SYMPOSIA
SYMPOSIA
SYMPOSIA
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Abstracts of the Invited Speakers<br />
Obesity and impulsivity<br />
Bilge Burçak Annagür<br />
Department of Psychiatry, Selcuk University, Selcuklu Medical School, Konya, Turkey<br />
E-mail: bilgeannagur@yahoo.com<br />
Obesity is not inlcuded in eating disorders characterized by the DSM-IV classification of the American Psychiatry Association. Current<br />
clinical diagnosis depends on body mass index (BMI). Although it was not evaluated among eating disorders, it presents psychological<br />
characteristics seen commonly in eating disorders. Characteristics related with eating disorders such as low self-esteem, body<br />
dissatisfaction, perfectionistic attitudes, impulsivity and disinhibition have also been observed in obese patients (1,2). Obese patients are<br />
divided into two subgroups, with or without binge eating disorder (BED). Body weights of subjects with binge eating disorder are related<br />
to their overeating and psychopathologies, especially depression, are more frequent compared to the other group.<br />
Aggressiveness and anger are involved in significant psychopathological characteristics common in patients with eating disorders (3).<br />
Some researchers suggested that impaired eating behavior is related to low self-esteem and high self-directed hostility. Problems about<br />
revealing their anger were detected among these individuals. Besides, problems in controlling the expression of anger, accompanying<br />
impulsive explosive behaviors are also present (4).<br />
The current status of obesity treatment is not satisfactory. Some treated individuals regain the lost weight in a short time (5). Many<br />
researchers are investigating approaches to keep off the lost weight with treatment strategies to lose weight. In previous reports, it has<br />
been demonstrated that most obese individuals returned back to their basal BMIs or to higher values within 1-5 years (6). Nowadays, the<br />
question is ‘What is the difference between the ones who keeps off the weight they lose and those who do not?’. Impulsivity is the possible<br />
predictor of relapse in obesity treatment (5). Obese subjects are suggested to be more impulsive than lean ones. Impulsive characteristics<br />
are higher in obese patients with BED (7). Impulsive people appear to have no control over their behaviors on eating and they have more<br />
interest in food with higher calories. Impulsivity is also considered as a predicting factor among patients who quit treatment. In a survey<br />
among the children between the ages of 8-12 years in the Netherlands, impulsivity was measured by behavior and the results of treatment<br />
were evaluated. As a result, it was demonstrated that impulsive children lose less weight compared to the others. It was also concluded<br />
that impulsive children are more prone to eating delicious foods; therefore more attention should be given to their dietary control (5).<br />
Another issue supporting the relationship between obesity and impulsivity is the occurrence of obesity in children with attention deficiency<br />
and hyperactivity disorder (ADHD) (8). ADHD was detected in most of the children (58%) who were receiving obesity treatment. Also, the<br />
BMI of children with ADHD was higher than the control group (9). In addition, there is evidence for decreased levels of D2 receptors in<br />
the striatum of obese subjects (10-13). With regard to the therapeutic implications, recent studies indicate that methylphenidate (MPH),<br />
a drug widely used for ADHD, reduced overall energy intake with a selective reduction in dietary fat (14,15). Dopamine (DA) exerts<br />
neuromodulatory influences over behavior and cognition via the fronto-striato-cerebellar circuitry and pharmacotherapy is thought to<br />
target these systems to ameliorate problems with impulsivity, inattention and hyperactivity. To explain the comorbidity of ADHD and<br />
obesity, it has been hypothesized that a predisposition to glucose starving and obesity is due to inadequate dopaminergic activity in the<br />
reward center of the brain. Consumption of large quantities of carbohydrates (carbohydrate binging) stimulates production and usage of<br />
dopamine within the brain and it results in a kind of therapeutic effect (16,17).<br />
All this information should guide the planning of treatment. Specific cognitive behavioral approaches developed for the treatment of<br />
impulsive behavior could contribute much to the treatment of obesity(18).<br />
Key words: Eating disorders, impulsivity, obesity<br />
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S94<br />
Efficacy of psychotherapy in bulimia nervosa<br />
Başak Yücel<br />
Department of Psychiatry, Istanbul University, Istanbul, Turkey<br />
E-mail: byucel@superonline.com, basakyucel@gmail.com<br />
The efficacy and importance of psychotherapy in bulimia nervosa have been examined in many studies recently. Most of the eating<br />
disorder experts acknowledge the notion that psychological interventions are the best available treatment for BN. Although different<br />
psychotherapeutic recommendations have been offered by NICE (National Institute for Health and Clinical Excellence) and APA (American<br />
S94 Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org