Trends in Psychiatry and Psychotherapy
https://trends.org.br/article/doi/10.1590/S2237-60892013000300009
Trends in Psychiatry and Psychotherapy
Original Article

Who are the children and adolescent patients of a national referral service of eating disorders in Brazil?: a cross-sectional study of a clinical sample

Quem são os jovens pacientes de um serviço de referência nacional em transtornos alimentares no Brasil?: estudo transversal de uma amostra clínica

Vanessa Dentzien Pinzon; Gizela Turkiewicz; Denise Oliveira Monteiro; Priscila Koritar; Bacy Fleitlich-Bilyk

http://dx.doi.org/10.1590/S2237-60892013000300009 Trends Psychiatry Psychother, vol.35, n3, p.221-228, 2013
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Abstract

Objectives: To investigate the sociodemographic and clinical profile of patients receiving treatment at a specialized service for children and adolescents with eating disorders (ED) in São Paulo, Brazil, and to compare data with the relevant literature. Methods: This cross-sectional study assessed male and female patients with ED up to 18 years of age. All data were collected upon admission. Results: A total of 100 subjects were assessed. Mean age was 15.41±0.18 years, and mean age at ED onset was 13.5±0.19 years. Mean disease duration was 21.06 ±1.67 months. Of the total sample, 82% of the patients were female, 84% were Caucasian, 64% came from A and B economic tiers. Moreover, in 60% ED started at 14 years of age or less, and 74% had psychiatric comorbidities. Anorexia nervosa was the most prevalent diagnosis (43%). Hospitalized patients had lower body mass index, longer ED duration, and more severe scores on the Children's Global Assessment Scale than outpatients (p < 0.05). Conclusions: Our young Brazilian patients with ED present epidemiological and symptomatic characteristics very similar to those found in the scientific literature, including a high prevalence of psychiatric comorbidities. The higher frequency of full syndrome ED, the predominance of cases with an early onset, the delay in beginning specialized treatment, and the more severe state of inpatients provide grounds for concern because these factors differ from what has been reported in reference studies and indicate greater ED severity.

Keywords

Anorexia nervosa, bulimia nervosa, eating disorders, children, adolescents

Resumo

Objetivos: Investigar o perfil sociodemográfico e clínico de pacientes de um serviço especializado no tratamento de crianças e adolescentes com transtornos alimentares (TA) em São Paulo, Brasil, e comparar os dados com a literatura científica relevante. Métodos: Este estudo transversal avaliou pacientes com diagnóstico de TA de ambos os sexos, com idade até 18 anos. Os dados foram coletados na admissão dos pacientes ao serviço. Resultados: A amostra foi composta por 100 sujeitos. A idade média foi de 15,41±0,18 anos, e a média de idade ao início dos TA foi de 13,5±0,19 anos. O tempo médio de duração da doença foi de 21,06±1,67 meses. Da amostra total, 82% dos pacientes eram meninas, 84% eram brancos, 64% provinham das classes econômicas A e B. Além disso, 60% iniciaram a patologia com 14 anos ou menos e 74% tinham comorbidades psiquiátricas. A forma total da anorexia nervosa foi o diagnóstico mais prevalente (43%). Os pacientes hospitalizados tiveram menor índice de massa corporal, mais tempo de TA e escores mais graves na Escala de Avaliação Global de Crianças quando comparados com pacientes do ambulatório (p < 0,05). Conclusões: Os pacientes brasileiros jovens com TA avaliados no presente estudo apresentaram características epidemiológicas e sintomatológicas muito semelhantes aos dados da literatura científica, inclusive com relação à alta prevalência de comorbidades psiquiátricas. A maior frequência das síndromes totais dos TA, o predomínio de quadros de início precoce, o longo tempo decorrido até iniciar tratamento especializado e a maior gravidade dos pacientes hospitalizados observados nesta amostra chamam atenção por diferirem do que tem sido relatado em estudos semelhantes e também por indicarem uma maior gravidade do TA.

Palavras-chave

Anorexia nervosa, bulimia nervosa, transtornos alimentares, crianças, adolescentes

References

Misra M, Aggarwal A, Miller KK, Almazan C, Worley M, Soyka LA. Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics. 2004;114:1574-83.

Treatment of patients with eating disorders, third edition. Am J Psychiatry. 2006;163:4-54.

Papadopoulos F, Ekbom A, Brandt L, Ekselius L. Excess mortality, causes of death and prognostic factors in anorexia nervosa. Br J Psychiatry. 2009;194:10-7.

Moya T, Cominato L. Complicações clínicas. Transtornos alimentares na infância e adolescência: uma visão multidisciplinar. 2008:89-114.

Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry. 1995;152:1073-4.

Fairburn CG, Cooper Z, Doll HA, Norman P, O'Connor M. The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry. 2000;57:659-65.

Bravender T, Bryant-Waugh R, Herzog D, Katzman D, Kreipe RD, Lask B. Classification of child and adolescent eating disturbances: Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord. 2007;40:S117-22.

Hoek HW. Distribution of eating disorders. Eating disorders and obesity - a comprehensive handbook. 2002:210-4.

Fleitlich-Bilyk B, Lock J. Eating disorders. Biological child psychiatry - recent trends and developments. 2008:138-52.

Nielsen S. Epidemiology and mortality of eating disorders. Psychiatr Clin North Am. 2001;24:201-14.

Nicholls D. Eating disorders in children and adolescents. Adv Psychiatr Treat. 1999;5:241-9.

Klein DA, Walsh T. Eating disorders: clinical features and pathophysiology. Physiol Behav. 2004;81:359-74.

Moya T, Fleitlich-Bilyk B. Waiting list for treatment of eating disorders in childhood and adolescence. Rev Bras Psiquiatr. 2003;25:259-60.

Pinzon V, Gonzaga AP, Cobelo A, Labaddia E, Belluzzo P, Fleitlich-Bilyk B. Peculiaridades do tratamento da anorexia e da bulimia nervosa na adolescência: a experiência do PROTAD. Rev Psiq Clin. 2004;31:167-9.

Steinhausen H. The outcome of anorexia nervosa in the 20th century. Am J Psychiatry. 2002;159:1284-93.

Diagnostic and Statistical Manual of Mental Disorders (DSMIV). 2002.

Turkiewicz G, Pinzon V, Lock J, Fleitlich-Bilyk . Feasibility, acceptability, and effectiveness of family-based treatment for adolescent anorexia nervosa: an observational study conducted in Brazil. Rev Bras Psiqiatr. 2010;32:169-72.

Goodman R, Ford T, Richards H, Gatward R, Meltzer H. The Development and Well-Being Assessment: description and initial validation of an integrated assessment of child and adolescent psychopathology. J Child Psychol Psychiatry. 2000;41:645-55.

Critério de Classificação Econômica Brasil (CCEB). 2003.

Brasil HH, Bordin IA. Convergent validity of K-SADS-PL by comparision with CBCL in a portuguese speaking outpatient population. BMC Psychiatry. 2010;10:83.

Growth reference data for 5-19 years: BMI-for-ages percentiles. 2007.

Bryant-Waugh R, Lask B. Overview of the eating disorders. Eating disorders in childhood and adolescence. 2007:35-50.

Keski-Rahkonen A, Raevuori A, Hoek HW. Epidemiology of eating disorders: an update. Annual Review of Eating Disorders.Part 2. 2008:58-68.

Keel PK, Gravener JA. Sociocultural influences on eating disorders. Annual Review of Eating Disorders.Part 2. 2008:43-57.

Lewinsohn PM, Striegel-Moore RH, Seeley JR. Epidemiology and natural course of eating disorders in young women from adolescence to young Adulthood. J Am Acad Child Adolesc Psychiatry. 2000;39:1284-92.

Moya T, Fleitlich-Bilyk B, Goodman R. Brief report: young people at risk for eating disorders in southeast Brazil. J Adolesc. 2006;29:313-7.

Nicholls D, Chater R, Lask B. Children into DSM don't go: a comparison of classification systems for eating disorders in childhood and early adolescence. Int J Eat Disord. 2000;28:317-24.

Machado PP, Machado BC, Gonçalves S, Hoek HW. The prevalence of eating disorders not otherwise specified. Int J Eat Disord. 2007;40:212-7.

Lock J, Agras S, Bryson S, Kraemer HC. A comparison of short- and long-term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry. 2005;44:632-9.

Zonnevylle-Bender MJS, Goozen SHM, Cohen-Kettenis PT, Elburg A, Wildt MD, Stevelmans E. Emotional functioning in anorexia nervosa patiens: adolescents compared to adults. Depress Anxiety. 2004;19:35-42.

Peebles R, Wilson JL, Lock JD. How do children with eating disorders differ from adolescents with eating disorders at initial evaluation. J Adolesc Health. 2006;39:800-5.

Moya T. Criação e análise da sessão de transtornos alimentares do DAWBA (levantamento sobre o desenvolvimento e bem-estar de crianças e adolescentes). .

Hoek HW, Hoeken D. Review of the prevalence and incidence of eating disorders. Int J Eat Disord. 2003;34:383-96.

Stice E, Burton EM, Shaw H. Prospective relations between bulimic pathology, depression, and substance abuse: unpacking comorbidity in adolescent girls. J Consult Clinl Psychol. 2004;72:62-71.

O'Brien K, Vincent N. Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev. 2003;23:57-74.

Keel PK, Klump KL, Miller KB, McGue M, Iacono WG. Shared transmission of eating disorders and anxiety disorders. Int J Eat Disord. 2005;38:99-105.

Overas M, Winje E, Lask B. Eating disorders in children and adolescents. Annual Review of Eating Disorders.Part 2. 2008:110-24.

Herzog DB, Eddy KT. Comorbidity in eating disorders. Annual review of eating disorders.Part 1. 2007:35-50.

Costello EJ, Egger H, Angold A. 10-year research update review: the epidemiology of child and adolescent psychiatric disorders: I. Methods and public health burden. J Child Psychol Psychiatry. 2005;44:972-86.

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