Psychiatric Disorder Comorbidity and Association With Eating Disorders in Bariatric Surgery Patients: A Cross-Sectional Study Using Structured Interview-Based Diagnosis

ArticleinThe Journal of Clinical Psychiatry 67(7):1080-5 · August 2006with89 Reads
DOI: 10.4088/JCP.v67n0710 · Source: PubMed
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.
    • "In addition, individuals with obesity who seek weight loss treatment exhibit more psychopathology than individuals with obesity from community samples [16,98,99]. Patients with severe obesity and/or those seeking surgical weight loss treatment are more likely to report current or lifetime mood and anxiety disorders (particularly posttraumatic stress disorder, social phobia, and panic disorder) [3,6,19,98,[100][101][102][103][104][105][106][107][108][109]. The relationship between presurgical psychopathology and WLS outcomes appears to be complex. "
    [Show abstract] [Hide abstract] ABSTRACT: Psychosocial factors have significant potential to affect long-term outcomes of bariatric surgery, including emotional adjustment, adherence to the recommended postoperative lifestyle regimen, weight loss outcomes, and comorbidity improvement/resolution. Thus, it is recommended that bariatric behavioral health clinicians with specialized knowledge and experience be involved in the evaluation and care of patients both before and after surgery. The evaluating clinician plays a number of important roles in the multidisciplinary treatment of the bariatric patient. Central among these is the role of identifying factors that may pose challenges to optimal surgical outcome and providing recommendations to the patient and bariataric team on how to address these issues. This document outlines recommendations for the psychosocial evaluation of bariatric surgery patients, appropriate qualifications of those conducting these evaluations, communication of evaluation results and suggested treatment plan, and the extension of behavioral health care of the bariatric patient to the entire span of the surgical and post-surgical process.
    Article · Feb 2016
    • "The prevalence of extreme obesity (body mass index ≥ 40 kg/ m2) in the US has increased from 4.8% in 2003–2004 [42] to 6.4% in 2011–2012 [41]. Patients with the most severe forms of obesity have the highest risk of medical comorbidities [20] , but also of psychiatric co- morbidities [22,23,43,56]. The latter also holds for obese people seeking surgical weight loss treatment, who show psychological disturbances including depression, anxiety disorders as well as eating disorders [1,15]. "
    [Show abstract] [Hide abstract] ABSTRACT: (Morbid) obesity is a chronic harmful condition with high risk of medical comorbidities and negative social and emotional consequences. Bariatric surgery is an effective intervention for obesity, but approximately 20 to 30% of the patients experience adverse outcomes after surgery and there is a need for augmentation of current treatment strategies. This study examines the added value of pre-operative cognitive behavioral therapy (CBT) focused on modification of thoughts and behaviors in terms of eating behavior and physical exercise as well as preparation for surgery and postoperative life style. We hypothesize that pre-operative CBT will result in better weight loss maintenance on the long term as compared to bariatric surgery alone with a regular preoperative program. One hundred and twenty eight patients that are on a waiting list for bariatric surgery are randomly assigned to the control or treatment condition. Patients in the treatment condition receive 10 sessions of CBT before surgery aimed at modifying dysfunctional eating habits and behaviors and developing more rational weight and body-related beliefs in order to enable long term maintenance of a healthier lifestyle after surgery. Weight loss, eating behavior, eating disorders, depression, quality of life and psychological distress are assessed before and after treatment, as well as 1, 3, and 5 year following surgery. Copyright © 2015. Published by Elsevier Inc.
    Full-text · Article · Apr 2015
    • "Although gender difference in the prevalence of psychiatric disorders was reported in general population [44, 46], these findings could not replicate in all pre-surgical studies on obesity [30, 31, 34]. However, some studies found gender difference in their rates of psychiatric disorders [5, 29, 32] and specific disorders also showed differences, for example, eating disorder [32], major depressive disorder, and anxiety disorders [28]. Explanations for this difference are gender-specific illness behavior and help-seeking habits that might be shaped by societal pressure of thinness. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Obesity and psychiatric disorders are burdensome health problems commonly observed in general population and clinical samples. However, non-standardized assessment and small size of the sample might hamper conclusions of the investigations. The objective of this study is to replicate previous findings on frequency of psychiatric disorders and associated factors among obese patients seeking bariatric surgery, assessed through standardized interview. Material and method: The sample was comprised of 393 treatment-seeking obese patients (79.1% women; mean age 43.0 years, mean BMI 47.8 kg/m(2)) recruited from a university-based bariatric center. Trained clinicians ascertained the psychiatric diagnosis of the participants through structured clinical interview for DSM-IV Axis I diagnosis (SCID-I). Results: The current rate of any psychiatric disorders was 57.8% (58.5% men vs. 57.6% women). The current anxiety disorders were the most frequent diagnosis (46.3%) among those participants with current disorder. Age and educational level were associated with the likelihood of presenting current psychiatric disorders. The lifetime rate of any psychiatric disorders was 80.9% (81.7 men vs. 80.7% women). Lifetime affective disorders were the most frequent diagnosis (total 64.9%; bipolar disorders 35.6% and depressive disorders 29.3%). About half of the sample presented 3 or more concurrent disorders among those respondents presenting any lifetime psychiatric disorders. Conclusions: Psychiatric disorders are frequent conditions among obese patients before bariatric surgery. Systematic assessment of patients in the pre-surgical phase is recommended. Prognostic implications of psychiatric disorders on surgery outcome should be demonstrated in follow-up study.
    Full-text · Article · Oct 2014
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