CME/CE: Bariatric Surgery & Mental Health

CME/CE: Bariatric Surgery & Mental Health

Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common. To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.   Taking a Closer Look For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27...
Bariatric Surgery & Mental Health

Bariatric Surgery & Mental Health

Bariatric surgery is recognized as a viable option to promote weight loss and to treat obesity-related comorbidities among the severely obese. “While bariatric surgery is increasingly being used with some success, less attention has been paid to the mental health of patients with obesity and how this may influence the outcomes of patients who undergo these types of procedures,” explains Aaron J. Dawes, MD. Studies estimate that about one in five Americans has a mental health condition, including about 8% who are depressed, and another 1% to 5% who have a binge eating disorder. Previous research has suggested that these conditions may be more common among bariatric surgery patients, but no good estimates exist to suggest how common. To address this research gap, Dr. Dawes and colleagues performed a systematic review, which was published in JAMA, to examine the prevalence of mental health conditions in patients seeking and undergoing bariatric surgery. The analysis also evaluated two important connections between surgery and mental health. First, the researchers explored if preoperative mental health conditions were associated with differences in weight loss after surgery. Second, they examined if surgery was associated with changes in the clinical course of mental health conditions.   Taking a Closer Look For the study, investigators searched trusted resources for studies published between January 1988 and November 2015 using terms like bariatric and obesity as well as the names of obesity surgery procedures, psychiatric disorders, and eating disorders. After screening nearly 2,300 articles, the authors identified 68 publications that met their inclusion criteria: 59 reported on the prevalence of preoperative mental health conditions (involving 65,363 patients) and 27...
Mental Healthcare: Time to End the Stigma

Mental Healthcare: Time to End the Stigma

It was with great sadness that we all saw the tragic news of Robin Williams’ suicide. For years, mental health has been a taboo topic. While the passing of this great actor is horrifying, we are only aware of it because of his stardom. How many others have met a tragic fate like his, but we just do not hear about it because they are ordinary people? It affects all ages, all races, and socioeconomic statuses. It is not a phenomena located to the U.S. but all across the globe. True that many people have trouble gaining access to mental healthcare sources, often for insurance coverage reasons or lack of available providers. But more often, help isn’t pursued because of the stigma attached to mental health diagnoses. All too often patients are embarrassed to admit they have a mental health problem. Yet, diseases such as anxiety and depression are very prevalent in our society. These conditions are chronic medical problems, just like diabetes and hypertension. But patients are often made to feel that these diseases are just in their head and that they can just “get over it.” This does not just happen in our general society, but when they seek medical help as well. Patients do not understand that even physical pain can be an underlying sign of depression. And many feel that their healthcare providers brush it off as “just depression.” So, rather than face these stigmas and embarrassments, many choose to deny or hide their illnesses. They are left untreated, which allows tragedies like suicide to occur. How can mental healthcare stigmas be ended? 1. More...
The Effects of Creative Art Therapy in Cancer

The Effects of Creative Art Therapy in Cancer

Many patients with cancer report using at least one complementary and alternative medicine (CAM) therapy. Various CAM therapies appear to improve the psychological symptoms that are commonly linked to cancer and its treatment, including disease-related fatigue, pain, and symptoms of anxiety and depression. Creative arts therapies (CATs)—which include drama therapy, writing therapy, music therapy, dance and movement therapy, and various forms of art therapy—have received less attention than other CAM therapies. Current clinical research on CATs has expanded from largely observational science to a wider, cross-disciplinary approach. Previous reviews have suggested that CATs may be useful adjuvant therapies to improve cancer- and treatment-related symptoms during and after treatment. To date, however, there has been no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients. A Comprehensive Review In JAMA Internal Medicine, my colleagues and I had a systematic review and meta-analysis published that used results from RCTs to evaluate the effect of CAT exposure on psychological symptoms and quality of life (QOL) in patients with cancer. In our review, we included 27 RCTs that involved more than 1,500 study participants. Our findings showed that CATs significantly reduced anxiety, depression, and pain and increased QOL after treatment. Pain appeared to remain significantly lower for patients using CAT when assessed at follow-up. Exposure to CAT did not appear to significantly reduce symptoms of fatigue after treatment or during follow-up, but these data are more difficult to interpret because the effects may be modality dependent. More specifically, reductions in anxiety were strongest in RCTs that had a non-CAT therapist administer the intervention as...
Managing Psychosocial Distress in ICD Recipients

Managing Psychosocial Distress in ICD Recipients

Implantable cardioverter defibrillators (ICDs) have been shown to prevent life-threatening ventricular arrhythmias, but recipients can sometimes have dramatic experiences resulting from care. Each month, about 10,000 Americans have ICDs implanted to restore normal heart rhythm and prevent sudden cardiac death. “Many people who experience cardiac arrhythmias are surprised to learn of their potentially life-threatening condition,” explains Sandra B. Dunbar, RN, DSN, FAAN, FAHA. “Patients and their family are often forced into critical medical decision making and required to confront and cope with their condition. They need to be educated on their treatment options and adjust to the fact that they need an ICD.” Studies have shown that ICDs can significantly improve survival and quality of life (QOL), but the underlying arrhythmia and its treatment may be accompanied by adverse psychological responses. “These responses may be underappreciated in some cases and warrant greater attention by healthcare providers,” says Dunbar. “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” Psychological outcomes are an important component of QOL and reflect an aspect of the costs and benefits beyond simply living longer.” “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” In an issue of Circulation, Dunbar and colleagues at the American Heart Association (AHA) had a scientific statement published that provides an evidence-based comprehensive review of psychosocial considerations and QOL for people who receive ICDs. The statement also describes the concerns and educational needs of ICD patients and their families and outlines evidence supporting interventions for improving educational and psychological outcomes for these patients....
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