Bjarte Stubhaug

Quality of life among patients undergoing bariatric surgery: associations with mental health- A 1 year follow-up study of bariatric surgery patients

BackgroundPreoperative mental health seems to have useful predictive value for Health Related Quality of Life (HRQOL) after bariatric surgery. The aim of the present study was to assess pre- and postoperative psychiatric disorders and their associations with pre- and postoperative HRQOL.MethodData were assessed before (n = 127) and one year after surgery (n = 87). Psychiatric disorders were assessed by Mini International Neuropsychiatric Interview (M.I.N.I.) and Structured Clinical Interview (SCID-II). HRQOL was assessed by the Short Form 36 (SF-36) questionnaire.ResultsSignificant improvements were found in HRQOL from preoperative assessment to follow-up one year after surgery. For the total study population, the degree of improvement was statistically significant (p values < .001) for seven of the eight SF-36 subscales from preoperative assessment to follow-up one year after surgery. Patients without psychiatric disorders had no impairments in postoperative HRQOL, and patients with psychiatric disorders that resolved after surgery had small impairments on two of the eight SF-36 subscales compared to the population norm (all effect sizes < .5) at follow-up one year after surgery. Patients with psychiatric disorders that persisted after surgery had impaired HRQOL at follow-up one year after surgery compared to the population norm, with effect sizes for the differences from moderate to large (all effect sizes ≥ .6).ConclusionThis study reports the novel finding that patients without postoperative psychiatric disorders achieved a HRQOL comparable to the general population one year after bariatric surgery; while patients with postoperative psychiatric disorders did not reach the HRQOL level of the general population. Our results support monitoring patients with psychiatric disorders persisting after surgery for suboptimal improvements in quality of life after bariatric surgery.Trial RegistrationThe trial is registered at http://www.clinicaltrials.gov prior to patient inclusion (ProtocolID16280).

The impact of preoperative counseling on postoperative treatment adherence in bariatric surgery patients: A randomized controlled trial

OBJECTIVE To assess if attendance to a preoperative counseling program improved weight loss or adherence to treatment guidelines in patients who underwent bariatric surgery. METHODS One-hundred-forty-one patients were included in the study. Sixty-nine percent chose to participate in the counseling groups. They were randomized to a Treatment group and a Control group. Thirty-one percent chose not to participate in the counseling. However, they gave their consent to assessment before and after surgery (Reference group). RESULTS One year after bariatric surgery, 88% had a weight loss of ≥ 50% EWL, 37% reported more than 30 min of physical activity daily, 74% had 5-7 meals daily, and 87% took recommended vitamins. There were no differences in weight loss, eating habits, or physical exercise between the Treatment group, the Control group and the Reference group one year after surgery. CONCLUSION Preoperative group counseling did not increase treatment adherence to recommended life-style changes. PRACTICE IMPLICATIONS In accordance with findings in the present study, it is not reasonable to offer a preoperative counseling program for all patients undergoing bariatric surgery. Further research should focus on developing and evaluating programs for postsurgical follow-up, and identifying patients that are in need for more comprehensive treatment programs.

Prevalence of psychiatric disorders before and 1 year after bariatric surgery: The role of shame in maintenance of psychiatric disorders in patients undergoing bariatric surgery

Objective: The present study examined prevalence of psychiatric disorders before and 1 year after weight loss surgery. Furthermore, we studied if level of pre-operative shame could be a maintaining factor for psychiatric disorders at 1-year follow-up. Method: One-hundred and twenty-seven patients (F/M: 94/33) with mean body mass index (BMI) ± standard deviation (s) =45.3±5.2 kg/m2 and mean age 41.3±10.3 years participated in the study. Eighty-seven patients met for follow-up 1 year after surgery. Psychiatric disorders were assessed by the Mini International Neuropsychiatric Interview (M.I.N.I.) and the Structured Clinical Interview (SCID-II). Levels of depression, anxiety and shame were assessed by the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI) and the Internalized Shame Scale (ISS). Results: Sixty-one patients (48%) at pre-operative assessment and 16 patients (18%) at 1-year follow-up had a comorbid psychiatric disorder. The strongest predictor of post-operative psychiatric disorder was pre-operative psychiatric disorder, odds ratio of 27.7 (95% CI for EXP (B) 3.2–239.8, P =0.003). Pre-operative level of shame (higher than 50-point ISS score) was also a significant predictor for post-operative psychiatric disorders, odds ratio of 9.1 (95% CI for EXP (B) 1.8–44.4, P =0.007). Conclusion: There was a significant reduction in prevalence of psychiatric disorders from pre-operative assessment to follow-up 1 year after surgery. Level of shame at pre-operative assessment was associated with maintenance of psychiatric problems. This finding is of clinical importance, since psychiatric disorders persisting after bariatric surgery have strong impact on the course of weight loss and quality of life.

Chronic fatigue syndrome 5 years after giardiasis: differential diagnoses, characteristics and natural course

BackgroundA high prevalence of chronic fatigue has previously been reported following giardiasis after a large waterborne outbreak in Bergen, Norway in 2004. The aim of this study was to describe and evaluate differential diagnoses and natural course of fatigue five years after giardiasis among patients who reported chronic fatigue three years after the infection.MethodsPatients who three years after Giardia infection met Chalder’s criteria for chronic fatigue (n=347) in a questionnaire study among all patients who had laboratory confirmed giardiasis during the Bergen outbreak (n=1252) were invited to participate in this study five years after the infection (n=253). Structured interviews and clinical examination were performed by specialists in psychiatry, neurology and internal medicine/infectious diseases. Fukuda et al’s 1994 criteria were used to diagnose chronic fatigue syndrome (CFS) and idiopathic chronic fatigue (ICF). Self-reported fatigue recorded with Chalder Fatigue Questionnaire three and five years after infection were compared.Results53 patients were included. CFS was diagnosed in 41.5% (22/53) and ICF in 13.2% (7/53). Chronic fatigue caused by other aetiology was diagnosed in 24.5% (13/53); five of these patients had sleep apnoea/hypopnoea syndrome, six had depression and five anxiety disorder, and among these two had more than one diagnosis. Fatigue had resolved in 20.8% (11/53). Self-reported fatigue score in the cohort was significantly reduced at five years compared to three years (p<0.001).ConclusionThe study shows that Giardia duodenalis may induce CFS persisting as long as five years after the infection. Obstructive sleep apnoea/hypopnoea syndrome, depression and anxiety were important differential diagnoses, or possibly comorbidities, to post-infectious fatigue in this study. Improvement of chronic fatigue in the period from three to five years after giardiasis was found.

Cognitive-behavioural therapy v. mirtazapine for chronic fatigue and neurasthenia: randomised placebo-controlled trial

BACKGROUND Single interventions in chronic fatigue syndrome have shown only limited effectiveness, with few studies of comprehensive treatment programmes. AIMS To examine the effect of a comprehensive cognitive-behavioural treatment (CCBT) programme compared with placebo-controlled mirtazapine medication in patients with chronic fatigue, and to study the effect of combined medication and CCBT. METHOD A three-armed randomised clinical trial of mirtazapine, placebo and a CCBT programme was conducted to investigate treatment effect in a patient group (n=72) with chronic fatigue referred to a specialist clinic. The CCBT programme was compared with mirtazapine or placebo therapy for 12 weeks, followed by 12 weeks treatment with a mixed crossover-combination design. Assessments were done at 12 weeks and 24 weeks. RESULTS By 12 weeks the treatment effect was significantly better in the group initially receiving CCBT, as assessed with the Fatigue Scale (P=0.014) and the Clinical Global Impression Scale (P=0.001). By 24 weeks the treatment group initially receiving CCBT for 12 weeks followed by mirtazapine for 12 weeks showed significant improvement compared with the other treatment groups on the Fatigue Scale (P<0.001) and the Clinical Global Impression Scale (P=0.002). Secondary outcome measures showed overall improvement with no significant difference between treatment groups. CONCLUSIONS Multimodal interventions may have positive treatment effects in chronic fatigue syndrome. Sequence of interventions seem to be of importance.

Shame, Psychiatric Disorders and Health Promoting Life Style after Bariatric Surgery

Objective: Postoperative outcomes after bariatric surgery depend greatly on engagement in health promoting behaviour, including regular physical activity and healthy eating behaviour. Adherence to these guidelines varies among patients after bariatric surgery. The present study examined associations between shame, psychiatric disorders and engagement in health promoting behaviour in patients with severe obesity that have undergone bariatric surgery. Method:One-hundred and twenty-seven patients (F/M: 74/ 26) with median Body Mass Index (BMI) 44.1 kg/m2 (IQR=6.0) and median age 40.0 years (IQR=15.0) were examined for psychiatric disorders and personality disorders. The participants completed the Eating Disorder Examination Questionnaire (EDE-Q) and Internalized Shame Scale (ISS) pre- and postoperatively. At one year follow-up, they also reported their compliance with postoperative guidelines regarding eating habits and physical activity. Results: The median ISS-score was significantly higher in patients with comorbid psychiatric disorders compared to patients without comorbid psychiatric disorders (median ISS score 36.0 and 9.0 respectively, p<.001). ISS score and self-evaluation based on body shape and weight were significantly correlated. Furthermore, preoperative ISS score was negatively correlated with level of physical activity (r=-.25, p=.022) one year after surgery. Conclusion:The present findings suggest that patients with a high level of shame should be given priority for postoperative follow-up, in order to improve the patients’ ability to establish life-style changes associated with sustained positive postoperative outcome.

P02-195 - Patient outcome expectancy from bariatric surgery

Aim The aim of the present study was to examine if patients’ expectancy after bariatric surgery was related to improvement of body appearance, health, physical fitness, or ability to work. Further, the relationship between psychiatric comorbid disorders and outcome expectancies after surgery was investigated. Method The study population consisted of 94 patients (F/M:74/20) age 22 to 62 years (mean 41.1, SD=10.2), with BMI from 33.4 to 64.7 kg/m 2 (mean 44.9 kg/m 2 , SD=5.5). Psychiatric assessment was done prior to bariatric surgery, and included structured psychiatric interviews (M.I.N.I. International Neuropsychiatric Interview and Structured Clinical Interview for DSM IV Axis II disorders). The patients were asked to identify their most important expectancies after surgery. Results The overall prevalence of current psychiatric disorders was 47%, with Social Phobia (18%, n=17), Dysthymic Disorder (14%, n=13), and Avoidant Personality Disorder (17%, n=16) as the most common ones. Thirty-six percent (n=34) rated improvement of health, 34% (n=32) physical fitness, 22% (n=21) improvement of body appearance, and 7% (n=7) ability to work as their most important expectancy after surgery. Patients with psychiatric comorbidity rated significantly more frequent improvement in body appearance as their most preferred outcome than patients without psychiatric comorbidity (34%/ 12%, p= .01 , chi-square test). Conclusion Patients with psychiatric disorders rated improvement in body appearance as their most preferred outcome after surgery more often than patients without psychiatric comorbidity. Future studies should examine whether patient expectations predict outcomes and satisfaction after surgery.