Bariatric Surgery in a Patient with Possible Psychiatric Contraindications

Abstract

Grade III obesity (BMI > 39.9 kg/m2) is considered a chronic disease where clinical and diet therapy show poor results, with high rates of relapse. The most consistent results are those obtained through surgical procedures. Several authors discuss the contraindications for the performance of anti-obesity operations. Psychiatric disorders are often considered contraindications to these operations, especially affective disorders, psychotic disorders and personality disorders. The authors report the case of a 37-year-old patient, with obesity history since the age of 12, and anorexiant abuse (amphetamine-derived substances) during 20 years, binge-eating episodes, purgative compensatory behaviors and recurrent depressive symptoms. She was submitted to anti-obesity surgery in August 2000 (BMI 40.2). The outcome is reported and a discussion of the possible psychiatric contraindications for the anti-obesity surgeries is proposed.

Psychosocial Predictors of Success following Bariatric Surgery

“…38,50 Thus, many authors do not contraindicate obesity surgery based on psychiatric disorders, provided that there is adequate preand postoperative psychiatric support. 48,83 In addi-tion, some workers suggest that, because candidates for bariatric surgery frequently show high levels of psychopathology, if subjects were excluded because of a history of psychiatric illness, few patients would be eligible for surgery. 48 There are even some studies that suggest that a history of having received treatment for a psychiatric disorder or substance abuse may be prognostic of favorable outcome; perhaps having participated in successful treatment may have assisted individuals in the development of skills for lifestyle change.…”

Indicações e contra-indicações para realização das operações bariátricas

“…Contudo não há dados precisos nem fatores preditivos de bom ou mau prognóstico adequadamente estudados e/ou comprovados. [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38] Esta é uma área de interesse, não só do ponto de vista científico como também clínico.…”

“…21,[28][29][30][38][39][40][41][42] Os resultados promissores não significam que pacientes candidatos às operações não necessitem de correto acompanhamento psicológico e psiquiátrico nas diversas fases do tratamento bariátrico. Estes pacientes apresentam maior associação com quadros psiquiátricos e o não tratamento adequado das patologias pode ameaçar seu prognóstico.…”

Variáveis psicossociais no excesso de peso e na obesidade infantil

“…During infancy the existence of childhood psychopathology tends to be higher among clinical populations of obese children and adolescents, and the major psychological consequences of obesity are low self-esteem, poor social interaction, depression and control disturbance 18 . Some authors report that at the level of psychological disorders, the most common is depression, and also the anxiety disorders 19,20 . A longitudinal study developed by Mustillo and colleagues with 991 children aged 9 to 16 years has shown that childhood obesity was not associated with problems of depression, with only the group with chronic obesity had psychiatric problems 21 .…”