartirana, Marwan El Ghoch, Simona Calugi Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy Abstract: Multistep cognitive behavioral therapy for obesity (CBT-OB) is a treatment that may be delivered at three levels of care (outpatient, day hospital, and residential). In a stepped-care approach, CBT-OB associates the traditional procedures of weight-loss lifestyle modification, ie, physical activity and dietary recommendations, with specific cognitive behavioral strategies that have been indicated by recent research to influence weight loss and maintenance by addressing specific cognitive processes. The treatment program as a whole is delivered in six modules. These are introduced according to the individual patient’s needs in a flexible and personalized fashion. A recent randomized controlled trial has found that 88 patients suffering from morbid obesity treated with multistep residential CBT-OB achieved a mean weight loss of 15% after 12 months, with no tendency to regain weight between months 6 and 12. The treatment has also shown promising long-term results in the management of obesity associated with binge-eating disorder. If these encouraging findings are confirmed by the two ongoing outpatient studies (one delivered individually and one in a group setting), this will provide evidence-based support for the potential of multistep CBT-OB to provide a more effective alternative to standard weight-loss lifestyle-modification programs. Keywords: obesity, cognitive behavioral therapy, lifestyle modification, weight loss, weight maintenance, outcom
Lifestyle modification in the management of obesity: Achievements and challenges
No full textLifestyle modification therapy for overweight and obese patients combines specific recommendations on diet and exercise with behavioral and cognitive procedures and strategies. In completers it produces a mean weight loss of 8-10 % in about 30 weeks of treatment. However, two main issues still to be resolved are how to improve dissemination of this approach, and how to help patients maintain the healthy behavioral changes and avoid weight gain in the long term. In recent years, several strategies for promoting and maintaining lifestyle modification have been evaluated, and promising results have been achieved by individualising the treatment, delivering the intervention by phone and internet or in a community setting, and combining lifestyle modification programs with residential treatment and bariatric surgery. These new strategies raise optimistic expectations for the effective management of obesity through lifestyle modification. © 2013 Springer International Publishing Switzerland
Eating disorders, physical fitness and sport performance: A systematic review
Full text linkBackground: Eating disorders are health problems that are particularly prevalent in adolescents and young adults. They are associated with considerable physical health and psychosocial morbidity, and increased risk of mortality. We set out to conduct a systematic review to determine their effect on physical fitness in the general population and on sport performance in athletes. Methods/Design: A systematic review of the relevant peer-reviewed literature was performed. For inclusion, articles retrieved from PubMed had to be published in English between 1977 and 2013. Wherever possible, methods and reporting adhere to the guidelines outlined in the PRISMA statement. Some additional studies were retrieved from among those cited in the reference lists of included studies and from non-electronic databases. Literature searches, study selection, method and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Results: Of the 1183 articles retrieved, twenty-nine studies met the inclusion criteria and were consequently analysed. The available data indicate that eating disorders have a negative effect on physical fitness and sport performance by causing low energy availability, excessive loss of fat and lean mass, dehydration, and electrolyte disturbance. Discussion: Although the paucity of the available data mean that findings to date should be interpreted with caution, the information collated in this review has several practical implications. First, eating disorders have a negative effect on both physical fitness and sport performance. Second athletics coaches should be targeted for education about the risk factors of eating disorders, as deterioration in sport performance in athletes, particularly if they are underweight or show other signs of an eating disorder, may indicate the need for medical intervention. However, future studies are needed, especially to assess the direct effect of eating disorders on sport performance. © 2013 by the authors; licensee MDPI, Basel, Switzerland
Management of Severe Rhabdomyolysis and Exercise-Associated Hyponatremia in a Female with Anorexia Nervosa and Excessive Compulsive Exercising
Full text linkThis case report describes the management of a 49-year-old female with restricting-type anorexia nervosa and excessive compulsive exercising associated with rhabdomyolysis, high levels of serum creatine kinase (CK) (3,238 U/L), and marked hyponatremia (Na+: 123 mEq/L) in the absence of purging behaviours or psychogenic polydipsia; it is the first case report to describe exercise-associated hyponatremia in a patient with anorexia nervosa. The patient, who presented with a body mass index (BMI) of 13.4 kg/m2, was successfully treated by means of an adapted inpatient version of an enhanced form of cognitive behavioural therapy (CBT-E). Within a few days, careful water restriction, solute refeeding, and the specific cognitive behavioural strategies and procedures used to address the patient's excessive compulsive exercising and undereating produced a marked reduction in CK levels, which normalised within one week. Exercise-associated hyponatremia also gradually improved, with serum sodium levels returning to normal within two weeks. The patient thereby avoided severe complications such as cerebral or pulmonary oedema or acute renal failure and was discharged after 20 weeks of treatment with a BMI of 19.0 kg/m2 and improved eating disorder psychopathology
Treating obesity with personalized cognitive behavioral therapy
No full textThis book describes a novel therapy for obesity that associates the traditional procedures of weight-loss lifestyle modification with specific, individualized cognitive behavioral procedures to address some obstacles that have been indicated by recent research to influence weight loss and maintenance. The Cognitive Behavioral Therapy for Obesity (CBT-OB) can be used to treat all classes of obesity, including patients with severe comorbidities and disability associated with obesity, who are not usually included in traditional weight-loss lifestyle modification treatments. The book describes the treatment program in detail, and with numerous clinical vignettes. It also discusses involving significant others in the change process and adapting the CBT-OB for patients with severe obesity, binge-eating disorder, medical and psychiatric comorbidity, and treated with weight-loss drugs or bariatric surgery. Lastly, a chapter is dedicated to the use of digital technology with CBT-OB in order to help patients monitor their food intake and physical activity and to addressing obstacles in real time. Thanks to the description of how to apply the latest, evidence-based CBT-OB to real world settings, this volume is a valuable useful tool for all specialists - endocrinologists, nutritionists, dietitians, psychologists, psychiatrists - who deal with obesity and eating disorders
Starvation symptoms in patients with anorexia nervosa: a longitudinal study
No full textObjective. The aim of this study was to evaluate the change in starvation symptoms over time and their role as potential predictors of change in eating disorder and general psychopathology in patients with anorexia nervosa treated by means of intensive enhanced cognitive behavioral therapy (ICBT-E). Method. Ninety adult female patients with anorexia nervosa (63 restricting type and 27 binge-eating/purging type) were recruited. Body mass index (BMI), Eating Disorder Examination (EDE) interview, Eating Disorder Examination Questionnaire (EDE-Q), Brief Symptom Inventory (BSI) and Starvation Symptoms Inventory (SSI) scores were recorded at admission, at the end of treatment, and at 6-month follow-up. All tests, except for the EDE, were also administered after 4 weeks of treatment to assess the role of refeeding on these variables. Results. At baseline, starvation symptoms were correlated with measures of eating disorder and general psychopathology. The treatment was associated with a significant increase in BMI, improvement in eating disorder and general psychopathology, and a significant reduction in starvation symptoms. The change in SSI scores from baseline to 4 weeks predicted the improvement in EDE eating concern subscale and global BSI scores. Among patients who had restored their body weight by the end of treatment, dietary restraint and eating concern EDE-Q subscales, global EDE-Q and SSI scores showed greater improvement in the first 4 weeks than in the remaining 16 weeks of treatment. Discussion. The findings underline the close relationship between improvements in both starvation symptoms and eating disorder and general psychopathology and indicate the important role of refeeding in ameliorating both
A review of self-report and interview-based instruments to assess mania and hypomania symptoms [Una rassegna degli strumenti autovalutativi ed eterovalutativi per valutare i sintomi maniacali e ipomaniacali]
Full text linkObjective: The aim of this paper is to provide an overview of the self-report and interview-based instruments to assess mania/hypomania symptoms and related features, with a focus on 7 selected instruments in widespread use to illustrate their psychometric properties, comparative performance and pros and cons. Methods: A systematic search strategy was devised and queried on Medline from 1973 to 2012 using the terms mania, hypomania, instrument, scale, questionnaire, interview, validity, reliability, psychometric properties and adults, elderly, aged. To be included, a study had to be published in a peer-reviewed journal or book in English or Italian. Results: Of the 17 self-report instruments identified, two (the Mood Disorder Questionnaire (MDQ) and the Hypomania Checklist-32 (HCL-32), received the most research attention. Although the psychometric properties of these instruments are good, their use as screening instruments to detect hypomania in the community or in patients with depression is partially limited by their low positive predictive value, related to the low prevalence of this condition. Nonetheless, they can be efficiently used to rule out the presence of hypomania. The Altman Self-Rating Mania Scale is increasingly being used to monitor mania symptoms over time by phone or email in patients diagnosed with bipolar disorder because it consists of only 5 items. When the aim is early detection of manic/hypomanic symptoms that a patient may have experienced during their lifetime, the 33-item subset of the MOODS-SR seems promising because it includes the key psychopathology dimensions that better discriminate bipolar from unipolar disorder. Of the interview-based instruments, the Young Mania Rating Scale and the Bech-Rafaelsen Mania Scale are the most widely used outcome measures in clinical trials. Although they were developed more than 30 years ago, they continue to be the gold standard for research purposes. The two instruments have a similar coverage, although the YMRS is preferred over the BR-MAS because it includes an item on insight. Conclusions: Although no instrument can replace the need for accurate clinical diagnosis based on patient history, we argue that the increasing use of self-report instruments to screen bipolar disorder in patients presenting with depression or to monitor mania/hypomania symptoms over time may contribute to increasing the use of routine standardized assessment. Measurement-based care as the standard of care has the potential to transform psychiatric practice, move psychiatry into the mainstream of medicine, and ultimately improve the quality of care for patients with psychiatric illness
Valutazione in ambito scolastico sui comportamenti alimentari e sulla percezione di sé su un campione di 4500 adolescenti
No full textDSM-5 severity specifiers for anorexia nervosa and treatment outcomes in adult females
No full textObjective: The aim of this study was to evaluate treatment outcomes across the BMI (body mass index)-based DSM-5 severity specifiers in a sample of adult females with anorexia nervosa (AN) treated with enhanced cognitive behavioural therapy (CBT-E). Method: One hundred and twenty-eight participants with AN (64 outpatients and 64 inpatients) were sub-categorised using DSM-5 severity specifiers and compared by baseline clinical characteristics and treatment outcomes at the end of treatment and at 6- and 12-month follow-ups. Results: No significant differences were found across the four severity groups for ‘weight recovery’ (i.e., BMI ≥ 18.5 kg/m2) or ‘good outcome’ (i.e., BMI ≥ 18.5 kg/m2 and minimal accompanying eating disorder psychopathology). Discussion: Our data suggest that the DSM-5 severity specifiers for anorexia nervosa may have limited clinical utility in predicting treatment outcomes of CBT-E
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