Psychological Evaluation of Bariatric Surgery Applicants: Procedures and Reasons for Delay or Denial of Surgery

Walfish, Steven; Vance, Dana; Fabricatore, Anthony N.

doi:10.1007/s11695-007-9274-0

Cited by 126 publications

(86 citation statements)

References 9 publications

(23 reference statements)

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“…This same position is advocated by more recent studies that consider that preoperative psychological assessments should identify and propose treatment of pathological situations, rather than excluding the patient from surgery [15][16][17][18][19][20] . There is no doubt that indexes of depression, anxiety, and other diseases persist and may increase in the 18 to 24 months after bariatric surgery.…”

Section: Discussionmentioning

confidence: 94%

Abordagem psicológica em cirurgia plástica pós-bariátrica

Pinho¹,

Chillof²,

Mendes

et al. 2011

Rev. Bras. Cir. Plást.

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Nowadays, plastic surgery plays an important role in the surgical treatment of morbid obesity, and it is used to restore optimal body contour in a large number of patients with massive weight loss. The outcome of surgery may affect the patient's psychological behavior, and a multispecialty approach should be adopted, before and after the gastric bypass, to better educate and prepare patients for the dramatic changes they will experience in their body image. The increase in bariatric surgery has also resulted in a greater demand for plastic surgery. In addition to the multispecialty services, patients are seeking out private practice surgeons who will need to recognize and manage the psychological aspects of candidates who undergo body reshaping. This paper reviews the literature on the complex psychological environment of obese patients, emphasizing the identification and management of psychological disorders, and providing plastic surgeons with tools for safer planning and superior outcomes in body contouring after massive weight loss.Keywords: Mental disorders. Plastic surgery. Bariatric surgery. Motivation. RESUMOAtualmente, a cirurgia plástica vem se firmando cada vez mais como parte integrante do tratamento cirúrgico da obesidade mórbida, na medida em que visa a devolver as melhores condições de contorno corporal ao enorme contingente de pacientes submetidos a grandes perdas ponderais. Os aspectos peculiares que acompanham essa nova trajetória do paciente obeso exigem abordagem interdisciplinar, com cuidadoso acompanhamento psicológico, antes e depois da cirurgia bariátrica, que deverá prepará-lo continuamente para as grandes transformações impostas a sua imagem corporal. Com a popularização das gastroplastias e a crescente demanda por procedimentos de contorno corporal após grandes emagrecimentos, é cada vez mais comum a presença desses pacientes nos consultórios de cirurgiões que não estão ligados aos serviços multidisciplinares, e que, portanto, precisam conhecer, avaliar e lidar também com os aspectos psicológicos envolvendo candidatos a cirurgia plástica pós--bariátrica. Este trabalho estabelece uma revisão da literatura acerca do complexo ambiente psicológico na obesidade, voltada para o cirurgião plástico, com ênfase na identificação e no controle das condições psíquicas desfavoráveis, possibilitando o melhor planejamento operatório em pacientes com perda significativa de peso após cirurgia bariátrica.Descritores: Transtornos mentais. Cirurgia plástica. Cirurgia bariátrica. Motivação.

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Section: Discussionmentioning

confidence: 94%

Abordagem psicológica em cirurgia plástica pós-bariátrica

Pinho¹,

Chillof²,

Mendes

et al. 2011

Rev. Bras. Cir. Plást.

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“…Although our evaluation process was standardized and executed by experienced psychiatrists, this potential bias cannot be fully ruled out. For this reason the use of psychometric rating instruments with internal correction and validity scales like the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) has been suggested [55]. Furthermore the PHQ did not reach the same diagnostic sensitivity compared to other psychometric tests [56,57], especially regarding dysthymia [57].…”

Section: Limitationsmentioning

confidence: 99%

Screening for Psychiatric Disorders in Bariatric Surgery Candidates with the German Version of the Patient Health Questionnaire

Palm

Thasler

Rittler

et al. 2014

Advances in Psychiatry

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Objective. Obesity has been linked to psychiatric disorders in several studies. Prevalence and severity of psychiatric disorders are high in patients undergoing bariatric surgery. Thus, psychiatric assessment of bariatric surgery candidates has become a standard procedure. However, socially desirable responding leads to biased results in self-reported questionnaires. Here, bariatric surgery candidates were screened with the Patient Health Questionnaire (PHQ-D) additionally to the psychiatric examination. Method. 355 bariatric surgery candidates filled in the PHQ-D before the psychiatric examination as a part of the surgery assessment procedure. PHQ-D results were compared to psychiatric diagnoses and body mass index (BMI). Results. Gender ratio, mean BMI, and age were comparable to earlier studies. Depressive and somatization symptoms did not correlate to BMI. However, females showed higher prevalence of psychiatric disorders with elevated syndrome severity in depressive and somatization disorders, as well as more frequent antidepressant intake. Eating disorders and addiction disorders were rarely reported. Conclusion. The findings suggest a socially desirable responding when filling in the PHQ-D before bariatric surgery. The use of the PHQ-D in this patient sample could be augmented by psychometric tests with internal correction and validation scales. Furthermore, psychiatric examination should be separated from the surgery evaluation process.

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“…25 Social desirability can influence psychosocial assessment; therefore, measures with validity scales to detect for impression management that have been validated with bariatric surgery samples such as the MMPI-2 and MBMD can be helpful. [25][26][27][28] These inventories can provide insight into underlying psychopathology, potential characterological issues, compliance, and ability to develop a secure support system, all of which are areas that could affect the outcome of a bariatric surgical procedure. More specifically, the Restructured Clinical Scales of the MMPI-2, when used with bariatric surgery candidates, have been found to correlate with life dissatisfaction, judgment, insight, life satisfaction, behavioral impulsivity, adherence, and potential for substance abuse.…”

Section: 12mentioning

confidence: 99%

“…4 The most widely accepted psychiatric contraindications to bariatric surgery include active substance abuse, psychosis, uncontrolled mood or eating disorders, major life stressors, and history of problematic adherence, with disagreement about binge eating disorder. 11,25,[29][30][31] In sum, research and clinical experience suggest that, although the presence of a psychiatric disorder is not necessarily a contraindication to bariatric surgery, it may suggest the need for concomitant psychological intervention and additional interpersonal support pre-and postoperatively. Diabetes health care professionals can work collaboratively with psychologists to formulate creative, individualized, and empirically supported treatment plans for bariatric patients with diabetes.…”

Section: 12mentioning

confidence: 99%

Psychosocial Evaluation, Preparation, and Follow-Up for Bariatric Surgery Patients

Bagdade¹,

Grothe²

2012

Diabetes Spectrum

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In Brief Bariatric surgery has become a highly effective treatment intervention for morbidly obese patients struggling with comorbidities such as diabetes. Research has found that patients with certain psychosocial stressors may be at higher risk for postoperative complications, including weight regain. As a result, psychologists often play an integral role on an interdisciplinary bariatric team to aid with assessment and treatment of these patients by using empirically validated treatment recommendations to optimize outcomes.

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Psychological Evaluation of Bariatric Surgery Applicants: Procedures and Reasons for Delay or Denial of Surgery

Cited by 126 publications

References 9 publications

Abordagem psicológica em cirurgia plástica pós-bariátrica

Abordagem psicológica em cirurgia plástica pós-bariátrica

Screening for Psychiatric Disorders in Bariatric Surgery Candidates with the German Version of the Patient Health Questionnaire

Psychosocial Evaluation, Preparation, and Follow-Up for Bariatric Surgery Patients

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