Psychiatric Comorbidities in Obese Patients Seeking Surgical Intervention

Abstract

SUMMARY O besity is considered a complex, multifactorial disorder. When obesity achieves the level of ‘morbid obesity’, it is associated with adverse effects on almost all the organ systems and can dramatically decrease the life expectancy and quality of life of its victims. Bariatric surgeries offer for these patients the opportunity to experience significant weight loss that can be maintained. The number of obese patients seeking bariatric surgery is steadily rising. Aim of the work:  To detect psychiatric comorbidities in patients with obesity seeking surgical intervention.  To determine the prevalence of psychiatric disorders in a sample of obese people seeking bariatric treatment.  To review the importance of psychiatric assessment before bariatric surgery and the follow up of psychological health to guarantee the optimal results of bariatric operations.

This study included two parts: 1. Theoretical part: It includes 4 chapters  Chapter I: Obesity (An overall review): This chapter defines obesity and its measurements. It also shows its epidemiology, the pathogenesis and pathophysiology of obesity, its etiology and factors leading to obesity as genetical, endocrinal, physiological, psychological factors and medications might cause obesity. This chapter also shows the consequences of obesity as medical, psychological and economic consequences.  Chapter II: Management of Obesity: This chapter discusses non surgical and surgical management of obesity and shows different types of bariatric surgeries.  Chapter III: Obesity and Mental Health: This chapter discusses stigma of obesity experienced by obese patients, and the impact of obesity on mental health. It shows the relationship between obesity and depression and obesity and anxiety disorder according to several studies and also shows the relation between obesity and eating disorders.

 Chapter IV: Psychiatric Assessment in subjects seeking bariatric surgery. This chapter shows the benefits of psychiatric assessment before bariatric surgery according to recent studies, and shows how this preoperative assessment may affect the surgery outcome. 2. Clinical part:  Subjects and methods: This study is a cross- sectional study. Study populations are recruited from Obesity Clinic in the department of General Surgery at Hospitals of Ain Shams University. There were 80 patients with age ranging from 16 years to 57 years. 16 were males and 64 were females. Patients with mental retardation, developmental disability, endocrinal disease or genetic disease causing obesity, acute psychiatric pathology, handicap or with cognitive impairment, were excluded from this study. Methodology: 1- Psychiatric sheet of Institute of Psychiatry in Ain Shams University that covers the following parameters:  Age, sex, marital status, education and occupation.  History of psychiatric and medical illnesses.  Family history of obesity and psychiatric history.

2- Body Weight Evaluation: BMI will be calculated (kg/m2), after measurement of height (m) and weight (kg). 3- Tools: a. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I): It is a diagnostic exam used to determine DSM-IV Axis I disorders (major mental disorders). The Arabic version of (SCID-I) validated for use in this study is done by Dr Hatata (Kamel et al., 2006). b. The Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II): The SCID-II is the counterpart of the SCID for making DSM-IV Axis II diagnoses of personality disorders. The translated Arabic version of SCID-II validated for use is done by Dr Asaad. It was validated through its use in many studies that were conducted in the Institute of Psychiatry-Ain Shams University (Asaad, 1998). c. Body Image Questionnaire (BIQ), Shokeir (2002): It is a scale based on a phenomenon that, the body image is a mental picture of body, at a time of rest and movement or either. It is derived from internal perception of external appearance and internal body, as well as accompanied emotional experiences, and it’s reflection on interactions with self and others. The Arabic version done by, Dr. Zeinab Shokeir (2002).