Obezite Cerrahisinde Psikiyatrik Değerlendirme
Özet
Obezite, dünya çapında prevalansı hızla artan, fiziksel hastalıkların yanı sıra depresyon ve anksiyete gibi psikiyatrik rahatsızlıklara yol açan kronik metabolik bir hastalıktır. Son dönemlerde kalıcı kilo kaybı sağlamada obezite cerrahisinin (bariatrik cerrahi) önemi klinisyenler ve hastalar açısından belirgin şekilde artmıştır. Bu cerrahi dalı psikiyatri ile son derece iç içe olup, hastaların ameliyat öncesi ve sonrası dönemde psikiyatrik takibi kritik rol oynamaktadır. Bariatrik cerrahi adaylarının yaklaşık %40'ının en az bir psikiyatrik tanıya sahip olduğu ve en sık depresif, anksiyete ve yeme bozukluklarının görüldüğü bildirilmektedir. Operasyon öncesi değerlendirmede; hastanın beklentileri, bilişsel yeterliliği, beden imgesi memnuniyetsizliği, çocukluk çağı travmaları ve kişilik özellikleri ayrıntılı şekilde incelenmelidir. Ayrıca tıkınırcasına yeme bozukluğu, bulimia nervoza gibi yeme patolojileri ile alkol/madde kullanım geçmişi operasyonun başarısını doğrudan etkileyebilir. Psikotik ve bipolar bozukluğu olan stabil hastalar için cerrahi bir seçenek olsa da, aktif dönemdeki semptomlar kesin kontrendikasyon oluşturur. Standart bir protokol bulunmamakla birlikte, multidisipliner bir yaklaşım ve özellikle Bilişsel Davranışçı Terapi (BDT) uygulamaları bariatrik hastaların psikolojik durumlarında anlamlı faydalar sağlayarak ameliyat sonrası psikososyal sonuçları optimize etmektedir.
Obesity is a chronic metabolic disease with a rapidly increasing global prevalence, leading to various physical illnesses as well as psychiatric conditions like depression and anxiety. Recently, the importance of bariatric surgery in providing permanent weight loss has significantly increased for both clinicians and patients. This surgical branch is deeply intertwined with psychiatry, making the pre- and post-operative psychiatric follow-up of patients critical. Approximately 40% of bariatric surgery candidates have at least one psychiatric diagnosis, with depressive, anxiety, and eating disorders being the most common. In the preoperative evaluation; the patient's expectations, cognitive competence, body image dissatisfaction, childhood traumas, and personality traits must be thoroughly examined. Additionally, eating pathologies like binge eating disorder, bulimia nervosa, and a history of substance abuse can directly affect surgical outcomes. While surgery is an option for stable patients with psychotic and bipolar disorders, active symptoms constitute absolute contraindications. Although there is no standard protocol, a multidisciplinary approach and particularly Cognitive Behavioral Therapy (CBT) interventions provide substantial benefits for the psychological state of bariatric patients, optimizing postoperative psychosocial outcomes.
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