Made available in DSpace on 2015-07-22T20:50:48Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-07-28 / Objetivo: Verificar a prevalência de alterações vocais em adolescentes de 16 anos, estudantes da rede pública estadual da cidade de Recife-PE, com características de bulimia nervosa. Método: Para este estudo foram avaliados 216 adolescentes sendo 80 do gênero masculino e 136 do gênero feminino para identificar os que apresentavam características de bulimia nervosa foi utilizado o Teste de Investigação Bulímica (BITE) e a identificação dos sinais e sintomas vocais foi por meio de análises vocais subjetivas (Escala de GRBASI e Escala Analógica Visual- Escala Numérica EAV-EN) e objetiva (Voxmetria). Resultados: A prevalência de características de bulimia nervosa entre a população estudada foi de 70 indivíduos (32,4%), tendo percentual maior para o gênero feminino 52(74,3%) e menor para o masculino 18(25,7%). Quanto à análise vocal destes indivíduos com características de bulimia nervosa, na escala de GRBASI 19(27,1%) apresentaram vozes normais enquanto que 51(73,9%) mostraram alterações na voz (p<0,001); na EAV-EN 31(44,3%) apresentaram vozes no padrão normal e 39(56,5%) tinham alterações vocais (p<0,001), para o Voxmetria 37(53,6%) possuíam vozes normais e 33(47,1%) tinham algum tipo de alteração (p=0,381). Conclusão: Este estudo apresentou uma alta prevalência de adolescentes com características de bulimia nervosa das escolas públicas da cidade de Recife, com 16 anos de idade, além de encontrar neste grupo um alto percentual de sinais na voz, com isso se conclui a necessidade de que haja uma maior atenção aos riscos causados pelos transtornos alimentares nas vozes dos adolescentes. / Objective: To verify the prevalence of voice disorders in teenagers of 16 years old, students from public schools in the city of Recife-PE, with characteristics of bulimia nervosa. Method: For this study, 216 teenagers were rated with 80 males and 136 females to identify those that had characteristics of bulimia nervosa was used Bulimic Investigatory Test (BITE) and the identification of signs and symptoms vocal was by analysis subjective voice (Scale GRBASI and Visual Analog Scale-Scale Numerical- EN VAS) and objective (Voxmetria). Results: The prevalence of features of bulimia nervosa among the study population was 70 individuals (32.4%) and higher percentage for females 52 (74.3%) and lower for males 18 (25.7%). As for vocal analysis of these individuals with characteristics of bulimia nervosa, scale GRBASI 19 (27.1%) had normal voices while 51 (73.9%) showed changes in voice (p <0.001) in VAS-EN 31 (44.3%) had voices in the normal pattern and 39 (56.5%) had vocal changes (p <0.001) for Voxmetria 37 (53.6%) had normal voices and 33 (47.1%) had some type of change (p = 0.381). Conclusion: This study showed a high prevalence of teenagers with bulimia nervosa characteristics of public schools in the city of Recife, with 16 years of age, and find this group a high percentage of sings in her voice, it concludes with the need that there is greater attention to the risks posed by eating disorders in the voices of adolescents. / TEDE / BV UNIFESP: Teses e dissertações

Abstract: The present study was designed to answer the following questions: (a) What is the level of awareness patients with Bulimia Nervosa (BN) and the professionals who work with them regarding the vocal health risks associated with self-induced vomiting? (b) Is the bulimic population at risk for under-referral for assessment and treatment of vocal pathology? (c) How do patients and professionals perceive the role of the Speech-Language Pathologist (SLP) in the treatment of eating disorder-related vocal pathology? Three original surveys were developed to address the research questions. There was one survey for individuals with a history of BN, one for SLPs, and one for other health care professionals involved in the care of bulimic individuals. There were 89 total participants in the present study. Thirty were respondents to the Health Care Providers Survey, 28 were respondents to the SLP Survey, and 31 were respondents to the Patient Survey. Results indicate a general lack of awareness concerning these risks and treatment options to address them on the part of patients and health care professionals and a lack of specific knowledge of how to recognize and treat individuals with BN on the part of SLPs. Results from all three groups supported the notion that the bulimic population is at risk for under-referral for treatment for voice disorders. Finally, results suggest that SLPs do in fact provide services to persons with BN, but that at present, patients and other health care professionals do not seem to perceive the SLP as having a role in management of care of this population. / text

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Although several writers have emphasized the habit-like characteristics of bulimia nervosa, no study has investigated the extent to which bulimia responds to treatment specifically for habit disorders. Habit reversal is a general treatment plan which teaches individuals to regain lost awareness of all aspects of a habit. The habit is then interrupted at the earliest movement in the chain by a physically competing response. Habit reversal (Azrin & Nunn, 1973) has been effective in treating other habits (e.g., stuttering, tics, bruxism). In the present study, habit reversal was adapted for the treatment of bulimia. In response to newspaper advertisements, ten females (aged 21-26) with a minimum of two binges/week were included in the study. Bingeing and vomiting ranged from .5/day to 3.57/day during baseline; duration of the disorder ranged from one to eight years. In a multiple-baseline, across-subjects design, subjects were randomly assigned to begin treatment following 14 days of baseline data collection. Subjects self-monitored and reported daily binge eating, vomiting, fasting and laxative use. Daily social contacts and athletic activities were self-monitored and reported as secondary dependent measures. A blood chemistry analysis to assess metabolic functioning, the Beck Depression Inventory (BDI) and the Symptom Checklist 90-Revised (SCL-90R) were administered pre- and post-treatment. Two subjects reported cessation of bulimic episodes during baseline data collection apparently as a result of self-monitoring and frequent phone contacts. A rapid and substantial reduction in the target behaviors for the subjects who received treatment was reported following presentation of habit reversal (mean bingeing reduction=66.7%; mean vomiting reduction=52.0%). As reports of bingeing and vomiting decreased, concomitant increase in reported social contacts and athletic activities was observed in five of seven subjects without treatment for social behavior. Scores on the BDI and SCL-90 R did not change as a function of treatment. However, the self-reported frequency of binge eating during treatment correlated positively with psychopathology (r=.95, p

Seit Jahren wird trotz der stetigen Modernisierung der medizinischen Versorgungsleistungen ein Anstieg der stationären Einweisungen in den psychiatrischen Kliniken registriert. Dabei nutzt eine kleine Gruppe von Patienten, die sogenannten Heavy User, den Großteil der zur Verfügung stehenden therapeutischen Ressourcen. Diese explorative Studie beschreibt eine Gruppe von erwachsenen, weiblichen Heavy Usern (n=23) mit restriktiver bzw. bulimischer Anorexie oder Bulimie, die mindestens drei stationäre Aufnahmen in einer psychiatrischen Klinik aufwiesen. Als Vergleich dient eine Kontrollgruppe von weiblichen Nicht-Heavy Usern (n=13) mit maximal einem stationären Voraufenthalt. Die Ergebnisse zeigen, dass Heavy User mit der Hauptdiagnose einer Essstörung spezifische soziodemographische, diagnostische und psychopathologische als auch Persönlichkeitsmerkmale aufweisen, die eine rechtzeitige Identifizierung dieser Patientengruppe ermöglichen könnten. Der Heavy Use wird als multifaktorielles Geschehen verdeutlicht und die Notwendigkeit einer frühen Identifikation und Intervention betont. Da die bisherigen Studienergebnisse sehr uneinheitliche Resultate lieferten, sind weitere Untersuchungen dieser Patientengruppe unerlässlich. Die Entwicklung alternativer und individueller Therapieansätze ist angezeigt, um passende Versorgungsangebote für diese therapieresistenten Patienten zu schaffen. / Despite the constant modernization of medical services, an increase of inpatient readmissions in psychiatric services has been noted for years. Patients who show a higher extent of use of inpatient medical treatment are known as heavy users. This explorative study describes a group of female adult heavy users (n=23) with at least three inpatient treatments and compares the findings with a control group of female non-heavy user patients (n=13) with a maximum of one previous admission, both suffering from restrictive or purging-type anorexia nervosa or bulimia nervosa. The results of this paper show that heavy users diagnosed with an eating disorder, appear to have individual sociodemographic, diagnostic and psychopathological characteristics as well as particular personality traits, which seemingly contribute to heavy service use and could be taken into consideration for early identification of this treatment resistant group of patients. The findings stress the heavy use as a multifactorial phenomenon and emphasize the need of early identification and intervention. Since prior studies show inhomogenous results, further qualitative analysis is necessary to develop alternative and individual treatment strategies for heavy users.