Thomas Horbach

Psychiatric disorders in bariatric surgery candidates: a review of the literature and results of a German prebariatric surgery sample

OBJECTIVE To investigate the prevalence of Axis I psychopathology in bariatric surgery candidates and to compare our results with the findings of the few studies published thus far. METHOD Structured clinical interviews (SCID) were conducted in 146 consecutive bariatric surgery candidates [71.9% women; mean age: 38.7 years (S.D.=10.0); mean BMI: 49.3 kg/m(2) (S.D.=7.8)] between September 2004 and January 2007 at the University Hospital of Erlangen. Assessments were administered independently of the preoperative screening and approval process. RESULTS The overall prevalence of current Axis I disorders was 55.5%; 72.6% had a lifetime history of at least one Axis I disorder. Axis I psychopathology was related to gender (with women reporting higher prevalence rates) and was positively associated with a lifetime history of any eating disorder. We compared our results with the findings of the three published studies having used structured clinical interviews to assess psychiatric comorbidity in bariatric surgery candidates. The authors provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. CONCLUSION About one half of the bariatric surgery candidates in Germany presented with a current Axis I disorder. Prevalence rates reported in the literature so far are based on different premises. Details for example about the evaluation should be taken into account when interpreting the results.

Binge eating and temperament in morbidly obese prebariatric surgery patients.

The objective of this study was to investigate the relationship between binge eating and temperament variables, controlling for depression and adult attention deficit/hyperactivity disorder (ADHD), in 90 extremely obese individuals. The participants completed questionnaires assessing eating pathology, reactive temperament, effortful control, depression and ADHD and were grouped based on the presence of regular binge eating. Patients reporting regular binge eating did not differ from patients not reporting regular binge eating with respect to BMI, age, gender, the occurrence of adult ADHD and reactive temperament. However, individuals with binge eating exhibited more pathological scores with regard to eating pathology, depression and effortful control. A logistic regression analysis revealed that only eating concerns and reduced effortful control remained significantly associated with regular binge eating. Binge eating in morbidly obese individuals appears to be associated with a lack of effortful control.

Pathologisches Kaufen und psychische Komorbidität

Compulsive buying is an excessive behavior that has begun to receive attention from researchers in recent years. The current study provides an overview of research on compulsive buying and examines the psychiatric co-morbidity in a German female treatment seeking compulsive buying sample in comparison with age and gender-matched normal buying control groups. Thirty women suffering from compulsive buying disorder, 30 community controls, and 30 bariatric surgery candidates were assessed with the German versions of the Structured Clinical Interview for DSM-IV diagnoses (SCID). Women with compulsive buying disorder showed significantly higher prevalence rates of affective, anxiety, and eating disorders compared to community controls, and suffered significantly more often from affective and anxiety disorders compared to bariatric surgery candidates. The compulsive buying group presented with the highest rates of personality disorders, most commonly avoidant, depressive, obsessive-compulsive, and borderline personality disorder, and reported the highest prevalence rates of other impulse control disorders, especially for intermittent explosive disorder. The findings suggest an elevated psychiatric co-morbidity in patients with compulsive buying disorder.

Attention-deficit/hyperactivity disorder in a prebariatric surgery sample.

BACKGROUND Research suggests that obese children, adolescents and adults frequently suffer from attention-deficit/hyperactivity disorder (ADHD). The aim of the current study was to estimate the prevalence of adult ADHD in a group of patients with grade 3 obesity (body mass index ≥40 kg/m(2)) prior to bariatric surgery. METHOD We assessed 116 patients for childhood and adult ADHD, co-occurring psychiatric disorders, severity of depression and daytime sleepiness. RESULTS Fourteen participants (12.1%) screened positive for adult ADHD. Even though this rate is higher compared with prevalence rates in representative population samples, it was not elevated compared with a group of morbidly obese individuals in a German general population sample (14.3%). Adult ADHD was associated with greater severity of depressive symptoms and more psychotherapy contact in the past but not with binge eating disorder or daytime sleepiness. CONCLUSION As ADHD appears to be a common condition in morbidly obese individuals, the impact of adult ADHD on postsurgical weight loss needs to be examined. Besides, the causal link between obesity and ADHD in adults should be further investigated.

Psychometric evaluation of the German version of the impact of weight on Quality of Life-Lite (IWQOL-Lite) questionnaire.

OBJECTIVE To evaluate the psychometric properties of a German version of the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire. METHOD IWQOL-Lite scores were obtained from 351 overweight/obese individuals and 127 lean adult volunteers. In addition, a subgroup of 126 obese subjects completed also the German versions of the 36-item short-form health survey (SF-36), the Beck Depression Inventory (BDI), the Eating Disorder Examination-Questionnaire (EDE-Q), and the German validated version of the Three-Factor Eating Questionnaire (TFEQ). RESULTS The German version of the IWQOL-Lite has psychometric properties comparable to those found for the original version and demonstrates high internal consistency and excellent construct validity. Furthermore, the German IWQOL-Lite clearly discriminates between groups based on BMI on all subscales and the total score. CONCLUSION The results of the present study suggest that the German IWQOL-Lite is a psychometrically validated instrument with which to measure weight-specific health related quality of life.

[Agreement between clinical evaluation and structured clinical interviews (SCID for DSM-IV) in morbidly obese pre-bariatric surgery patients].

The goal of the study was to determine the concordance between mental disorder assessed during clinical evaluation and those independently obtained by a SCID interview in morbidly obese patients prior to bariatric surgery. In 116 patients a SCID interview was conducted. The agreement was moderate for any current diagnosis (kappa 0.43) current affective disorder (kappa 0.41) and current eating disorders (kappa 0.47). For current anxiety disorders agreement was poor wit a kappa of 0.11. For anxiety disorders and eating disorders the use of SCID resulted in more diagnoses than did standard clinical evaluation. Generally, the SCID produced more current axis 1 diagnoses than the clinical evaluation. When conducting a clinical evaluation prior to bariatric surgery a structured clinical interview should be used to assess mental co-mobidity.