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Mental Illness Conditions Related to Morbid Obesity

According to Nature, statistics show that the United States has the highest numbers of obesity as compared to other countries, with overweight and obesity associated with decreasing levels of emotional and physical well-being. Morbid obesity is not tracked by the government, but in 1999 the Journal of American Medical Association measured obesity at 30 percent and morbid obesity at 6 percent.. Recent studies show that obesity is an independent risk factor for type 2 diabetes, hypertension, sleep apnea, osteoarthritis, certain kinds of cancer and coronary heart disease.

Obesity is not listed as a psychiatric illness because it is not considered a psychiatric disorder. Yet some cases can be caused by psychiatric illness, genes, medications, and endocrine disorders. However, it is known that many pharmaceutical treatments for various mental illnesses increase the risk of obesity – such as antidepressants and atypical antipsychotics (second generation antipsychotics).

-Studies show link between mental illness and obesity

A study at the University College London, led by Mika Kivimaki, was quoted in Thaindian as saying that “obese people – especially those who perceive themselves as being overweight – often experience weight-related stigma and discrimination, and consequently present with symptoms of low self-esteem, low self-worth and guilt.” It went on to say that obesity was associated with low levels of physical activity and socio-economic disadvantages, strong predictors of depression. Overeating with comfort foods is common with depressant patients or those with anxiety. The publication suggests that patients who visit their doctors with mental disorder symptoms should be assessed for obesity and related chronic diseases … or vice versa.

In 2004, the Harvard University Mental Health said that the American Psychiatric Association had never considered obesity or over-eating as a psychiatric disorder. But experts and the public opinion have discovered that with obesity becoming a national issue, they feel it is not a personal emotional problem alone but a relationship between mental health and obesity.

-Night eating syndrome (NES)

NES is a newly discovered controversial mental disorder that is diagnosed as an eating disorder, consisting of late night binge eating. It is currently proposed for the next Diagnostic and Statistical Manual of Mental Disorders. Affecting up to 2% of the population, NES has higher scores for depression and low self-esteem with decreased levels of leptin and melatonin during the night. One study shows that 28% of gastric bypass surgeries suffer from NES, showing it is more common in obese people than in the general population.

Studies at Harvard are showing that the neurotransmitter profile of the NES individual is one of the keys, with a reduced amount of the amino acid “tryptophan” in the person’s brain, which is supposed to convert to the “feel good” neurotransmitter serotonin. They also have a reduced amount of melatonin in the brain, a neurotransmitter that regulates sleep.

– Psychogenic non-epileptic seizures

Psychogenic non-epileptic seizures (PNES) are considered somatic manifestations of psychological distress, with weight problems and obesity more common in those with psychiatric illness. Approximately 20 to 30 percent of patients who are seen at epilepsy centers have PNES instead of epilepsy, which makes it as prevalent as multiple sclerosis. Yet until lately there has been little information on somatoform disorders, with a misdiagnosis of epilepsy in patients instead of PNES a very common thing. The problem is patients with obesity and PNES fight the stigma of both conditions, making the situation much worse.

About 25% of patients who are diagnosed with epilepsy and do not respond to drug treatment are misdiagnosed, having PNES instead. Physicians are taught to look at physical disorders as the primary symptoms, prescribing the patient antiepileptic drugs. Also, for an accurate diagnosis the physicians need to have access to an EEG video monitoring machine operated by a neurologist who specializes in epilepsy. An epileptic patient has abnormal brain electrical discharges. In comparison, a PNES patient has manifestations of psychological distress.

PNES is more common among women than men, especially women who have gone through a traumatic event – incest, physical abuse, sexual abuse, divorce, a close death, a sudden change or a great loss. Called a conversion disorder (a somatoform disorder), PNES is a manifestation of a psychological disturbance caused by psychological conflict, usually developing anywhere from adolescence to early adulthood. Considered a difficult condition to treat by mental health care workers, as soon as one symptom is treated – another one quickly arises. Also called Post Traumatic Stress Disorder, the seizures are manifestations of trauma stored in a particular part of the body.

-Psychiatric drugs and obesity
The growing rate of obesity in the United States among the chronically mentally ill is higher than in the general population – especially when taking antipsychotics. The choice is to accept the weight gain, change drugs or do without and go insane. Some of the highest risk drugs for weight gain are Zyprexa, Seroquel, Risperdal, Abilify and Clozaril. Lithium and Depakote will also cause the weight to add on, a difficult side effect to deal with over time. Older first generation antipsychotics are less risky for gaining weight, like Geodon or Trilafon.

-Relatives of morbid obese patients
A study by Donald W. Black, RiseB. Goldstein, Edward E. Mason, Sue E. Bell and Nancee Blum at the University of Iowa, College of Medicine, interviewed 88 patients for vertical banded gastroplasty. The typical subject was female, middle-aged and of low socioeconomic status. Patients who were morbidly obese were more than likely to have first-degree relatives with antisocial personalities, bipolar disorder, depression and other psychiatric disorders with frequent emotional disturbance. (Science Direct)