Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-03-09T22:56:26Z No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-03-10T23:32:29Z (GMT) No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) / Made available in DSpace on 2016-03-10T23:32:29Z (GMT). No. of bitstreams: 1 ClarissaNesiVenzon_DISSERT.pdf: 2129281 bytes, checksum: 8bd476fcced3f9ebacf23659cc288b48 (MD5) Previous issue date: 2013-09-19 / A Obesidade ? uma doen?a cr?nica de etiologia multifatorial que se caracteriza por excesso de gordura corp?rea, cujo grau varia de acordo com o ?ndice de Massa Corporal (IMC=m2 /kg). A obesidade grave ? caracterizada por IMC>40, frequentemente associada a altera??es cl?nicas end?crino-metab?licas ou mec?nicas e transtornos psicol?gicos; o quadro de Compuls?o Alimentar Peri?dica (CAP) tem alta incid?ncia nesta popula??o. A cirurgia Bari?trica vem sendo o tratamento de escolha para a obesidade grave, por apresentar r?pido emagrecimento e melhora nas condi??es cl?nicas. T?m-se verificado aumento de peso ap?s dois anos de cirurgia em 20% a 30% dos casos. O objetivo geral desta pesquisa ? avaliar caracter?sticas psicol?gicas e comportamentais entre obesos graves submetidos ? Cirurgia Bari?trica do tipo Bypass G?strico h? pelo menos 24 meses. Foram investigados aspectos espec?ficos como, (1) caracter?sticas do funcionamento personalidade e presen?a de transtornos cl?nicos e de personalidade; (2) a incid?ncia de CAP e sua rela??o com perda de peso; (3) a diferen?a entre os grupos em rela??o aos acompanhamentos p?s-cir?rgicos; atividade f?sica, acompanhamento psicol?gico e nutricional. M?todo: 40 adultos (homens e mulheres), com idades entre 23 a 60 anos, submetidos ? cirurgia bari?trica h? pelo menos 24 meses, na cidade de Natal-RN, foram divididos em dois grupos com n= 20, Grupo de Ganho, com perda < 50% do peso excedente inicial, e o Grupo de Perda, com perda >50%. O protocolo de pesquisa foi composto por question?rio biossociodemogr?fico, o m?todo de Rorschach ? Sistema Compreensivo (SC); Invent?rio de Personalidade de Millon (MCMI-III); e Escala de Compuls?o Alimentar Peri?dica (ECAP). Atrav?s do m?todo de Rorschach foram evidenciadas diferen?as significativas entre os dois grupos, relacionadas aos tipos vivenciais (EB), maior presen?a de EB Extratensivo no Grupo Ganho e Intratensivo no Grupo de Perda; e ao descontrole na express?o dos afetos, com eleva??o de respostas de Cor Pura no Grupo Ganho. Em rela??o ? popula??o normativa do SC, a amostra como um todo apresentou maior tend?ncia a experienciar sofrimento ps?quico, auto percep??o denegrida, autocr?tica excessiva, distor??es perceptivas, vulnerabilidade a desenvolver transtornos afetivos e eleva??o da pontua??o na Constela??o de Suic?dio. O MCMI-III indicou maior incid?ncia de transtornos cl?nicos e de personalidade no Grupo Ganho: Transtorno Depressivo e Esquizot?pico, Ansiedade, Distimia, Depress?o Maior; Transtorno do Pensamento, Bipolar- Man?aco e Transtornos de Estresse P?s-Traum?tico. Os resultados da ECAP indicaram diferen?a significativa, com eleva??o de CAP no Grupo de Ganho como tamb?m, entre a gravidade de CAP e presen?a de transtornos cl?nicos e de personalidade. Em rela??o aos acompanhamentos foi encontrada diferen?a significativa no quesito atividade f?sica com mediana elevada no Grupo de Perda. Os grupos ainda se diferenciaram em rela??o ao peso inicial e tempo p?scir?rgico, indicando que quanto maior o peso inicial e tempo percorrido maior o aumento de peso p?s-cir?rgico. Os resultados ainda revelam que os participantes com mais de 3 anos de tempo cirurgia, apresentam eleva??o na presen?a de Transtornos Cl?nicos de Transtorno Depressivo Maior; Transtorno Somatoforme; Distimia. Tais resultados corroboram conclus?es de estudos sobre a rela??o entre CAP p?s-cir?rgico e novo ganho de peso, como tamb?m acerca de maior incid?ncia de transtornos cl?nicos na popula??o obesa grave. Conclui-se que o processo cir?rgico ? apenas uma faceta do tratamento da obesidade grave, e que o acompanhamento p?s-cir?rgico deve receber maior aten??o e ocorrer em longo prazo para a manuten??o n?o s? dos resultados cir?rgicos, como da melhoria da qualidade de vida dos pacientes. / Obesity is a chronic disease that has multi-factorial aetiology, characterized by high degree of body fat; the degree of obesity will vary according to the Body Mass Index (BMI=m2 /kg). The severe degree of obesity is characterized by BMI>40 and it is regularly associated to endocrine-metabolic or mechanic clinical alterations, and to psychological disorders. Binge Eating (BE) results were overly high for this population. The Bariatric Surgery has been the treatment chosen by those diagnosed with severe obesity as this intervention provides prompt outcomes for loss of weight and clinical improvement conditions. However, recent research has acquiesced that after two years between 20% and 30% of people subject to this intervention gained weight. The main objective of this research is to assess the psychological and behavioral characteristics of those diagnosed with severe obesity that have been subject to Gastric Bypass Surgery in the past 24 months. Specific aspects were investigated: (1) characteristics of different personalities and diagnose of clinic and personality disorders; (2) BE and its relation with loss of weight; (2) the difference between the groups regarding post-surgery care, e.g. physical activity, psychological and dietician input. Method: 40 adults (women and men) aged 23 and 60 year-old who went through a bariatric surgery in the past 24 months, in the city of Natal-RN (Brazil); they were assembled in two groups n=20, Gain group displaying loss of < 50% of their initial surplus of weight, and the Loss group displaying loss of >50%. The research protocol is made of a socio-demographic questionnaire and 3 psychometric instruments: Rorschach ? Comprehensive System; Millon Personality Inventory (MCMI-III); and the Binge Eating Scale (Escala de Compuls?o Alimentar Peri?dica (ECAP). Through Rorschach significant differences between these groups were verified according to the kind of personality (EB) - more EB Extratensivo in Gain group and Intratensivo in Loss group ? and the lack of control to express affect, increasing the answer for Color Pure at Group I. Concerning the people standardization, the sample as a whole tends to show psychic pain, denigrated selfperception, high levels of self-criticism, distorted perceptions, vulnerability to develop mood disorders and high scores regarding Suicide. MCMI-III results showed more clinic and personality disorders in Group I: Depressive Disorder and Schizotypal, Anxiety, Dysthymia, Major Depressive Disorder; Thought Disorder, Bipolar- Manic and Posttraumatic Stress Disorder. In relation to ECAP, the results indicated significant differences, showing increased BE results in Gain group. There were found significant differences between BE severity and the presence of clinic and personality disorders. Concerning the post-surgery care, the observed differences are statistically significant regarding physical activities with median-increased differences in Loss group. There is a difference between the initial weight and the time post-surgery, indicating that the higher the initial weight and the time after the surgery the higher the re-gain of weight post-surgery. Finally, the results show that the participants with more than 3 years of surgery will have Clinic and Major Depressive Disorders; Somatoform Disorder; Dysthymia. These results confirm prior studies related to BE post-surgery and re-gain of weight as well as the proneness of clinic disorders in severe obesity people. That means the results reinforce that the surgery process is a facet of the severe obesity treatment. The post-surgery process needs to be the main focus of attention and have a long-term input to sustain the care of the surgery results and the quality of life of the patients.