Patología psiquiátrica y cirugía bariátrica / Bariatric surgery and mental disorders

Medical treatments have shown poor outcomes, bariatric surgery has become a frequent treatment alternative for obesity. Obese patients seeking treatment have higher psychiatric comorbidity than not consulting ones. Bariatric surgery has allowed a reduction in medical comorbidity and some improvement in pre surgery psychopathology. Recent evidence reports a decrease in depressive disorders rate, improvement in self-esteem and life quality, in direct association with weight reduction, with no significant anxiety changes. Although weight decrease should help to have a better social life, important difficulties in adapting to the new environment can emerge. An increase in suicides and problematic alcohol use has been observed, as well as a decrease in binge eating disorder with further appearance of compensatory behavior, distorted body image, and marital problems. Pre surgery personality disorder could be a risk factor for a negative outcome. In this context a rigorous post surgery follow up is desirable, in order to optimize mental health benefits of massive weight reduction.

Los tratamientos médicos de la obesidad han demostrado baja efectividad, lo que ha llevado a que la cirugía bariátrica se haya establecido como una alternativa de tratamiento cada vez más frecuente. Las personas obesas que buscan tratamiento presentan tasas significativamente elevadas de comorbilidades psiquiátricas en comparación con las personas obesas que no consultan. La cirugía bariátrica ha permitido una reducción de las comorbilidades médicas y una mejoría de las patologías psiquiátricas presentes antes de la cirugía. Publicaciones recientes reportan una disminución de los trastornos depresivos, mejoría de la autoestima y de la calidad de vida, directamente asociados a la reducción de peso, sin variaciones significativas en los niveles de ansiedad. Si bien la pérdida de peso debería ayudar al mejoramiento de la vida social del paciente, pueden surgir importantes dificultades para adaptarse al nuevo entorno. Se ha visto un aumento de la tasa de suicidios y del uso problemático de alcohol, disminución precoz del trastorno por atracones con aparición posterior de conductas compensatorias, distorsión de la imagen corporal y aparición de conflictos conyugales. La presencia de trastorno de personalidad previo a la cirugía, constituiría un predictor negativo de resultado a largo plazo. Es en este contexto que se hace necesario un seguimiento post operatorio exhaustivo a estos pacientes, de tal forma de intervenir precozmente y optimizar los beneficios en la salud mental obtenidos con la baja de peso.

Evaluación y manejo psicológico del paciente candidato a cirugía metabólica / Evaluation and psychological management of patient candidate to metabolic surgery

Psychological factors can play a role in the onset, course and the way a patient copes with diabetes; therefore the mental health approach is gaining increasing relevance in the management of the disease. With the advent of metabolic surgery as a new treatmentalternative, assessment of psychosocial variables and pre and postoperative psychological support acquire a significant role in the short and long term outcomes. The objective of thisarticle is to highlight the importance of a proper assessment and treatment of behaviors and mental disorders that can interfere the adherence to post operatory directions, which is fundamental given the high prevalence of psychopathology in this population. The main psychological problems associated with this disease are presented, as well as psychosocialand behavioral domains assessed pre and post operatively. Patients must have realistic expectations regarding the surgery and be aware of their responsibility in the outcomes,committing themselves to change their lifestyle and self-care. Continuous follow up that includes psychological support and treatment if necessary is required.