Güzin Mukaddes Sevinçer, Halil Coşkun, Numan KONUK, Süleyman BOZKURT

Bariatrik Cerrahinin Psikiyatrik ve Psikososyal Yönleri

Bariatrik cerrahi ülkemizde ve dünyada son on yıl içerisinde giderek popüler hale gelen ve daha çok tercih edilmeye başlayan bir obezite tedavi yöntemidir. Hastalar konvansiyonel tedavi yöntemleriyle yeterli kilo verememekte ya da verdikleri kiloları kolayca geri almaktadırlar. Hastaların bariatrik cerrahi ile hızlı kilo vermeleri ve obeziteye komorbid hastalıklarda da düzelmenin beraberinde gelmesi sebebiyle bariatrik cerrahi uygulanan hasta sayısı her geçen gün artmaktadır. Gerek obezite gerekse bariatrik cerrahi psikiyatri ve psikososyal değişkenlerle karşılıklı ilişki içindedir. Psikiyatrik ve psikososyal konular daha hastanın değerlendirilmesi aşamasında, hastaların cerrahiye uygun olup olmamalarının değerlendirilmesi sürecinde başlar. Bu hastaları değerlendirmede incelenmesi gereken diğer konular; cerrahi öncesi hastanın herhangi bir psikopatolojisinin var olup olmadığı, cerrahi işlem ve sonrası ile ilgili bilgi düzeyi, cerrahi sonrası ortaya çıkması beklenen fiziksel, psikolojik ve sosyal değişikliklerle ilgili beklenti düzeyleri, cerrahi sonrası ortaya çıkabilecek davranış değişiklikleri ve tıbbi önerilere uyabilme kapasitesinin değerlendirilmesidir. Bu makalede obezite hastalığında bir tedavi yöntemi olarak bariatrik cerrahi hastalarının psikiyatrik ve psikososyal açıdan değerlendirmenin gerekliliği mevcut literatür ışığında gözden geçirilmiştir. Bariatrik cerrahinin muhtemel tıbbi, psikiyatrik ve psikososyal komplikasyonları ve ilgili konular gözden geçirilmiş olup bariatrik cerrahiden beklenen başarılı sonuç için psikiyatrik bozuklukların ne kadar öngörücü olabildiği ile ilgili literatür derlenmiştir. Bariatrik cerrahi hastalarında sıkça gözlenen özgül yeme bozukluklarının doğası ve başlı başına psikiyatrik bir hastalık mı yoksa cerrahi işlemlerle ilgili ayrı antiteler mi olduğu gibi tartışmalı konular yanında intihar gibi doğrudan cerrahi ile ilişkili psikopatolojilerin varlığına ait veriler aktarılmıştır. Pek çok araştırmada sonuç olarak, ileri sürüldüğü üzere multidisipliner anlayışın önemine vurgu yapan ve psikososyal değerlendirmenin kim tarafından, nasıl ve ne zaman yapılacağı ile ilgili tartışmalar da bu makale kapsamında özetlenmiştir.

Anahtar Kelimeler:

Bariatrik cerrahi, Psikiyatri, Obezite, Psikososyal Değerlendirme, Psikopatoloji

Psychiatric and Psychosocial Aspects of Bariatric Surgery

Bariatric surgery is a treatment modality which is becoming increasingly popular in the last decade in our country and around the world. Patients who treated with a conventional methods are unable to loose sufficient weight and even they regained most of their lost weight easily. The number of patients undergoing bariatric surgery are increasing day by day considering the success of bariatric surgery with regard to lose weight fast and the improvement in co-morbid conditions. Obesity and bariatric surgery are in a reciprocal relationship both with psychiatric disorders and psychosocial variables. Relations are begin with the evaluation of a patients eligibility for surgery in terms of psychiatric and psychosocial issues at a very early stage of the process. Presence of psychopathology, level of knowledge related to the surgical procedure and patients expectations about physical, psychological and social changes that may occur after surgery are the significant parts of the evaluation of bariatric surgery patients. These components should be considered in assessing capacity of patients to comply with medical advice in post-operative stage. In this article the needs for assesment of psychiatric and psychosocial aspects of obese patients who will undergo bariatric surgery is reviewed in the light of current literature . Possible medical, psychiatric and psychosocial complications of bariatric surgery and related issues are reviewed and psycosocial factors that may be predictors of the successful outcome of bariatric surgery are discussed.Discussions around the nature of specific eating disorders seen frequently in bariatric surgery patients, wheter it is a separate entities from well known eating disorders and controversial issues such as presence or absence of psychopathology like suicide as directly consequence of the surgical procedures are summarized. Discussions about performing of psychiatric and psychosocial assesment (i.e by whom, how and when) and conclusion of debate that finally highlighted the importance of a multidisciplinary approach are presented as well.

Keywords:

Bariatric surgery, Psychiatry, Obesity, Psychosocial assesment, Psychopathology,

PDF

___

World Health Organisation. International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva, WHO, 1992.
Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents and adults, 1999-2002. JAMA 2004; 291:2847-2850.
Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes (Lond) 2012; 37:889-891. Sturm R: Increases in morbid obesity in the USA: 2000-2005. Public Health 2007; 121:492-496.
Arslan E, Özçelik F, Demirbaş Ş. Obezite ile ilişkili kanser türleri. Anatolian Journal of Clinical Investigation 2013;7:176-184. Colditz GA. Economic costs of obesity. Am J Clin Nutr 1992; 55:503-507.
Babayiğit Z, Alçalar N, Bahadır G Obez kadınlarda tıkanırcasına yeme bozukluğunun psikopatoloji ve bilişsel açıdan incelenmesi. Turkiye Klinikleri J Med Sci 2013; 33:1077-1087.
Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP, Pilkonis PA, Ringham RM et al. Psychiatric disorders among bariatric surgery candidates: relationship to obesity and functional health status. Am J Psychiatry 2007; 164:328-334.
Sarwer DB, Wadden TA, Fabricatore AN. Psychosocial and behavioral aspects of bariatric surgery. Obes Res 2005; 13:6396
Buchwald H. Bariatric surgery for morbid obesity: health implications for patients, health professionals, and third-party payers. J Am Coll Surg 2005; 200;593-604.
Calle EE, Thun MJ, Petrelli JM, Rodriguez C, Heath CW: Body-Mass Index and mortality in a prospective cohort of U.S. adults. N Engl J Med 1999; 341:1097-1105.
Hsu LK, Mulliken B, McDonagh B, Krupa Das S, Rand W, Fairburn CG et al. Binge eating disorder in extreme obesity. Int J Obes Relat Metab Disord 2002;26:1398-1403.
Fabricatore AN, Wadden TA, Sarwer DB, Faith MS. Depressive symptoms as a function of body mass index and healthrelated quality of life in the treatment seeking obese adults. Obes Res 2003; 11:10.
Fine JT, Colditz GA, Coakley EH, Moseley G, Manson JE, Willett WC et al. A prospective study of weight change and healthrelated quality of life in women. JAMA 1999; 282:2136-2142.
Fontaine KB, Cheskin LJ, Barofsky I. Health-related quality of life in obese persons seeking treatment. J Fam Pract 1996; 43:265-270.
Larsson U, Karlsson J, Sullivan M. Impact of overweight and obesity on health-related quality of life -a Swedish population study. Int J Obes Relat Metab Disord 2002; 26:417-424.
Sullivan M, Karlsson J, Sjöström L, Backman L, Bengtsson C, Bouchard C et al. Swedish obese subjects (SOS)-an intervention study of obesity: baseline evaluation of health and psychosocial functioning in the first 1743 subjects examined. Int J Obes Relat Metab Disord 1993; 17:503-512.
Dixon JB, Dixon ME, O’Brien PE. Body image: appearance orientation and evaluation in the severely obese. Obes Surg 2002; 12:65-71.
Camps MA, Zervos E, Goode S, Rosemurgy AS. Impact of bariatric surgery on body image perception and sexuality in morbidly obese patients and their partners. Obes Surg 1996; 6:356-360.
Rand CSW, Juldau JM, Robbins L. Surgery for obesity and marriage quality. JAMA 1982; 247:1419-1422.
Bagriacik N, Onat H, Ilhan B, Tarakci T, Oşar Z, OzyazarM, Hatemi H et al. Obesity profile in Turkey. International Journal of Diabetes & Metabolism 2009; 17:5-8.
Sağlık Bakanlığı. "Sağlıklı Beslenelim, Kalbimizi Koruyalım" Projesi Araştırma Raporu, Sağlık Bakanlığı Temel Sağlık Hizmetleri Genel Müdürlüğü, Ankara, 2004.
Sağlık Bakanlığı. Türkiye Hastalık Yükü Çalışması 2004. Ankara, Refik Saydam Hıfzıssıhha Merkezi Başkanlığı Hıfzıssıhha Mektebi Müdürlüğü, 2006
Onat A,Yıldırım B, Çetinkaya A, Aksu H, Keleş, Sansoy V. Obesity prevelance in Turkey. Turk Kardiyol Dern Ars 1999; 27:2092
Hatemi H, Turan N, Arık N, Yumuk V. Türkiye obezite ve hipertansiyon taraması sonuçları (TOHTA). Endokrinde Yönelişler Dergisi 2002; 11:1-15.
Satman I, Yilmaz T, Sengül A, Salman S, Salman F, Uygur S et al. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care 2002; 25:1551-1556. Eren İ, Erdi Ö. Obez hastalarda psikiyatrik bozuklukların sıklığı. Klinik Psikiyatri Dergisi 2003; 6:152-157.
Özdel O, Sözeri-Varma G, Fenkçi S, Değirmenci T, Karadağ F, Oğuzhanoğlu NK ve ark. Obez kadınlarda psikiyatrik tanı, sıklığı. Klinik Psikiyatri Dergisi 2011; 14:210-217.
Poole NA, Al Atar A, Kuhanendran D, Bidlake L, Fiennes A, McCluskey S et al. Compliance with surgical after-care following bariatric surgery for morbid obesity: a retrospective study. Obes Surg 2005; 15:261-265.
Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005; 294:1909-1917.
Ayyad C, Andersen T: Long-term efficacy of dietary treatment of obesity: a systematic review of studies published between 1931 and 1999. Obes Rev 2000; 1:113-119.
Wysoker A. The lived experience of choosing bariatric surgery to lose weight. J Am Psychiatr Nurses Assoc 2005; 11:26-34. Korenkov M, Sauerland S: Clinical update: bariatric surgery. Lancet 2007; 370:1988-1990.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K et al. Bariatric surgery: a systematic review and meta-analysis. JAMA 2004; 292:1724-1737.
Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med 2007; 357:741-752.
Karlsson J, Taft C, Ryden A, Sjostrom L, Sullivan M. Ten-year trends in health-related quality of life after surgical and conventionaltreatment for severe obesity: the SOS intervention study. Int J Obes 2007; 31:1248-1261.
Benotti PN, Forse RA. The role of gastric surgery in the multidisciplinary management of severe obesity. Am J Surg 1995; 169:361-367.
Susan F. Franks and Kathryn A. Kaiser Rethinking the Preoperative Psychological Evaluation -A New Paradigm for Improved Outcomes and Predictive Power, Advanced Bariatric and Metabolic Surgery, Dr. Chih-Kun Huang (Ed.),InTech,2012.
McMahon MM, Sarr MG, Clark MM, Gall MM, Knoetgen J 3rd, Service FJ et al. Clinical management after bariatric surgery: value of a multidisciplinary approach. Mayo Clin Proc 2006; 81:S34-S45.
Berkowitz RI, Fabricatore AN. Obesity, psychiatric status, and psychiatric medications. Psychiatr Clin North Am. 2011; 34:47-64.
Lin HY, Huang CK, Tai CM, Lin HY, Kao YH, Tsai CC et al. Psychiatric disorders of patients seeking obesity treatment. BMC Psychiatry 2013; 13:1.
Powers PS, Perez A, Boyd F, Rosemurgy A. Eating pathology before and after bariatric surgery: a prospective study. Int J Eat Disord 1999; 25:295-300.
Wadden TA, Sarwer DB, Womble LG, Foster GD, McGuckin BG, Schimmel A. Psychosocial aspects of obesity and obesity surgery. Surg Clin North Am 2001; 81:1001-1024.
Wildes JE, Kalarchian MA, Marcus MD, Levine MD, Courcoulas AP. Childhood maltreatment and psychiatric morbidity in bariatric surgery candidates. Obes Surg 2008; 18:306-313.
Ostlund MP, Backman O, Marsk R, Stockeld D, Lagergren J, Rasmussen F et al. Increased admission for alcohol dependence after gastric bypass surgery compared with restrictive bariatric surgery. JAMA Surg. 2013; 148:374-377.
Friedman MA, Brownell KD: Psychological correlates of obesity: moving to the next research generation. Psychol Bull 1995; 117:3-20.
Zuckoff A. "Why won't my patients do what's good for them?" Motivational interviewing and treatment adherence. Surg Obes Relat Dis 2012; 8:514-521.
Eldar S, Heneghan HM, Brethauer S, Schauer PR. A focus on surgical preoperative evaluation of the bariatric patient-the Cleveland Clinic protocol and review of the literature. Surgeon. 2011; 9:273-277.
Herpertz S, Kielmann R,Wolf AM, Hebebrand J, Senf W: Do psychosocial variables predict weight loss or mental health after obesity surgery? - a systematic review. Obes Res 2004; 12:1554-1569. de Zwaan M, Lancaster KL, Mitchell JE, Howell LM, Monson N, Roerig JL et al. Health-related quality of life in morbidly obese patients: effect of gastric bypass surgery. Obes Surg 2002; 12:773-780.
Niego SH, Kofman MD, Weiss JJ, Geliebter A: Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord 2007; 40:349-359.
Tindle HA, Omalu B, Courcoulas A, Marcus M, Hammers J, Kuller LH. Risk of suicide after long-term follow-up from bariatric surgery. Am J Med 2010; 123:1036-1042.
Bauchowitz AU, Gonder-Frederick LA, Olbrisch ME, Azarbad L, Ryee MY, Woodson M et al. Psychosocial evaluation of bariatric surgery candidates: a survey of present practices. Psychosom Med 2005; 67:825-832.
Sandberg RM, Dahl JK, Vedul-Kjelsås E, Engum B, Kulseng B, Mårvik R et al. Health-related quality of life in obese presurgery patients with and without binge eating disorder, and subdiagnostic binge eating disorders. J Obes 2013; 2013:878310.
American Society for Metabolic and Bariatric Surgery Public/Professional Education Committee. Bariatric surgery: postoperative concerns. revised Feb 27, 2008. accessed at http:// www.asbs.org/html/pdf/asbs_bspc.pdf.
Vella A, Service FJ: Incretin hypersecretion in post-gastric bypass hypoglycemia: primary problem or red herring? J Clin Endocrinol Metab 2007; 92:4563-4565.
Niego SH, Kofman MD, Weiss JJ, Geliebter A: Binge eating in the bariatric surgery population: a review of the literature. Int J Eat Disord 2007; 40:349-359.
Conceição E, Orcutt M, Mitchell J, Engel S, Lahaise K, Jorgensen M et al. Eating disorders after bariatric surgery: a case series.Int J Eat Disord 2013; 46:274-279.
Herpertz S, Kielmann R, Wolf AM, Langkafel M, Senf W, Hebebrand J. Does obesity surgery improve psychosocial functioning? a systematic review. Int J Obes Relat Metab Disord 2003; 27:1300-1314.
Segal A, Kinoshita Kussunoki D, Larino MA. Post-surgical refusal to eat: anorexia nervosa, bulimia nervosa or a new eating disorder? a case series. Obes Surg 2004; 14:353-360.
Marcus MD, Kalarchian MA, Courcoulas AP. Psychiatric evaluation and follow-up of bariatric surgery patients. Am J Psychiatry. 2009; 166:285-291.
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007; 357:753-761. Güzin Mukaddes Sevinçer, Yrd.Doç.Dr., İstanbul Gelişim Üniversitesi, İstanbul; Halil Coşkun, Doç. Dr. Bezmialem Vakıf Üniversitesi Tıp Fakültesi, İstanbul; Numan Konuk, Prof. Dr., İÜ Cerrahpaşa Tıp Fakültesi, İstanbul; Süleyman Bozkurt, Uzm. Dr., Bezmialem Vakıf Üniversitesi Tıp Fakültesi, İstanbul. Yazışma Adresi/Correspondence: Güzin Mukaddes Sevinçer, İstanbul Gelişim Üniversitesi, İİSBF Psikoloji Bölümü, İstanbul, Turkey. E-mail: gmsevincer@gelisim.edu.tr Yazar bu makale ile ilgili herhangi bir çıkar çatışması bildirmemiştir. The author reported no conflict of interest related to this article. Çevrimiçi adresi / Available online at: www.cappsy.org/archives/vol6/no1/ Çevrimiçi yayım / Published online 17 Mayıs/May 17, 2013; doi: 10.5455/cap.20130522110439

ISSN: 1309-0658
Yayın Aralığı: Yılda 4 Sayı
Başlangıç: 2009
Yayıncı: Psikiyatride Güncel Yaklaşımlar

Arşiv