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-

RESUMO Objetivo: Associar a trajetória de vida de Dom Pedro II com o começo da história da psiquiatria brasileira por meio do Hospício Pedro II. Métodos: Realizamos uma revisão narrativa da literatura com a pesquisa de três bases de dados: Google Scholar, PubMed e Web of Science (SciELO). Resultados: A primeira instituição psiquiátrica brasileira, o Hospício Pedro II (1841-1889), foi criado por meio do Decreto nº 82, publicado no dia 18 de julho de 1841. Essa publicação ocorreu durante a cerimônia de coroação de Dom Pedro II. O objetivo dessa cerimônia de coroação era fortalecer o poder da monarquia brasileira e legitimizar a antecipação da maioridade do imperador com 14 anos. Ao longo dos 48 anos do império de Dom Pedro II, seus interesses culturais e científicos influenciaram o surgimento de uma incipiente pesquisa científica brasileira. Nesse sentido, o Hospício Pedro II não era apenas representativo de uma instituição de saúde, mas uma resposta às mudanças sociais e culturais que ocorreram após a chegada da família real portuguesa em 1808. Também era um representativo da influência da psiquiatria francesa baseada no tratamento moral de Phillipe Pinel (1745-1826). Conclusão: De forma concisa, o Hospício Pedro II era uma representação da personalidade de Dom Pedro II como um patrono da ciência, a emergência de uma psiquiatria brasileira e da hierarquia da sociedade imperial.

ABSTRACT Objective: Associate Dom Pedro II’s life trajectory and the beginning of Brazilian psychiatry through the Pedro II Asylum. Methods: We conducted a narrative review of the literature on three search databases: Google Scholar, Pub Med, and Web of Science (SciELO). Results: The first Brazilian psychiatry institution, the Pedro II Asylum (1841-1889), was created by the number 82 decree on 18 July 1841. The launching occurred at Dom Pedro II’s coronation ceremony. It was a celebration that aimed at enhancing the Brazilian monarch’s power and at legitimizing the emperor’s adulthood at the age of fourteen. Throughout the 48 years of the Dom Pedro II empire, his cultural and science interests influenced the emergence of incipient Brazilian scientific research. In this regard, the Pedro II Asylum was portrayed not only as a health care institution but also undertook an effort to attend the social and cultural modifications promoted at the Brazilian imperial court after the Portuguese Crown family arrived in 1808. It also represented the influence of French psychiatry based on Phillipe Pinel’s (1745-1826) principles of moral treatment. Conclusions: Concisely, the Pedro II Asylum was a representation of Dom Pedro II’s personality as a patron of science, the emergence of Brazilian psychiatry, and the imperial society hierarchy.

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.