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Cognitive and psychological assessment before and after bariatric surgery. pp (1)
- 1. COGNITIVE AND PSYCHOLOGICAL ASSESSMENT BEFORE AND AFTER THE BARIATRIC SURGERY prepared By: Dalal Alroais NeuroPsychologist
- 2. Many people believe that going through a Bariatric surgery is enough for losing the unnecessary weight The Bariatric surgery is the beginning because the person should add important changes to their lifestyle including habits and exercising
- 3. OBESITY AND DEPRESSION Emotions such as :Psychological Stress, sadness feelings, tenseness can lead people to eat too much Obesity is often accompanied by depression and the two can trigger and affect each other Depression can both cause and result from stress, which, in turn, may cause the person to change his eating and activity behaviors
- 4. 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
- 5. 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
- 6. Many research suggests that obesity may be significantly associated with mood disorders Eating disorders have been shown to be more common among adolescent girls and young adult women with type 1 diabetes than among their nondiabetic peers The successful weight loss is associated with decreased depression, and the depression predicts poorer success in weight loss
- 7. 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
- 8. 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
- 9. The psychological testing provides an objective measure of the patient presentation style, psychological adjustment, and readiness for surgery
- 10. PSYCHOLOGICAL ASSESSMENT Assessment of eating habits and behaviors Motivation and attitude about a lifestyle change
- 11. PSHYCHOLOGICAL CHANGES Mental 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
- 12. 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
- 13. The researchers also discovered that a subgroup of the 107 study participants experienced a relative increase in depression six months after the procedure The majority of patients with discernible worsening in mood experienced these mood changes between six and 12 months post surgery
- 15. 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
- 16. Cognitive therapy and cognitive behavioral therapy CBT have become an important aspect of the treatment of obesity Cognition influence both feelings and behaviors CBT 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
- 17. 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
- 18. 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
- 19. 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
- 20. During this discussion, the role of the surgery as a tool, and not as a magical cure is 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
- 21. 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
- 22. Psychological evaluation after bariatric surgery should focus on an assessment of depression, eating disorder ,behaviors, self-esteem and social functioning