Article

Mood disorders in laparoscopic sleeve gastrectomy patients: Does it affect early weight loss?

Cleveland Clinic, Cleveland, OH 44195, USA.
Surgery for Obesity and Related Diseases (Impact Factor: 4.07). 03/2010; 6(2):191-6. DOI: 10.1016/j.soard.2009.11.017
Source: PubMed

ABSTRACT

Research has demonstrated that laparoscopic Roux-en-Y gastric bypass patients with a lifetime history of a mood disorder have a lower percentage of excess weight loss (%EWL) compared with patients without this lifetime history. No studies have examined the effect of psychiatric history on postoperative outcomes among laparoscopic sleeve gastrectomy (LSG) patients. The objectives of the present study were to determine whether mood disorders relate to the first year of weight loss for patients undergoing LSG at an academic medical center.
A total of 104 patients (78.6% white and 71.2% women), with a median body mass index of 60.35 kg/m(2) (range 31.37-129.14) underwent LSG. The patients were prospectively followed up at 1, 3, 6, 9, and 12 months. The semistructured preoperative psychiatric evaluations demonstrated that 43.1% had a current, and 62.5% a lifetime, diagnosis of a mood disorder.
LSG patients with current mood disorders had a significantly lower %EWL than patients without a psychiatric diagnosis at the 1-, 3-, 6-, and 9-month follow-up visits. LSG patients with a lifetime history of a mood disorder had a significantly lower %EWL than patients without psychiatric diagnosis at the 1-, 9-, and 12-month follow-up examinations. However, after removing patients with bipolar disorder from the analyses, no significant differences were found in the %EWL between patients with and without a lifetime history of depressive disorders.
Consistent with the laparoscopic Roux-en-Y gastric bypass findings, a lifetime history of mood disorders appears to be associated with significantly less weight loss in LSG patients. These findings highlight the importance of the psychiatric assessment in bariatric patients. Additionally, patients with a current or lifetime history of mood disorders might need additional pre- and postoperative care to improve their outcomes.

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    • "The prevalence rate for alcohol abuse 2 years postoperatively is 9.6% and is statistically higher than the presurgical prevalence rate, although it is unrelated to weight loss [11]. In terms of factors related to internalizing psychopathology (mood-and anxiety-related problems), some reports suggest that a presurgical presence of a mood or anxiety disorder impedes weight loss outcomes [12] [13] [14], whereas others suggest no association [13] [15] or enhanced outcomes [16] between measures of mood or anxiety and weight loss outcomes. Because of these high rates of psychosocial comorbidities and their potential impact on treatment, the American Society for Metabolic and Bariatric Surgery (ASMBS) [17] recommends multidisciplinary assessment of the bariatric surgery candidates that includes presurgical psychological screening [18]. "
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    ABSTRACT: Previous studies suggest that presurgical psychopathology accounts for some of the variance in suboptimal weight loss outcomes among Roux-en-Y gastric bypass (RYGB) patients, but research has been equivocal. The present study seeks to extend the past literature by examining associations between presurgical scale scores on the broadband Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and suboptimal weight loss and poor adherence to follow-up 1 year postoperatively after accounting for several methodologic considerations. Cleveland Clinic Bariatric and Metabolic Institute, Cleveland, Ohio, USA. The sample consisted of 498 RYGB patients, who produced a valid presurgical MMPI-2-RF protocol at program intake. The sample was primarily female (72.9%), Caucasian (64.9%), and middle-aged (mean = 46.4 years old; standard deviation [SD] = 11.6). The mean presurgical body mass index (BMI) was 47.4 kg/m(2) (SD = 8.2) and mean percent weight loss (%WL) at 1 year postoperatively was 31.18 %WL (SD = 8.44). As expected, scales from the Behavioral/Externalizing Dysfunction (BXD) domain of the MMPI-2-RF were associated with worse weight loss outcomes and poor adherence to follow-up, particularly after accounting for range restriction due to underreporting. Individuals producing elevated scores on these scales were at greater risk for achieving suboptimal weight loss (<50% excess weight loss) and not following up with their appointment compared with those who scored below cut-offs. Patients who are more likely to engage in undercontrolled behavior (e.g., poor impulse control), as indicated by presurgical MMPI-2-RF findings, are at greater risk for suboptimal weight loss and poor adherence to follow-up following RYGB. Objective psychological assessments should also be conducted postoperatively to ensure that intervention is administered in a timely manner. Future research in the area of presurgical psychological screening should consider the impact of underreporting and other discussed methodologic issues in predictive analyses. Copyright © 2015 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
    No preview · Article · Apr 2015 · Surgery for Obesity and Related Diseases
    • "Consequently, the absence of clinically elevated scores on the substantive scales cannot be interpreted as indicating the absence of problems assessed by those scales [13]. The more homogenous substantive scales of the MMPI-2- RF assess broadband psychological constructs associated with many psychological disorders that are prevalent among bariatric surgery candidates [1] [2] [3] [4] [5] [6]. Specifically, the MMPI-2- RF substantive scales assess constructs associated with emotional, behavioral, and thought dysfunction as well as various somatic/cognitive complaints and interpersonal functioning. "
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    ABSTRACT: Background Presurgical Psychological Screening (PPS) is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory – 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task. Objectives To explore whether there are clinically meaningful gender, ethnicity, or age differences in pre-surgical MMPI-2-RF scores and the validity of these scores in bariatric surgery candidates. Setting Cleveland Clinic Bariatric and Metabolic Institute, United States Methods The sample was composed of 872 men and 2337 women. Ethnicity/race groups included 2,204 Caucasian, 744 African American, and 96 Hispanic individuals. Ages groups included 18-35 year olds (n= 454), 36-49 year olds (n = 1154), 50-64 year olds, (n = 1246), 65 years old or older (n = 355). Validity data, obtained via a retrospective chart review, were available for a subset patients (n=1,268) who were similarly distributed. Step-down hierarchical regression analyses were conducted to assess for differential validity. Results Bariatric surgery candidates produced comparable MMPI-2-RF scores in all subsamples, indicating that the test norms generalize across demographic groups. Validity findings were also generally comparable, indicating that MMPI-2-RF scores have the same interpretive implications in demographically diverse subgroups of bariatric surgery candidates. Conclusions The MMPI-2-RF can assist in presurgical psychological screening of demographically diverse bariatric surgery candidates. http://www.soard.org/article/S1550-7289(14)00393-1/abstract#article-footnote-☆☆
    No preview · Article · Oct 2014 · Surgery for Obesity and Related Diseases
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    • "Identification of these disorders improves the quality of perioperative management and helps predict the weight loss outcome after bariatric surgery. For example, a lifetime history of mood disorder implies poor weight loss [16]. In a follow-up study, patients with two or more psychiatric diagnoses were significantly more likely to experience weight loss cessation or weight regain after 1 year compared with those with less than two psychiatric diagnoses [17]. "
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    ABSTRACT: Purpose of review Bariatric surgery has been consistently shown to be effective in long-term marked weight loss and in bringing significant improvement to medical comorbidities such as metabolic syndrome. Empirical data suggest a high prevalence of psychiatric disorders among bariatric surgery candidates. In this review, we focus on the studies published recently with a high impact on our understanding of the role of psychiatry in bariatric surgery. Recent findings This article reviews the specific psychopathologies before surgery, changes in psychopathologies after surgery, suicide risk related to bariatric surgery, factors associated with weight loss, and recommendations for presurgical and postsurgical assessment and management. Research indicates a decrease in certain psychiatric symptoms after weight loss with bariatric surgery. However, the risk of suicide and unsuccessful weight loss in some bariatric surgery patients make monitoring following surgery as important as careful assessment and management before surgery. Specific considerations for youth and older populations and future potential research foci are discussed. Summary Recent publications suggest new directions for psychiatric evaluation and interventions for bariatric surgery patients. Future research on outcomes of specific populations, effectiveness of psychopharmacotherapy, and underlying pathophysiology are warranted for the advancement of treating bariatric surgery patients.
    Full-text · Article · Jul 2014 · Current Opinion in Psychiatry
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