Joanna M. Marino

Alcohol abuse and dependence before and after bariatric surgery: a review of the literature and report of a new data set

BACKGROUND To review the published data on alcohol abuse and alcohol dependence after bariatric surgery and to assess the prevalence of alcohol abuse and alcohol dependence in a sample of bariatric surgery patients, both before and after surgery. All participant data were collected from patients who had undergone gastric bypass at a Midwestern hospital. METHODS The participants were contacted by mail 6-10 years after surgery and asked to complete the Post-Bariatric Surgery Appearance Questionnaire. RESULTS The results of the analysis indicated that a small percentage of the sample appeared to spontaneously develop alcohol abuse or dependence after bariatric surgery. CONCLUSION The results of the present study will be useful in understanding the likelihood of bariatric surgery patients developing alcohol abuse and dependence after surgery. However, additional research is needed to fully understand the risk of this outcome.

The emergence of eating pathology after bariatric surgery: A rare outcome with important clinical implications

OBJECTIVE The present review examines the extant literature regarding the post-operative development of eating disorders (e.g., EDNOS) in bariatric surgery patients. METHOD Internet, PsycINFO, Pubmed, and reference lists were examined to aggregate and compare literature from January 1985 to May 2010. RESULTS Several case studies and case series have investigated the emergence of eating disorders after bariatric surgery. Clinical considerations are outlined. DISCUSSION The development of classical eating disorders after bariatric surgery appears to be a rare occurrence; however, eating problems are far more common. Unfortunately no typology exists to classify such eating problems. Future research should examine the incidence, risk factors, symptomatology, course, and outcome of such eating disorders and eating problems. It is highly likely that such problems are underreported.

Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates

BACKGROUND Mental health professionals have become increasingly involved in working with bariatric surgical candidates, particularly in performing preoperative psychological evaluations to clear candidates for surgery. The objective of the present study was to examine the concordance of the psychiatric diagnoses obtained during routine clinical evaluation before bariatric surgery and the diagnoses obtained separately at a research facility using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV axis I disorders. METHODS The study included 68 consecutively enrolled bariatric surgical candidates who had participated in the Longitudinal Assessment of Bariatric Surgery-3 study. The Structured Clinical Interview for DSM disorders data obtained from the research assessments were compared with the diagnostic data from the routine preoperative psychiatric evaluations. The congruence of the current and lifetime diagnoses was assessed using Cohens coefficient kappa. RESULTS Considerable variability was found among the major diagnostic categories, with generally poor agreement found for the current diagnoses. The kappa coefficients tended to be larger for the lifetime diagnoses. The agreement was moderate for any lifetime mood disorder, with a kappa value of 0.45. Regarding any lifetime anxiety, substance use, and eating disorder, the clinical diagnoses rarely concurred with the results from the Structured Clinical Interview for DSM disorders, with a kappa statistic of 0.30, 0.36, and 0.32, respectively. CONCLUSION The congruence between the diagnoses assigned during the routine clinical psychiatric evaluations and research assessment using the Structured Clinical Interview for DSM disorders was surprisingly low. These conclusions should be considered tentative, given the interval and the possibility of treatment having occurred between the 2 evaluations. Overall, these data raise interesting questions concerning the use of unstructured psychiatric evaluations before bariatric surgery.

Therapeutic factors affecting the cognitive behavioral treatment of bulimia nervosa via telemedicine versus face-to-face delivery†

OBJECTIVE Recently, Mitchell et al. (Behav Res Ther, 46, 581-592, 2008) conducted a randomized controlled trial of an empirically supported treatment for bulimia nervosa (BN) delivered face-to-face (FTF-CBT) or via telemedicine (TV-CBT). Results suggested that the TV-CBT and FTF-CBT were generally equivalent in effectiveness. The objective of the current study was to examine ratings of therapeutic alliance factors in TV-CBT and FTF-CBT. METHOD Data obtained from 116 adults who met criteria for BN or eating disorder-not otherwise specified with binge eating or purging weekly and six doctoral-level psychologists who delivered the therapy were used in the analyses. RESULTS Therapists generally endorsed greater differences between the treatment delivery methods than patients. Patients tended to make significantly higher ratings of therapeutic factors than therapists. DISCUSSION TV-CBT is an acceptable method for the delivery of BN treatment compared to FTF-CBT, and TV-CBT is more easily accepted as a treatment delivery method by patients than therapists.

Current Status of Cognitive-Behavioral Intervention for Compulsive Buying Disorder

Compulsive buying disorder is a condition characterized by repeated episodes of unnecessary, excessive purchases. These behaviors are frequently accompanied by negative mood states that are reduced by compulsive buying. Those with compulsive buying disorder are also observed to have a number of highly comorbid disorders. This clinical presentation creates a complex set of symptoms of which clinicians must be mindful when approaching the treatment of compulsive buying. The present article examines previous literature about compulsive buying disorder and outlines the use of an empirically supported cognitive-behavioral approach to treating compulsive buying.

Effects of acute alcohol intoxication on verbal memory in young men as a function of time of day

This experiment examined whether the time of day of alcohol administration influences alcohol metabolism and the impact of alcohol on verbal memory. It was hypothesized that circadian fluctuations in endogenous levels of testosterone in young men would differentially affect blood alcohol levels, which would consequently impair their memory performance to a different degree. Participants were administered alcohol or placebo drinks either at 8am or 6pm and recall of 4 prose passages was examined. The results indicated that recall declined for subjects administered alcohol but time of day did not moderate these effects. Nevertheless, generally alcohol breath levels changed in the predicted direction as a function of the time of the day with higher levels recorded in the morning and lower levels in the afternoon. The results suggested that observed differences in breath alcohol levels may be influenced by differences in endogenous levels of testosterone, but the effect of this presumed interaction on verbal memory appears inconclusive.

Psychosocial Aspects of Body Contouring Surgery After Bariatric Surgery

Obesity is widely recognized as a serious public health problem both in the United States and, increasingly, throughout the world. In the United States, nearly one-third of the adult population is obese, having a body mass index (BMI) of 30 kg/m2 or greater [1]. As the rate of obesity among adults continues to rise, so does the rate of overweight and obesity among children and adolescents [1], suggesting that the problems associated with obesity will continue to be causes for concern for some time to come. A large number of dietary, pharmacological, and counseling techniques have been used as interventions for overweight and obese individuals; however, the weight loss experienced from these interventions is often modest, and in many cases, postintervention weight gain is experienced.

Caffeine, artificial sweetener, and fluid intake in anorexia nervosa.

OBJECTIVE This article provides an analysis of the use of artificial sweeteners, caffeine, and excess fluids in patients diagnosed with anorexia nervosa (AN). METHOD Seventy participants with AN were recruited to participate in an ecologic momentary assessment study which included nutritional analysis using the Nutrition Data Systems for Research, a computer based dietary recall system. RESULTS When subtypes were compared, participants with AN-restricting subtype (AN-R) and participants with AN-Binge-Purge (AN-B/P) did not differ in quantity of aspartame, caffeine, or water consumed. Daily water consumption was related to daily vomiting frequency in AN-B/P but not to daily exercise frequency in either participants with AN-R or AN-B/P. DISCUSSION Caffeine, water, and aspartame consumption can be variable in patients with AN and the consumption of these substances seems to be only modestly related to purging behavior.