Erişkin dikkat eksikliği ve hiperativite bozukluğu, dürtüsellik ve emosyon regülasyonunun obezite hastalarında bariyatrik cerrahi başarısı üzerine etkilerinin incelenmesi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
İnönü Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Hastaların bariyatrik cerrahi ameliyatı öncesi, operasyondan elde edecekleri başarı düzeyinin ve başarıyı etkileyen faktörlerin tespiti, bu hastalara uygun destek ve tedavi yaklaşımının belirlenmesinde önemlidir. Bu bilgiler ışığında, çalışmamızda DEHB ve DEHB çekirdek belirtilerinden biri olan dürtüsellik ile moderatörlerinden duygu düzenleme güçlüklerinin, bariyatrik cerrahi tedavisi başarısına ve kilo verme sürecine etkisini, obezite cerrahisi sonrası en az 1 ile en fazla 5 yıl süre geçmiş olan hastalarda incelemeyi amaçladık. Yöntem: Bu araştırma, Mart 2019 ile Eylül 2019 tarihleri arasında Turgut Özal Tıp Merkezi Genel Cerrahi ve Konsultan-Liyezon Psikiyatrisi polikliniğine ayaktan başvuran obezite cerrahisi geçirmiş gönüllü hastalar bir psikiyatrist tarafından DSM-5 kriterlerine göre değerlendirildi. Sosyo-demografik Veri Formu, Erişkin Dikkat Eksikliği Hiperaktivite Bozukluğu Kendi Bildirim Ölçeği (ASRS), Wender-Utah Derecelendirme Ölçeği (WUDÖ), Duygu Düzenleme Güçlüğü Ölçeği (DERS) ve Yeme Tutumu Ölçeği öz bildirim yoluyla dolduruldu. Kesitsel tasarımlı planlanan çalışmada 120 postbariyatrik gönüllü katılımcı (42 kadın, 78 erkek) değerlendirmeye alındı. Bulgular: Çalışma örneklemimizin % 65'i (78 kişi) erkek, % 35'i (42 kişi) kadındı. Katılımcıların yaş ortalaması 37,22±14,22'dir. En düşük yaş 20 olup en yüksek yaş 66'dir. Katılımcıların %16,7'sinde (20 kişi) psikiyatrik hastalık mevcuttu ve örneklem dışı bırakıldı. Örneklemimizde DEHB açısından pozitif olma oranı % 22 olup DEHB tanısının doğrudan görüşme ile değerlendirildiği diğer çalışmaların sıklığı ile karşılaştırılabilir düzeydeydi. Katılımcıların operasyon öncesi BKİ'leri incelendiğinde 8 kişi evre 1 obez, 24 kişi evre 2 obez ve 64 kişi evre 3 obez sınıfındaydı. Operasyon süresi sonrasındaki geçen süre olarak değerlendirildiğinde; % 7'si 24 aydan az, % 73'ü 24-48 ay arası ve % 20'si 48 aydan fazlaydı. Kilo verme süreci başarılı olanlar ile olmayanlar arasında yaş, cinsiyet, medeni durum, eğitim, çalışma durumu, operasyon tipi ve operasyon öncesi BKİ açısından fark yoktu. Operasyon süresinin üzerinden 36 aydan fazla süre geçenlerde, 36 ay ve daha az zaman geçenlere göre kilo geri alma oranları daha yüksek çıktı (p=0,001). Örneklemimizde kilo kaybına göre başarılı ve başarısız gruplar arasında anormal yeme davranışları, yetişkin ve/veya çocukluk çağı DEHB olma durumu, dürtüsellik ve duygu düzenleme yetersizliği duygu düzenleme güçlülüğü açısından fark yoktu. Ek olarak kilo geri alanların anormal yeme davranışları, yetişkin ve/veya çocukluk çağı DEHB olma durumu, dürtüsellik ve duygu düzenleme yetersizliği açısından kilo geri almayanlardan farkı yoktu. Tartışma: DEHB tanısının bariyatrik cerrahi sonuçlarına etkisi olmaması bulgumuz literatür ile uyumlu iken duygu düzenleme güçlülüğünün bariyatrik cerrahi sonuçlarına direk etkisini inceleyen başka bir çalışma olmaması verilerimizi ilk kılmaktadır. İleriki çalışmalar, DEHB tanısı ve bileşenlerinden dürtüsellik, duygu düzenleme yetisi ve yeme davranışlarını cerrahiden önce görüşmeye dayalı değerlendirme ile araştırmalı ve cerrahi sonrası uzun süreyle takip programları ile bu faktörlerin seyrini araştırmalıdır. Son çalışmalar ve bizim çalışmamız cerrahi sonrası sonuçları etkileyebilecek psikopatolojileri tanımak ve yönetebilmenin mümkün olması adına cerrahi sonrasındaki uzun dönemde psikiyatri takip programlarının gerekliliğine işaret etmektedir. Anahtar kelimeler: DEHB, obezite cerrahisi, duygu düzenleme yetisi, yeme tutumu, obezite
Objective: The determination of the level of success and the factors affecting success before the operation of bariatric surgery is important in determining the appropriate support and treatment approach for these patients. In the light of this information, in our study, we aimed to examine the effects of ADHD, impulsivity and emotion regulation difficulties from moderators on the success of bariatric surgery treatment and weight loss in patients who have passed at least 1 to 5 years after obesity surgery. Method: This study was evaluated by a psychiatrist according to DSM-5 criteria, who had undergone obesity surgery who applied to Turgut Özal Medical Center General Surgery and Consultancy-Liaison Psychiatry outpatient clinic between March 2019 and September 2019. Sociodemographic Data Form, Adult Attention Deficit Hyperactivity Disorder Self-Reporting Scale (ASRS), Wender-Utah Rating Scale (WURS), Difficulties of Emotion Regulation Scale (DERS) and Eating Attitude Scale were filled in by self-report. In the planned cross-sectional study, 120 post-bariatric participants (42 women, 78 men) were included in the evaluation. Results: 65% (78 people) of our study sample were male and 35% (42 people) were female. The average age of the participants is 37.22 ± 14.22. The lowest age is 20 and the highest age is 66. Psychiatric illness was present in 16.7% (20 people) of the participants and was excluded from the sample. The rate of being positive for ADHD in our sample was 22%, and it was comparable to the frequency of other studies in which ADHD diagnosis was evaluated by direct interview. When the preoperative BMIs of the participants were examined, 8 people were in grade 1 obese, 24 people were in grade 2 obese and 64 people were in grade 3 obese. When it is evaluated as the elapsed time after the operation period; 7% were less than 24 months, 73% were between 24-48 months and 20% were more than 48 months. There was no difference in terms of age, gender, marital status, education, employment status, type of operation, and preoperative BMI between those who succeeded and did not lose weight. In those who spent more than 36 months after the operation period, the rate of weight gain was higher than those who passed 36 months or less (p = 0.001). There was no difference in our sample in terms of abnormal eating behaviors, adult and / or childhood ADHD, impulsivity, and inability to regulate emotion among successful and unsuccessful groups according to weight loss and regain weight. Discussion: The fact that ADHD diagnosis has no effect on the results of bariatric surgery is consistent with the literature, while the absence of another study examining the direct effect of emotional dysregulation on the results of bariatric surgery makes our data first. Further studies should investigate the diagnosis of ADHD, its impulsivity, emotion regulation ability, and eating behaviors based on interviews before surgery, and the course of these factors with long-term follow-up programs after surgery. Recent studies and our study point to the necessity of long-term psychiatric follow-up programs in order to be able to recognize and manage psychopathologies that may affect post-surgical outcomes. Keywords: ADHD, obesity surgery, emotion regulation, eating attitude, obesity
Objective: The determination of the level of success and the factors affecting success before the operation of bariatric surgery is important in determining the appropriate support and treatment approach for these patients. In the light of this information, in our study, we aimed to examine the effects of ADHD, impulsivity and emotion regulation difficulties from moderators on the success of bariatric surgery treatment and weight loss in patients who have passed at least 1 to 5 years after obesity surgery. Method: This study was evaluated by a psychiatrist according to DSM-5 criteria, who had undergone obesity surgery who applied to Turgut Özal Medical Center General Surgery and Consultancy-Liaison Psychiatry outpatient clinic between March 2019 and September 2019. Sociodemographic Data Form, Adult Attention Deficit Hyperactivity Disorder Self-Reporting Scale (ASRS), Wender-Utah Rating Scale (WURS), Difficulties of Emotion Regulation Scale (DERS) and Eating Attitude Scale were filled in by self-report. In the planned cross-sectional study, 120 post-bariatric participants (42 women, 78 men) were included in the evaluation. Results: 65% (78 people) of our study sample were male and 35% (42 people) were female. The average age of the participants is 37.22 ± 14.22. The lowest age is 20 and the highest age is 66. Psychiatric illness was present in 16.7% (20 people) of the participants and was excluded from the sample. The rate of being positive for ADHD in our sample was 22%, and it was comparable to the frequency of other studies in which ADHD diagnosis was evaluated by direct interview. When the preoperative BMIs of the participants were examined, 8 people were in grade 1 obese, 24 people were in grade 2 obese and 64 people were in grade 3 obese. When it is evaluated as the elapsed time after the operation period; 7% were less than 24 months, 73% were between 24-48 months and 20% were more than 48 months. There was no difference in terms of age, gender, marital status, education, employment status, type of operation, and preoperative BMI between those who succeeded and did not lose weight. In those who spent more than 36 months after the operation period, the rate of weight gain was higher than those who passed 36 months or less (p = 0.001). There was no difference in our sample in terms of abnormal eating behaviors, adult and / or childhood ADHD, impulsivity, and inability to regulate emotion among successful and unsuccessful groups according to weight loss and regain weight. Discussion: The fact that ADHD diagnosis has no effect on the results of bariatric surgery is consistent with the literature, while the absence of another study examining the direct effect of emotional dysregulation on the results of bariatric surgery makes our data first. Further studies should investigate the diagnosis of ADHD, its impulsivity, emotion regulation ability, and eating behaviors based on interviews before surgery, and the course of these factors with long-term follow-up programs after surgery. Recent studies and our study point to the necessity of long-term psychiatric follow-up programs in order to be able to recognize and manage psychopathologies that may affect post-surgical outcomes. Keywords: ADHD, obesity surgery, emotion regulation, eating attitude, obesity
Açıklama
Anahtar Kelimeler
Psikiyatri, Psychiatry
