Psychiatric and Psychosocial Aspects of Bariatric Surgery

Öz

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.

Anahtar Kelimeler

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

Bariatrik Cerrahinin Psikiyatrik ve Psikososyal Yönleri

Öz

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

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