Psychiatric disorder comorbidity and association with eating disorders in bariatric surgery patients: A cross-sectional study using structured interview-based diagnosis.
ABSTRACT This study examined the prevalence of DSM-IV Axis I psychiatric disorders in severely obese bariatric surgery candidates and explored whether eating disorders were associated with psychiatric comorbidity.
The Structured Clinical Interview for DSM-IV Axis I Disorders was administered to a study group of 174 consecutively evaluated bariatric surgery candidates. All evaluations were completed between September 2002 and November 2004.
Overall, 36.8% of the participants met criteria for at least one lifetime psychiatric disorder, with 24.1% meeting criteria for a current disorder. The most commonly observed lifetime psychiatric diagnoses were affective disorders (22.4%), anxiety disorders (15.5%), and eating disorders (13.8%). Participants with eating disorders were significantly more likely than those without eating disorders to meet criteria for psychiatric disorders overall (66.7% vs. 26.7%) and specifically for anxiety disorders (45.8% vs. 10.7%).
Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. The observed prevalence rates based on structured diagnostic interviews are lower than previously reported based on questionnaire, clinical, and chart review methods but are similar to those reported for nationally representative samples. Among bariatric surgery candidates, the presence of eating disorders is associated with higher rates of other psychiatric disorders. The findings highlight the importance of systematic diagnostic assessment using a structured diagnostic interview for determining the full spectrum of Axis I disorders.
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ABSTRACT: Objective To describe eating patterns, prevalence of problematic eating behaviors, and determine factors associated with binge eating disorder (BED), before bariatric surgery.Method Before surgery, 2,266 participants (median age 46 years; 78.6% female; 86.9% white; median body mass index 45.9 kg/m2) of the Longitudinal Assessment of Bariatric Surgery-2 (LABS-2) study completed eating behavior survey items in the self-administered LABS-2 Behavior form. Other measures included the Alcohol Use Disorder Identification Test, the LABS-2 Psychiatric and Emotional Test Survey, the Beck Depression Inventory, the Interpersonal Support Evaluation List-12, the Short Form-36 Health Survey, and Impact of Weight Quality of Life-Lite Survey.ResultsThe majority (92.1%) of participants reported eating dinner regularly, whereas just over half (54.0%) reported eating breakfast regularly. Half of the participants reported eating at least four meals/week at restaurants; two meals/week were fast food. Loss of control eating was reported by 43.4%, night eating syndrome by 17.7%; 15.7% satisfied criteria for binge eating disorder (BED), 2% for bulimia nervosa. Factors that independently increased the odds of BED were being a college graduate, eating more times per day, taking medication for psychiatric or emotional problems, and having symptoms of alcohol use disorder, lower self-esteem and greater depressive symptoms.DiscussionBefore undergoing bariatric surgery a substantial proportion of patients report problematic eating behaviors. Several factors associated with BED were identified, most suggesting other mental health problems, including higher levels of depressive symptomotology. The strengths of this study include the large sample size, the multi-center design and use of standardized assessment practices. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014)International Journal of Eating Disorders 04/2014; 48(2). · 3.03 Impact Factor
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ABSTRACT: The relationship between obesity and alcohol/drug misuse has been examined through both site studies and large epidemiological studies. In reviewing 19 site studies that have examined alcohol misuse among the obese, in comparison with rates before 1990, rates since 1990 have doubled (6.2% to 14.3%). Of the 7 studies that have examined drug misuse among the obese, rates average 8.0%. Given the potential limitations of varying study populations, methodologies, and prevalence assessments, these rates closely reflect those in the general population, according to data from the National Comorbidity Survey Replication study. As for the findings from 5 large epidemiological studies, Overall, findings do not clearly support the contention that obese individuals are at a higher risk for substance misuse, although specific sub-populations of the obese may be (e.g., those with Cluster B personality disorders). If there is an association between some obese populations and substance abuse, this may be accounted for by overlapping neurohormonal correlates. However, some authorities contend that food and drugs compete for the same reward pathways in the brain, suggesting that obesity may actually be protective against substance misuse.Innovations in Clinical Neuroscience 01/2013; 10(9-10):30-35.
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ABSTRACT: Bariatric surgery candidates have higher rates of co-morbid psychological illnesses than those in the general population. The effect of weight loss on these illnesses is unclear. This prospective observational study explored psychiatric co-morbidities and weight loss outcomes in 204 gastric banding surgery candidates. Psychiatric co-morbidities were assessed prior to surgery and 2 years post-surgery. One hundred and fifty patients (74 %) completed assessments at both time points. At baseline, 39.7 % of the patients met the criteria for a current axis I disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). Mood disorders were the most frequent (26.5 %), followed by anxiety disorders (15.2 %) and binge eating disorder (13.2 %). Preoperative psychopathology predicted clinical psychopathology at 2 years. No preoperative or post-operative axis I disorder was significantly related to weight loss at 2 years. The frequency of current axis I disorders decreased significantly from 39.7 % preoperatively to 20 % 2 years post-surgery. The point prevalence of psychopathology in this sample of Australian bariatric candidates is high. Psychopathology, preoperatively and at 2 years of follow-up, was not associated with weight loss at 2 years.Obesity Surgery 02/2014; · 3.74 Impact Factor