PRE‐OPERATIVE PSYCHIATRIC ASSESSMENT OF PATIENTS PRESENTING FOR GASTRIC BARlATRlC SURGERY (SURGICAL CONTROL OF MORBID OBESITY)

Abstract

One hundred and fifty‐three consecutive patients referred to the Royal Prince Alfred Hospital for consideration of gastric bariatric (surgery obesity) were assessed pre‐operatively by the one psychiatrist. with regard to social, psychological and psychiatric factors. Fifty‐one patients (33%) were considcrcd to be uncomplicated from a psychiatric point of view. Eighty‐eight patients (58%) had identifiable psychopathology and 14 patients (9%) were of doubtful motivation. Thirty patients (20%) were rejected from the treatment programme after the initial assessment because of overt psychiatric illness. severe situational stress. insufficient motivation or lack of significant support. Six of these patients after further assessment or after responding to psychiatric treatment were reviewed and found suitable for a bariatric operation. Of the 113 patients who had a bariatric procedure performed, 17 patients (15%) required postoperative psychiatric management. While the need for psychiatric assessment of patients presenting for bariatric surgery is disputed by some, our experience would indicate that careful pre‐operative screening by a liaison psychiatrist, familiar with morbid obesity and its surgical management, is useful in any bariatric surgical programme. Such screening should identify and enable exclusion of the small number of patients who for psychiatric reasons, are poor risk candidates. A number of other patients in whom identifiable psychopathology will be discerned. will require pre‐operative psychiatric management. While such a programme will decrease postoperative psychiatric problems, these will not be eliminated in the morbidly obese, and the assessing liaison psychiatrist will have a valuable role to play in the collaborative postoperative management of such patients.

Does obesity surgery improve psychosocial functioning? A systematic review

“…The other studies used presurgery interviews and postsurgery questionnaires or only questionnaires. 67 Presurgery prevalence of axis I psychiatric disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Diseases (DSM-III, 68 DSM-III R 69 varied between 27.3 60 and 41.8% 61 and of axis II between 22 and 24%. [64][65][66] Axis I diagnoses, when divided into the single psychiatric disorders, 60,61,64 were predominantly affective disorders, anxiety disorders, and eating disorders.…”

“…67 Presurgery prevalence of axis I psychiatric disorders according to the criteria of the Diagnostic and Statistical Manual of Mental Diseases (DSM-III, 68 DSM-III R 69 varied between 27.3 60 and 41.8% 61 and of axis II between 22 and 24%. [64][65][66] Axis I diagnoses, when divided into the single psychiatric disorders, 60,61,64 were predominantly affective disorders, anxiety disorders, and eating disorders. Compared to presurgery status prevalence rates of axis I, psychiatric disorders were considerably less at follow-up, ranging from no diagnosis, 60 one-half, 64 or one-third 61 of the presurgical rate.…”

“…[64][65][66] Axis I diagnoses, when divided into the single psychiatric disorders, 60,61,64 were predominantly affective disorders, anxiety disorders, and eating disorders. Compared to presurgery status prevalence rates of axis I, psychiatric disorders were considerably less at follow-up, ranging from no diagnosis, 60 one-half, 64 or one-third 61 of the presurgical rate. Personality disorders (axis II) did not change considerably after surgery.…”

“…Personality disorders (axis II) did not change considerably after surgery. 61,64 Anxiety and depression ratings Besides psychiatric disorders which are mainly diagnosed by psychiatric interviews, the majority of studies assessed psychological symptoms such as depression and anxiety by means of standardized or self-made questionnaires. Four studies 55,64,70,71 evaluated anxiety and/or depressive symptoms on a quantitative basis using psychometric test procedures.…”

“…[60][61][62][63][64][65][66][67] Psychiatric disorders were diagnosed by standardized, 61,62 structured, [62][63][64] clinical 65,66 interviews and standardized questionnaire. 67 Four studies 61,[64][65][66] used psychiatric interviews pre-and postsurgery. The other studies used presurgery interviews and postsurgery questionnaires or only questionnaires.…”