Dissertations / Theses on the topic 'Anorexia nervosa in adolescents'
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1
Noetel, Melissa Dianne. "Compulsive Exercise in Adolescents with Anorexia Nervosa." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17123.
Abstract:
The current thesis aimed to contribute to the understanding of the role and overall management of compulsive exercise in adolescents. The first aim was to systematically review the existing research that has studied the prevalence and psychopathological correlates of compulsive exercise in adolescents with eating disorders, which highlighted the limited research within this area. To contribute to the developmental of a clinical profile of compulsive exercise in adolescents with Anorexia Nervosa (AN), a second study was conducted to explore associations between compulsive exercise and both eating and general psychopathology in 60 adolescent inpatients with AN. Results revealed that the avoidance aspect of compulsive exercise was associated with elevated scores on measures of eating disorder and general psychopathology, whereas the mood improvement value of exercise did not reflect such trends. In aim of furthering our understanding of the mood regulatory role of exercise and moving towards examining possible means of managing compulsive exercise, an observational study was then conducted with the same clinical sample. This third study aimed to explore whether supervised exercise produced acute psychological benefits for adolescent inpatients receiving treatment for AN. Promising acute psychological benefits were found from participation in the supervised exercise program. Taken together, such research emphasized the need for the development of treatment guidelines that target the complexities of compulsive exercise in adolescents with AN. In the absence of empirical evidence, a final study was conducted that used the Delphi methodology to explore and establish expert clinical consensus on how to manage compulsive exercise in this vulnerable population. These findings serve as preliminary clinical practice guidelines, and the research project as a whole highlights the complex nature of compulsive exercise in AN that requires continued research and clinical efforts.
2
O'Connor, G. "Refeeding low weight hospitalised adolescents with anorexia nervosa." Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1434816/.
Abstract:
Refeeding adolescents with anorexia nervosa (AN) carries risks, the extent of which have been much debated but subject to little research. As such, the optimal nutritional management of such patients is unknown, and the lack of evidence from interventional studies has led to worldwide disparities in clinical management recommendations. In this first randomised controlled trial in this area, we tested the hypothesis that refeeding with a higher energy intake than that currently recommended in Europe, improves outcomes in low weight adolescents with AN. The aim of this study was to investigate the association between total energy intake on QTc interval, heart rate and hypophosphataemia. The primary outcome was QTc interval (ms). Secondary outcomes were heart rate, electrolytes (phosphate, magnesium and potassium) and anthropometry (weight [kg] and %BMI). Participants were 38 adolescents’ aged 10-16years with a DSM IV diagnosis of AN recruited from six acute paediatric services around the UK and were randomly allocated to commence refeeding at 1200kcal/ day (intervention) or at 500kcal/ day (control). Energy intake was incrementally increased by 200kcal day up to 80% of estimated energy requirements. The results showed that compared to controls, adolescents randomised to the higher calorie group had a greater weight gain. However, randomised groups did not differ statistically in QTc interval or heart rate. Refeeding hypophosphataemia (serum phosphate <0.9mmol/l) developed in a proportion of patients. However, there was no statistical difference in the incidence or severity of refeeding hypophosphataemia between the two groups. Participants that were below 68%BMI and those with low WBC’s (WBC <3.8 x 109/l) had a greater reduction in post refeeding phosphate. Together, these findings suggest that oral refeeding at 1200kcal/ day (38kcal/ kg/ day) which increases incrementally to 1900kcal/ day (58kcal/ kg/ day) is more beneficial for the majority of patients than commencing refeeding at 500kcal/ day in low weight adolescents with AN. The findings from this study challenge current European and UK recommendations.
3
Bezance, Jessica. "Treatment of adolescent anorexia nervosa." Thesis, University of Oxford, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.589463.
Abstract:
Adolescence is the most common period for the onset of anorexia nervosa. A growing body of quantitative evidence exists for treatment efficacy for adolescents. However, it is important, given the large dropout rates and high relapse rates that qualitative research attempts to understand how treatment and recovery is experienced by adolescents. Similarly, an appreciation for mothers' experience of treatment is vital given the evidence for high carer burden in this population and that families' involvement in treatment for anorexia nervosa is crucial. The first paper provides a review of the qualitative evidence looking at adolescents' experience of treatment and recovery for anorexia nervosa. The review made tentative yet important conclusions regarding crucial aspects of treatment and recovery for adolescents including the role of peers, families and professionals, physical and psychological nature of treatment and the adolescents' own concept of recovery. Methodological limitations of the studies and subsequent recommendations for future research were discussed in addition to clinical implications for future service delivery. The second paper adopts an Interpretative Phenomenological Analysis (IPA) methodology in exploring mothers' experiences of home treatment for their adolescent daughters with anorexia nervosa. Nine mothers who had experience of home treatment for at least two weeks participated in the study. IPA revealed two key themes which provided an important context to home treatment: 'becoming enmeshed' and 'reaching rock bottom.' These themes described the mother-daughter relationships and maternal stress and distress prior to home treatment. The third theme 'experience of help' described participants' experience of when help is needed, the need for containment, gaining strength and skills and finally how home treatment fitted into the families own philosophy and values. The results provide important rich accounts on how home treatment is experienced and outline both the helpful and unhelpful aspects. Further research is required to assess its effectiveness.
4
Paulson-Karlsson, Gunilla. "Anorexia nervosa : treatment expectations, outcome and satisfaction." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2012. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-26142.
Abstract:
Anorexia nervosa is a serious mental disorder with high mortality. It has the lowest prevalence compared with other eating-disorder diagnoses and the onset is related to adolescence, with a majority of female patients. The focus of this thesis is anorexia nervosa and the aim is to study adolescent and adult patients' comprehension and the course of treatment in order to make a contribution to the clinical work relating to these patients. The areas that were studied are expectations of treatment, outcome, predictors of outcome and satisfaction with treatment. Four research papers are included; three originate from work at a specialist eating-disorder unit at Queen Silvia Children's Hospital, Göteborg, Sweden and one from a multicentre study comprising 15 specialised eating-disorder units in Sweden. Paper I has a qualitative design, where participants, 18-25 years of age, were interviewed about their expectations while on the waiting list at a specialist eating-disorder unit. Three main categories of expectations emerged: "Treatment content," "Treatment professionals" and "Treatment focus." The participants expected to receive the appropriate therapy in a collaborative therapeutic relationship and to recover. Paper II evaluated the outcome of a family-based treatment for adolescent patients, 13-18 years old, and their parents. The results indicate that the treatment that is offered appears to be effective, as 78% of the patients were in full remission with less distance and a less chaotic family climate at the 36-month follow-up. Paper III examined the importance of motivation to change eating behaviour, treatment expectationsand experiences, ED symptomatology, self-image and treatment alliance for predicting weight increase in adult patients, 18-46 years of age. Patients' motivation to change eating habits, social relations, self-image, body image and duration of illness were found to predict weight increase both in both the short term (six months) and the long term (36 months). PaperIV studied adolescent patients' and their parents' satisfaction with a family-based treatment a tan 18-month follow-up. The majority of patients (73%) and parents (83%) stated that their expectations had been fulfilled and individual sessions for patients and parents respectively were of great help. Family-based treatment with a combination of individual and family sessions corresponds well to patients' and parents' treatment expectations. Young adult patients' expectations before treatment are multifaceted and should be taken into account in the therapeutic relationship. From the start of treatment, issues relating to patients' motivation, self-image, body image and social relationships should be continuously addressed in order to establish positive collaboration and a weight increase. Anorexia nervosa treatment for adolescents and their parents should be family-based and include family sessions as well as individual sessions for patients and parents. In addition, prevention programmes with the emphasis on early detection should be a prioritised area.
5
Chang, Jennifer. "The neuropsychological functioning of children and adolescents with anorexia nervosa." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6391.
Abstract:
Researchers have suggested there is a wide range of neuropsychological deficits individuals with anorexia nervosa (AN) possess, including impairments in nonverbal reasoning, attention and processing speed, memory, and executive functioning. While growing, examination of the neuropsychological functioning of children and adolescents with AN is quite sparse compared to the abundance of research on adults with AN, and the many conflicting findings have been attributed to inconsistent methodologies across studies. This study examined the neuropsychological functioning of children and adolescents with AN by conducting a quantitative study loosely based on Bayless et al. (2002) and Remberk, Namysłowska, Krempa-Kowalewska, Gadaś, and Skalska (2011). Results indicated verbal intellectual functioning was significantly higher than other intellectual domains, and verbal memory was almost significantly higher than nonverbal memory (p = .051). Negative correlations were found between individual subtests and clinical data (e.g., age of onset of AN and duration of AN) as well as the EDI-3 Personal Alienation scale and the BMI-for-age percentile. Clinical implications include providing treatment improving cognitive functioning and implementing a biopsychosocial model.
6
Pinto, Diana Raquel Meireles. "Cuidar do adolescente com anorexia nervosa." Bachelor's thesis, [s.n.], 2016. http://hdl.handle.net/10284/5498.
Abstract:
Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de licenciada em EnfermagemCom a elaboração deste projeto de graduação pretendeu-se cumprir um dos requisitos para a obtenção do grau de licenciada em Enfermagem e escolhemos estudar “ Cuidar de Adolescentes com anorexia nervosa”. Para o efeito ouvimos os Enfermeiros que trabalham num Serviço de Pedopsiquiatria e que cuidam diariamente destas crianças. Quisemos saber o que pensam e como as ajudam na sua adaptação ao internamento, qual a sua opinião sobre a influência que a moda do corpo perfeito veiculada pelos média tem, sobre o aparente aumento do número desta doença nos adolescentes o que preconiza que a sociedade faça para a combater e como interagem com as famílias. Esta preocupação surgiu durante as aulas de Enfermagem de Saúde mental e Psiquiátrica e no Ensino Clínico de Psiquiatria onde vivenciamos histórias de adolescentes de quem nos sentimos muito próximas o que nos motivou para a realização do projeto. O estudo teve um carácter exploratório descritivo com base numa abordagem qualitativa. A amostra foi constituída por 8 enfermeiros que trabalham em Pedopsiquitria a quem de acordo com um guião previamente elaborado foram realizadas entrevistas semiestruturadas para a obtenção dos dados que foram posteriormente interpretados. Os resultados obtidos permite-nos concluir que os Enfermeiros procuram integrar as crianças no internamento de modo a que se adaptem às regras estabelecidas que designam como contrato terapêutico o qual inclui o afastamento forçado da família mas que na sua opinião favorece a mudança de atitude em relação à ingestão de alimentos. Concluímos também que as razões que levam as adolescentes à anorexia não são totalmente compreendidas por todos os enfermeiros e que existe um aparente distanciamento entre os Enfermeiros e os adolescentes, necessário para facilitar a adaptação e a consciencialização daquilo a que chamam o problema das anoréticas. Também foi possível concluir que a sociedade tem uma grande influência nestes jovens ao veicular de forma intensiva a construção do modelo de “corpo ideal”.
With the development of this graduation project we wanted to meet one of the requirements for obtaining a degree in nursing and chose to study "take care of teens with nervous anorexia”. For this purpose we heard the nurses who work in child psychiatry service and daily take care of these childrens. We wanted to know what they think and how they help the chidren in her adaptation to internament, what is their opinion about the perfect body ideal settled down by the media, and about of the apparent increase in the number of this disease in teens which advocates that society do to combat it and how they interact with families. This concern arose during of Health Nursing and Psychiatric classes and Clinical Teaching of Psychiatry where we saw experience stories of teenagers that we feel very close and they motivated us to do this project. The study was a descriptive exploratory character based on a qualitative approach. The sample has been consisted of eight nurses working in Pedopsiquitria who according to a previously prepared script i realized semistructured interviews and after i analyzed the all the information answered. The results allow us to conclude that nurses try integrate the children in the internament and that they follow the rules established by a therapeutic contract but in the nurses opinion helps change her attitude in relation to their feeding process. We conclude also that anorexia pathology is not fully understood by all nurses and that there is an apparent gap between the nurses and adolescents, necessary to facilitate the adaptation and aware of what they call the problem of anorexic. It was also possible to conclude that society has a great influence on these young people intensively conveys the construction of the model of "ideal body ".
7
Smith, Jacqueline. "Emotional well-being in children and adolescents attending specialist schools for the performing arts." Thesis, University College London (University of London), 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264169.
8
Williams, Sadie. "Measuring and modelling the multidimensional nature of anorexia nervosa in adolescents." Thesis, University of Westminster, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.434385.
9
Vale, Antonio Maia Olsen do. "Abnormal eating behavior and inappropriate practices for weight control amongst female adolescents in fortaleza." Universidade Federal do CearÃ, 2002. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=24.
Abstract:
CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorObjectives: characterize eating habits and possible risk factors associated with Eating Disorders, amongst female adolescents in Fortaleza-CE, Brazil. Methodology: transversal study, with 652 women between 14 and 20 years of age, students of the second year of Middle-level education. The Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and the Eating Attitudes Test (EAT-26) were used. Results: 73.6% of the subjects are out of risk for development of an Eating Disorder, 25.2% are at risk and in 1.2% a strong possibility of eating disorder in course was found. The proportion of adolescents who showed risky habits was greater in private schools (p<0.05). According to the EAT-26, 9% of the sample showed a score (>=21) which characterizes them as being at risk and practicing pathological eating habits. The BSQ indicated that 36.2% of the adolescents showed concern with their body image (BI); of these, 61% (n=236) were concerned to a degree considered mild, 26.3% showed a moderate concern and 12.7% showed serious concern with BI. Students at public and private schools demonstrated a similar desire to be thin, but adolescents from private schools more frequently used inappropriate practices in order to reach that wish. Conclusion: Adolescents who demonstrate eating disorders in their clinical form, are a rare phenomenon in public and private schools in Fortaleza, whilst the symptoms of eating disorder, either isolated or in small groups, occur with relevant frequency amongst the population studied.
Objetivo: caracterizar prÃticas alimentares e os possÃveis fatores de risco associados aos Transtornos Alimentares, entre estudantes adolescentes do sexo feminino de Fortaleza-CE. MÃtodos: estudo transversal, com 652 mulheres de 14 a 20 anos, estudantes do 2 ano do segundo grau. Foram utilizados o Bulimic Investigatory Test Edinburgh (BITE), o Body Shape Questionaire (BSQ) e o Eating Attitudes Test (EAT-26). Resultados: Das adolescentes, 73,6% estÃo fora de risco para o desenvolvimento de um Transtorno Alimentar, 25,2% delas estÃo em situaÃÃo de risco e em 1,2% foram encontrados indicativos para a ocorrÃncia de um transtorno alimentar. A proporÃÃo de adolescentes que apresentaram prÃticas de risco foi superior nas escolas particulares (p<0,05). Segundo o EAT-26, 9% da amostra apresentam uma pontuaÃÃo (>=21) que caracteriza um estado de situaÃÃo de risco, alÃm de atitudes alimentares patolÃgicas. O BSQ apontou que 36,2% das adolescentes apresentam preocupaÃÃo com a imagem corporal; destas 61% tiveram uma preocupaÃÃo considerada de grau leve, 26,3% apresentaram uma moderada preocupaÃÃo e 12,7% apresentaram uma grave preocupaÃÃo com a imagem corporal. A proporÃÃo de adolescentes que apresentam preocupaÃÃo com a imagem corporal em colÃgios particulares (43%) foi superior à proporÃÃo das que estudam em colÃgios pÃblicos (32,3%), ou seja, a ocorrÃncia de adolescentes com alteraÃÃo de imagem corporal à maior nos colÃgios particulares (p<0,05). As estudantes de colÃgios pÃblicos e particulares demonstraram um desejo similar de serem magras, mas as adolescentes de colÃgios particulares usam de forma mais freqÃente prÃticas inapropriadas para alcanÃar este desejo. ConclusÃo: Adolescentes que apresentam todos os critÃrios diagnÃsticos para caracterizar um transtorno alimentar sÃo uma ocorrÃncia rara em escolas pÃblicas e privadas de Fortaleza, enquanto que os sintomas de transtorno alimentar, apresentando-se em pequena mas preocupante quantidade, ocorrem numa freqÃÃncia relevante entre a populaÃÃo estudada.
10
Lang, Katie. "Neuropsychological and socio-emotional processing in children and adolescents with Anorexia Nervosa." Thesis, King's College London (University of London), 2015. http://kclpure.kcl.ac.uk/portal/en/theses/neuropsychological-and-socioemotional-processing-in-children-and-adolescents-with-anorexia-nervosa(d9f09cba-296b-4cd0-a23d-c111e1790616).html.
11
Hellgren, Frida, and Schlieben Annette von. "Viktiga aspekter i sjuksköterskors strategier i omvårdnaden av ungdomar med anorexia nervosa och deras föräldrar : En litteraturstudie." Thesis, University of Gävle, Department of Caring Sciences and Sociology, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hig:diva-3922.
Abstract:
Syftet med denna deskriptiva litteraturstudie var att beskriva viktiga aspekter i omvårdnaden av ungdomar med anorexia nervosa och deras föräldrar ur ungdomars, föräldrars och sjuksköterskors perspektiv. De vetenskapliga artiklarna (n=16) hittades i databaserna Medline (PubMed), PsycInfo och Academic Search Elite (ASE) och samtliga genomgick en kvalitetsanalys. I resultatet framkom att det var viktigt att sjuksköterskor utvecklade goda relationsband med anorektiska ungdomar vilket låg till grund för en effektiv behandling. Genom motivation och stöttning kunde sjuksköterskor stärka anorektikerns självkänsla och på så vis lägga en bra grund för en verksam behandling. Sjuksköterskor behövde också sätta upp regler och vara kontrollerande för att hjälpa ungdomarna att hålla sig inom behandlingens ramar. Det framkom även att det var mycket betydelsefullt att involvera föräldrarna till anorektiska ungdomar i vården och behandlingen av deras barn. Många föräldrar hade bristande förståelse och insikt i sjukdomen, sjuksköterskor borde därför informera om sjukdomens natur och dess behandling. Det var vanligt att föräldrar lade skulden för sitt barns sjukdom på sig själva och mådde psykiskt dåligt, vilket i sin tur påverkade den anorektiske ungdomens välmående negativt. Det var därför viktigt att sjuksköterskor var ett stöd också för föräldrarna.
The purpose of this descriptive study was to describe important aspects in the care of adolescents who suffer from Anorexia Nervosa and their parents, out of adolescents, parents and nurses perspective. The scientific articles (n=16) was searched in the database Medline (PubMed), PsychInfo and Academic Search Elite (ASE) and a quality analysis of all articles was made. In the result it was concluded that it was important that nurses developed good relationship with young people with anorexia, which in turn lead to an effective treatment. Through motivation and encouragement the nurses could strengthen the self esteem of the anorectic person and in this a good foundation for an effective treatment was build. The nurses also needed to set up rules and to be controlling in order to help the young people to stay within the framework of the treatment. It appeared also that it was very important to involve parents to anorectic youths in the care and treatment of their children. Many parents lacked understanding and knowledge of the illness, nurses should therefore inform the parents of the nature of the illness and its treatment. It was not unusual that parents blamed themselves for their children´s illness and felt psychologically bad, which in turn affected the anorectic young people´s health in a negative way. For this reason it was important that the nurses were supportive also to the parents.
12
Ekström, Paula, and Anna Wendelin. "Unga kvinnors tillfrisknande från anorexia nervosa." Thesis, Kristianstad University College, School of Health and Society, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-6273.
Abstract:
Bakgrund: Anorexia nervosa blir allt vanligare bland unga kvinnor. Med rätt behandling och stöd tillfrisknar ändå de flesta från sin ätstörning. Syfte: Syftet med litteraturstudien var att ur en ung kvinnas perspektiv som har haft anorexianervosa, beskriva faktorer som har betydelse för tillfrisknandet från ätstörningen, för att sjuksköterskan ska få en ökad förståelse för unga kvinnor med anorexia nervosa och därmed kunna hjälpa dem. Metod: Litteraturstudien baseras på tio vetenskapliga artiklar, både kvalitativa och kvantitativa, som analyserades och utformades till studiens resultat. Resultat: De faktorer som hade betydelse för tillfrisknandet var att den unga kvinnan själv kom till insikt om sin sjukdom och lärde sig begripa och hantera sina känslor, sin självbild och självkänsla. Tillfrisknandet påverkades även av den unga kvinnans egen motivation till att vilja tillfriskna och ändra sitt matbeteende. Resultatet visade att sjuksköterskan hade en viktig roll i att vägleda den unga kvinnan med anorexia nervosa genom tillfrisknandeprocessen. Andra personer som familj, vänner, partner, terapeuter och sjukvårdspersonal hade också en betydelsefull roll, men även aktiviteter för att sysselsätta sig var viktigt. Slutsats: För att en ung kvinna med anorexia nervosa ska kunna tillfriskna krävs rätt stöd från familj och vänner men även sjuksköterskor med rätt utbildning har en betydelsefull roll i att stödja kvinnan till ett liv utan anorexia nervosa.
Background: Anorexia nervosa is increasing more and more among young women, although with accurate treatment and support most of them recover from their eating disorder. Aim: The aim of the literature study is to describe factors of importance concerning recovery from an eating disorder from a young woman’s perspective, in order for nurses to receive an increased understanding of young women with anorexia nervosa. Method: The literature study is based on ten scientific articles, qualitative as well as quantitative, which were analysed to obtain the result of the study. Result: Factors of importance for recovery were that the young woman herself obtains an awareness of her disease and learns to understand and handle her feelings, her selfimage, self-esteem and the young woman’s motivation and will to get well and to change her eating habits. In addition the result also shows that nurses have an important role in guiding the young woman in her process of recovery, as well as family, friends, partners, therapists and remaining medical staff. Finally occupational activitites are also vital for the recovery process. Conclusion: In order for a young woman suffering from anorexia nervosa to recover she needs support from family and friends but especially from nurses with suitable training and education. They have an important role in supporting the young woman on her way to recovery to a life without anorexia nervosa.
13
Liveley, Katie. "Exploring the metacognitive profile and role of memory in adolescents with anorexia nervosa." Thesis, University of East Anglia, 2014. https://ueaeprints.uea.ac.uk/52520/.
Abstract:
The aim of this qualitative study was to explore the metacognitive profile and role of memory in adolescents with anorexia nervosa (AN). Nine adolescent females with AN participated in the study. Metacognition can be conceptualised as ‘thinking about thinking’ (Wells, 2000). Metacognitive factors or cognitive processes involved in regulating thoughts and emotions can be explained by the Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994). Metacognitive dysfunction has been identified in adults with AN (e.g., McDermott & Rushford, 2011). Individuals with AN present with a toxic style of thinking, which is characterised by processing negative self-beliefs, perseverative thinking, self-focussed attention, threat monitoring and avoidance (e.g., McDermott & Rushford, 2011; Wells, 2000, 2009). Metacognitive factors can have an effect on memory processing (Mazzoni & Kirsch, 2002). Research on memory in eating disordered populations has focussed on the origins of the disorder, content of early recollections and the families’ relationship with food. Studies indicate that negative early experiences are associated with disordered eating (e.g., Sweetingham & Waller, 2008). This was the first qualitative study of metacognitive factors and role of memory, whereby the content, use, and impact of memories were explored. The primary research question was to explore and describe the metacognitive profile of adolescents with AN. The secondary question aimed to understand and capture the role of memory in this clinical sample. Semi-structured interviews were conducted to assess metacognitive factors and memories, based on Wells and Matthews’ (1994) metacognitive profiling interview. Data analysis was performed using thematic analysis, where the information was organised into four themes, Relationships in Anorexia Nervosa, Cognition, Coping Strategies, and Early Experiences and Memory. The key findings were that 8 participants described patterns of metacognitive dysfunction and indicated that memory can have a negative impact on mood and lead to dietary restriction.
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Mather, Sandra Joan. "Ultrasound bone analysis in children and adolescents with anorexia nervosa and related eating disorders." Thesis, University College London (University of London), 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.325694.
15
Kells, Meredith Rose. "Factors Associated with Refeeding Hypophosphatemia in Adolescents and Young Adults Hospitalized with Anorexia Nervosa:." Thesis, Boston College, 2019. http://hdl.handle.net/2345/bc-ir:108355.
Abstract:
Thesis advisor: Susan Kelly-WeederRefeeding Hypophosphatemia (RH) is the most common complication of nutritional restoration during medical hospitalization for individuals with anorexia nervosa (AN). Characterized by a drop in serum phosphorus levels, consequences of RH can be seen throughout the body and are potentially life threatening. Despite the seriousness of this outcome, little is known about which individuals with AN are at greatest risk of developing RH and best practices for prevention. The purpose of this retrospective cohort study was to examine demographic, feeding, and biochemical factors found in hospitalized adolescent and young adults (AYA) diagnosed with AN that may contribute to the development of RH. Individuals diagnosed with AN who were admitted to Boston Children’s Hospital between the years of 2010-2016 were considered for inclusion. Three hundred charts were analyzed using logistic regression to determine factors associated with RH and multivariate regression to determine factors associated with serum phosphorus nadir. In the final logistic regression model, receiving nasogastric tube feeding (p=0.54), age at admission (p=.022), weight gain during hospitalization (p=.003), serum potassium level (p=.001), and serum magnesium level (p=.024) significantly contributed to the model. Odds of RH were 3 times higher in those who received NG feeding, 1.2 times higher for each year of increasing age, 1.5 times higher for each kilogram of weight gain, 9.2 times higher for each unit reduction in potassium, and 13.7 times higher for each unit reduction in magnesium. With regards to phosphorus nadir, 1-unit increase in magnesium resulted in 1.2 increase in phosphorus, and each unit of admit BMI increased phosphorus by .060. The results indicate that NG feeding, age, weight gain, electrolyte abnormalities, and admit BMI are potential indicators of development of RH in AYA hospitalized with AN. This study will inform clinicians of risk factors associated with RH, and may guide further investigation into the clinical management of AYA diagnosed with AN
Thesis (PhD) — Boston College, 2019
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
16
Burns, Emily J. "Efficacy of yoga as adjunct therapy for treatment of anorexia nervosa in female adolescents." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12301.
Abstract:
Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Anorexia nervosa is a restrictive eating disorder in which the individual refuses to maintain a normal body weight and focuses on decreasing energy intake, commonly through food avoidance, and increasing energy expenditure, through excessive activity or exercise. The first medical report of AN dates back the seventeenth century; however, AN was not given considerable clinical attention until the twentieth century. The prevalence of AN continues to increase, most significantly among adolescent females. AN now exists as a medically recognized disorder, but no uniform method of treatment has been found to be successful. This paper will examine the efficacy of yoga as a component of therapy for treatment of anorexia nervosa in female adolescents. To do so, research articles, clinical studies, and literature on eating disorders--specifically anorexia nervosa--and yoga-including the philosophy and foundations of yoga in addition to the application of yoga practice- were reviewed and analyzed. The application of yoga as therapy for anorexia nervosa has been most widely studied in its effectiveness as a form of mindful-based therapy to treat psychological symptoms, specifically eating-disordered thoughts, of AN. Currently, the evidence of the application of yoga as therapy for AN reports successful results in treatment of the disorder. Future studies providing further evidence of physiological benefits of yoga in treating AN will help to gamer support from the members of the medical community who are directly involved in the treatment of AN patients. Further evidence of the success of the use of yoga in treatment of AN may lead to a widespread application of yoga as a component of therapy for AN and increased success of recovery from the disorder.
17
Nilsson, Karin. "Recovery from adolescent onset anorexia nervosa : a longitudinal study." Doctoral thesis, Umeå : Univ, 2007. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-1119.
18
Galbraith, Michael. "A study of attitudes and beliefs associated with anorexia nervosa in adolescents and their parents." Thesis, Open University, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.287021.
19
Sarrar, Lea. "Kognitive Funktionen bei adoleszenten Patienten mit Anorexia nervosa und unipolaren Affektiven Störungen." Phd thesis, Universität Potsdam, 2014. http://opus.kobv.de/ubp/volltexte/2014/7243/.
Abstract:
Anorexia nervosa und unipolare Affektive Störungen stellen häufige und schwerwiegende kinder- und jugendpsychiatrische Störungsbilder dar, deren Pathogenese bislang nicht vollständig entschlüsselt ist. Verschiedene Studien zeigen bei erwachsenen Patienten gravierende Auffälligkeiten in den kognitiven Funktionen. Dahingegen scheinen bei adoleszenten Patienten lediglich leichtere Einschränkungen in den kognitiven Funktionen vorzuliegen. Die Prävalenz der Anorexia nervosa und unipolaren Affektiven Störung ist mit Beginn der Adoleszenz deutlich erhöht. Es ist anzunehmen, dass kognitive Dysfunktionen, die sich bereits in diesem Alter abzeichnen, den weiteren Krankheitsverlauf bis in das Erwachsenenalter, die Behandlungsergebnisse und die Prognose maßgeblich beeinträchtigen könnten. Zudem ist von einem höheren Chronifizierungsrisiko auszugehen.
In der vorliegenden Arbeit wurden daher kognitive Funktionen bei adoleszenten Patientinnen mit Anorexia nervosa sowie Patienten mit unipolaren Affektiven Störungen untersucht. Die Überprüfung der kognitiven Funktionen bei Patientinnen mit Anorexia nervosa erfolgte vor und nach Gewichtszunahme. Weiterhin wurden zugrundeliegende biologische Mechanismen überprüft. Zudem wurde die Spezifität kognitiver Dysfunktionen für beide Störungsbilder untersucht und bei Patienten mit unipolaren Affektiven Störungen geschlechtsbezogene Unterschiede exploriert. Insgesamt gingen 47 Patientinnen mit Anorexia nervosa (mittleres Alter 16,3 + 1,6 Jahre), 39 Patienten mit unipolaren Affektiven Störungen (mittleres Alter 15,5 + 1,3 Jahre) sowie 78 Kontrollprobanden (mittleres Alter 16,5 + 1,3 Jahre) in die Untersuchung ein. Sämtliche Studienteilnehmer durchliefen eine neuropsychologische Testbatterie, bestehend aus Verfahren zur Überprüfung der kognitiven Flexibilität sowie visuellen und psychomotorischen Verarbeitungsgeschwindigkeit. Neben einem Intelligenzscreening wurden zudem das Ausmaß der depressiven Symptomatik sowie die allgemeine psychische Belastung erfasst.
Die Ergebnisse legen nahe, dass bei adoleszenten Patientinnen mit Anorexia nervosa, sowohl im akut untergewichtigen Zustand als auch nach Gewichtszunahme, lediglich milde Beeinträchtigungen in den kognitiven Funktionen vorliegen. Im akut untergewichtigen Zustand offenbarten sich deutliche Zusammenhänge zwischen dem appetitregulierenden Peptid Agouti-related Protein und kognitiver Flexibilität, nicht jedoch zwischen Agouti-related Protein und visueller oder psychomotorischer Verarbeitungsgeschwindigkeit. Bei dem Vergleich von Anorexia nervosa und unipolaren Affektiven Störungen prädizierte die Zugehörigkeit zu der Patientengruppe Anorexia nervosa ein Risiko für das Vorliegen kognitiver Dysfunktionen. Es zeigte sich zudem, dass adoleszente Patienten mit unipolaren Affektiven Störungen lediglich in der psychomotorischen Verarbeitungsgeschwindigkeit tendenziell schwächere Leistungen offenbarten als gesunde Kontrollprobanden. Es ergab sich jedoch ein genereller geschlechtsbezogener Vorteil für weibliche Probanden in der visuellen und psychomotorischen Verarbeitungsgeschwindigkeit.
Die vorliegenden Befunde unterstreichen die Notwendigkeit der Überprüfung kognitiver Funktionen bei adoleszenten Patienten mit Anorexia nervosa sowie unipolaren Affektiven Störungen in der klinischen Routinediagnostik. Die Patienten könnten von spezifischen Therapieprogrammen profitieren, die Beeinträchtigungen in den kognitiven Funktionen mildern bzw. präventiv behandeln.Anorexia nervosa and unipolar affective disorders are common and severe psychiatric disorders whose pathogenesis is not fully understood so far. Several studies have revealed serious impairments in cognitive functions among adult patients whereas recent research in adolescent patients shows only subtle cognitive dysfunctions. The prevalence in both disorders increases with the beginning of adolescence. Cognitive impairments that occur during adolescence may exacerbate the course of disease. Early cognitive deficits may also hinder treatment efforts and prognosis to a greater extent than during adulthood. Moreover, there is a higher risk for chronification. In the present study cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders were examined. Cognitive functions in patients with anorexia nervosa were assessed before and after weight gain. Furthermore, the underlying biological mechanisms were explored. Moreover, the specificity for these psychiatric diagnoses as well as gender differences in patients with unipolar affective disorders were investigated. 47 patients with anorexia nervosa (mean age 16.3 + 1.6), 39 patients with unipolar affective disorders (mean age 15.5 + 1.3) and 78 healthy adolescents (mean age 16.5 + 1.3) participated in this study. Each of them completed a battery of neuropsychological tests for cognitive functions including tests for assessing cognitive flexibility as well as visual and psychomotor processing speed. Moreover, intelligence, depressive symptoms and psychological stress were explored. The findings revealed only subtle cognitive impairments in adolescent patients with anorexia nervosa, both in underweight condition and after weight gain. Besides, the results showed an association between cognitive flexibility and plasma agouti-related protein levels in female adolescent patients with acute anorexia nervosa, but not for visual or psychomotor speed and plasma agouti-related protein levels. Comparing anorexia nervosa and unipolar affective disorders, the results suggested a higher risk for cognitive dysfunctions when belonging to the anorexia nervosa group. Furthermore, the results only revealed a slightly weaker performance in psychomotor processing speed in adolescent patients with unipolar affective disorders compared to healthy adolescents. Moreover, female subjects generally displayed a better performance in visual and psychomotor processing speed. The present findings underlie the necessity of exploring cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders within routine clinical diagnostic. Patients may benefit from specific therapy programs to reduce or prevent cognitive dysfunctions.
20
Wormald, Charlotte L. "Inflated responsibility and perfectionism in child and adolescent anorexia nervosa." Thesis, Canterbury Christ Church University, 2013. http://create.canterbury.ac.uk/12339/.
Abstract:
Theory suggests that cognitive biases in obsessive compulsive disorder (OCD) may occur in individuals with anorexia nervosa (AN) and anorexia nervosa /eating disorder not otherwise specified (AN/EDNOS), which may partly explain the large co-morbidity between the two disorders. The aim of the current study was to investigate the cognitive biases of inflated responsibility (IR) and perfectionism in children and adolescents who had been diagnosed with AN and AN/EDNOS. An additional aim was to investigate the relationship between IR and perfectionism and to test an interaction effect on AN severity. The relationship between young people and their parents’ levels of inflated responsibility was also investigated. A cross-sectional multi-site pilot study using standardised questionnaires was conducted. Full ethical approval was gained and 30 young people diagnosed with AN and AN/EDNOS and 32 of their parents participated. This included 22 matched pairs of children and parents. Children and adolescents with AN and AN/EDNOS reported significantly higher levels of IR and perfectionism, compared to the published data for non-clinical norms. Self-orientated perfectionism was associated with frequency of IR thoughts. There was also a significant interaction effect: young people who had a higher frequency of IR thoughts and self-orientated perfectionism had lower BMIs. Parents reported higher levels of IR compared to the published non-clinical norms, but there was no relationship between child and parent IR. Further independent replication of these results is needed. IR and perfectionism should be considered in the assessment and treatment of child and adolescent AN and AN/EDNOS, both in individual and systemic interventions. This research also adds to the growing body of literature examining cognitive biases of OCD in an AN population, which may offer some insight into the overlap between the two disorders.
21
Andres, Karen. "A narrative inquiry into understanding female adolescence and anorexia nervosa." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk2/tape17/PQDD_0003/MQ34331.pdf.
22
Lögdberg, Lisa. "Att sträva mot en allians : Sjuksköterskors erfarenheter av att stödja ungdomar med anorexia nervosa till att vara delaktiga i sin vård." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-39240.
Abstract:
Background:To be struck down with anorexia nervosa as an adolescent means that their everyday life is all about avoiding meals in order to starve themselves and often do long sessions of physical activity. The illness can quickly develop into an identity in the adolescent's life. Anorexia nervosa is a serious illness that can become life-threatening. An ambivalence to receive care often arises related to, among other things, the difficulty to break the compulsive behavior. To involve the adolescents in their own care poses a challenge for health care providers. Aim:To describe nurses' experiences with supporting adolescents with anorexia nervosa to be involved in their own care within the Department of Child and Adolescent Psychiatry. Method:A descriptive design with a qualitative inductive approach. Five nurses have been interviewed, these have been analyzed with a qualitative content analysis. Results:The nurses support the adolescents to involvement in their own care by being together with them in a two-sided alliance. This is described as: The nurses support the adolescent to involvement in their own care by aiming for an alliance. This is described as to use information as a tool to get the adolescent to dare change, to bring attention to the adolescent's individual needs and motivation, and to make their own commitment possible and encouraged. Conclusion: In order for nurses to support patients to participate, information about how the illness works has to be given, and they have to clearify which model of treatment is used, and bring attention to and encourage the adolescent's former interests and life story and part of their own treatment. To, as a nurse, get support from the undertakings and skills that are described in the Tidal Model can make starting from the adolescents' needs and wishes easier and consequently also the possibility of supporting them to involvement. Keywords: Adolescents, Anorexia nervosa, Participation, Nurses, Qualitative content analysis
23
Bighetti, Felícia. ""Tradução e validação do Eating Attitudes Test (EAT-26) em adolescentes do sexo feminino na cidade de Ribeirão Preto - SP"." Universidade de São Paulo, 2003. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-12042004-234230/.
Abstract:
BIGHETTI, F. Tradução e validação do Eating Attitudes Test (EAT-26) em adolescentes do sexo feminino na cidade de Ribeirão Preto - SP. 2003. (número de páginas) Dissertação de Mestrado Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, Ribeirão Preto - SP. Os distúrbios da conduta alimentar, entre eles, a anorexia e bulimia nervosas, são síndromes psicossomáticas consideradas graves e de prognóstico ruim, caracterizadas pelo medo mórbido de engordar, levando à redução voluntária da ingestão alimentar com perda progressiva de peso, ingestão maciça de alimentos seguida de vômitos e uso abusivo de laxantes e/ou diuréticos. Desta forma, é de suma importância que o diagnóstico dessas doenças seja realizado precocemente, sendo que um dos instrumentos que auxiliam na triagem de possíveis doentes é o Eating Attitudes Test (EAT-26). O objetivo dessa pesquisa foi traduzir e validar o EAT-26 para a língua portuguesa em adolescentes do sexo feminino de nível sócio-econômico alto e, para tanto, o teste foi aplicado em 365 estudantes com idade entre 12 e 18 anos de duas escolas particulares de Ribeirão Preto-SP onde essas doenças ocorrem com maior incidência. Para desenvolver esta investigação, foram utilizados o referencial metodológico da tradução e retro-tradução do instrumento e métodos de análise estatística para avaliar a consistência interna dos itens do teste, isto é, a intensidade da concordância entre as versões traduzidas e sua confiabilidade. Além disso, caracterizou-se a amostra sob o ponto de vista nutricional e socioeconômico. Como resultados, a idade média das meninas foi de 14,2 anos com desvio-padrão de 1,7 anos e a maioria (81,7%) se mostrou eutrófica pelo índice de massa corporal. A avaliação socioeconômica revelou que praticamente todas as adolescentes recebem desconto na mensalidade escolar, moram em bairros de estrato socioeconômico médio-baixo e médio-alto, cujas famílias têm renda mensal entre 5 e 10 salários mínimos (28,8%) e 10 e 15 salários mínimos (7,5%). A contagem total média do EAT-26 foi de 19,8 pontos. A validação e confiabilidade de consistência interna do teste, representadas pelo alfa de Crombach 0,80, foram consideradas estatisticamente bastante satisfatórias por este valor estar próximo de 1,00. Concluímos assim, que o EAT-26 encontra-se em ótimas condições para ser aplicado em adolescentes, auxiliando no pré-diagnóstico de possíveis casos de transtornos alimentares. Além disso, políticas públicas devem reconhecer e valorizar a elaboração de programas informativos para adolescentes e outros grupos de risco para conhecimento mais amplo desses quadros, possibilitando a precocidade do tratamento e favorecendo o seu prognóstico.The disturbances of eating conduct, among them, anorexia and nervous bulimia, are psychosomatical syndrome considered serious and of a bad prognostic, characterized by the morbid fear of getting fat, taking to a volunteer reduction of the food ingestion with a losing of weight, solid food ingestion followed by vomit and abusive use of laxatives and/or diuretics. This way, it is very important to obtain the diagnostic for these diseases precociously, and one of the instruments that helps the triagem of possible sick people is the Eating Attitude Test (EAT-26). The objective of this research was translating EAT-26 into Portuguese and validating it in female adolescents and so, the test was applied in 365 students from two private schools from Ribeirão Preto, ages between 12 and 18, the ages where these diseases most frequently occur. To develop this investigation, the metodological referencial of translation and retro-translation of the instrument were used, and statistical analysis method, to evaluate the internal consistence of the items of the test, this is, the intensity of the concordance between the translated versions and their confiability. Besides that, the sample was characterized under the nutritional and socioeconomical point of view. As results, the girls average age was 14,2 years old and most of them looked eutrofic by the body mass index. The socioeconomical evaluation revelead that practically all the adolescents receive a discount in their school payment, they live in neighborhoods of middle-low and middle-high socioeconomical standard of living, whose families have a month income between 5 and 15 minimum wages. The total average count of EAT-26 was 19,8 points. The validation and confiability of internal consistence of the test, represented by alfa of 0,80, were considered statistically satisfactory, because this value is next to 1,00. We can conclude that, the EAT-26 is in great conditions for being applied in adolescents helping the pre-diagnostic of possible cases of these diseases. Besides that, public policies must recognize and value the elaboration of informative programs for adolescents and other risk groups so that they can have more knowledge about these diseases, allowing the precocity of the treatment and favoring its prognostic.
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Espírito, Santo Andreia Cristina Jales do. "Transição do internamento para o ambulatório de adolescentes com anorexia nervosa." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2014. http://hdl.handle.net/10400.26/6600.
Abstract:
Relatório do Trabalho de Projeto para candidatura ao grau de Mestre em Enfermagem de Saúde Mental e PsiquiatriaA Anorexia Nervosa é uma patologia complexa, desafiante, que necessita de uma intervenção multidisciplinar. Com ela surgem múltiplas complicações físicas e psicológicas, assim como tem associadas diversas comorbilidades. Implica a necessidade de resposta a vários níveis de cuidados, nomeadamente internamento hospitalar e ambulatório. Colocando a hipótese de várias transições se apresentarem ao mesmo tempo, particularmente de desenvolvimento (adolescência), de saúde-doença (diagnóstico de anorexia nervosa) e situacional (transição do internamento para o ambulatório); e a importância de melhor as conhecer, com o intuito de promover o sucesso da transição, pretendemos compreender como decorre o processo de transição do internamento para o ambulatório. A partir daqui desenhámos um projeto de intervenção em serviço utilizando a metodologia de trabalho projeto. Este implicou a realização do diagnóstico de situação, definição de objetivos, planeamento, execução, avaliação e divulgação dos resultados. Na compreensão da problemática em estudo foram realizadas entrevistas semiestruturadas a adolescentes com o diagnóstico de anorexia nervosa em ambulatório, com internamento prévio; enfermeiros da unidade de internamento e médicos do ambulatório. Foram também levantadas dos processos clínicos as intervenções de enfermagem realizadas durante o internamento com o objetivo da preparação para alta. Da análise das categorias encontradas constatámos que as principais preocupações e dificuldades se evidenciavam no acompanhamento realizado em ambulatório. Este facto conduziu-nos a realizar um planeamento de intervenção no ambulatório, nomeadamente uma consulta multidisciplinar de perturbações do comportamento alimentar e mais especificamente uma consulta de enfermagem. Propôs-se ainda a divulgação aos enfermeiros da unidade de internamento dos resultados da recolha de dados através de uma sessão de formação em serviço. Numa segunda parte do trabalho realizámos uma análise crítica sobre as competências de mestre e do percurso efetuado para as adquirir.
Abstract:Anorexia nervosa is a challenging, complex condition incorporating significant long-term physical and psychological complications from which recovery is difficult. Treatment planning will require a coordinated multidisciplinary intervention. This implicates the need for responses at different levels of care, namely in secondary and primary care. Hypothesizing multiple transitions are present at one time, namely development (adolescence), health-disease (diagnosis of anorexia nervosa) and situational (transition from secondary to primary care); and because it is paramount to promote a smooth transition between tiers of care, in the present study we focus on the transition of care at the primary – secondary interface. The purpose of this study is to understand how the transition from secondary to primary care is made. From here we designed an intervention project in service using the methodology of project work. This led to the diagnosis of the situation, setting goals, planning, implementation, evaluation and dissemination of results. Semi-structured interviews were conducted on adolescents diagnosed with anorexia nervosa followed up in a primary care setting, who had been previously hospitalized; on primary care physicians; and on secondary care nurses. Information from patient records was also retrieved to examine nursing interventions aiming at preparation of patients for discharge. Upon analysis of the identified categories, it was found that the main challenges and difficulties were present in outpatient care. This led us to design an intervention plan in primary care, namely a multidisciplinary consultation regarding eating disorders and more specifically a nursing consultation. It is also proposed to disclose the results of data collection to the secondary care nurses through a dissemination session. In the second part of the work a critical analysis of the competences of the master course and route taken to acquire them.
25
Oliveira, Letícia Langlois. ""Padrões disfuncionais de interação em famílias de adolescentes com anorexia nervosa"." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2004. http://hdl.handle.net/10183/13412.
Abstract:
Este estudo se propõe a investigar a interação em quatro famílias de adolescentes acometidas de anorexia nervosa. A ênfase está na descrição e compreensão de padrões disfuncionais de interação referentes aos estilos parentais, práticas educativas parentais, comunicação, regras, papéis, liderança, conflitos, afeição física, manifestação da agressividade, interação conjugal, integração, auto-estima e individualização. O delineamento utilizado é o de “Estudos de Caso” e o referencial teórico eleito é o paradigma sistêmico. As informações foram obtidas através da Entrevista Inicial, Entrevista Familiar Estruturada, Escalas de Responsividade e Exigência Parental e Entrevista de Práticas Educativas Parentais. Os resultados apontaram para uma disfuncionalidade dos padrões de interação estabelecidos, o que dificulta o desenvolvimento emocional dos membros nas famílias investigadas. Foram observados uma ausência de sintonia comunicacional entre os membros dos sistemas, presença de regras rígidas e disfuncionais, inadequação dos papéis, liderança fixa e autocrática, tendência a evitar a expressão de conflitos, manifestação destrutiva da agressividade, baixo nível de afeição física e autoestima, dificuldades na individualização, delimitação débil de fronteiras entre os subsistemas, falta de gratificação dos subsistemas conjugais com trocas afetivo-relacionais pobres entre os membros dos casais e baixa integração familiar. Além disso, pôde ser constatado um predomínio de técnicas parentais coercitivas na educação das filhas. Em relação aos estilos parentais, embora a maioria dos membros perceba a autoritatividade na postura parental, acredita-se que os pais tenham, na realidade, estilos autoritários e negligentes.The purpose of this study is to investigate the interaction in four families with anorexical adolescents. The emphasis is given to the description and comprehension of dysfunctional patterns of interaction regarding parental styles, parental educative practices, communication, rules, roles, leadership, conflicts, manifestation of agressivity, physical affection, interaction of the couple, individualization, self-steem and integration. The design employed is the “Case Studies” and the elected theoretical reference is the systemic paradigm. Informations were obtained by the means of the Initial Interview, Structured Family Interview, Parental Responsiveness and Exigency Scales, Parental Educative Practices Interview. Results suggested a dysfunctionality of the established patterns of interaction, which difficult the emotional development of the members in the investigated families. The main observation included an absence of communicational syntony between the members, presence of dysfunctional and rigid rules, inadequacy of the roles, fixed and authoritarian leadership, tendency to avoid conflict expression, destructive manifestation of agressivity, poor levels of physical affection and self-steem, difficulties in individualization, weak demarcation of boundaries among the subsystems, absence of gratification between the members of the couple and low familiar interaction. The predominance of coercitive and negligent parental techniques in the daughter’s education was also ascertained. Considering the parental styles, though most of the members perceive authoritativeness in the parental posture, it is supposed that parents actually has authoritarian and negligent styles.
26
Medway, Meredith. "Adolescent Development in Family-based Treatment for Anorexia Nervosa: Patients' Narratives." Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/17893.
Abstract:
Family-based treatment (FBT) is a well-supported intervention for adolescents with Anorexia Nervosa (AN). While supporting return to healthy adolescent development is a key aim in the latter phases of FBT, little is understood regarding to what extent patients view this treatment as addressing their developmental needs. The present research thus aimed to: 1) evaluate qualitative studies exploring family interventions for AN from the patient’s perspective, and 2) investigate the perspectives of young people and their parents regarding the developmental impact of AN, and the role of FBT in facilitating return to a health developmental trajectory. Two studies were conducted. The first was a meta-synthesis of qualitative studies investigating patients’ perspectives on family interventions for AN. Findings suggested patients view family treatment as integral to their recovery, while at the same time often neglecting underlying difficulties. The second study was a qualitative investigation of patients’ and parents’ views regarding the impact of AN on development, and the function of FBT in addressing developmental challenges. Semi-structured interviews were conducted with young people (N =12) and their parents (N = 12), and data were analysed using narrative inquiry. Analysis revealed that patients experienced a pervasive developmental impact of AN, and found phase one to often accentuate this. Post-phase one, three trajectories toward developmental recovery were identified: Supporting return to adolescent pursuits, facilitating autonomy, and providing freedom to develop post-FBT. This research represents a first step in improving our understanding of the varied ways in which FBT supports development, as well as ways in which clinicians may be able to improve this.
27
Solstrand, Dahlberg Linda. "Assessment of Function, Structure and Working Memory in Adolescents with a Recent Diagnosis of an Eating Disorder." Doctoral thesis, Uppsala universitet, Funktionell farmakologi, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-259050.
Abstract:
Body, weight and shape related obsessions and ruminations are characteristic traits of individuals with eating disorders (ED) that are found to predate the onset of the disorder. Individuals with chronic ED display altered neural activation in response to food stimuli, and are reported to have volumetric differences compared to healthy individuals, which is likely an effect of prolonged starvation. ED individuals are also seen to dispose an attentional bias to food stimuli, even when perceived sub-consciously, which are reported to interfere with cognitive tasks, including working memory (WM). However, whether the differences in neural activation and structure are present in adolescents with a recent ED diagnosis is not known. In paper I we describe how images of high- and low-calorie foods resulted in greater responses in the prefrontal circuitry in ED adolescents compared to healthy controls (HC). Obsessive-compulsive symptoms in ED individuals were associated with prefrontal circuitry and cerebellar activation, whereas faster reaction times to the WM were associated with greater superior frontal gyrus activity. The findings indicate that ED cognitions may be linked to WM abilities, both of which are associated with frontal cortex functioning. WM performance is examined further in paper II, where we found that the presence of subliminal food images were seen to disrupt WM performance in terms of slower reaction times and less correct responses in ED but not HC. The WM interference was associated with increased activity in the parietal and superior temporal cortex. WM interference caused by subliminal food stimuli may reflect a pre-attentive bias to food in adolescents with ED, which could be a risk factor for further development of an ED. The structural differences in brain volume between adolescents with ED and HC were examined in paper III. ED symptoms were found to be associated with volume differences in insular cortex and superior temporal gyrus, whereas obsessive-compulsive symptoms were associated with reduced volumes in the putamen and cerebellum. These volumetric differences in regions implicated in restraint, obsessions and WM are likely to precede structural variations caused by starvation as seen in chronic ED’s. Connectivity from these regions, in addition to other regions believed to be implicated in ED, was studied in paper IV. Fronto-parietal regions as well as the insula showed increased connectivity in ED, whereas connectivity from the mesolimbic reward regions did not differ from HC. Regions with increased connectivity in ED are involved with self-awareness, body image and ED related ruminations, connections that could influence how one’s body is perceived. In conclusion, the studies included in this thesis describes changes in functional activity, connectivity and brain volume in regions involved with ED cognitions, eating behaviour, and body image in adolescents recently diagnosed with an ED.
28
Jacobs, M. Joy. "Temperament patterns in families of individuals with anorexia nervosa /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2006. http://wwwlib.umi.com/cr/ucsd/fullcit?p3208601.
29
Madden, Sloane. "Inpatient Treatment of Anorexia Nervosa: Does Inpatient Weight Restoration Prior to Outpatient Family Treatment Improve Outcomes in Adolescent Anorexia Nervosa? A Randomised Controlled Trial." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/13699.
Abstract:
Background Anorexia Nervosa (AN) is a serious disorder, with high costs due to hospitalisation and complications due to malnutrition. International treatments vary with prolonged hospitalisations in Europe and shorter hospitalisations in the USA. Uncontrolled studies suggest longer initial hospitalisations that normalise weight produce better outcomes than shorter hospitalisations with lower discharge weights. This study aimed to compare effectiveness of hospitalisation for weight restoration (WR) to medical stabilisation (MS) in adolescent AN. Secondary aims were to assess the safety of a rapid refeeding protocol and to identify early markers in Family Based Treatment (FBT) predicting remission. Methods A randomised controlled trial of 82 adolescents, 12-18 years, with DSM-IV AN and medical instability, admitted to two paediatric units. Participants were randomised to shorter hospitalisation for MS or longer hospitalisation for WR to 90% expected body weight (EBW) for gender, age, and height, both followed by 20 sessions of outpatient FBT. Results Primary outcome was hospital days, following initial admission, at 12-month follow-up. Secondary outcomes were total hospital days used to 12-months, full remission (>95% EBW and global Eating Disorder Examination score within 1 SD of published means), weight gain and medical complications during initial refeeding and early markers of remission. There was no significant difference between groups in hospital days used following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome. All patients gained weight from week one without medical complications. Weight gain of 1.8kg by week 4 of FBT predicted full remission. Conclusions Outcomes are similar with hospitalisations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalisation with FBT.
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Campos, Lia Keuchguerian Silveira 1981. "Vivências emocionais de mães de adolescentes do sexo feminino com anorexia nervosa, atendidas no Hospital das Clínicas da Unicamp = um estudo clínico-qualitativo = Emotional experiences of mothers of female adolescents with anorexia nervosa, attended in the general hospital of Unicamp : a clinical qualitative study." [s.n.], 2012. http://repositorio.unicamp.br/jspui/handle/REPOSIP/308982.
Abstract:
Orientador: Egberto Ribeiro TuratoDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
Made available in DSpace on 2018-08-20T19:17:05Z (GMT). No. of bitstreams: 1 Campos_LiaKeuchguerianSilveira_M.pdf: 8034389 bytes, checksum: a01465db3be6cb1234ecc307cb5b3ab1 (MD5) Previous issue date: 2012
Resumo: O presente estudo teve como objetivo conhecer as vivências emocionais das mães de adolescentes do sexo feminino, cujas filhas receberam o diagnóstico de anorexia nervosa e que estão em tratamento no Ambulatório de Transtornos Alimentares do Hospital das Clínicas da UNICAMP. Utilizamos o método clínico qualitativo, por meio de entrevistas semidirigidas em profundidade, em uma amostra intencional, fechada pelo critério de saturação, com sete mães de paciente com anorexia nervosa. As entrevistas foram feitas individualmente no Ambulatório de Transtornos Alimentares do HC UNICAMP. Cuidados éticos foram tomados seguindo as normas preconizadas pelo Conselho Nacional de Saúde. A técnica de tratamento de dados foi feita por meio da análise de conteúdo das entrevistas transcritas na íntegra e categorização. Os resultados foram submetidos à validação externa, junto ao Laboratório de Pesquisa Clínico-qualitativo do Departamento de Psicologia Médica e Psiquiatria da UNICAMP e na apresentação em congressos nacionais e internacionais. Os resultados possibilitaram identificar aspectos das mães das pacientes com anorexia nervosa que foram organizados em três categorias: Não diferenciação mãe-filha e falhas na comunicação; Quantidade versus qualidade; e Anorexia e oposição como um ataque. As mães das pacientes com anorexia nervosa propõem uma relação fusional na qual os aspectos da individualidade da filha ficam mal definidos e as tentativas de busca de individuação por parte das filhas são sentidas como um ataque e oposição aos cuidados maternos. As mães apresentam dificuldades em compreender as reais necessidades de suas filhas e tentam compensar deficiências qualitativas com quantidades, especialmente de alimentos e cuidados. Forma-se um círculo vicioso no qual a maternidade fica confundida com padrões rígidos de controle e de expectativas em relação à filha e as atitudes desta filha que sinalizam tentativas de individuação são sentidas como um ataque à mãe e sua devoção, o que leva as mães a recrudescerem os esforços no sentido de controlá-las e adequá-las ao padrão rígido proposto. Concluímos que os achados permitem contribuições para a ampliação dos conhecimentos e tratamentos da anorexia nervosa, ressaltando a necessidade do acompanhamento psicológico e psicoeducacional para as mães dessas pacientes
Abstract: The present study aimed to understand the emotional experiences of mothers of female adolescents whose daughters were diagnosed with anorexia nervosa and who are receiving treatment at the Out-patient Clinic for Eating Disorders at the University Hospital of UNICAMP. The Clinical Qualitative Method was used, through in-depth semi directed interviews, using an intentional sample, closed by saturation, with seven mothers of female patients with anorexia nervosa. The interviews were conducted individually in the Outpatient Clinic of Eating Disorders, HC UNICAMP. Ethical Care was taken following the ethical standards established by the National Council of Health. The technical data processing was done through the qualitative content analysis of the fully transcribed interviews and categorization. The emerging categories were validated by peer-reviewers from the Laboratory of Clinical-Qualitative Research, UNICAMP and presentation at national and international conferences. The findings made it possible to identify aspects in mothers of patients with anorexia nervosa which were organized in three categories: Non-differentiated mother-daughter and failures in communication; Quantity versus quality; e Anorexia and opposition as an attack. Mothers propose a fusional relationship with their daughters, in which the aspects of individuality are ill-defined. The daughters' attempts to become individuals are felt as an attack, and experienced by mothers as injustice and aggression. The mothers have difficulties to understand their daughters' logic and try to remedy a qualitative deficiency with quantity, especially of food and care. A vicious circle is formed, in which motherhood is confused with rigid control standards and expectations for the daughter and every attempt of the daughters to individualize are experienced by their mothers as an attack on the mother and on her devotion, which leads mothers to increase her offensive to make her daughter adapt to the model she is proposing. We concluded that the findings provide important contributions which can improve knowledge and clinical interventions to treat anorexia nervosa, emphasizing the need for psychotherapeutic and psycho-education for the mothers of these patients
Mestrado
Ciencias Biomedicas
Mestre em Ciências Médicas
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Luís, Ana Sofia Frade Cardoso. "A integração da família no processo terapêutico do pré- adolescente / adolescente com anorexia nervosa." Master's thesis, Instituto Politécnico de Setúbal. Escola Superior de Saúde, 2013. http://hdl.handle.net/10400.26/6143.
Abstract:
Trabalho de Projeto apresentado para
cumprimento dos requisitos necessários à obtenção do
grau de Mestre em Enfermagem de Saúde Mental e
PsiquiatriaA anorexia nervosa (AN) em crianças e adolescentes é uma patologia psiquiátrica importante, dadas as limitações físicas e psíquicas que podem comprometer a sua vida. A importância do afastamento ou presença da família junto destes utentes é controversa e alvo de estudo. Este relatório de projeto foi elaborado no âmbito do segundo Mestrado em Enfermagem de Saúde Mental e Psiquiatria, da Escola Superior de Saúde – Instituto Politécnico de Setúbal e os seus objetivos consistiram em relatar um Projeto de Intervenção em Serviço (PIS), elaborado com base na Metodologia de Projeto, assim como proceder à análise crítica das competências do Mestre em Enfermagem de Saúde Mental e Psiquiatria. O PIS teve por base o estágio realizado numa unidade de internamento de Psiquiatria da Infância e Adolescência do nosso país e comtemplou as fases de diagnóstico e de planeamento da metodologia de projeto. Da questão de partida “Como é que num serviço de internamento de Psiquiatria da Infância e Adolescência, a família dos pré-adolescentes / adolescentes internados com AN é integrada no processo terapêutico?”, partiu-se para o Diagnóstico de Situação, onde foram utilizadas ferramentas como a observação participante, FMEA, análise dos registos de enfermagem, questionário e Focus Group. Foi definido como objetivo geral: - Conhecer como é que num serviço de internamento de Psiquiatria da Infância e Adolescência, a família dos pré-adolescentes / adolescentes internados com AN é integrada no processo terapêutico. Após o conhecimento das necessidades da população alvo – os enfermeiros – a linha teórica orientadora do projeto foi a Teoria das Transições, de Meleis, dada a identificação da sua teoria às necessidades apresentadas. A fase de planeamento pretendeu dar resposta à questão decorrente do diagnóstico e inspirada na teoria de Meleis, “Como é que o enfermeiro pode ajudar estes pais na transição de papel de cliente para o de recurso terapêutico?”. Concluímos que a terapia familiar e os grupos familiares psicoeducativos são dois tratamentos de eleição para crianças e adolescentes com AN e que seria benéfica a formação da equipa de enfermagem nestas duas abordagens psicoterapêuticas. Como limitações do projeto destacam-se a impossibilidade de realização da fase de execução, assim como a escassez de publicações relacionadas com o papel do enfermeiro na abordagem à família da criança/adolescente com AN.
32
Farrington, Alice. "Dissociation and adolescent psychopathology." Thesis, University of Southampton, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326578.
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Martins, Tatiana Moya. ""Validação da sessão de transtornos alimentares do DAWBA (levantamento sobre o desenvolvimento e bem-estar de crianças e adolescentes)"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-19102006-103302/.
Abstract:
Esta tese teve por objetivo validar e pesquisar a confiabilidade da Sessão de Transtornos Alimentares do DAWBA (Development and Well-Being Assessment), um pacote de entrevistas e técnicas de avaliação planejado para ser aplicado por entrevistadores sem experiência clínica prévia, para rastrear e diagnosticar transtornos alimentares em crianças e adolescentes do sexo feminino, de 7 a 17 anos, em estudos epidemiológicos. Participaram deste estudo 174 crianças e adolescentes de 8 a 17 anos, do sexo feminino, procedentes de três grupos: (1) 48 meninas com transtornos alimentares; (2) 55 controles clínicos 21 em tratamento para depressão unipolar, 14 em tratamento para transtorno obsessivo-compulsivo e 20 em tratamento para doença gastrointestinal e (3) 71 controles comunitários. Um dos pais de cada menina também foi entrevistado com o instrumento. Foram eleitos sujeitos destes três grupos para pesquisar a validade discriminante do instrumento quanto à sua capacidade de diferenciar jovens com transtornos alimentares e outros transtornos físicos ou psiquiátricos mimetizantes. O diagnóstico da presença ou não de transtorno alimentar anorexia e bulimia nervosas e síndromes parciais - em cada sujeito, foi gerado utilizando-se três métodos diferentes independentes: (1) diagnóstico padrão-ouro, baseado no DSM-IV e CID-10, estabelecido através de entrevista clínica livre do pai e da menina juntos, realizada por psiquiatra infantil especialista em transtornos alimentares, cego para o grupo de origem da menina; (2)diagnóstico preliminar do computador gerado por algoritmo específico baseado na CID-10 e DSM-IV levando em considerando a informação estruturada coletada pelo instrumento e (3) diagnóstico final DAWBA, estabelecido por especialista treinado, baseado na CID-10 e DSM-IV, através da revisão cuidadosa dos relatórios fornecidos pelo software DAWBA com o resumo das informações colhidas com o instrumento. A validade concorrente dos diagnósticos DAWBA (preliminar do computador e final) foi pesquisada mediante comparação com o diagnóstico padrão ouro. A confiabilidade teste-reteste foi pesquisada reaplicando o instrumento duas ou três semanas após a primeira utilização, em 55 sujeitos (7 com transtornos alimentares, 20 controles clínicos e 28 controles comunitários). Os aplicadores estiveram cegos (tanto no teste quanto no reteste) para o grupo de origem do sujeito. Pesquisou-se a consistência interna (Alfa de Crombach) e os melhores pontos de corte das cinco questões de rastreamento, bem como sua sensibilidade e especificidade. Houve diferença significativa na média de idade entre os grupos com transtornos alimentares (média de 16,0 anos) e controles clínicos (média de 14,5 anos). Para a detecção de qualquer transtorno alimentar segundo o DSM-IV e a CID-10, o diagnóstico final pelo DAWBA apresentou sensibilidade de 100% e especificidade de 94%. Houve boa concordância teste-reteste (Kappa de 0,81) e boa consistência interna das questões de rastreamento, sendo o Alfa de Crombach de 0,76 na entrevista com as meninas e 0,81 na entrevista dos pais. Os melhores pontos de corte nas questões de rastreamento foram de dois e três, observando que, para um ponto de corte de três a sensibilidade foi de 89,8% em ambas as entrevistas (meninas e pais) e a especificidade de 85,6% na entrevista das meninas e 85,5% na entrevista dos pais. Foram limitações do estudo a diferença significativa na média de idade entre os grupos com transtornos alimentares e controles clínicos, a não inclusão de crianças com transtornos alimentares menores de 11 anos e a impossibilidade de estabelecer comparações entre os grupos com relação a variáveis sócio-econômicas. Desta forma, pode-se concluir com o presente estudo que a Sessão de Transtornos Alimentares do DAWBA apresenta boa validade e confiabilidade no rastreamento e diagnóstico de transtornos alimentares em crianças e adolescentes do sexo feminino e tem aplicabilidade tanto em pesquisa clínica quanto em estudos epidemiológicos comunitários.This thesis concerns the validation and investigation of the reliability of The Eating Disorders Section of The Development and Well-eing Assessment (DAWBA), a package of interviews and assessment techniques designed to be administered by trained interviewers without previous experience in eating disorders, for screening and diagnosis in epidemiological studies of eating disorders in female children and adolescents, from 7 to 17 years old. This study was carried out with the participation of 174 female children and adolescents, from 8 to 17 years old, recruited from three groups: (1)48 girls with eating disorders; (2) 55 clinical controls 21 in treatment for unipolar depression, 14 for obsessive compulsive disorder and 20 for gastrointestinal disease and (3) 71 community controls. One of the parents of each girl was also interviewed with the measure. Subjects were recruited from the three groups to assess the discriminant validity of the measure concerning its ability in discriminate girls with eating disorders from other mimicking psychiatric or physic disorders. The diagnosis of the presence or not of eating disorder in each subject anorexia, bulimia nervosa and partial syndromes was made using three different independent methods (1) gold standard diagnosis, based on DSM-IV and ICD-10, assigned through free clinical interview of the parent and the girl together, made by a child and adolescent psychiatrist specialized in eating disorders, blind to the group of origin of the girl; (2) preliminary computer diagnosis, generated by a specific algorithm based on ICD-0 and the DSM-IV, using the structured information collected with the measure and (3) final DAWBA diagnosis, established by a trained specialist, based on DSM-IV and ICD-10, through the careful review of the information on the reports provided by the DAWBA software, containing the abstracts of the information collected by the measure. The concurrent validity of the DAWBA diagnoses (computer preliminary and final) was assessed through the comparison with the gold standard. The test-retest reliability was assessed reassessing 55 subjects (7 with eating disorders, 20 clinical controls and 28 community controls) with the measure two or three weeks after the first assessment. The DAWBA interviewers were blind (both in test and retest) for the origin group of the subject. Internal consistency (Crombach Alpha), best cutoffs in the screening questions, sensibility and specificity were assessed. There was a significant difference in mean age between the eating disorder (mean = 16 years) and clinical control (mean = 14,5 years) groups. For the detection of any eating disorder according the DSM-IV and ICD-10, the final DAWBA diagnosis presented sensibility of 100% and specificity of 94%. There was good test-retest agreement (Kappa = 0,81) and good internal consistency in the screening questions, being the Crombach Alpha of 0,76 in the girls interview and 0,81 in the parent interview. The best cutoffs on the screening questions were two and three, noting that for a cutoff of three the sensibility was 89,8% in both interviews (girls and parents) and the specificity was 85,6% for the girls interview and 85,5% for the parent interview. The significant difference in mean age between the eating disorder and clinical control groups, not including children with eating disorders younger than 11 years old and the absence of comparisons of social economic variables between groups were limitations of this study. In summary, the present study shows that The Eating Disorders Section of the DAWBA has good validity and reliability for the screening and diagnosis of female children and adolescents with eating disorders and has applicability both in clinical and community settings.
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Martins, Tatiana Moya. ""Criação e análise da Sessão de Transtornos Alimentares do DAWBA (levantamentos sobre o desenvolvimento e Bem-Estar de Crianças e Adolescentes)"." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5142/tde-09082005-104933/.
Abstract:
Este estudo apresenta a criação e análise da Sessão de Transtornos Alimentares do DAWBA, um instrumento construído para rastrear e fornecer, em estudos epidemiológicos, o diagnóstico de transtorno alimentar (TA) - anorexia e bulimia nervosas e síndromes parciais - em meninas de 8 a 17 anos. O estudo ocorreu em 3 fases: (1) criação do instrumento, (2) aprimoramento aplicando-o em 45 mulheres e seus familiares e (3) aprimoramento testando-o em 30 meninas e seus pais. Participaram das fases 2 e 3 sujeitos com TA, transtornos obsessivo-compulsivo e depressivo unipolar e com doenças de acometimento gastrintestinal. Dessa forma, produziu-se a versão final do instrumento, que está pronta para validaçãoThis study presents the creation and analysis of The Eating Disorders Section of The DAWBA, a measure designed for epidemiological studies to screen and diagnose eating disorders (ED) - anorexia and bulimia nervosa and partial syndromes - in 8 to 17 year-old girls. The study was carried out in 3 phases: (1) measure creation, (2) refinement by applying it to 45 women and their relatives and (3) fine-tuning by testing it in 30 girls and their parents. Phases 2 and 3 involved subjects with ED, obsessive-compulsive and unipolar depression disorders and gastrointestinal disease, producing the final version of the measure, which is ready for validation
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Vieira, Paula Cunha Pegado de Souza Aranha. "Desenvolvimento, avaliação e manualização de um programa piloto de tratamento cognitivo comportamental para adolescentes brasileiros com anorexia nervosa." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-06042018-124923/.
Abstract:
Introdução: A Anorexia Nervosa (AN) é um transtorno alimentar grave com altas taxas de morbimortalidade. O tratamento padrão para adolescentes com AN é baseado na inclusão da família e quanto mais precoce for o início em pacientes mais jovens, menor o risco de cronificação. Como o Family based treatment (FBT) pode não se adequar a todas as famílias ou pacientes, a Terapia Cognitivo-Comportamental (TCC) pode ser uma alternativa, porém ainda apresenta dados insuficientes na literatura cientifica. Objetivos: Desenvolver e avaliar os efeitos de um programa piloto de TCC em grupo no cuidado de adolescentes com AN. Desfechos primários: recuperação do peso, com base na adequação ou melhora do percentil esperado para a idade, de acordo com a curva de crescimento, e melhora dos sintomas, avaliada pelo Questionário de Exame para Transtornos Alimentares (Eating Disorder Examination Questionnaire [EDE-Q]). Desfechos secundários: funcionamento global avaliado pelo Children Global Assessment of Functioning Scale (CGAS), autoestima avaliada pelo Rosenberg Self-Esteem Scale (RSES), motivação medida através da Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) e satisfação de vida investigada pela Escala Multidimensional de Satisfação de Vida (ESMVA). Método: Ensaio clínico com 22 pacientes com AN (DSM IV) divididos em dois grupos: grupo intervenção (GI) (n=11; TCC, psiquiatria, nutrição e psicoeducativo familiar) e grupo controle GC (n=11; psiquiatria, nutrição e psicoeducativo familiar). Dados coletados antes dos grupos, ao final e seis meses após seu término. Resultados: Grupos homogêneos na linha de base, com exceção da medida de funcionamento global, superior no GI (p=0,024). Adesão de 91% no GI vs 54% no GC (Z=1,91; p=0,05). Todos os pacientes que concluíram o GI (n=10) e o GC (n=06) recuperaram peso e diminuíram sintomas de transtornos alimentares (TA). Embora apenas a subescala de restrição do EDE-Q tenha apresentado diferença estatisticamente significativa na comparação de desempenho entre GI e GC, no follow-up (W=6,19, p=0,012), a análise descritiva das médias de todas as escalas do EDE-Q é inferior no GI, o que indica menor severidade de sintomas de transtorno alimentar nesse grupo. Nas medidas de desfechos secundários os dois grupos produziram efeitos positivos entre o início e o final e entre o início e o follow-up. GI se diferenciou do GC por produzir efeitos entre o final e o follow-up, com melhora significativa nas medidas de autoestima, motivação e nas dimensões da escala de satisfação de vida relacionadas ao \"self\" e à \"não violência\", o que indica que continua produzindo efeitos, mesmo após o término do grupo, diminuindo o risco de recaídas. Conclusão: Os resultados sugerem que o programa de TCC em grupo foi aceito, produziu efeitos positivos e pode ser aplicado em adolescentes brasileiros com AN como coadjuvante no tratamento multidisciplinar para melhorar a adesão e evitar o risco de recaídasIntroduction: Anorexia Nervosa (AN) is a severe eating disorder with high morbimortality rates. The standard treatment for adolescents with anorexia nervosa always includes the family. The earlier treatment is initiated, higher the chances of avoiding chronicity. Family based treatment (FBT) might not work for all families and cognitive behavioral therapy (CBT) becomes an alternative. However the scientific reaserch investigating effectiveness of CBT for adolescents with anorexia nervosa still needs to develop further. Objective: To develop and evaluate the effects of a pilot program of CBT in group when treating adolescents with AN. Primary outcomes: weight gain based on adjustment to or improvement of percentile for their age according to the growth curve, and improvement in symptoms assessed through Eating Disorder Examination Questionnaire (EDE-Q). Secondary outcomes: Global functioning assessed through the Children Global Assessment of Functioning Scale (CGAS), self-esteem through the Rosenberg Self-Esteem Scale (RSES), motivation measure by the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) and life satisfaction according to the Multidimensional Life Satisfaction Scale (ESMVA). Method: Clinical trial with 22 AN patients (DSM IV) divided into two groups: intervention group (IG) (n = 11; received CBT, psychiatric, nutritional and psychoeducational treatment) and control group (CG) (n = 11; received psychiatric, nutritional and psychoeducational treatment. Data collected at baseline, post-treatment and at a 6-month follow-up were analysed. Results: Homogeneous baseline groups, with the exception of the superior overall functioning measure in the IG (p=0,024). Adherence to treatment was 91% in the IG vs 54% in the CG (Z=1,91; p=0,05). All patients who completed the IG (n=10) and the CG (n=06) regained weight and decreased symptoms of eating disorders (ED). Although only the restriction subscale of the EDE-Q presented a statistically significant difference in the comparison between groups. At follow-up the descriptive analysis of the means of all scales of the EDE-Q were lower in the IG, which indicates a lower severity of eating disorder symptoms (W=6,19, p=0,012). The secondary outcomes showed that the two groups produced positive effects between baseline and post-treatment and between baseline and follow-up. IG differed from CG because it presented effects between the end and the follow-up, with significant improvement in measures of self-esteem, motivation and the dimensions \"self\" and \"non-violence\" at the life satisfaction scale, suggesting that IG might continue to show effects even after the end of treatment, possibly decreasing the risk of relapse. Conclusion: The results suggest that the program of group CBT was accepted, produced positive effects and can be applied in Brazilian adolescents with AN, as a coadjuvant in a multidisciplinary approach to improve adherence and avoid the risk of relapse
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Lima, Rodrigo César Alves de. "Erosão dental em adolescentes com sintomas de transtornos alimentares." Universidade Federal de Pernambuco, 2014. https://repositorio.ufpe.br/handle/123456789/12743.
Abstract:
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A adolescência é definida pela Organização Mundial de Saúde como período da vida que compreende a faixa etária entre 10 e 19 anos. É um período propenso ao desenvolvimento da insatisfação com o próprio corpo. Inseridos numa sociedade que priorizam a magreza como marco do sucesso e beleza, adolescentes passam por sacrifícios, como dietas exageradas, jejuns prolongados e exercícios físicos excessivos. Esses hábitos podem contribuir para o aparecimento de condutas patológicas em relação ao padrão alimentar. Os Transtornos Alimentares são condições psicopatológicas, com sérias complicações no estado geral de saúde, caracterizadas por preocupação excessiva com a imagem corporal e alteração no comportamento alimentar. Os principais tipos são a Anorexia Nervosa e a Bulimia Nervosa, que são caracterizadas por padrões anormais de comportamento alimentar e controle de peso, bem como, alterações na percepção do próprio corpo. O ato de vomitar e o jejum prolongado, prática comum de pacientes com estes transtornos, podem proporcionar problemas bucais, principalmente a erosão dental. Esta é representada pela perda de estrutura de tecido mineralizado através de um processo patológico e crônico pelo ataque químico da superfície do dente. Esta perda é irreversível e pode advir de fatores extrínsecos ou intrínsecos. Diante do exposto, este estudo teve como objetivo determinar a frequência de erosão dental em adolescentes e sua relação com a presença de sintomas de transtornos alimentares. Tratou-se de um estudo descritivo, transversal e de associação com uma amostra de 136 adolescentes de ambos os sexos, na faixa etária de 10 a 19 anos, matriculados na escola pública estadual Professora Amélia Coelho. Os instrumentos utilizados foram: questionário biodemográfico; as versões para adolescentes do Teste de Atitudes Alimentares – EAT-26 e do Teste de Avaliação Bulímica de Edinburgh – BITE, esta última com uma de sintomas e outra de gravidade; e uma ficha clínica odontológica para o preenchimento do Índice de Desgaste Dentário. O examinador foi submetido aos processos de calibração teórica e prática. Foi realizado o teste de Kappa (teste de concordância) intra-examinador e inter-examinador, obtendo um resultado de 0,90. A estatística é representada pelos testes de associação qui-quadrado de Pearson e exato de Fisher. Após análise dos resultados, observou-se que 30,8% dos pesquisados apresentaram escore médio/elevado na escala BITE, 33% apresentaram escore positivo para o EAT-26 e 74,3% apresentavam erosão. Houve associação estatisticamente significativa entre a presença de erosão e os escores do BITE com o sexo e com a idade. Em relação ao grupo de dentes e faces, a presença de erosão concentrou-se nos dentes anteriores (Incisivos e Caninos) nas faces linguais/palatinas, não havendo associação com a presença de sintomas de transtornos alimentares. Portanto, conclui-se que a erosão dental é fator importante para que o cirurgião-dentista investigue precocemente a presença de transtornos alimentares e exerça seu papel no encaminhamento do paciente para um atendimento multidisciplinar. Esse desfecho enaltece o Cirurgião-Dentista, que pode ser considerado como o primeiro profissional de saúde a diagnosticar o quadro, tratando o paciente concomitantemente com outros profissionais da saúde, evitando o agravo do transtorno ou até mesmo seu aparecimento.
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Vale, Antonio Maia Olsen do. "Comportamento alimentar anormal e práticas inadequadas para controle de peso entre adolescentes do sexo feminino de Fortaleza." reponame:Repositório Institucional da UFC, 2002. http://www.repositorio.ufc.br/handle/riufc/1016.
Abstract:
VALE, Antonio Maia Olsen do. Comportamento alimentar anormal e práticas inadequadas para controle de peso entre adolescentes do sexo feminino de Fortaleza. 2002. 129 f . Dissertação (Mestrado em Saúde Pública)-Universidade Federal do Ceará, Fortaleza, 2002.Submitted by denise santos (denise.santos@ufc.br) on 2011-10-31T12:52:21Z No. of bitstreams: 1 2002_dis_amovale.pdf: 372471 bytes, checksum: 8e09fd83f72ad8264a8ea6797d2f7be8 (MD5)
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Objectives: characterize eating habits and possible risk factors associated with Eating Disorders, amongst female adolescents in Fortaleza-CE, Brazil. Methodology: transversal study, with 652 women between 14 and 20 years of age, students of the second year of Middle-level education. The Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and the Eating Attitudes Test (EAT-26) were used. Results: 73.6% of the subjects are out of risk for development of an Eating Disorder, 25.2% are at risk and in 1.2% a strong possibility of eating disorder in course was found. The proportion of adolescents who showed risky habits was greater in private schools (p<0.05). According to the EAT-26, 9% of the sample showed a score (>=21) which characterizes them as being at risk and practicing pathological eating habits. The BSQ indicated that 36.2% of the adolescents showed concern with their body image (BI); of these, 61% (n=236) were concerned to a degree considered mild, 26.3% showed a moderate concern and 12.7% showed serious concern with BI. Students at public and private schools demonstrated a similar desire to be thin, but adolescents from private schools more frequently used inappropriate practices in order to reach that wish. Conclusion: Adolescents who demonstrate eating disorders in their clinical form, are a rare phenomenon in public and private schools in Fortaleza, whilst the symptoms of eating disorder, either isolated or in small groups, occur with relevant frequency amongst the population studied.
Objetivo: caracterizar práticas alimentares e os possíveis fatores de risco associados aos Transtornos Alimentares, entre estudantes adolescentes do sexo feminino de Fortaleza-CE. Métodos: estudo transversal, com 652 mulheres de 14 a 20 anos, estudantes do 2º ano do segundo grau. Foram utilizados o Bulimic Investigatory Test Edinburgh (BITE), o Body Shape Questionaire (BSQ) e o Eating Attitudes Test (EAT-26). Resultados: Das adolescentes, 73,6% estão fora de risco para o desenvolvimento de um Transtorno Alimentar, 25,2% delas estão em situação de risco e em 1,2% foram encontrados indicativos para a ocorrência de um transtorno alimentar. A proporção de adolescentes que apresentaram práticas de risco foi superior nas escolas particulares (p<0,05). Segundo o EAT-26, 9% da amostra apresentam uma pontuação (>=21) que caracteriza um estado de situação de risco, além de atitudes alimentares patológicas. O BSQ apontou que 36,2% das adolescentes apresentam preocupação com a imagem corporal; destas 61% tiveram uma preocupação considerada de grau leve, 26,3% apresentaram uma moderada preocupação e 12,7% apresentaram uma grave preocupação com a imagem corporal. A proporção de adolescentes que apresentam preocupação com a imagem corporal em colégios particulares (43%) foi superior à proporção das que estudam em colégios públicos (32,3%), ou seja, a ocorrência de adolescentes com alteração de imagem corporal é maior nos colégios particulares (p<0,05). As estudantes de colégios públicos e particulares demonstraram um desejo similar de serem magras, mas as adolescentes de colégios particulares usam de forma mais freqüente práticas inapropriadas para alcançar este desejo. Conclusão: Adolescentes que apresentam todos os critérios diagnósticos para caracterizar um transtorno alimentar são uma ocorrência rara em escolas públicas e privadas de Fortaleza, enquanto que os sintomas de transtorno alimentar, apresentando-se em pequena mas preocupante quantidade, ocorrem numa freqüência relevante entre a população estudada.
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Turner, Justine Marie. "Adolescent onset anorexia nervosa : a model for the effects of inadequate nutrition upon bone size and development." University of Western Australia. School of Paediatrics and Child Health, 2006. http://theses.library.uwa.edu.au/adt-WU2006.0131.
Abstract:
Despite usual onset during adolescence the cause of low bone density in adolescent onset anorexia nervosa is incompletely understood. Puberty is known to be a crucial time for the development of peak bone mass, due principally to growth plate bone formation and modelling on preformed surfaces. This results in bone formation uncoupled from bone resorption leading to increased bone size due to increase in matrix and bone mineral content. It was hypothesized that low bone density in adolescent anorexia nervosa was caused by malnutrition during puberty suppressing normal bone matrix formation at all sites of bone formation thus arresting bone mineralization. Method 49 female adolescents with anorexia nervosa and 109 healthy female adolescent controls were studied. 22 of the anorexia nervosa subjects were studied again a year later. Bone area, mineral content and density were measured using Dual Xray Absorptiometry at the spine, hip and whole body sites, including body composition assessment. Estimated volumetric bone density was calculated using published equations in order to study bone density independent of bone size. Height, weight and Tanner stage in puberty were measured. Dietary intake and physical exercise were assessed using questionnaires. In a subset of anorexia nervosa and control subjects bone age was measured. In a subset of anorexia nervosa subjects bone formation was assessed using serum bone specific alkaline phosphatase and osteocalcin, and bone resorption was assessed using urine N-telopeptide.
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Pinzon, Vanessa Dentzien. "Impacto de comorbidades psiquiátricas e de outros fatores de risco na resposta ao tratamento de crianças e adolescentes com transtornos alimentares." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-08112012-164654/.
Abstract:
INTRODUÇÃO: Os transtornos alimentares (TA) incluem os diagnósticos de anorexia nervosa (AN), bulimia nervosa (BN) e transtorno alimentar não-especificado (TANE). Apresentam altas morbidade e mortalidade. Acometem indivíduos jovens, afetando amplamente o seu desenvolvimento. Na infância e adolescência, os TA possuem peculiaridades epidemiológicas, diagnósticas e clínicas que ainda são pouco conhecidas em pacientes jovens brasileiros. As comorbidades psiquiátricas podem interferir no curso do tratamento e na evolução dos TA, podendo aumentar sua letalidade. Outros fatores prognósticos dos TA também têm sido investigados e seu papel permanece indefinido. Os objetivos deste estudo foram investigar o perfil sociodemográfico e clínico dos pacientes com TA; identificar a prevalência de comorbidades psiquiátricas; investigar o impacto de comorbidades psiquiátricas e de outros fatores de risco na resposta ao tratamento de pacientes com TA que receberam o mesmo tratamento. MÉTODOS: Estudo realizado em um serviço multidisciplinar especializado no tratamento de crianças e adolescentes com TA (PROTAD IPq/HCFMUSP). A amostra consistiu de 100 pacientes de ambos os sexos, com idade até 18 anos e diagnóstico de TA, síndromes totais e parciais, segundo critérios do DSM IV - TR. Os dados foram coletados à entrada e à saída do tratamento. Os três tipos de resposta ao tratamento foram Alta Clínica, Abandono e Falha de Tratamento. Foram testados, também, quais fatores preditivos influenciaram no tempo de tratamento até a alta clínica dos pacientes pela análise de sobrevida. O nível de significância considerado em todos os testes estatísticos foi de 5%. RESULTADOS: A idade média dos pacientes foi de 15,41 anos, a média de idade de início dos TA foi de 13,5 anos e o tempo médio de duração do TA foi de 21,06 meses. Características da amostra: 82% de mulheres, 84% brancas, 64% das classes econômicas A e B; 69% de famílias tradicionais; 43% com diagnóstico de AN, 17% de BN e 41% de TANE; 56,8% admitidos na internação; 66% com tratamentos prévios; 88% cuidados pela mãe durante o tratamento; 75,7% com transtornos do humor (TH) que, em 81% dos casos, iniciaram durante os TA, e 54% com transtornos ansiosos que, em 75% das vezes, começaram antes dos TA; 60% com grande impacto dos TA, segundo a Escala de Avaliação Global de Crianças. Os pacientes do grupo AN eram mais jovens, pesavam menos, tinham menos tempo de TA, procuraram mais tratamentos prévios, apresentavam menos obesidade prévia, usavam mais os exercícios físicos excessivos como compensação e tinham mais amenorreia do que aqueles do grupo BN. Os sujeitos da enfermaria apresentaram menor índice de massa corporal, mais tempo de TA e maior impacto dos TA do que os do ambulatório. Na análise de sobrevida, os pacientes sem TH tiveram quase 3 vezes a chance de alta clínica do que aqueles que tinham TH. Os pacientes cuidados por suas mães apresentaram 4 vezes a chance de alta clínica do que os indivíduos que foram cuidados por outras pessoas. Pacientes do grupo abandono eram 12 meses mais velhos do que os dos outros grupos de resposta ao tratamento. O grau de instrução dos responsáveis pelos grupos abandono e falha de tratamento era maior do que do grupo alta clínica. Os outros fatores prognósticos investigados não tiveram impacto no tipo de resposta ao tratamento. CONCLUSÃO: Os pacientes jovens brasileiros com TA apresentaram características epidemiológicas e sintomatológicas muito semelhantes aos dados da literatura científica na mesma população, inclusive da alta prevalência de comorbidades psiquiátricas. A maior frequência das síndromes totais dos TA, o predomínio de quadros de início precoce, o longo tempo de duração até iniciar tratamento especializado e a maior gravidade dos pacientes da enfermaria, evidenciados nessa amostra, chamaram atenção por serem indicadores de maior gravidade em TA. A presença de TH e ausência de cuidados maternos aumentaram significativamente o tempo de tratamento até a remissão dos pacientes com TA. A idade mais avançada dos pacientes e maior nível educacional dos responsáveis estiveram associados com maior risco de abandono de tratamento. Os outros fatores preditivos investigados não tiveram impacto na resposta ao tratamento e no tempo de tratamento até a remissão. Os resultados podem contribuir para a estruturação de novos serviços direcionados às crianças e aos adolescentes brasileiros com TA e para o desenvolvimento de estratégias mais racionais e eficazes de diagnóstico e tratamentoINTRODUCTION: Eating disorders (ED), which present high morbidity and mortality, include anorexia nervosa (AN), bulimia nervosa (BN) and nonspecific eating disorder (EDNOS), and affect youth, greatly impacting their development. ED in childhood and adolescence, which involve epidemiological, diagnostic and clinical peculiarities, have been little studied among young Brazilians. Psychiatric comorbidities may also interfere with the treatment and progress of ED, and may increase their lethality. Other prognostic factors for ED have also been investigated, and their role remains undefined. The objectives of this study were to 1) investigate the sociodemographic and clinical profile of ED patients, 2) to identify the prevalence of psychiatric comorbidities, 3) to investigate the impact of such comorbidities on patient treatment response in comparison to that of patients without comorbidities under the same treatment conditions, and 4) to determine the impact of other risk factors on patient response to ED treatment. METHODS: The study was conducted at a multidisciplinary service specializing in the treatment of children and adolescents with ED (PROTAD IPq/HC-FMUSP). The sample consisted of 100 patients of both genders up to 18 years old who had been diagnosed with ED (either total or partial syndromes) according to DSM IV - TR criteria. The data were collected upon admission and at discharge from treatment. The three types of treatment response were: clinical discharge, abandonment and treatment failure. Based on the survival analysis, the patients were also tested regarding which predictive factors influenced patient treatment time until clinical discharge. A significance level of 5% was adopted for all statistical tests. RESULTS: The mean patient age was 15.41 years; the mean time since ED onset was 13.5 years and the mean duration of ED was 21.06 months. Sample characteristics: 82% female, 84% white, 64% from socioeconomic classes A and B; 69% from traditional families; 43% diagnosed with AN, 17% with BN and 41% with EDNOS; 56.8% admitted via hospital admission; 66% had previous treatment; 88% were assisted by the mother during treatment; 75.7% had mood disorders (MD) which, in 81% of the cases, began during the ED, and 54% had anxiety disorders that, in 75% of the cases, began before the ED ; 60% of patients had a great impact by the ED. Patients in the AN group were younger, weighed less, had less time of ED, had sought previous treatment more frequently, presented less previous obesity, more frequently resorted to excessive physical exercise as compensation and had more amenorrhea than those in the BN group. The patients from the hospital ward had a lower body mass index, longer time with ED and were more impacted by the ED than patients from the clinic. In the survival analysis, patients without MD were almost three times as likely to receive a clinical discharge as those with MD. Patients assisted by their mothers were four times as likely to receive a clinical discharge as those assisted by others. Patients from the abandonment group were an average of 12 months older than those in the other treatment response groups. The educational level of guardians in the abandonment and treatment failure groups was higher than that of parent/guardians in the clinical discharge group. The other investigated prognostic factors had no impact on treatment response type. CONCLUSION: Young Brazilian patients with ED present epidemiological and symptomatic characteristics very similar to those found in the scientific literature regarding similar populations, including a high prevalence of psychiatric comorbidities. The higher frequency of total ED syndromes, the predominance of cases with an early beginning, the long delay in beginning a specialized treatment and the more severe state of patients from the hospital ward attracted attention because these factors differed from what has been reported in reference studies and indicated greater ED severity. The presence of MD and the absence of maternal care significantly increased treatment time for ED. Greater patient age and higher guardian educational level were associated with higher risk of treatment abandonment. The other predictive factors investigated had no impact on treatment response or on treatment time until discharge. These results can contribute to the structuring of new services for Brazilian children and adolescents with ED and to the development of more rational and efficient strategies for diagnosing and treating ED
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Turkiewicz, Gizela. "Comparação de efetividade entre duas modalidades de tratamento para anorexia nervosa em adolescentes: tratamento familiar e tratamento multidisciplinar." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-26042012-112051/.
Abstract:
Adolescentes do sexo feminino são a população mais frequentemente acometida pela anorexia nervosa (AN), com prevalência média de 2,5%, quando considerados critérios diagnósticos adaptados para esta faixa etária. A apresentação da AN em adolescentes é semelhante a de adultos, no entanto existem particularidades nos sintomas relacionadas ao nível de desenvolvimento cognitivo e emocional. A AN manifesta-se por: perda de peso, perturbações na forma de vivenciar a forma corporal, medo de engordar, restrição alimentar, comportamentos compensatórios e alterações menstruais. No Brasil, existem poucos recursos especializados para o tratamento da AN na adolescência e não foram realizados previamente estudos sistematizados sobre o tema. Estudos realizados em países de língua inglesa demonstram que o tratamento familiar (TF) apresenta bons resultados no tratamento da AN em adolescentes. Este estudo tem como objetivo a comparação de efetividade e de custos entre o TF e o tratamento multidisciplinar (TM). Inicialmente foi realizado um estudo piloto, incluindo nove pacientes de 11 a 17 anos do sexo feminino com diagnóstico de AN, tratadas com o TF. Posteriormente foi realizado um estudo comparativo, com os mesmos critérios de inclusão, com 20 pacientes que receberam o TF e foram comparadas com um grupo-controle histórico de 24 pacientes tratadas com TM. Foram calculados os custos diretos de ambas as modalidades de tratamento. Foram utilizadas como medidas de avaliação: DAWBA, CGAS, EDE-Q. No estudo piloto, as variáveis peso, IMC, EDE-Q, CGAS e amenorreia foram comparadas antes e após o TF. Foram observados resultados estatisticamente significativos em recuperação de peso e IMC (p=0,036). Foi observada melhora das demais variáveis após o tratamento, no entanto estes resultados não foram estatisticamente significativos. No estudo comparativo, 75% das pacientes que receberam o TF e 62,5% das pacientes que receberam TM apresentaram recuperação dos sintomas de AN, sem diferença estatisticamente significativa entre os grupos (p=0,378). Ambos os grupos apresentaram recuperação de peso, IMC e CGAS satisfatórias após o tratamento, sem diferença estatisticamente significativa entre os grupos. Tanto no TF quanto no TM, o maior tempo de sintomas antes do início do tratamento interferiu negativamente na resposta ao tratamento, reduzindo a chance de recuperação dos sintomas. Os custos diretos do TM são aproximadamente o dobro dos custos do TF. Tanto o TF quanto o TM demonstraram-se alternativas efetivas de tratamento para AN ! na população estudada. No entanto, o custo do TM é consideravelmente maior. O TF é uma alternativa de tratamento efetiva e economicamente viável, podendo ser disseminado para outros centros, possibilitando maior acesso a tratamento para adolescentes com ANFemale adolescents are the population most frequently affected by anorexia nervosa (AN), with average prevalence of 2.5% when adapted diagnostic criteria for this age group are considered. AN presentation in adolescents is similar to that of adults, but there are peculiarities in symptoms related to the level of cognitive and emotional development. AN main symptoms are: weight loss, disturbance in the way body shape is experienced, fear of becoming fat, dietary restriction, compensatory behaviors and menstrual abnormalities. In Brazil, there are few specialized resources for AN treatment in adolescence and no previous systematic studies have been conducted on this theme. In English-speaking countries, some studies have shown that the family-based treatment (FBT) is effective for adolescent AN. The aim of this study is to compare the effectiveness and the costs between the FBT and the multidisciplinary treatment (MT). Initially, a pilot study was conducted, including nine female patients from 11 to 17 years old diagnosed with AN, and treated with FBT. It was later performed a comparative study with the same inclusion criteria. Twenty patients who received FBT were compared with a historical control group of 24 patients treated with MT. We calculated the direct costs of both treatment modalities. The evaluation measures were: DAWBA, CGAS, EDE-Q. In the pilot study, the variables weight, BMI, EDE-Q, CGAS and amenorrhea were compared before and after FBT. We observed statistically significant results in weight and BMI recovery (p=0.036). The other variables have improved after treatment, although results were not statistically significant. In the comparative study, 75% of patients receiving FBT and 62.5% of patients receiving MT recovered from AN symptoms, no statistically significant difference was found between groups (p=0.378). Both groups have shown satisfactory recovery of weight, BMI and CGAS after treatment, with no statistical significant difference between groups. Both in the FBT and in the MT, the greater duration of symptoms before starting treatment had negative influence on treatment response, reducing the chance of recovery. The direct costs of the MT are approximately twice the cost of the FBT. Both the FBT and the MT were shown to be effective for AN treatment in the study population. However, the costs of MT are considerably higher. The FBT is an effective and economically viable treatment alternative and, can be disseminated to other centers, allowing ! greater treatment access for adolescents with AN
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Koruth, Nina. "A grounded theory exploration of the experiences of the early stages of anorexia in adolescence." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/2839.
Abstract:
Background: Anorexia Nervosa is mental health problem which crosses both psychological and physical realms. It is also known to be a difficulty that often arises in adolescence. Unfortunately its prognosis is not favourable with elevated rates of chronicity and a higher mortality rate than any other psychiatric disorder in adolescence. Objectives: This research set out to explore the experiences of young people about the early stages of Anorexia. It was anticipated that this would improve clinicians’ knowledge in this area. Design and Method: This study adopted a qualitative Grounded Theory design for the interviewing and analysing process. Eight participants took part in an interview on their experiences of the early stages of Anorexia. The participants were aged between 13-17 years old. The majority were female with one male participant. Interviews were transcribed verbatim and data were analysed using NVivo software. The process of analysis involved moving between the interviews and generating codes. Through this repeated process the themes emerged from and were validated by the data. Results & Conclusions. Themes developed which illustrated the importance of the interpersonal context. Further analysis and conclusions were drawn from this and presented as this study’s main findings. The main findings were that there is a strong emotional element to the experiences of the early stages of Anorexia; that the level of awareness into Anorexia is something that develops and finally that emotions and awareness impact on responses to interpersonal interactions. The results were considered in reference to literature and clinical recommendations were provided.
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Silva, Mariana Moraes Xavier da. "Avaliação da densidade mineral óssea em adolescentes do sexo feminino com transtorno alimentar." Universidade de São Paulo, 2012. http://www.teses.usp.br/teses/disponiveis/5/5141/tde-07022013-091655/.
Abstract:
INTRODUÇÃO: Anorexia nervosa (AN) e transtorno alimentar não especificado (TANE) são os transtornos alimentares (TA) mais frequentes na adolescência. Cursam com amenorreia e comprometimento da massa óssea. A Anorexia nervosa é responsável por anormalidades na mineralização óssea, que são bem conhecidas e descritas em mulheres adultas, porém menos documentadas em adolescentes. Está associada à diminuição da densidade mineral óssea (DMO) em adolescentes, comprometendo o pico de massa óssea e aumentando o risco de fraturas. OBJETIVO: Avaliar a densidade mineral óssea lombar (L1-L4) em adolescentes do sexo feminino com transtorno alimentar no momento do diagnóstico e a evolução após seis meses e um ano de tratamento. PACIENTES E MÉTODOS: Estudo prospectivo com 35 adolescentes do sexo feminino, portadoras de anorexia nervosa ou TANE acompanhadas ao longo de um ano em serviço especializado no tratamento de transtornos alimentares. As pacientes foram submetidas a tratamento psicológico, acompanhamento psiquiátrico e endocrinológico e terapia nutricional. A densitometria óssea da coluna lombar L1-L4 pelo método de DXA (absorciometria por dupla emissão de raios X) foi realizada no início do acompanhamento, após seis meses e um ano de tratamento. RESULTADOS: Das 35 pacientes avaliadas, inicialmente quatro pacientes apresentavam DO lombar L1-L4 com escore-Z < -2 DP (11,4 %), esta proporção diminuiu para duas (5,7%) após seis meses e um ano de tratamento. Houve um aumento significativo do peso, da altura e do IMC das pacientes quando comparados os valores iniciais com os valores com seis meses e um ano de tratamento (p<0,001). Houve progressão da idade óssea (p<0,001) e 70% das adolescentes com amenorreia secundária restabeleceram os ciclos menstruais durante o primeiro ano de tratamento. No entanto não houve diferença significativa do escore-Z da densitometria óssea lombar ao longo de um ano de seguimento (p = 0,76). CONCLUSÕES: Amenorreia e comprometimento do ganho de massa óssea foram complicações frequentes encontradas no estudo. Mais de dois terços das pacientes recuperaram a função menstrual, porém no seguimento de um ano, não houve uma melhora da massa óssea nesta amostra estudada. Considerando que a amostra estudada é pequena, novos estudos, incluindo um maior número de pacientes, são necessários para confirmar nossos achadosINTRODUCTION: Anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS) are the most frequent eating disorders in adolescence. Amenorrhea and bone loss are the main complications. Anorexia nervosa is responsible for abnormalities in bone mineralization, which are well known and described in adults, but less well documented in adolescents. It is associated with low bone mineral density (BMD) in adolescents, concerning for suboptimal peak bone mass and for an increased risk of fractures. OBJECTIVE: The aim of this study was to evaluate lumbar (L1-L4) bone mineral density in female adolescents with eating disorders in the beginning of the study, at six months and after one year of treatment. PATIENTS AND METHODS: This prospective study involved 35 female adolescents with anorexia nervosa or EDNOS who were treated at an eating disorders unit during one year. Patient treatment involved psychotherapy, medical intervention and nutritional rehabilitation. Lumbar (L1-L4) bone mineral density by DXA (dual energy X-ray absorptiometry) was performed on patients in the beginning of the study, at six months and after one year of treatment. RESULTS: In total, four patients presented lumbar BMD Z-score < -2 SD (11,4 %) in the beginning, and from those, only two patients (5,7%) presented Z-score < -2 after six months and one year of treatment. Patients had good nutritional recovery, with improvement of weight, length and BMI (p<0.001). There was improvement of bone age (p<0.001) and 70% of the adolescents with secondary amenorrhea had their menstrual cycles restored. However, the Z-score of lumbar BMD did not showed significant difference during one year of follow-up (p = 0.76). CONCLUSIONS: Amenorrhea and lack of bone mass gain were the main complications showed by this study. More than two thirds of the patients had restoration of menses, but there was no significant change in lumbar DXA with treatment. One limitation to this study was the short size of the sample. Further studies are needed to confirm these findings
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Miedema, Lorraine Elizabeth. "Hormonal changes due to anorexia nervosa and their effects on bone remodeling during adolescence." Thesis, Boston University, 2012. https://hdl.handle.net/2144/12520.
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Thesis (M.A.)--Boston University
PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.Anorexia nervosa is a disease that afflicts a large portion of the adolescent population. Anorexia is clinically characterized by a very low weight for the adolescent's height and age, an extreme fear of gaining weight, a distorted body image, and amenorrhea. When anorexia is acquired during adolescence, specifically before or during puberty, a negative affect is observed in bones, which are peaking in their remodeling process to create more bone mass. This negative outcome is the result of altered hormone levels that regulate normal bone. This thesis aimed to review the literature on how anorexia affects bone growth and development and to discuss the current therapies available to remedy these effects. This study evaluated a vast amount of literature assessing the negative effects of anorexia nervosa on adolescent hormones and further evaluated how these hormonal changes affect bone in the pubertal adolescent. Research found that an individual with anorexia will have low levels of leptin and estrogen. They will also have high levels of cortisol and ghrelin. There is a high level of growth hormone, but low levels of insulin like growth factor 1 conferring a resistance to growth hormone. Each of these hormones plays a role in the bone remodeling process. Leptin, growth hormone, and insulin like growth factor normally stimulate osteoblast formation or activity. With a decrease in leptin and insulin like growth factor and a resistance to growth hormone, there is a subsequent decrease in osteoblastic activity. Estrogen is known to decrease bone resorption markers through the increase in apoptosis of osteoclasts and decreasing osteoblast apoptosis. With a decrease in the estrogen level, the osteoclast population increases and osteoblasts decrease in number. High cortisol levels are associated with impaired bone growth and increased bone resorption markers whereas ghrelin levels correlate inversely with bone turnover markers. Since ghrelin levels are high in anorexia, there is less bone turnover. These hormonal alterations decrease the bone mineral density in pubertal adolescent leading to an increase in fractures; additionally, if the disease progresses long enough, osteopenia or osteoporosis can ensue. There are many ways to combat the bone issues associated with anorexia and to help repair the many issues surrounding it. Ultimately, the best way to increase the bone health of the adolescent is through weight gain. There are also hormone replacement therapies aimed at correcting hormones levels as well as drugs aimed at improving the negative thoughts and compounded effects of an anorexic's psyche. Other psychological therapies include group therapy, cognitive-behavior therapy, and nutritional counseling. A long term solution to this primarily adolescent disorder requires considerable changes socially in addition to medical and psychological therapies. The media's portrayal of the beauty standard must be radically altered in order to change how youth perceive themselves. Additionally, educational awareness must be raised in middle and high school curriculums to help adolescent's combat anorexia. These changes must be varied and can be in the form of media (commercials, social, written, online), better advocacy (celebrities for healthier lifestyles) and education (through schools). Without changing the perceptions of beauty in the media first, anorexia nervosa will remain prevalent because adolescents will have no other role model to try to emulate.
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Stadler, Babette. "Väter und anorektische Jugendliche : Interaktionsanalysen im Kontext der Bindungstheorie /." Hamburg : Kovač, 2002. http://www.gbv.de/dms/bs/toc/354036173.pdf.
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Alves, Emilaura. "Sintomas de anorexia nervosa e imagem corporal em adolescentes femininas do município de Florianópolis, SC." Florianópolis, SC, 2006. http://repositorio.ufsc.br/xmlui/handle/123456789/89076.
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Dissertação (mestrado) - Universidade Federal de Santa Catarina, Centro de Ciências da Saúde. Programa de Pós-Graduação em Nutrição.Made available in DSpace on 2012-10-22T16:30:40Z (GMT). No. of bitstreams: 1 229792.pdf: 483595 bytes, checksum: 6a0f3c610187b8f9a6678ed5ebb134c0 (MD5)
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Hodes, Matthew. "The family treatment of adolescent anorexia nervosa : changes in the individual and parental expressed emotion." Thesis, King's College London (University of London), 2003. https://kclpure.kcl.ac.uk/portal/en/theses/the-family-treatment-of-adolescent-anorexia-nervosa--changes-in-the-individual-and-parental-expressed-emotion(1d361af2-59a4-4820-b02f-e4045e2e2c2c).html.
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Rhind, Charlotte. "Socio-emotional aspects, assessment and response to a carer's skills intervention in adolescent anorexia nervosa." Thesis, King's College London (University of London), 2015. http://kclpure.kcl.ac.uk/portal/en/theses/socioemotional-aspects-assessment-and-response-to-a-carers-skills-intervention-in-adolescent-anorexia-nervosa(5302a2be-8b57-4ee3-b6a1-4f3b2ed19946).html.
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Hurst, Kim. "Placing the Focus on Perfectionism in Female Adolescent Anorexia Nervosa: Augmented Maudsley Family-based Treatment." Thesis, Griffith University, 2017. http://hdl.handle.net/10072/367064.
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Anorexia nervosa (AN) is one of the most difficult and costly eating disorders to treat. Maudsley family-based treatment (FBT) is one widely-used treatment that has been called the gold-standard treatment for adolescents diagnosed with AN. However, FBT does not directly address some of the biased belief patterns that may reduce the likelihood of recovery and increase the risk of relapse. Addressing perfectionism has been proposed as a way to enhance the effectiveness of FBT treatment for AN, given that it has been found to be a correlate of greater chronicity of symptoms and predictive of relapse. Three studies were conducted to consider the efficacy of FBT augmented with cognitive behavioural therapy (CBT) to address perfectionism. In the first study, published meta-analyses on FBT were located and described, supplementing them with a systematic search and review of newer published FBT trials. In the next two studies, the feasibility and outcomes of ‘FBT + CBT’ were investigated. The CBT sessions focused on reducing adolescents’ perfectionistic and other self-related maladaptive cognitions and behaviours that could maintain AN. In both studies, eating disorder pathology and perfectionism were measured at four times during treatment, including pre–FBT + CBT treatment, prior to the start of CBT, after the completion of CBT, and post–FBT + CBT treatment.Thesis (PhD Doctorate)
Doctor of Philosophy (PhD)
School of Applied Psychology
Griffith Health
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Olawale, Oluwapelumi. "What are the experiences of adolescents during the recovery process from Anorexia Nervosa after receiving inpatient treatment? : an interpretative phenomenological analysis study." Thesis, London Metropolitan University, 2018. http://repository.londonmet.ac.uk/3534/.
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Background: Evidence suggests that eating disorders appear to be a significant issue in the United Kingdom. Report also suggests that people with eating disorders have a higher rate of mortality, with Anorexia Nervosa having the highest risk of mortality within eating disorders. Adolescents are most likely to be at risk suggesting closer attention should be given to this population. Despite the move towards outpatient services, inpatient treatment remains important to Anorexia Nervosa treatment for adolescents due to its life threatening features. Studies however indicate that a high number of patients who are discharged from inpatient treatment often relapse. Qualitative studies into the experiences of anorexic sufferers has shown that improvement during the recovery process may lead to new difficulties particularly in regards to managing their negative feelings without restricting their dietary intake. Most studies that have explored the experiences of people with Anorexia Nervosa tend to report more on their experience of treatment interventions. Furthermore, the limited research literature on recovery tends to focus more on adult experiences whilst little attention is given to the experience of adolescents. Aim: This study aims to contribute towards the topic as it explores the experiences of adolescents during the recovery process from Anorexia Nervosa after receiving inpatient treatment. Methodology: Semi-structured interviews were conducted with four adolescents who had been discharged into the community following inpatient treatment for Anorexia Nervosa. Results: From the analysis, the following four super-ordinate themes emerged from the data: self & recovery; relational; the world against me: back in the world; and psychological recovery vs. physical recovery. Conclusions: The findings highlight the impact of inpatient treatment on adolescents as well as the different roles played by parents, friends, and therapists in maintaining the course of recovery for adolescents with AN following their discharge from inpatient treatment. The findings also inform counselling psychologists as to how best to help adolescents manage the challenges they may face in the later stages of their recovery after discharge from inpatient treatment. Evaluation of the current study is followed by recommendations for future research.
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Teixeira, Carla Somaio. "Estado nutricional de adolescentes: percepção da autoimagem e riscos de transtornos alimentares." Faculdade de Medicina de São José do Rio Preto, 2016. http://hdl.handle.net/tede/351.
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Introduction: Adolescence is characterized by great changes, such as biological, emotional and social. Changes can occur in the nutritional status and the weight increase is a main cause of body dissatisfaction. The fat gain becomes significant among girls and muscle mass gain, twice as higher among boys. Obese adolescents are more susceptible to body dissatisfaction, leading to a body denial since this does not fit according to the standards of beauty in fashion. Objectives: To identify the risks of eating disorders in adolescents and to correlate them with age, color, body mass index, cardiovascular risk and body image among the public and private schools. Casuistics and Methods: A descriptive, cross-sectional study of quantitative approach was carried out in two schools of São José do Rio Preto, São Paulo state: a public and private one. The sample comprised 546 female and male adolescents; 230 from public schools and 316 from private school. Female adolescents answered the Eating Attitude Test instrument (EAT-26), and to evaluate the body image of adolescents, Thompson and Gray silhouette scale was used. Anthropometric data weight, height and waist circumference were measured. Software Statistical Package for the Social Sciences was used, and the averages were compared by the Student t test, the proportions by Fisher test and associations, the Chi-Square test. Multiple correspondence analysis was used to observe the relationship between the variables collected from adolescents from public and private schools. The significance level used was 5% (p <0.05). Results: Out of the 230 adolescents from public schools most of them was older than 13 years; the adolescents with the nutritional status of overweight and obesity showed cardiovascular risk, dissatisfaction with body image to overweight and risk of dietary behavior for eating disorder. For nutritional status of Eutrophia, adolescents showed no cardiovascular risk, no risk for eating disorders and body image dissatisfaction to overweight. Students with body mass index of underweight showed no cardiovascular risk and no dissatisfaction to their body image to thinness. Out of the 316 adolescents from private school, the age was between 10 and 13 years; the nutritional status of Euthrophia and overweight did not show cardiovascular risk; they are dissatisfied with their body image to overweight and no dietary behavior for eating disorder. There are also students classified as obese body mass index that reported being dissatisfied with their body image to overweight with cardiovascular risk and risk behaviors for eating disorders. Low weight adolescents, no significant association for cardiovascular risk and risk behaviors for eating disorders, but are dissatisfied with their body image to thinness. All these associations were significant in both schools (p <0.001). Conclusion: The study identified adolescents with inappropriate dietary behavior, enhancing the need for
Introdução: A adolescência é caracterizada por grandes transformações biológicas, emocionais e sociais, podendo ocorrer mudanças no estado nutricional, sendo o aumento de peso uma das principais causas da insatisfação corporal, com ganho de gordura significante entre as meninas e ganho de massa muscular duas vezes maior entre os meninos. Adolescentes obesos são mais susceptíveis à insatisfação corporal, que gera uma negação do próprio corpo, por não se enquadrar aos padrões de beleza da moda. Objetivos: Identificar os riscos de transtornos alimentares de adolescentes, correlacionar com idade, cor, índice de massa corpórea, risco cardiovascular e imagem corporal entre as escolas pública e privada. Casuística e Métodos: Estudo descritivo, transversal e de abordagem quantitativa realizado em duas escolas de São José do Rio Preto, do Estado de São Paulo; uma pública e a outra privada. Uma amostra representativa de 546 adolescentes de ambos os sexos, sendo 230 da escola pública e 316 da privada. O instrumento Eating Attitude Test (EAT-26), respondido somente pelas adolescentes. Para avaliação da imagem corporal, foi aplicada a escala de silhueta de Thompson e Gray em ambos os sexos. Foram aferidos os dados antropométricos peso, altura e circunferência de cintura. Utilizou-se o software Statistical Package for the Social Sciences, sendo que as médias foram comparadas pelo teste t de Student, as proporções pelo teste Fisher e as associações o teste qui-quadrado. Realizou a análise de correspondência múltipla para observar a relação entre as variáveis coletadas dos adolescentes das escolas públicas e privadas. O nível de significância adotado foi de 5% (p<0,05). Resultados: Dos 230 adolescentes da escola pública a maioria apresentou mais de 13 anos; alunos com estado nutricional de sobrepeso e obesidade, com risco cardiovascular, insatisfação com a imagem corporal para excesso de peso e comportamento alimentar de risco para transtorno alimentar. Para o estado nutricional de eutrofia, os adolescentes não apresentaram risco cardiovascular, ausência de risco para transtorno alimentar, mas insatisfação com a imagem corporal por excesso de peso. Alunos com índice de massa corpórea abaixo do peso não apresentaram risco cardiovascular e insatisfação com a sua imagem corporal relacionada à magreza. Dos 316 adolescentes da escola privada, a idade era entre 10 e 13 anos; para o estado nutricional de eutrofia e sobrepeso não apresentou risco cardiovascular, insatisfação com a imagem corporal para excesso de peso e ausência de comportamento alimentar de risco para transtorno alimentar. Há também os alunos classificados com índice de massa corpórea obesidade que relataram estar insatisfeitos com sua imagem corporal para excesso de peso, com risco cardiovascular e comportamento de risco para transtornos alimentares. Adolescentes de baixo peso, associação significativa para ausência de riscos cardiovasculares e comportamento de risco para transtornos alimentares, mas estão insatisfeitos com a imagem corporal relacionada à magreza. Todas essas associações foram significativas em ambas às escolas (p<0,001). Conclusão: O estudo possibilitou identificar adolescentes com comportamento alimentar inadequado, suscitando a necessidade de estratégias educativas para prevenção de transtornos alimentares e imagem corporal.