Anorexia Nervosa in a 38-Year-Old Woman 2 Years After Gastric Bypass Surgery

Scioscia, Thomas N.; Bulik, Cynthia M.; Levenson, James L.; Kirby, Donald F.

doi:10.1016/s0033-3182(99)71278-8

Cited by 15 publications

(10 citation statements)

References 9 publications

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“…Assim, a presença de compulsão alimentar prévia à cirurgia deve alertar para o risco de piores resultados em termos de redução de peso após a intervenção, especialmente a partir do segundo ano de evolução. Outro fenômeno observado é o surgimento de diversos casos pós-cirurgia bariátrica em que os pacientes passaram a apresentar sintomas semelhantes aos observados em transtornos alimentares [76][77][78] . De fato, um estudo feito por De Zwaan et al sugere a existência de um grupo de pacientes submetidos a RYGB que evoluem com perda de controle alimentar e vômitos compensatórios, comportamentos associados à presença de TCAP no pré-operatório 79 .…”

Section: Seguimento Pós-operatóriounclassified

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Gordon

Kaio²,

Sallet³

2011

Rev. psiquiatr. clín.

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ResumoContexto: Nas últimas décadas, diversos estudos longitudinais têm demonstrado a eficácia da cirurgia bariátrica no controle de peso em longo prazo e na redução da mortalidade resultante de complicações clínicas associadas à obesidade. Contudo, os estudos também revelam aumento significativo da mortalidade devida a suicídio e comportamento impulsivo, por razões largamente desconhecidas, o que demonstra a escassez de informações relativas ao manejo clínico de pacientes bariátricos. O presente estudo tem como objetivo sintetizar o estado atual de conhecimentos referentes ao acompanhamento psiquiátrico de pacientes bariátricos. Método: Revisão seletiva da literatura envolvendo artigos indexados no Medline e PubMed até junho de 2010, utilizando-se os termos: "bariatric surgery", "psychiatry", "binge eating", "follow-up" e "outcome". Resultados: Há relativo consenso na literatura de que não haja contraindicação psiquiátrica absoluta para a cirurgia bariátrica, embora a avaliação pré-operatória seja de extrema importância para o diagnóstico e tratamento de eventuais transtornos psiquiátricos, objetivando assegurar aderência ao tratamento multidisciplinar, melhor qualidade de vida e, possivelmente, melhor prognóstico pós-cirúrgico. Entre os transtornos mais prevalentes nessa população, encontra-se o transtorno da compulsão alimentar periódica (TCAP), que está relacionado com menor perda ponderal e pior qualidade de vida, especialmente quando presente no pós-operatório. No acompanhamento pós-operatório, também se deve atentar para o surgimento de sintomas impulsivos, incluindo abuso de álcool e outras substâncias. Conclusão: Diversos estudos indicam elevada prevalência de transtornos mentais e alterações psicopatológicas na população de pacientes bariátricos. Embora a maioria dos pacientes apresente adequado controle ponderal e melhora na qualidade de vida em médio e longo prazo, alguns pacientes desenvolvem alterações relativas ao comportamento alimentar, abuso de álcool e outras substâncias e complicações associadas a comportamento impulsivo, o que remete a hipóteses etiológicas que vão desde modelos neuroquímicos até teorias psicossociais. Por todas essas razões, é de fundamental importância que os profissionais de saúde mental integrem as equipes que avaliam e acompanham os pacientes bariátricos. Gordon PC, et al. / Rev Psiq Clín. 2011;38(4):148-54Palavras-chave: Obesidade, cirurgia bariátrica, psiquiatria, transtorno da compulsão alimentar periódica. AbstractBackground: In recent decades, several longitudinal studies show the efficacy of bariatric surgery on long-term weight control and reductions in mortality due to clinical complications associated with obesity. However, studies also show significantly increased mortality due to suicide and impulsive behavior, for reasons largely unknown, which demonstrates the paucity of information concerning the clinical management of bariatric patients. This study aims to synthesize the current state of knowledge regarding the psychiatric care of bariatric patients. Meth...

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Section: Seguimento Pós-operatóriounclassified

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Gordon

Kaio²,

Sallet³

2011

Rev. psiquiatr. clín.

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“…There have been reports of anorexia nervosa (26,27) and bulimia nervosa (28) after surgery, but the onset of frank eating disorders appears to be uncommon (29). Some patients present with the onset of eating problems that do not meet DSM-IV criteria for an eating disorder but are associated with impairment and distress.…”

Section: Postsurgical Eating Disordersmentioning

confidence: 99%

Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients

Marcus¹,

Kalarchian²,

Courcoulas³

2009

AJP

107

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Treatment in Psychiatry begins with a hypothetical case illustrating a problem in current clinical practice. The authors review current data on prevalence, diagnosis, pathophysiology, and treatment. The article concludes with the authors' treatment recommendations for cases like the one presented. "Ms. W," a 43-year-old white married woman with a body mass index (BMI) of 47 (height 5 feet, 5 inches, weight 280 lb), presents for a presurgical psychiatric evaluation for bariatric surgery. She was trained as a nurse but has not worked outside of the home since sustaining a work-related back injury 6 years ago. Ms. W has been markedly overweight since age 11 and has struggled continually to control her weight with numerous bouts of dieting. Her lowest body weight as an adult was 210 lb (BMI=34.9) at the time of her marriage at age 23. Ms. W has lost more than 50 lb at least two times but has not been successful in maintaining the losses. She suffers from hypertension, hyperlipidemia, and impaired fasting glucose. Concerned about her family history of type 2 diabetes, Ms. W feels that bariatric surgery is her only option to achieve a healthier body weight.Ms. W reports that her 20-year marriage to her husband, a machinist, is good but acknowledges that her body weight affects her sex life and her willingness to socialize. She has a history of depression, with one clear episode of major depressive disorder at age 35 after the death of her mother. At that time, her primary care physician prescribed fluoxetine (40 mg/day), which she took for 9 months and describes as "helpful." She reports her mood as "variable" since the younger of her two sons moved out of the family home last year. Ms. W also reports intermittent periods of binge eating during adulthood, and she currently meets criteria for binge eating disorder. She has been trying hard to manage her weight but has had two or three episodes per week of uncontrolled overeating accompanied by guilt and self-loathing during the past 2 years. She does not smoke and is an occasional social drinker. What factors should be considered in evaluating Ms. W as a candidate for surgery? Given her history of mood and eating problems, what kinds of ongoing monitoring or intervention are indicated if she proceeds with surgery? Bariatric SurgeryRates of severe obesity (defined as a BMI ≥40) have increased faster than rates of more moderate obesity. Data from the Behavioral Risk Factor Surveillance System indicate that the prevalence of BMI ≥40 quadrupled between 1986 and 2000 (1). Although the reasons for the increase in severe obesity are not understood completely, current rates are consistent with general increases in the prevalence of obesity and a corresponding rightward shift in the overall distribution of population BMIs. Severe obesity is associated with high levels of medical (2) and psychiatric (3, 4) comorbidity as well as increased mortality and increased medical expenditures (5). Current nonsurgical treatments are regarded as inadequate for severe obesity, as they are usu...

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“…She reported forced vomiting as often as 5 times per day, and by 24 months after surgery, weighed 88 pounds. 32 Fandino et al 33 report on a patient hospitalized 2 months after gastric bypass surgery with disorientation and amnesia associated with extreme food avoidance secondary to intense fear of postoperative weight gain. The patient was diagnosed with Wernicke-Korsakoff syndrome.…”

Section: Anorexiamentioning

confidence: 99%

Maladaptive Eating Patterns After Weight‐Loss Surgery

Rusch

Andris

2007

Nut in Clin Prac

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Weight-loss surgery has been shown to contribute to the improved health and well-being of the clinically severe obese, and for many has been seen as their "last resort." Although the majority of patients who choose this option as a means to achieve a healthier weight are successful, for some patients it is not beneficial. Bariatric surgery is not a panacea, and its immediate and long-term success depends on the patient's ability to incorporate lifestyle and behavioral changes. Patients who are not successful in achieving and maintaining their anticipated weight loss struggle to comply with diet, exercise, and vitamin regimens. Not only do these patients exhibit diminished weight loss, they have put themselves at risk for vitamin and mineral deficiencies and protein malnutrition. Their problematic response to weight-loss surgery may or may not be due to a worsening of presurgical depression, binge eating, emotion-triggered eating, body image, or eating behaviors associated with specific situations such as social events. This paper describes clinical responses we have observed in our bariatric practice. Several case studies are presented to highlight problems we have encountered when following bariatric surgery patients in the early postoperative period, as well as in a long-term setting. Recommendations are made for screening and follow-up of at-risk patients.

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Anorexia Nervosa in a 38-Year-Old Woman 2 Years After Gastric Bypass Surgery

Cited by 15 publications

References 9 publications

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Aspectos do acompanhamento psiquiátrico de pacientes obesos sob tratamento bariátrico: revisão

Psychiatric Evaluation and Follow-Up of Bariatric Surgery Patients

Maladaptive Eating Patterns After Weight‐Loss Surgery

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