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Psychiatric patients

Bipolar patients should be eligible for bariatric surgery

All-cause mortality was lower in bariatric patients than controls

Patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery, according to a study published in the journal Bipolar Disorders. The study authors report that surgery did not increase the risk for hospitalisation or the use of outpatient psychiatric services among stable patients with bipolar disorder.

The researchers included 144 severely obese patients with bipolar disorder who underwent bariatric surgery, and 1,440 control patients with bipolar disorder, matched for gender, medical centre, and contemporaneous health plan membership. Controls met referral criteria for bariatric surgery. Hazard ratio for psychiatric hospitalization, and change in rate of outpatient psychiatric utilization from baseline to years 1 and 2, were compared between groups.


A total of 13 bariatric surgery patients (9.0%) and 153 unexposed to surgery (10.6%) had psychiatric hospitalisation during follow-up. In multivariate Cox models adjusting for potential confounding factors, the hazard ratio of psychiatric hospitalisation associated with bariatric surgery was 1.03 [95% confidence interval (CI): 0.83–1.23]. This was not significantly different to the 10.6% of 1,440 patients with bipolar disorder who did not undergo such surgery.

After taking into consideration factors such as age, ethnicity, psychiatric medication use, baseline BMI, and comorbidities, the hazard ratio for psychiatric hospitalization following bariatric surgery was non-significant at 1.03, the team reports in Bipolar Disorders.

There was also no significant increase in the use of psychiatric outpatient services following surgery, with only a 0.5 visit per year difference in outpatient utilisation from baseline to year 2 when compared with controls.

All-cause mortality was lower in bariatric patients than controls, at 2.88 versus 8.96 deaths per 1,000 person–years of follow-up. This finding is contrary to previous study that have reported an increased risk for suicide following bariatric surgery were not supported by the study.

The researchers point out that the study participants all had stable bipolar disorder, having not been admitted to hospital in the year prior to surgery and with no current substance abuse or dependence. They therefore cannot surmise how bariatric surgery affects disease course in patients with unstable bipolar disorder.

“Given that patients with bipolar disorder have a higher prevalence of obesity and obesity-related comorbidities, this suggests that people with stable bipolar disorder can be evaluated for bariatric surgery using the same criteria as other patients,” say the study authors, led by Ameena Ahmed, The Permanente Medical Group, San Francisco, California.

The authors concluded that bariatric surgery did not affect psychiatric course among stable patients with bipolar disorder and that the results of the study suggest that patients with bipolar disorder who have been evaluated as stable can be considered for bariatric surgery.

The study was presented at the American Psychiatric Association 165th Annual Meeting, 5–9 May 2012, Philadelphia.

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