Surgical Management of Obesity Among People with Schizophrenia and Bipolar Disorder: a Systematic Review of Outcomes and Recommendations for Future Research

Kouidrat, Youssef; Amad, Ali; Stubbs, Brendon; Moore, Suzan; Gaughran, Fiona

doi:10.1007/s11695-017-2715-5

Cited by 25 publications

(5 citation statements)

References 44 publications

(78 reference statements)

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“…When examining weight loss outcomes, despite demonstrating a significant drop in 6 month %EBWL, DAB patients had comparable results 1 year after BS. Although earlier literature on this subject has suggested patients with psychiatric histories are associated with decreased post-operative weight loss outcomes [2], our weight loss outcome data are in agreement with recent literature on the subject [3, 5, 7, 9, 10]. A large multicenter study which reviewed outcomes after bariatric surgery for over 8000 patients found no association between psychiatric disorders and lower weight loss outcomes after BS.…”

Section: Discussionsupporting

confidence: 90%

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

et al. 2018

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Background The impact of well-controlled or historical psychiatric diagnoses in patients seeking bariatric surgery (BS) on perioperative outcomes is unclear. The primary objective of this study was to determine the impact of psychiatric diagnoses on hospital length of stay (LOS), 30-day readmission rates after BS, and post-operative weight loss outcomes. Methods Patients who underwent laparoscopic sleeve gastrectomy (LSG) or Roux-en-Y gastric bypass (LRNYGB) from 2014 to 2016 at a single academic institution were retrospectively reviewed. Baseline demographic data and psychiatric history including depression, anxiety, and/or bipolar disorder (DAB) were obtained from the electronic medical record. Hospital LOS, 30-day readmissions, and % excess body weight loss (%EBWL) were obtained on all patients and compared between DAB patients and those without any psychiatric history. Results During the study period, 354 patients were reviewed, of which 78% were female; 60% underwent LSG. The mean preoperative BMI was 48.9 ± 8.4 m/kg2. Major depression was the leading diagnosis (42%), and 13% had both depression and anxiety. The 30-day readmission rate was significantly higher than the control (10.5% vs. 3.7%, p = 0.02). Mean hospital LOS and the incidence of long hospital LOS (≥ 4 days) was not different between the groups, although within LSG patients, the incidence of long hospital LOS trended towards being higher for DAB patients (9.2% vs. 4%, p = 0.10). Patients with depression and anxiety had a higher incidence of long LOS (23.4% vs. 9.2%, p < 0.005). While 6-month %EBWL was significantly lower for DAB patients (41% vs. 46%, p = 0.004), 1-year weight loss outcomes were not different, even when adjusting for surgical procedure. Conclusion Patients with baseline or historical DAB had significantly higher early readmission rates, and those with multiple diagnoses were associated with a hospital LOS ≥ 4 days. Future studies should focus on elucidating the impact of psychiatric diagnoses on these quality metrics.

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Section: Discussionsupporting

confidence: 90%

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

et al. 2018

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“…However, similar to other obesity-driven phenotypes such as physical inactivity (Friend et al., 2017), anxiety-like behavior is not simply caused by increased body mass. Interestingly, loss of body weight alone does not always correspond to improvements in mental health, e.g., after bariatric surgery (Canetti et al., 2016, Cunningham et al., 2012, Fisher et al., 2017, Kouidrat et al., 2017, Matini et al., 2014). Thus, the mechanistic basis of obesity-induced anxiety-like behavior is not yet fully understood.…”

Section: Discussionmentioning

confidence: 99%

Obesity-Induced Cellular Senescence Drives Anxiety and Impairs Neurogenesis

et al. 2019

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Summary Cellular senescence entails a stable cell-cycle arrest and a pro-inflammatory secretory phenotype, which contributes to aging and age-related diseases. Obesity is associated with increased senescent cell burden and neuropsychiatric disorders, including anxiety and depression. To investigate the role of senescence in obesity-related neuropsychiatric dysfunction, we used the INK-ATTAC mouse model, from which p16 Ink4a -expressing senescent cells can be eliminated, and senolytic drugs dasatinib and quercetin. We found that obesity results in the accumulation of senescent glial cells in proximity to the lateral ventricle, a region in which adult neurogenesis occurs. Furthermore, senescent glial cells exhibit excessive fat deposits, a phenotype we termed “accumulation of lipids in senescence.” Clearing senescent cells from high fat-fed or leptin receptor-deficient obese mice restored neurogenesis and alleviated anxiety-related behavior. Our study provides proof-of-concept evidence that senescent cells are major contributors to obesity-induced anxiety and that senolytics are a potential new therapeutic avenue for treating neuropsychiatric disorders.

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“…Careful patient selection including optimized preoperative psychiatric care has the potential to improve outcomes. As mentioned by Kouidrat et al, the focus on pre-surgical evaluation should be on the severity of psychiatric symptoms, mental stability, and psychotropic medication, since these factors have a relevant influence on the surgical outcome 35 . Special attention should be paid to a closer monitoring and tailored, supportive psychological therapy with the aim of improving weight loss outcomes in patients with known mental illness.…”

Section: Discussionmentioning

confidence: 99%

Mental Illness Has a Negative Impact on Weight Loss in Bariatric Patients: a 4-Year Follow-up

Mûller

Nett

Borbély

et al. 2019

Journal of Gastrointestinal Surgery

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Surgical Management of Obesity Among People with Schizophrenia and Bipolar Disorder: a Systematic Review of Outcomes and Recommendations for Future Research

Abstract: Growing evidence suggests that bariatric surgery may improve short-term weight status among people with BD. However, given the paucity of studies for schizophrenia, and the lack of information on medium-to long-term results, future large-scale high-quality studies are required.

Cited by 25 publications

References 44 publications

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Baseline psychiatric diagnoses are associated with early readmissions and long hospital length of stay after bariatric surgery

Obesity-Induced Cellular Senescence Drives Anxiety and Impairs Neurogenesis

Mental Illness Has a Negative Impact on Weight Loss in Bariatric Patients: a 4-Year Follow-up

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