Obesity surgery and serious psychiatric conditions, lessons learned from 5 patients: A case report
Abstract
Rationale: Obesity and severe psychiatric disorders, including schizophrenia, bipolar disorder, and major depressive disorder, frequently coexist, with obesity prevalence nearly twice that in the general population. This association is driven by antipsychotic-induced metabolic effects, sedentary behavior, and poor dietary habits. Despite the proven efficacy of bariatric surgery for morbid obesity, its application in patients with serious psychiatric illness remains controversial due to concerns regarding treatment adherence, psychiatric relapse, and decision-making capacity.
Patient concerns: Five patients with established severe psychiatric disorders (schizophrenia, bipolar disorder, and severe depression) presented with morbid obesity requiring surgical management. Concerns included poor adherence to medical recommendations, vulnerability to psychiatric decompensation, and limited preoperative psychiatric evaluation.
Diagnoses: All patients were diagnosed with morbid obesity in the setting of chronic severe psychiatric illness. Postoperatively, several patients developed complications, including psychiatric relapse (psychotic or mood episodes), somatic symptomatology without an identifiable organic cause, and surgical complications.
Interventions: Patients underwent various bariatric procedures. However, preoperative psychiatric assessment was insufficient, and structured postoperative psychiatric follow-up was lacking across all cases.
Outcomes: Although significant…
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Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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