COGNITIVE AND PSYCHOLOGICAL ASSESSMENT

BEFORE AND AFTER THE BARIATRIC SURGERY

prepared By: Dalal Alroais NeuroPsychologist

Many people believe that going through a Bariatric surgery is enough for losing the unnecessary weightThe Bariatric surgery is the beginning because the person should add important changes to their lifestyle including habits and exercising

OBESITY AND DEPRESSION

Emotions such as :Psychological Stress, sadness feelings, tenseness can lead people to eat too muchObesity is often accompanied by depression and the two can trigger and affect each otherDepression can both cause and result from stress, which, in turn, may cause the person to change his eating and activity behaviors

Some people who have difficulty recovering from unexpected or emotionally exhausting events loss of a family member or close friend losing a job or facing a medical problem relationship difficulties begin eating too much of unhealthy foods or forgoing exercise, and these become habits and take long time to change

EATING DISORDER

Binge eating is a behavior associated with obesity and other disorders such as bulimia and anorexia nervosa, and it is also a symptom of depression

A study of obese people with binge eating disorder found that 51 percent had a history of depression Other research shows that obese women with binge eating disorders developed body dissatisfaction and depression

Many research suggests that obesity may be significantly associated with mood disordersEating disorders have been shown to be more common among adolescent girls and young adult women with type 1 diabetes than among their nondiabetic peersThe successful weight loss is associated with decreased depression, and the depression predicts poorer success in weight loss

PSYCHOLOGICAL ASSESSMENT

Psychological assessment is important for obese patients to determine their appropriateness for surgery

The psychological assessment involves two parts: a clinical interview and psychological tests

The clinical interview includes reasons for seeking Bariatric surgery, current eating behaviors, weight history, psychiatric symptoms current and past

It may also include understanding of the surgery, lifestyle changes and social support

The psychological testing provides an objective measure of the patient presentation style, psychological adjustment, and readiness for surgery

PSYCHOLOGICAL ASSESSMENT

Assessment of eating habits and behaviors Motivation and attitude about a lifestyle

change

PSHYCHOLOGICAL CHANGESMental health conditions or emotional problems

Unhealthy habits of eating, such as binge eating, that could cause problems after

surgery Realistic expectations of what life will be like after the surgery

Patients are at risk for possible mood disorders and for

noncompliance after the weight loss surgery

The study, published in September 2014 in the journal Obesity Surgery, examined the possible causes and

frequency of depression in patients after bariatric surgery. The study

concluded that most of the patients’ emotional well-being improved in the

months following the surgery

The researchers also discovered that a subgroup of the 107 study participants experienced a relative increase in depression six months after the procedureThe majority of patients with discernible worsening in mood experienced these mood changes between six and 12 months post surgery

Bariatric patients seeking surgery have a higher prevalence of psychological distress compared to other obese patients who do not seek surgery They are often driven to pursue surgery due to a distressing event

A high prevalence of psychological comorbidities exists in obese patients, particularly mood disorders, anxiety, and low self-esteem. Extremely obese individuals are almost 5 times more likely than their average weight counterparts to have suffered from a major depressive episode in the past year

Cognitive therapy and cognitive behavioral therapy CBT have become an important aspect of the treatment of obesity

Cognition influence both feelings and behaviorsCBT in the treatment of obesity is to help patients change their negative eating behaviors and their lifestyle

These CBT interventions are self-monitoring techniques, stress management, social support, problem solving, and cognitive restructuring helping patients have more realistic weight loss goals, avoidance and challenging of self defeating beliefs

The psychologist functions as an assessor collecting data, an educator - providing information, and a therapist - reinforcing

motivation and managing the emotions that often appear during the Psychological evaluation

UNDERSTANDING OF THE SURGERY AND ITS ASSOCIATED LIFESTYLE CHANGES

As part of the psychological assessment, patients are asked to describe what the surgery requires the risks and possibility outcomes associated with it, and the behavioral changes that are required for success

The patients specific procedure laparoscopic gastric banding or gastric bypass determines the details of this discussion

If patients are unable to demonstrate a clear understanding of these factors, they are referred back to the surgeon and/or nutritionist for additional counseling

The need for intellectual testing has been apparent to determine the ability for consent

It's useful for patients to attend a group therapy and seminars and talked with people who have had the surgery: this enhances their understanding of the

surgery

During this discussion, the role of the surgery as a tool, and not as a magical cureis emphasized

The idea that the surgery “stops” them from overeating is challenged

They are reminded that the surgery allows them to feel satisfied with a small amount of food but that they are responsible for stopping when that point has been reached

It is important that the patient realize if they fail to stop, they will face consequences such as dumping after the surgery and possible weight gain after the surgery

This point undermines the notion that the surgery absolves patients of responsibility for their eating choices

Patients are encouraged to view the surgery as a tool that they can use to improve their health if they make the appropriate choices

Psychological evaluation after bariatric surgery should focus on an

assessment of depression, eating disorder ,behaviors, self-esteem and

social functioning