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Unformatted text preview: Module 1 --- Article 7 TREATMENT HIGHLIGHTS PSYCHIATRIC DISORDERS AMONG BARIATRIC SURGERY CANDIDATES Among patients applying for bariatric surgery, both past and current psychiatric disorders are found to be common and are associated with both greater severity of obesity and a poorer functional health status. Demographic and clinical information were collected from 288 patients seeking bariatric surgery. Psychiatric disorders were assessed using the Structured Clinical Interview for DSM-IV1 (SCID). Functional health status was assessed using the Medical Outcomes Study 36-item Short-Form Health Survey, which includes 8 subscales (the first 4 of which assess physical health and the remaining 4 of which assess emotional health): physical functioning, role limitations due to physical health, pain, general health perceptions, role limitations due to emotional problems, energy/fatigue, emotional well-being, and social functioning. All assessments were conducted independently of preoperative screening. Among the participants, 66.3% met criteria for a lifetime history of an Axis I disorder, 37.8% had a current Axis I disorder, and 28.5% had an Axis II disorder. 25% met criteria for both an Axis I and an Axis II disorder. The authors comment that current disorders may have been underreported, leading to a discrepancy between lifetime and current diagnoses. Lifetime prevalences of mood, anxiety, and substance use disorders were 45.5%, 37.5%, and 32.6%, respectively, compared to estimates from the general population (based on the 2001-2003 National Comorbidity Survey Replication) of 20.8%, 28.8%, and 14.6%, suggesting a higher level of psychopathology among bariatric surgery candidates. Having an Axis I disorder (either current or lifetime) was associated with higher BMIs.2 Also, lifetime diagnosis of an Axis I or Axis II disorder was associated with poorer functional health status. The authors conclude that “this investigation provides compelling evidence that psychiatric disorders are a major concern for this patient population, not only because they are relatively common but also because they are associated with severity of obesity and decreased functional health status.” The authors note that bariatric surgery has been found to be ineffective for 20% of patients in that they either fail to lose weight or regain much of the weight they lost after surgery. The authors suggest that “in light of the sharply increasing number of patients who opt for surgical treatment of obesity, targeted interventions to help patients achieve optimal surgery preparation and outcome will have a strong public health impact.”
1 2 Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), Washington DC: American Psychiatric Association, 1994. BMI refers to body mass index. BMI = [weight in kilograms] divided by [height in meters, squared]. To determine BMI using pounds for weight and inches for height, see the chart in the March 2007 issue of The Complete Practitioner (also in the March 2007 Assessment entry in the Subscribers’ Area of our Web site); or go to http://www.nhlbisupport.com/bmi. Kalarchian MA, Marcus MD, Levine MD, et al. Psychiatric disorders among bariatric surgery candidates: Relationship to obesity and functional health status. American Journal of Psychiatry, 164:328-334, 2007. Support: University of Pittsburgh Obesity & Nutrition Research Center; National Institute of Diabetes, Digestive & Kidney Diseases. ©Copyright 2011 MWK Publishing LLC; from The Complete Practitioner: Mental Health Applications (Vol. 10, No. 4 -- April 2007) For next article, go to next page. ...
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This note was uploaded on 02/10/2011 for the course PCO 4930 taught by Professor Neimeyer during the Spring '09 term at University of Florida.
- Spring '09