Provider-reported use of butylscopolamine in gastrointestinal endoscopy in Germany.

Introduction The anti-cholinergic agent hyoscine-N-butylbromide (HBB) is used in gastrointestinal (GI) endoscopy to decrease motility and facilitate endoscopic procedures. Data from clinical studies to support this practice is limited especially for therapeutic procedures. Likewise, patterns of use among endoscopist are largely unclear. This study sought to assess usage of HBB among German-speaking endoscopists. Material and Methods We conducted an anonymous online survey among endoscopists in German-speaking countries. Results A total of 207 physicians participated in the survey. The majority (76.9%) were experienced endoscopists and 92.3% of respondents use HBB at least occasionally during procedures. The reported median stated frequency of HBB use varied greatly between different types of procedures and increased with the complexity of the procedure being performed. HBB was rarely used in diagnostic esophagogastroduodenoscopies (EGD) (median stated frequency 1% of procedures), while use frequency was significantly higher in EGD with endoscopic mucosal resection (EMR) (10%; p=0.002) and EGD with endoscopic submucosal dissection (ESD) (20%; p<0.001). Similarly, use frequency during diagnostic colonoscopy was lower (5%) compared to colonoscopy with EMR (20%, p=0.005) or ESD (42.5%, p<0.001). The highest use frequency was reported for ERCP (50%). The most frequently stated reason to use HBB was facilitation of the procedure (80.6%) followed by increasing diagnostic yield (58.3%). Conclusion German-speaking endoscopists commonly use HBB, most frequently to facilitate complex therapeutic procedures. Given there is almost no data supporting HBB use in therapeutic endoscopy, we suggest that more research is needed to evaluate benefits and risks of this practice.

Update on treatment studies for compulsive buying-shopping disorder: A systematic review.

Background and aims: Compulsive buying-shopping disorder (CBSD) is mentioned as an example of other specified impulse control disorders in the ICD-11 coding tool, highlighting its clinical relevance and need for treatment. The aim of the present work was to provide a systematic update on treatment studies for CBSD, with a particular focus on online CBSD. Method: The preregistered systematic review (PROSPERO, CRD42021257379) was performed in accordance with the PRISMA 2020 statement. A literature search was conducted using the PubMed, Scopus, Web of Science and PsycInfo databases. Original research published between January 2000 and December 2022 was included. Risk of reporting bias was evaluated with the CONSORT guideline for randomized controlled trials. Effect sizes for primary CBSD outcomes were calculated. Results: Thirteen studies were included (psychotherapy: 2 open, 4 waitlist control design; medication: 2 open, 3 placebo-controlled, 2 open-label phase followed by a double-blind discontinuation phase; participants treatment/control 349/149). None of the studies addressed online CBSD. Psychotherapy studies suggest that group cognitive-behavioral therapy is effective in reducing CBSD symptoms. Pharmacological studies with selective serotonin re-uptake inhibitors or topiramate did not indicate superiority over placebo. Predictors of treatment outcome were rarely examined, mechanisms of change were not studied at all. Risk of reporting bias was high in most studies. Discussion: Poor methodological and low quality of reporting of included studies reduce the reliability of conclusions. There is a lack of studies targeting online CBSD. More high-quality treatment research is needed with more emphasis on the CBSD subtype and mechanisms of change.

The Relationship of Shopping-Related Decisions with Materialistic Values Endorsement, Compulsive Buying-Shopping Disorder Symptoms and Everyday Moral Decision Making.

BACKGROUND: Compulsive buying-shopping disorder (CBSD) is associated with high materialistic values endorsement and excessive purchasing of consumer goods. A subgroup of individuals with CBSD engage in socially unacceptable behaviors to continue shopping despite negative consequences. This investigation aimed at exploring possible links between ego-oriented shopping-related decisions, materialism, symptoms of CBSD and close-to-everyday moral decision making. METHODS: In study 1, patients with CBSD were interviewed to develop a list of conflict situations, capturing typical shopping-related dilemmas. In study 2, the shopping-related dilemmas from study 1, standardized close-to-everyday moral dilemmas, the Material Values Scale and Pathological Buying Screener were administered to a web-based convenience sample (n = 274). RESULTS: The main effects of a moderated hierarchical regression analysis revealed an association of more ego-oriented shopping-related decisions with both higher materialistic values endorsement and more CBSD symptoms, but not with everyday moral decision-making. However, a more egoistic everyday moral decision making style moderated the effect of CBSD symptoms on ego-oriented shopping related decisions. CONCLUSIONS: The findings indicate that a more egoistic everyday moral decision making style is not directly linked to domain-specific shopping-related decision making but strengthens the link between symptoms of CBSD and ego-oriented shopping-related decisions.

Who Was Shopping More During the Spring Lockdown 2020 in Germany?

Background: During the lockdown, governmental restrictions resulted in changes to the day-to-day routines of many individuals. Some people appear to cope with stress by panic buying in an attempt to stockpile specific goods, resulting in empty supermarket shelves. Moreover, e-commerce experienced significant growth during this period. We aimed to investigate potential changes in shopping frequencies and preferred shopping type (offline/online) and their relationship with pandemic-specific anxiety and stress during the 2020 spring lockdown in Germany. Methods: To address this question, we assessed self-reported changes in shopping behavior in a German sample via an online survey conducted during April and May 2020. Results: A total of 3,122 adults were included in the analysis. Of the total sample, 35% reported no changes in their shopping behavior, 46.8% shopped less, while 18.2% shopped more during the lockdown. The groups differed with respect to sociodemographic variables, and those participants who were shopping more reported greater pandemic-related health fears and stress due to the restrictions. Moreover, they shopped online more often during the lockdown than the other two groups. Conclusion: While the majority of the sample reported no changes in their shopping behavior or even shopped less during the 2020 spring lockdown, a subgroup of individuals was shopping more during this time, especially food and drugstore products. It is important to understand which factors influenced individuals to shop more so that policy makers can target this group and prevent panic buying, especially during subsequent waves of infection. It is also important to inform vulnerable persons about the risk of developing a buying-shopping disorder.

The Effects of the Lockdown during the COVID-19 Pandemic on Alcohol and Tobacco Consumption Behavior in Germany.

BACKGROUND: Similar to other countries, the government of Germany has implemented various restrictions of social life in March 2020 to slow the spread of COVID-19 pandemic. This results in millions of people being isolated for long periods, which may increase feelings of worry and anxiety. As the consumption of alcohol and tobacco is an often used dysfunctional strategy to cope with such feelings, these restrictions might cause an increase of consumption. Already at the beginning of the COVID-19 pandemic, the World Health Organization (WHO) warned that increased alcohol consumption during the lockdown can increase the prevalence of alcohol use disorders in the future. However, up to now little is known about the changes in alcohol-drinking behavior and tobacco smoking in the general population during the COVID-19 pandemic. METHODS: To address this theme, we investigated the changes in alcohol and tobacco consumption in the German population aged between 18 and 80 years via an online survey. RESULTS: In total, 3,245 persons participated in the survey; 35.5% of them reported an increase in drinking during the lockdown (42.9% did not change their drinking behavior, 21.3% drank less, and 0.3% started drinking). The odds of consuming more alcohol during lockdown were associated with middle age, higher subjective stress due to the COVID-19 pandemic, a lower agreement with the importance of the restrictions, and consuming alcohol more than once per week before the lockdown. Also, 45.8% of the participants increased their smoking during the lockdown. The odds of smoking more during lockdown were associated with higher subjective stress due to the COVID-19 pandemic. CONCLUSION: These findings suggest that it is important to start campaigns to inform the general population about potential long-term effects of increased alcohol and tobacco consumption and to raise the health-care professionals' awareness of this topic.

[The Pathological Buying Screener: Validation in a Clinical Sample]. / Der Pathological Buying Screener: Validierung in einer klinischen Stichprobe.

AIM: The aim of the study was to evaluate the psychometric properties of the 13-item Pathological Buying Screener (PBS, [1]) in a clinical sample. METHOD: The PBS was administered to a total sample of 413 treatment-seeking patients (buying-shopping disorder n=151, gambling disorder n=59, alcohol dependency n=60, other mental disorders [anxiety, depressive, eating, somatoform disorders] n=143). Factor structure was tested in the total sample using confirmatory factor analysis (CFA), reliability was determined by means of Cronbach's α. Group comparisons were used to determine to which degree the PBS discriminates between patients with BSD and other clinical groups. The BSD-group completed a battery of other measures to explore convergent and divergent validity. A subgroup (n=29) answered the PBS before and after psychotherapy to investigate sensitivity to change. A receiver operating characteristic (ROC) curve analysis with PBS data of patients with buying-shopping disorder and those from a previous community sample 1 was performed to define a cut-off point for buying-shopping disorder. RESULTS: The CFA showed a good model fit for both a one-factor and a two-factor structure with the subscales "loss of control/consequences" (10 items) and "excessive buying behavior" (3 items). The subscales were highly intercorrelated (r=0.92). A hierarchical regression analysis with another BSD measure as dependent variable did not indicate an own incremental validity of the subscale "excessive buying behavior". Good convergent, divergent and discriminative capacity was obtained for the PBS total score. At its recommended cut-off point of ≥29 the PBS has a sensitivity of 98% and a specificity of 94.7%. CONCLUSION: The findings indicate good psychometric properties of the PBS and suggest that the PBS total score can be used in clinical settings.

Associations of Buying-Shopping Disorder Symptoms with Identity Confusion, Materialism, and Socially Undesirable Personality Features in a Community Sample.

INTRODUCTION: While identity problems and materialistic value endorsement have been described as predisposing factors for buying-shopping disorder (BSD) in the literature, little empirical data are available on the role of socially undesirable personality features that may contribute to financial misconduct and manipulative interpersonal behaviors in BSD. The dark triad of personality refers to such offensive yet non-pathological personality traits and has been applied to addictive behaviors in the past. The aim of the present study was to investigate whether the "dark triad" dimensions Machiavellianism, subclinical narcissism, and subclinical psychopathy predict symptoms of BSD above and beyond identity confusion and materialism, or moderate the relationship between materialism and symptoms of BSD. METHOD: The participants comprised a convenience sample (N = 272, 72.4% women) aged between 18 and 67 years. Assessment included standard questionnaires for BSD, identity problems, materialism, and the dark triad of personality. RESULTS: Zero-order correlations indicate a weak association between BSD and the dark triad dimensions Machiavellianism and narcissism, but not psychopathy. Results of a moderated regression analysis with BSD symptoms as a dependent variable revealed significant main effects for materialism, female gender, and a significant "narcissism by materialism" effect, after accounting for identity confusion/synthesis and the single dark triad traits. CONCLUSION: The findings suggest that individuals with BSD attempt to address their narcissistic deficits via materialistic possessions. This assumption warrants further investigation in a clinical sample.

COVID-19 Lockdown Restrictions and Online Media Consumption in Germany.

The lockdown restrictions due to the COVID-19 pandemic have led to increased stress levels and feelings of anxiety in the general population. Problematic usage of certain online applications is one frequent way to compensate for negative feelings and stress. The current study investigated changes of online media consumption during the lockdown in Germany. Gender and age specific differences in specific online activities were assessed. n = 3245 subjects participated in an online survey conducted between the 8th April and the 11th May 2020. Participants' age ranged between 18 and >55 years. A considerably high percentage (71.4%) of participants reported increased online media consumption during the lockdown. Male participants were more likely to increase their consumption of gaming and erotic platforms, while female participants reported a higher increase in the engagement in social networks, information research, and video streaming than males. The findings revealed an increased usage of all online applications during the lockdown. For the clarification whether the increase might present a risk for elevated Internet-use disorders or can be regarded as a functional and time-limited phenomenon, further studies, assessing changes in these online activities after the end of the pandemic, are needed.

The prevalence and risk factors for mental distress among Syrian refugees in Germany: a register-based follow-up study.

BACKGROUND: Mental disorders among refugees as well as their risk factors are already well documented in cross-sectional reports. However, longitudinal follow-up designs are widely lacking. Therefore, the aim of this study was to examine the change of the prevalence of mental disorders among Syrian refugees with German residence permission, taking into account their increasing length of stay in Germany, and to uncover the change in their relationship to pre- and post-migration risk factors. METHODS: This study formed part of a register-based follow-up study with two measurement points in Erlangen (Germany). At the first time of recruitment in 2017, 200 of the 518 Syrian refugees with residence permission living in Erlangen took part. During the second survey timeframe 1.5 years later, in 2019, 108 of the former 200 Syrian refugees participated again and formed the total sample for this follow-up study. The survey instruments included demographics, migration-related variables and symptoms of post-traumatic stress (Essen Trauma Inventory, ETI), depression (Patient Health Questionnaire - PHQ-9) and generalized anxiety disorder (GAD-7). RESULTS: At the time of the first survey, 26.9% of the participants exceeded the cut-off for a clinically relevant depression diagnosis, 16.7% for an anxiety disorder and 13.9% for a PTSD diagnosis. At the second measurement point, it was 30.6% for depression, 15.7% for an anxiety disorder and 13.0% for PTSD. No significant changes between the measurement points were found for any of the disorders. In multiple linear regression analyses, higher perceived discrimination, a higher number of traumatic experiences and a shorter duration of residence permission were shown to be the most important pre- and post-migration predictors of psychological stress independent of the time of measurement. CONCLUSIONS: There is strong empirical evidence that the prevalence rates of mental distress among refugees are significantly higher compared to the overall population. However, it has not yet become clear how these prevalence rates change with an increasing length of stay in the host countries. The results of our study indicate that the psychological burden on this refugee population remains consistently high over time, despite partly improved living conditions, and confirm the importance of therapeutic interventions.

Current status of the intercultural opening at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria.

Objectives: Intercultural opening of the health care system is supposed to optimize health services for migrants. It is part of the National Integration Plan and promoted by medical societies in Germany. This study examines its state of implementation at hospitals and rehabilitation centres for psychosomatic medicine and psychotherapy in Bavaria. Methods: A written survey was conducted using a modified version of the questionnaire for the implementation of intercultural opening in the mental health care system IKÖ-P (Penka et al. 2012a). Results: Altogether 18 institutions responded. Migrants were underrepresented among patients and employees excluding physicians. Specialized psychotherapeutic interventions for migrants were rarely available, but frequently used when offered. Conclusions: Intercultural opening was poorly implemented in a structural level. Due to the low response-rate of 21.7 % the survey is not representative. Participation of institutions interested in intercultural opening could have led to biased results. To provide adequate psychosomatic medical care for migrants, intercultural opening should be further developed.

Does the separation from marital partners of Syrian refugees with a residence permit in Germany have an impact on their quality of life?

OBJECTIVE: Around 700,000 Syrian refugees live in Germany, most of them having come alone since 2015 as asylum seekers and waiting in Germany for family reunification. This study focused on separation from marital partner and its impact on quality of life among Syrian refugees with a residence permit. METHODS: For the present investigation, we included only married participants of a larger registry-based study. Therefore, we analyzed 119 participants; 93 of them were married, and their partner accompanied them in Germany at the time of the investigation (partner+), while a further 26 were married but separated from their partner (partner-). The respondents were investigated for mental stress, quality of life and protective factors. RESULTS: The partner- group reported significantly lower quality of life in the domains of psychological and social health in comparison to the partner+ group. Higher general quality of life was associated with higher social support, higher sense of coherence and fewer symptoms of depression. Predictors for a higher quality of life were male gender, fewer symptoms of depression, a higher sense of coherence, higher perceived social support and living together with the marital partner. CONCLUSION: Family separation of Syrian refugees with a residence permit in Germany can have an impact on their quality of life. Longitudinal studies are needed to confirm our results and determine the long-term effects of family separation.

The Perceptions of Trauma, Complaints, Somatization, and Coping Strategies among Syrian Refugees in Germany-A Qualitative Study of an At-Risk Population.

Background: A high prevalence of mental distress, especially posttraumatic stress disorder, has been widely confirmed among refugees. In order to establish adequate interventions in psychotherapy, however, it must first be examined whether refugees have similar ideas and concepts of stress, trauma, and healing. This study, therefore, aimed to analyze the representations of trauma, self-reported complaints, indications of somatization, and coping strategies among a refugee population. Methods: Semi-structured interviews based on the Cultural Formulation Interview (CFI) of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) were conducted with Syrian refugees who have residence permission in Germany. The interviews were audio-recorded, transcribed, and analyzed according to the qualitative content analysis of Mayring. The foci of interest were determined on the basis of the predefined interview guideline, and inductive subcategories were extracted from the transcripts. Results: Sixteen refugees participated (50% women; mean age: 35.5 years, SD = 11.2; the mean duration of stay in Germany: 23.3 months, SD = 6.6). War experiences were the most frequently reported subjective perceptions of trauma. Frequently reported complaints included sleeping disturbance, cardiovascular symptoms, rumination, and pain. Among half of the participants, we found indications of somatization. We identified the following coping strategies: Activity, cognitive coping, social coping, religious coping, avoidance, and emotional coping. Conclusions: War-related traumatic events are the most common trauma perceptions among Syrian refugees. The self-reported complaints demonstrate somatoform, depressive, and posttraumatic symptoms. Syrian refugees should be screened for somatization, depression, and posttraumatic stress disorder and should receive targeted interventions that consider and support individual coping resources.

Professional and Volunteer Refugee Aid Workers-Depressive Symptoms and Their Predictors, Experienced Traumatic Events, PTSD, Burdens, Engagement Motivators and Support Needs.

In 2016, the Department of Psychosomatic Medicine and Psychotherapy of the University Hospital of Erlangen started conducting training for professional and voluntary aid workers. In total, 149 aid workers took part in the training courses, of which 135 completed the corresponding questionnaires. Engagement motivators, perceived distress in refugee work and training needs were examined. Moreover, depressive symptoms, the prevalence of traumatic experiences and symptoms of posttraumatic stress disorder were explored. Participants named helping others as the highest motivating factor for their work with refugees and communication problems as the main burden. Thirteen aid workers (10.1%) showed clinically relevant depressive symptoms. In total, 91.4% of refugee aid workers had experienced at least one traumatic event personally or as a witness but only three (3.6%) fulfilled the psychometric requirements of a PTSD diagnosis. These three participants all belonged to the professional aid workers (6.3%). More severe symptoms of depression were significantly associated with female gender (ß = 0.315, p = 0.001), higher perceived burdens of refugee work (ß = 0.294, p = 0.002), and a larger number of experienced traumatic events (ß = 0.357, p < 0.001). According to our results, we recommend psychological trainings and regular screenings for psychological stress in order to counteract possible mental illnesses.

Online shopping in treatment-seeking patients with buying-shopping disorder.

BACKGROUND AND AIMS: With e-commerce becoming an important shopping activity, it has been argued that traditional buying-shopping disorder (BSD) migrates to the online retail market resulting in BSD predominantly online. The aims of the current study were to investigate how many patients with BSD report symptoms of online BSD, and to determine whether symptoms of probable online BSD are related to sociodemographic variables, anxiety, depression, and a higher severity of general BSD. METHOD: A post hoc analysis of pooled data collected within previous studies (n = 122 treatment-seeking patients with BSD; age Mdn = 42.50, range 20-68 years; 76% women) was conducted. Assessment included the short version of the Internet Addiction Test modified for online shopping sites (s-IATshop), the Pathological Buying Screener (PBS) as an instrument assessing BSD in general, regardless of the buying or shopping environment, and measures for anxiety and depression. RESULTS: 33.6% of the sample met the s-IAT threshold for probable online BSD. Higher s-IAT scores were related to lower age and to a higher severity of anxiety, depression and general BSD. A hierarchical regression analysis with general BSD (PBS score) as dependent variable and partnership status, symptoms of anxiety, depression and online BSD (s-IAT-shop) as predictors indicated a significant positive association of probable online BSD with the severity of general BSD above and beyond anxiety and depression. CONCLUSION: The findings may encourage future studies addressing phenomenological characteristics, underlying features, associated comorbidity, and clinical relevance of online BSD.

Prevalence of Mental Distress Among Syrian Refugees With Residence Permission in Germany: A Registry-Based Study.

Background: High rates of prevalence of mental distress among the Syrian refugee population have been repeatedly confirmed. However, little is known about the influence of length of stay, living conditions, and residence permission in the host country or about the duration of the escape journey and travel conditions on mental health in this refugee population. This study examines the mental health of Syrian refugees, taking into account the circumstances in their country of origin and host country, as well as their escape conditions. Methods: This investigation formed part of a registry-based study. A sample of 518 adult Syrian refugees in Erlangen, Germany, who have residence permission was identified. The response rate was 38.6%; a total of 200 Syrian refugees thus participated in the study. The respondents were investigated for post-traumatic stress disorder (ETI), depression (PHQ-9), generalized anxiety (GAD-7) and post-migration variables. Results: The prevalence of participants who had personally experienced and/or witnessed traumatic events was 75.3%. Symptoms of PTSD were found in 11.4% of the participants. Moderate to severe depression was confirmed in 14.5% and moderate to severe generalized anxiety in 13.5% of the sample. The criteria for at least one diagnosis were met by 30.5% of the participants. More severe PTSD symptoms were associated with older age, shorter validity of the residence permit, larger number of traumatic events (TEs) and higher generalized anxiety symptoms. Depression symptoms were associated with younger age, shorter duration of escape journey, larger number of TEs and higher generalized anxiety symptoms. Generalized anxiety symptoms correlated with female gender, PTSD, and depression symptoms. Conclusions: These findings suggest that Syrian refugees in Germany are a vulnerable population, especially if they have experienced and/or witnessed multiple traumatic events. However, post-migration conditions and positive future prospects in the host country can be protective factors for this population.

High Manifestations of Mental Distress in Arabic Asylum Seekers Accommodated in Collective Centers for Refugees in Germany.

The number of asylum seekers in Germany has significantly increased in the last two years. Coming from regions of political conflict and war, the refugees have often experienced traumatic events which designate them as a high risk group for mental disorders. In a sample of Arabic speaking asylum seekers in collective accommodation centers in Erlangen, Germany, we estimated the extent of posttraumatic stress, depression, and anxiety. A further objective of the study was to test the comprehensibility and cultural appropriateness of the Arabic translations of the questionnaires in this sample. Between August and September 2016, 56 Arabic speaking asylum seekers placed among three collective accommodation centers in Erlangen completed self-report questionnaires assessing posttraumatic stress disorder (Essen Trauma-Inventory, ETI), and symptoms of depression (Patient Health Questionnaire-depression module, PHQ-9) and anxiety (Generalized Anxiety Disorder, GAD-7). The prevalence of participants with personally and/or witnessed traumatic events was 80.4% (n = 45). About one-third of the examinees (35.7%, n = 20) endorsed symptoms of PTSD (posttraumatic stress disorder). The total score for depression in this sample was M = 11.9 (SD = 7.9, range: 0-27). Moderate to severe depression (PHQ-9 score ≥ 15) was found in 35.7% (n = 20) of our sample and severe depression (PHQ-9 score ≥ 20) was found in 23.2% (n = 13). The total score for anxiety was M = 8.8 (SD = 6.9, range: 0-21), with 26.8% (n = 15) of the sample showing symptoms of severe anxiety (GAD-7 score ≥ 15). No significant difference between women and men with respect to frequency and symptom scores of PTSD, depression, and anxiety was found. Amongst asylum seekers of the presented sample, the rates of traumatic events as well as the prevalence of possible PTSD, depression, and anxiety were significantly higher than in the German population. This indicates that the refugee population is in need of culturally sensitive psychological interventions. However, more studies are required to improve the understanding of mental health among this particularly vulnerable population.

[Distress, Main Burdens, Engagement Motivators and Needs of Fulltime and Volunteer Refugee Aid Workers]. / Psychische und kontextuelle Belastungen, Motivationsfaktoren und Bedürfnisse von haupt- und ehrenamtlichen Flüchtlingshelfern.

In the psychosomatic department of the University Hospital of Erlangen trainings were conducted for active refugee aid workers with start in January, 2016. Meanwhile 49 helpers participated in the training and 45 of them filled out a survey questionnaire. Perceived distress when providing care for refugees, as well as engagement motivation and further training needs were explored. Furthermore, depressive symptoms as well as the prevalence of traumatic experiences were investigated. The main burden was experienced through lacking freedom of action on the background of legal regulations. Furthermore dissociative symptoms (15.4%) and aggressive behavior (26.9%) of refugees were reported as distress factors. To help others proved to be the highest motivator for their work with refugees. Only 2 workers (4.4%) showed elevated depressive symptom manifestations. In contrast, 93.3% of refugee helpers had experienced a traumatic event personally or as a witness. For the helpers the greatest training needs were the recognition of mental health problems and to learn concrete intervention strategies to help those affected.

Attention Deficit Hyperactivity Disorder Prevalence and Correlates Pre- and Post-Bariatric Surgery: A Comparative Cross-Sectional Study.

OBJECTIVE: Previous research shows an association between obesity and attention deficit hyperactivity disorder (ADHD). The present study compares pre- and post-bariatric surgery patients using the internationally used Conners' Adult ADHD Rating Scale (CAARS™) to screen for ADHD. METHODS: Matched samples pre- (N = 120) and post-bariatric surgery (N = 128) were compared using self-rating instruments to assess ADHD-relevant symptomatology, depression, eating-related psychopathology, and BMI. RESULTS: Prevalence of probable ADHD did not differ between groups using the CAARS Index Scale T-scores; however, CAARS subscales Inattention/Memory and Self-Concept showed significantly lower scores in post-surgery patients. All CAARS subscales correlated significantly with each other, with depression and eating-related psychopathology. There was no correlation between ADHD and excess BMI loss in post-surgery patients. CONCLUSION: The findings suggest that a considerable number of patients before and after bariatric surgery screened positive for ADHD. It can be hypothesized that some core ADHD symptoms improve after surgery. Future studies are warranted to investigate the influence of ADHD on long-term surgery outcomes.

Body image and quality of life in patients with and without body contouring surgery following bariatric surgery: a comparison of pre- and post-surgery groups.

BACKGROUND: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning. METHODS: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7). RESULTS: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains. DISCUSSION: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.