비만수술 프로그램에서 정신과적 평가와 개입

Psychiatric Evaluation and Intervention in a Weight Loss Surgery Program: A Review

ObjectivesZZWeight loss surgery (WLS) is an effective treatment for morbidly obese patients. A pre- and postoperative multimodal team-based approach is essential for maximizing the efficacy of WLS. Although there is currently no standard psychiatric approach in WLS programs, this paper summarizes the value and methods of assessment and intervention suggested in the literature. MethodsZZA Pubmed search of English-language reports (1985 to 2010) and a manual search of bibliographies of related papers were reviewed. Relevant clinical information was extracted. ResultsZZPatients receiving WLS show a substantial prevalence of psychopathology, including depression, anxiety, and eating disorders, and also impaired quality of life. Most psychiatric symptoms and impaired psychosocial functioning tend to be improved after WLS, and this improvement is one of the important goals of WLS besides weight loss. However, outcomes are not promising in all patients, and the literature suggests that some psychiatric variables have prognostic value. One of the most widely researched poor prognostic factors is postoperative binge eating disorder. The identification of vulnerable patients and the offer of an appropriate intervention may be critical for their future full recovery. ConclusionZZThere are several reasons why psychiatric evaluation and intervention are worthwhile in a WLS program. Further researches will be required for the establishment of prognostic psychological factors, their biological mechanisms, and clinical guidelines for psychiatric assessment and intervention.