Findings and outcomes of psychological evaluations of gastric bypass applicants

Among severely obese persons seeking surgical treatment, lifetime prevalence rates of Axis 1 psychiatric disorders range up to 50%; 27% to 42% have a diagnosable psychiatric disorder at the time of evaluation. Despite recommendations by the National Institutes of Health Consensus Development Panel that evaluation for surgery include a mental health component, little data are available on the outcomes of such evaluations. Similarly, there are also few data on the frequency and type of psychotropic medication use by these patients. The primary objective of this study was to describe the recommendations resulting from psychological evaluations of bariatric surgery applicants; a secondary purpose was to describe the point and lifetime prevalences of psychotropic medication use. We examined the psychological evaluation recommendations of successive gastric bypass applicants at the Medical University of South Carolina. Results indicated that the overwhelming majority (81.5%) of gastric bypass applicants had no psychological contraindication to surgery. A smaller percentage (15.8%) required psychological treatment before surgery, and only 2.7% of all applicants were considered psychologically inappropriate for surgery. Results also indicate that 47.7% were using at least 1 psychotropic medication at the time of the evaluation, and that 9.2% were using more than 1. The overwhelming majority of medications used were antidepressants, followed by antianxiety medications and mood stabilizers. These results indicate that the vast majority of patients will not be denied surgery as the result of a psychological assessment, yet approximately 20% of patients may be considered, based on psychological evaluation, psychologically inappropriate for immediate surgery, at least without initial treatment. These data also suggest that pharmacologic treatment of psychiatric disorders is quite common among gastric bypass applicants.