RESUMO
Bariatric surgery is considered an effective treatment against obesity. This intervention and the subsequent weight loss can affect several pharmacokinetic parameters leading to a possible need of dosing adjustment. Despite an increasing number of bariatric interventions, clinical recommendations are often based on theoretical principles and expert opinions. Because reliable clinical and biological parameters for adjusting psychotropic drug are not available, the use of therapeutic drug monitoring needs to be advised as a useful approach. However, it is not currently possible to predict the effect of bariatric surgery on psychotropic blood levels, and due to their important inter-individual variability, preoperative medication blood levels should be measured to ensure an adequate postoperative dosing adaptation.
La chirurgie bariatrique est un traitement efficace de l'obésité. Cette intervention, ainsi que la perte de poids consécutive, peuvent affecter différents paramètres pharmacocinétiques, justifiant une adaptation posologique du traitement. Malgré l'essor de cette chirurgie, les recommandations cliniques restent basées sur des concepts théoriques et des avis d'experts. En raison du manque de paramètres cliniques et biologiques permettant d'adapter les traitements psychotropes, l'usage des dosages plasmatiques des médicaments peut être justifié. Cependant, ne pouvant prédire l'effet d'une intervention bariatrique sur les concentrations plasmatiques du médicament et de par la grande variabilité interindividuelle, un dosage plasmatique préopératoire devrait être effectué afin d'assurer une adaptation correcte des posologies postopératoires.
Assuntos
Cirurgia Bariátrica , Obesidade Mórbida , Psicotrópicos , Humanos , Obesidade Mórbida/cirurgia , Período Pós-Operatório , Psicotrópicos/uso terapêutico , Redução de PesoRESUMO
Obesity has become a worldwide public health concern. Bariatric surgery is nowadays the most effective treatment to lose weight and control somatic comorbidities of this disease. However, a careful preparation of the patients undergoing bariatric surgery seems mandatory, despite the existence of a feeling of emergency that is often shared by the therapeutic team, and thus difficult to handle. In this context, the importance to address psychological issues such as patients' representation of their body while they will be confronted to a major physical transformation cannot be over-emphasized. Taking time is crucial to create a therapeutic context that raises the patients' awareness of their underlying psychological functioning.
Le traitement de l'obésité est devenu une problématique de santé publique mondiale. La chirurgie bariatrique est actuellement le moyen le plus efficace pour perdre du poids et contrôler les comorbidités somatiques de cette maladie. Toutefois, une préparation approfondie des patients semble incontournable malgré une impulsion d'urgence souvent partagée par les soignants qui peinent à refréner cette dynamique. L'importance d'anticiper le vécu psychique du patient, face à un corps qui va rapidement se trouver confronté à une modification de son schéma et de son image corporels, nous semble indispensable. Prendre du temps est essentiel afin d'aménager un espace permettant au patient de conscientiser les changements à venir et de pouvoir les affronter sereinement pour le reste de sa vie.
Assuntos
Cirurgia Bariátrica/métodos , Obesidade/cirurgia , Redução de Peso , Cirurgia Bariátrica/psicologia , Humanos , Obesidade/psicologia , Fatores de Tempo , Resultado do TratamentoRESUMO
BACKGROUND: While bariatric surgery is an effective therapy for patients with severe obesity, not all patients benefit equally. An explanation might be that psychosocial risk factors hamper outcome. The study aimed to evaluate if biopsychosocial case complexity predicts evolution of BMI over 10 years after bariatric surgery. METHODS: Charts of patients (N = 236) of the Cohort of Obesity Lausanne (COOL) were retrospectively reviewed and rated with the INTERMED, a reliable and validated instrument, which assesses biopsychosocial case complexity and has been proven to predict outcome of medical treatments in different patient populations. The sample was stratified into BMI quartiles, computed from the patients' baseline BMI. For each quartile, BMI evolution was analyzed using individual growth curve analysis. RESULTS: Growth curve analyses showed that in quartiles 1, 2, and 3, none of the INTERMED domain scores significantly predicted the BMI evolution after surgery. However, in the fourth quartile-including patients with the highest pre-surgical BMI-the social domain score of the INTERMED significantly predicted BMI evolution: patients with more social complexity showed higher increase in BMI. CONCLUSION: Effectiveness of interventions targeted at social complexity, especially when patients suffer from severe obesity, may therefore be evaluated in future studies.