Psychiatric disorders in bariatric surgery candidates: A review of the literature and results of a German pre-bariatric surgery sample

Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Erlangen, Germany.
General hospital psychiatry (Impact Factor: 2.61). 09/2009; 31(5):414-21. DOI: 10.1016/j.genhosppsych.2009.05.004
Source: PubMed


To investigate the prevalence of Axis I psychopathology in bariatric surgery candidates and to compare our results with the findings of the few studies published thus far.
Structured clinical interviews (SCID) were conducted in 146 consecutive bariatric surgery candidates [71.9% women; mean age: 38.7 years (S.D.=10.0); mean BMI: 49.3 kg/m(2) (S.D.=7.8)] between September 2004 and January 2007 at the University Hospital of Erlangen. Assessments were administered independently of the preoperative screening and approval process.
The overall prevalence of current Axis I disorders was 55.5%; 72.6% had a lifetime history of at least one Axis I disorder. Axis I psychopathology was related to gender (with women reporting higher prevalence rates) and was positively associated with a lifetime history of any eating disorder. We compared our results with the findings of the three published studies having used structured clinical interviews to assess psychiatric comorbidity in bariatric surgery candidates. The authors provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries.
About one half of the bariatric surgery candidates in Germany presented with a current Axis I disorder. Prevalence rates reported in the literature so far are based on different premises. Details for example about the evaluation should be taken into account when interpreting the results.

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    • "Thus, given the mixed findings noted above and the independent contribution of overweight/ obesity to neurocognitive deficits, the extent to which a BED diagnosis among obese individuals may confer greater risk for impairments in neurocognitive functioning beyond that associated with an elevated BMI remains unclear. A growing literature has also examined cognitive functioning among individuals seeking bariatric surgery, a group in which a history of BED is fairly common (Kalarchian et al., 2007; Mühlhans et al., 2009). This population is at risk for neurocognitive deficits due to their obese status, as well as due to the presence of certain conditions that are often comorbid with obesity (e.g., depression, diabetes; Austin et al., 2001; Van den Berg et al., 2010). "
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    ABSTRACT: Evidence suggests that both obesity and binge eating disorder (BED) may be associated with deficits in cognitive functioning. The purpose of this study was to examine whether a lifetime history of BED would be associated with changes in several domains of cognitive functioning (attention, executive function, language, and memory) following bariatric surgery. Participants were 68 bariatric surgery patients who completed a computerized battery of cognitive tests within 30 days prior to undergoing surgery and again at a 12-Month postoperative follow-up. Results revealed that on the whole, participants displayed improvements from baseline to follow-up in attention, executive function, and memory, even after controlling for diagnostic history of depression; no changes were observed for language. However, individuals with and without a history of BED did not differ in changes in body mass index or in the degree of improvement in cognitive functioning from baseline to follow-up. Such results suggest that a history of BED does not influence changes in cognitive functioning following bariatric surgery. Future research will be needed to further clarify the role of BED in predicting cognitive function over time.
    Journal of Psychiatric Research 08/2014; 59. DOI:10.1016/j.jpsychires.2014.08.004 · 3.96 Impact Factor
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    • "Previous research has shown that individuals with obesity and comorbid BED suffer from more eating disorder symptoms and higher levels of general psychopathology, including depression (e.g. Mühlhans et al., 2009; Nazar et al., 2014; Villarejo et al., 2014). Moreover, obese individuals with BED exhibit more food-related impulsivity (e.g. "
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    ABSTRACT: This study aimed to investigate temperament subtypes in obese patients. Ninety-three bariatric surgery candidates and 63 obese inpatients from a psychotherapy unit answered the Behavioral Inhibition System/Behavioral Activation System Scale (BIS/BAS), the Effortful Control subscale of the Adult Temperament Questionnaire-Short Form (ATQ-EC), and questionnaires for eating disorder, depressive and attention deficit hyperactivity disorder (ADHD) symptoms and completed neurocognitive testing for executive functions. Binge eating disorder and impulse control disorders were diagnosed using interviews. A latent profile analysis using BIS/BAS and ATQ-EC scores revealed a 'resilient/high functioning' cluster (n = 88) showing high ATQ-EC and low BIS/BAS scores and an 'emotionally dysregulated/undercontrolled' cluster (n = 68) with low ATQ-EC and high BIS/BAS scores. Patients from the 'emotionally dysregulated/undercontrolled' cluster showed more eating disorder, depressive and ADHD symptoms, and poorer performance in the labyrinth task. The findings support the assumptions regarding the heterogeneity of obesity and the association between temperament subtypes and psychopathology. Copyright © 2014 John Wiley & Sons, Ltd and Eating Disorders Association.
    European Eating Disorders Review 07/2014; 22(4). DOI:10.1002/erv.2294 · 2.46 Impact Factor
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    • "Our psychiatric evaluation is a part of the standardized pre-treatment evaluation process. However, patients might be worried about disclosing psychiatric problems if they thought it would affect their treatment, which may have lowered the prevalence of psychiatric disorders, as Muhlhans et al. [12] mentioned. "
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    ABSTRACT: Background Obese and overweight people have a higher risk of both chronic physical illness and mental illness. Obesity is reported to be positively associated with psychiatric disorders, especially in people who seek obesity treatment. At the same time, obesity treatment may be influenced by psychological factors or personality characteristics. This study aimed to understand the prevalence of mental disorders among ethnic Chinese who sought obesity treatment. Methods Subjects were retrospectively recruited from an obesity treatment center in Taiwan. The obesity treatments included bariatric surgery and non-surgery treatment. All subjects underwent a standardized clinical evaluation with two questionnaires and a psychiatric referral when needed. The psychiatric diagnosis was made thorough psychiatric clinic interviews using the SCID. A total of 841 patients were recruited. We compared the difference in psychiatric disorder prevalence between patients with surgical and non-surgical treatment. Results Of the 841 patients, 42% had at least one psychiatric disorder. Mood disorders, anxiety disorders and eating disorders were the most prevalent categories of psychiatric disorders. Females had more mood disorders and eating disorders than males. The surgical group had more binge-eating disorder, adjustment disorder, and sleep disorders than the non-surgical group. Conclusion A high prevalence of psychiatric disorders was found among ethnic Chinese seeking obesity treatment. This is consistent with study results in the US and Europe.
    BMC Psychiatry 01/2013; 13(1):1. DOI:10.1186/1471-244X-13-1 · 2.21 Impact Factor
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