U
NIVERSITÀ DEGLI
S
TUDI DI
P
ISA
F
ACOLTA DI
M
EDICINA E
C
HIRURGIA
Dipar&mento di Medicina Clinica e
Sperimentale
Scuola di Specializzazione in Psichiatria
Direttore: Prof. Liliana Dell’Osso
Tesi di Specializzazione
Psychopathological evaluation of a sample of
Bariatric Surgery candidates
Relatore:
Prof. Stefano PINI
Candidato: Dott. Luca DI PAOLO
INDICE
✴ ABSTRACT! 4
✴ Abbreviations used throughout this text:! 5 ✴ OBESITY! 6
✴ Definition! 6
✴ Obesity Epidemics! 8 ✴ Obesity Treatment! 10 ✴ Bariatric Surgery! 11
✴ An Overview of Surgical Techniques! 13
✴ Gastric reduction techniques (Adjustable Gastric Banding, Vertical Sleeve
Gastrectomy).!13
✴ Gastric reduction with associated gastro-jejunal bypass (Laparoscopic Roux-en-Y
Gastric Bypass - RYGB).! 14
✴ OBESITY AND PSYCHOPATHOLOGY ! 15
✴ Eating Disorder comorbidity!18
✴ MATERIALS AND METHODS! 19
✴ Study Protocol Summary ! 19
✴ PSYCHOMETRIC INSTRUMENTS !20 ✴ M.I.N.I. 5,0,1:! 20 ✴ PAS-SR – Lifetime! 21 ✴ MOODS-SR-Lifetime}! 23 ✴ SCI-ABS-SR:! 23 ✴ SCL-90:! 27
✴ Barratt Impulsiveness Scale - BIS 11! 29
✴ Results!31
✴ Psychiatric Diagnosis!33
✴ Group analysis by BED and Axis I general comorbidity! 36 ✴ Obesity Measures! 42
✴ Gender!46
ABSTRACT
This work discusses data obtained from an observational project
proposed within the framework of a clinical protocol arranged
between the operating units of Psychiatry 2 and Internal Medicine 3.
Since 2009, dedicated liaison psychiatrists and residents have
screened candidates to obesity surgery from the inpatient medical
ward. Patients who gave specific written consent were assessed
through a psychometric battery comprising structured and
semi-structured clinical interviews, along with self-report instruments. In
light of the growing literature suggesting a multidimensional approach
to obesity surgery evaluation, we propose to assess dimensional
psychopathology measures in a sample of obese patients undergoing a
diagnostic evaluation protocol for bariatric intervention. Our
evaluation, relying mainly on dimensional constructs, DSM-IV
categories, sociodemographic and antropometric variables has not
pointed out solid predictors for severity of obesity or
psychopathological features associated to obesity.
Abbreviations used throughout this text:
BD: Bipolar Disorder BED: Binge-Eating Disorder BMI - Body Mass Index (Qutelet’s) CBT: Cognitive-Behavioural Therapy
DSM: Diagnostical-Statisticla Manual of Mental Disorders ED: Eating Disorders
GB: laparoscopic adjustable Gastric Banding MDR: Major Recurring Depression
PD: Panic Disorder
RYGB: Roux-en-Y Gastric Bypass
VSG: Vertical Sleeve Gastrectomy (Mason’s) BIS-11: The Barratt Impulsiveness Scale
