ABSTRACT
Background: Bariatric surgery aims to improve quality of life by means of weight loss. Obesity-related physical and psychological health problems should improve, but long-term data are scarce. Objectives: To evaluate preoperative physical and mental health problems perceived by the patient and the association with weight loss and quality of life, 5 years after bariatric surgery. Methods: 101 persons (response rate 67%) who had had bariatric surgery an average of 4.6 years before this study completed a written survey on obesity-related physical and psychological health problems and three psychological questionnaires collecting information on eating behavior and quality of life. Over half of the participants (55%) had had a laparoscopic adjustable gastric banding. Results: Preoperatively reported health problems improved but were not necessarily associated with weight loss. Minimal improvement in tiredness, shame and weight instability were associated with significantly less weight loss. Preoperative type 2 diabetes mellitus (T2D) improved but participants had significantly less weight loss and more dissatisfaction regarding the bariatric trajectory than participants without T2D. Eating concerns, emotional eating and external eating improved but not restrained eating. Compared to the Dutch population reference, most quality of life scores of the participants were lower. Conclusion: In this analysis, participants did report satisfaction although from a patients' perspective, improvements of weight and health did not necessarily lead to satisfaction regarding the bariatric trajectory. Participants with postoperative reported fatigue and shame as well as participants with preoperative T2D showed significant less weight loss. More long-term research is necessary to close the current knowledge gap.
ABSTRACT
A 57-year-old man was referred to the Department of Psychiatry & Psychology of a university hospital because of recurrent depressive episodes. He claimed to have had a total amnesia for approximately the first 30 years of his life following an incident resembling a fugue. This case of a focal retrograde amnesia shows the limitations of a dichotomic view of organic, psychogenic and intentional factors.
Subject(s)
Amnesia, Retrograde/diagnosis , Amnesia, Retrograde/etiology , Brain/pathology , Craniocerebral Trauma/complications , Humans , Male , Middle Aged , Stress, Psychological/complicationsABSTRACT
OBJECTIVE: The aim of the current study was to examine the relation between catastrophizing and pain intensity, pain-related disability, and psychological distress in a group of patients with chronic pain, controlling for the level of physical impairment. Furthermore, it was examined whether these relations are the same for three subgroups of chronic pain patients: those with chronic low back pain, those with chronic musculoskeletal pain other than low back pain, and those with miscellaneous chronic pain complaints, low back pain and musculoskeletal pain excluded. DESIGN: Correlational, cross-sectional. PATIENTS AND SETTING: Participants in this study were 211 consecutive referrals presenting to a university hospital pain management and research center, all of whom had a chronic pain problem. RESULTS: Overall, chronic pain patients who catastrophize reported more pain intensity, felt more disabled by their pain problem, and experienced more psychological distress. Regression analyses revealed that catastrophizing was a potent predictor of pain intensity, disability, and psychological distress, even when controlled for physical impairment. No fundamental differences between the three subgroups were found in this respect. Finally, it was demonstrated that there was no relation between physical impairment and catastrophizing. CONCLUSIONS: It was concluded that for different subgroups of chronic pain patients, catastrophizing plays a crucial role in the chronic pain experience, significantly contributing to the variance of pain intensity, pain-related disability, and psychological distress. These relations are not confounded by the level of physical impairment. Some clinical implications of the results are discussed. Finally, the authors concluded that these results support the validity of a cognitive-behavioral conceptualization of chronic pain-related disability.
Subject(s)
Disabled Persons/psychology , Pain Measurement/psychology , Pain/psychology , Stress, Psychological/psychology , Adult , Chronic Disease , Cross-Sectional Studies , Disability Evaluation , Female , Humans , Low Back Pain/psychology , Male , Middle Aged , Musculoskeletal Diseases/psychology , Predictive Value of Tests , Regression AnalysisABSTRACT
OBJECTIVE: To investigate the long-term effects of surgically induced weight loss on the psychological functioning of morbidly obese patients. DESIGN: Comparison between preoperative and postoperative psychometric test results in a cross-sectional study. PATIENTS AND METHODS: Three psychometric tests were administered to 62 morbidly obese patients before and after surgery. RESULTS: The mean follow-up was 85.9+/-48.1 months. Surgical treatment resulted in a mean weight loss of 45.0+/-21.3 kg (P < 0.0001). The psychometric test results before surgery demonstrated somatisation, depression, denial of emotional stress, social incompetence and an indifferent attitude towards certain aspects of interpersonal behaviour. All psychopathology, except for somatisation, disappeared after surgical treatment. Improvement of psychological functioning was determined by weight loss and not influenced by the surgical procedure. The level of self-esteem before surgery predicted 15.4% of the outcome variance (P < 0.05). CONCLUSION: The psychopathology before surgery is almost totally reversed after sustained, surgically induced weight loss. This suggests that the preoperative psychological disturbances are the result, rather than the cause, of morbid obesity.
