ABSTRACT Objective Weight regain is a common outcome of weight loss interventions. Mental health-related comorbidities, among other factors, can mediate weight regain regardless of the implemented treatment modality. This study explores whether postoperative psychopathological comorbidities are associated with weight regain after bariatric surgery. Subjects and methods This cross-sectional study recruited 90 outpatients who underwent Roux-en-Y gastric bypass surgery. Anthropometric measurements were collected retrospectively from medical charts. The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) Axis I Disorders (SCID-I) was applied to evaluate psychiatry diagnoses. Validated self-report instruments were used to assess depression, anxiety, alcohol use, impulsivity, binge eating, and body image dissatisfaction. Weight regain was defined as a ≥20% increase from the maximum weight lost. Level of evidence: Level III, cross-sectional study based on a well-designed study. Results Overall, 55.6% of participants experienced weight regain. Notably, mental disorders such as current binge-eating disorder and lifetime diagnoses including bulimia nervosa, alcohol abuse/dependence, and obsessive-compulsive disorder were significantly associated with weight regain. However, controlled analysis found that, for mental disorders, only current binge-eating disorder (odds ratio [OR] 6.3, 95% confidence interval [CI] 1.26-31.06, p = 0.024) remained associated with weight regain. Eating-related psychopathologies also associated with weight regain included binge eating (d = 0.55; p = 0.013), eating disinhibition (d = 0.76; p = 0.001), higher hunger levels (d = 0.39; p = 0.004), and non-planning trait impulsivity (d = 0.69; p = 0.0001). Conclusion Postoperative presence of psychopathological comorbidities, such as eating psychopathology and trait impulsivity, were associated with weight regain after bariatric surgery. These findings highlight the importance of addressing mental health in individuals experiencing postsurgical weight regain. interventions healthrelated related factors modality surgery crosssectional cross sectional 9 RouxenY Roux en Y charts DisorderIV Disorder IV DSMIV DSM (DSM-IV SCIDI SCID (SCID-I selfreport self report depression anxiety use dissatisfaction 20 ≥20 lost evidence III welldesigned well designed Overall 556 55 6 55.6 Notably bingeeating nervosa abusedependence abuse dependence abuse/dependence obsessivecompulsive obsessive compulsive However that odds OR [OR 63 3 6.3 95 CI [CI 1.2631.06, 1263106 1.26 31.06, 1 26 31 06 1.26-31.06 0.024 0024 0 024 Eatingrelated Eating d 0.55 055 0.013, 0013 0.013 , 013 0.013) 0.76 076 76 0.001, 0001 0.001 001 0.001) 0.39 039 39 0.004, 0004 0.004 004 0.004) nonplanning non planning 0.69 069 69 0.0001. 00001 0.0001 . 0.0001) 2 ≥2 5 55. 6. 2631 1.2631.06 126310 126 1.2 3106 31.06 1.26-31.0 0.02 002 02 0.5 05 0.01 01 0.7 07 7 000 0.00 00 0.3 03 0.6 0000 0.000 ≥ 263 1.2631.0 12631 12 1. 310 31.0 1.26-31. 0.0 0. 1.2631. 1263 31. 1.26-31 1.2631 1.26-3 1.263 1.26-

ABSTRACT Objective: Binge eating disorder (BED) is the most prevalent eating disorder in individuals with obesity. Its association with factors that control hunger and satiety has not yet been elucidated. We evaluated whether levels of inflammatory markers, frequency of psychiatric comorbidities, and appetite-related hormones levels differ between individuals with obesity with and without BED. Materials and methods: The Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-5 – Clinician Version (SCID-5-CV), Binge Eating Scale, and Hospital Anxiety and Depression Scale were evaluated in 39 individuals with obesity. Plasma levels of C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), leptin, ghrelin, and glucagon-like peptide-1 (GLP-1) were measured. Results: Individuals of the BED group exhibited significantly higher percentages of altered eating patterns (hyperphagia, bingeing, post-dinner eating, feeling “stuffed”, and emotional eating), higher depressive symptom scores and levels of leptin, CRP, and TNF-α, compared to those from the non-BED group. Logistic regression showed that BED was independently associated with depressive symptoms and CRP levels. Conclusions: Individuals with obesity and BED showed greater psychiatric comorbidity, worse eating patterns and worse inflammatory profile than those without BED. BED should be assessed as an indicator of clinical severity in patients with obesity.

ABSTRACT Objective: To investigate the influence of parental depression and substance use in the oral health care of children with disabilities. Material and Methods: A cross-sectional study was conducted involving 151 children with disabilities and their parents/caregivers. To detect the presence of depression and alcohol or tobacco use, the parents/caregivers answered three questionnaires: two versions of the Patient Health Questionnaire (PHQ), AUDIT (Alcohol Use Disorders Identification Test), and the Fagerstrom Test for Nicotine Dependence (FTND). Then, the children with disabilities underwent oral examination to evaluate biofilm control, gingival condition and the dental carie index (decayed, missing, and filled teeth - dmft ̸ DMFT). Results: There was a statistically significant association between tobacco use and dental caries in deciduous teeth (p=0.046). The children of smokers had six times greater need for dental treatment than that of non-smokers (OR= 6.36; CI= 1.3-30.5). There was no statistically significant association between the oral health of the children with disabilities and parental alcohol consumption and depression (p>0.05). Children with medical condition had a higher need for dental treatment than children with intellectual disability (p=0.003). Conclusion: Parental smoking habits increase dental caries in the deciduous teeth of children with disabilities, but parental depression and alcohol use do not influence the oral health of children with disabilities. Children with medical condition have more treatment needs than children with intellectual disability.

RESUMO A cirurgia bariátrica (CB) é considerada o tratamento mais eficaz para obesidade grave em longo prazo. Apesar de estar associada à resolução ou melhora das comorbidades clínicas, um desfecho possível é o reganho de peso. Um conjunto de evidências aponta a presença do transtorno da compulsão alimentar (TCA) como um dos fatores de risco associados ao reganho de peso pós-operatório. O objetivo desta apresentação de casos clínicos é discutir o possível impacto dos episódios de compulsão alimentar em pacientes submetidos à CB. Serão apresentados os seguintes casos (1): uma mulher de 41 anos, avaliada após 8 anos da cirurgia, apresentando um reganho de 22,9 kg e psicopatologia alimentar compatível com TCA; (2): um homem de 48 anos, avaliado no pós-operatório de 7 anos, com um reganho de 30 kg e exibindo queixas de beliscamento alimentar, porém sem sintomas compatíveis com TCA; (3): uma mulher de 44 anos, avaliada no pós-operatório de 3 anos, mantendo peso estável sem reganho e que exibia à avaliação TCA. Os autores discutem, a partir destes três casos, as evidências relacionadas ao impacto da compulsão alimentar no resultado da CB. Apesar de não haver, no momento, um consenso definitivo quanto ao real impacto dos transtornos alimentares neste recrudescimento ponderal, fica claro que o clínico deve estar atento ao TCA e sua possível associação com o reganho de peso.

ABSTRACT Bariatric surgery (BS) is the most effectiveness long term treatment to severe obesity. However being associated with resolution or improvement of clinic comorbidities, one possible outcome is weight regain. A group of evidences appoint to the presence of BED (binge eating disorder) as one risk factor associated to post-surgery weight regain. The aim of this case report is to discuss a possible impact of binge eating in patients submitted to BS. The following cases will be presented: (1): 41 years woman, evaluated after 8 years post-surgery, showing weight regain of 22.9 kg and compatible eating psychopathology with BED; (2): 48 years men, evaluated 7 years post-surgery, with weight regain of 30 kg and showing grazing complaints, although without compatible BED symptomatology; (3): 44 years woman, evaluated 3 years post-surgery, maintaining stable weight without weight regain and BED exhibited in evaluation. The authors discuss, from these three index cases, the associated evidences related to the impact of the binge eating in the BS result. Although, for the moment, any definitely consensus on the real impact of eating disorders in weight recrudescence is not possible, it is clear that the clinician need to be alert to BED and possible association with weight regain.

O objetivo desta revisão é verificar, na literatura, uma relação entre níveis plasmáticos aumentados de corticosteróides e sintomas psiquiátricos, identificar as manifestações clínicas mais comuns e os tratamentos propostos. Alterações no eixo hipotálamo-hipófise-supra-renal levando a hipercortisolemia estariam associadas a distúrbios do humor, sobretudo depressão, enquanto que o uso de drogas glicocorticóides estaria relacionado ao aparecimento de sintomas psiquiátricos, como mania, depressão, labilidade afetiva e psicose. O levantamento bibliográfico foi realizado através dos indexadores Medline e Bireme no período de 1993 a 2003, em inglês, francês e espanhol, utilizando-se o cruzamento das seguintes palavras-chave: cortisol, corticosteróides, depressão, transtorno bipolar e psicose. Foram incluídos artigos originais (33) e de revisão (22) e excluídos relatos de caso. Alguns estudos sugerem que altas concentrações plasmáticas de cortisol, em longo prazo, podem levar à depressão, propondo que a utilização de drogas antiglicocorticóides teria efeito antidepressivo. Outros estudos, por outro lado, indicam não haver associação entre hipercortisolemia e episódios depressivos.

The objective of this study was to make a literature review on associations between high plasma levels of corticosteroids and psychiatry symptoms, as well as to identify the most common clinical manifestations and treatments suggested. Hipercortisolemia resulting from alterations in the HPA axis would be associated with mood disorders, especially depression, whereas the use of glucocorticoid drugs would be related to the occurrence of psychiatric symptoms such as mania, depression, affective lability and psychosis. The review was performed via Medline and Bireme indexes, and articles published in English, French and Spanish between 1993 and 2003 were included. The following keywords were used: cortisol, corticosteroids, depression, bipolar disorder and psychosis. Original (33) and review (22) articles were included in the review; case reports were excluded. Some studies suggest that long-term high plasma cortisol concentrations may cause depression, and that the use of antiglucocorticoid drugs would have an antidepressant effect. On the other hand, other studies do not show association between hypercortisolemia and depressive episodes.

El objetivo de esta revisión es verificar en la literatura una relación entre niveles plasmáticos aumentados de corticosteróides y síntomas psiquiátricos, identificando las manifestaciones clínicas mas comunes y los tratamientos propuestos. Alteraciones en el eje hipotálamo-hipófisis-supra-renal (HHSR) llevando a una hipercortisolemia estarían asociadas a disturbios del humor, sobretodo depresión, mientras el uso de drogas glicocorticóides estaría relacionado al aparecimiento de síntomas psiquiátricos como: manía, depresión, labilidad afectiva e psicosis. El levantamiento bibliográfico fue realizado a partir de los indexadores MEDLINE y BIREME en el período de 1993 a 2003 en ingles, francés y español, utilizando el entrecruce de las palabras clave: cortisol, corticosteróides, depresión, trastorno bipolar e psicosis. Fueron inclusos artículos originales (33) y de revisión (22) y excluidos relatos de caso. Algunos estudios sugieren que altas concentraciones plasmáticas de cortisol, a largo plazo, pueden llevar a una depresión, proponiendo que la utilización de drogas antiglicocorticóides tendría un efecto antidepresivo. Otros, por otro lado, indican no haber asociación entre hipercortisolemia e episodios decisivos.