Preoperative Psychiatric Evaluation Research Articles

The evaluation of patients apply for septorhinoplasty in terms of body perception, disability, depression and social phobia

Objective: Psychiatric suitability is an important parameter that is evaluated together with anatomical suitability when deciding on rhinoplasty surgery. There is no matter how successful the treatment or surgery is, the results are not satisfactory in individuals with psychiatric symptoms. In order to make a broader assessment to determine psychiatric suitability, we aimed to evaluate the body perception, disability, depression and social phobia in individuals who applied for rhinoplasty surgery. Method: In this study, patients were planned to be included who applied to …………………… University Hospital Otorhinolaryngology outpatient clinic between 1/1/2019 - 1/1/2020. Among the patients, 50 volunteers who applied with the complaints of dissatisfaction with the aesthetic appearance of the nose and underwent septorhinoplasty were included in the case group. In the control group, 50 patients who applied to the Otorhinolaryngology outpatient clinic and had any complaints other than nasal deformity and were not planned for aesthetic any other operation were included. Results: There was no statistically significant difference found in terms of body image, disability, depression and social phobia. Conclusion: It has been confirmed that depression and body image do not show significant changes in patients who will undergo septorhinoplasty, and the information that disability and social phobia are not effective has been brought to the literature. Further studies with larger samples are needed on preoperative psychiatric evaluation.

The effect of body satisfaction on female sexual life after bariatric surgery: a follow-up study

Aim: Discomfort with body shape is common among individuals with obesity and has effects on their sexual life. We aimed to investigate the effects of bariatric surgery on the body satisfaction and sexual life of women in this study.
 Material and Method: The study consisted of 63 female patients who were aged between 20 and 55. Pre-operative psychiatric evaluations of the candidates were conducted and Hamilton Anxiety Scale , Hamilton Depression Scale, Arizona Sexual Experiences Questionnaire and Body Shape Questionnaire were used. Psychiatric evaluations of the patients were re-evaluated in the first year after surgery.
 Results: The mean age was 35.4±8.6 years. While 87.3% of the participants had moderate-severe anxiety about the appearance of their bodies before the operation, 57.1% described problems in their sexual life. After the operation, 63.5% of the participants stated that they did not have any concerns about their body appearance, and 73% stated that they did not have any problems in their sexual life. The BSQ-34 scale score was found to be higher in those with an Arizona score of 11 and above before the operation (p=0.045; p

Surgeon-driven preoperative psychiatric evaluation of plastic surgery patients

Objectives: Dissatisfaction with body image is common in patients seeking corrective plastic surgery. However, surgery may not be suitable for every patient. Surgery can enhance quality of life in mentally healthy patients but those with psychopathology such as body dysmorphic disorder (BDD) tend to have poorer outcomes. For these patients, surgery is not always recommended and psychiatric care can have a useful role. This paper aimed to estimate the rates of psychopathology in a select group of elective plastic surgery candidates and discuss the role of preoperative psychoplastic referral in triaging these candidates. Method: A retrospective cohort study of patients considering elective surgery at Flinders Medical Centre in South Australia referred by their surgeon for psychoplastic evaluation from 2010 to 2016. Medical records were reviewed to determine compliance with psychiatric referral, the number and types of psychiatric diagnosis and rates of subsequent surgery. Results: We found 83 per cent (54/65) of surgical candidates assessed by our psychiatrist had a mental illness. Post-traumatic stress disorder (n=19, 34.5%) and major depressive disorder (n=19, 34.5%) were most common. Nine patients (13.6%) were diagnosed with BDD. A total of 57 (87.7%) patients were considered to need some kind of psychiatric care to improve potential surgery outcomes. Conclusions: In our study, the rate of psychopathology in patients referred for psychiatric evaluation suggests that careful screening is important for clinical decision making. A combined surgical /psychiatric approach is effective in ensuring vulnerable patients are identified and managed appropriately.

Risk Factors for Suicide After Bariatric Surgery in a Population-based Nationwide Study in Five Nordic Countries.

To identify risk factors for suicide after bariatric surgery. Bariatric surgery reduces obesity-related mortality. However, it is for unclear reasons is associated with an increased risk of suicide. This population-based cohort study included patients having undergone bariatric surgery in 1982 to 2012 in any of the 5 Nordic countries, with follow-up through 2012. Eleven potential risk factors of suicide (sex, age, comorbidity, surgery type, surgical approach, calendar year of surgery, history of depression or anxiety, psychosis, schizophrenia, mania, or bipolar disorder, personality disorder, substance use, and number of previously documented psychiatric diagnoses) were analyzed using Cox regression. Of 49,977 bariatric surgery patients, 98 (0.2%) committed suicide during follow-up. Women had a decreased risk of suicide compared to men (hazard ratio [HR] = 0.48, 95% confidence interval [CI] 0.33-0.77), although age and comorbidity did not influence this risk. Compared to gastric bypass, other types of bariatric surgery had lower risk of suicide (HR = 0.44, 95%CI 0.27-0.99). There was no difference in suicide risk between laparoscopic and open surgical approach. A history of depression or anxiety (HR = 6.87, 95%CI 3.97-11.90); mania, bipolar disorder, psychosis, or schizophrenia (HR = 2.70, 95%CI 1.14-6.37); and substance use (HR = 2.28, 95%CI 1.08-4.80), increased the risk of suicide. More of the above psychiatric diagnoses increased the risk of suicide (HR = 22.59, 95%CI 12.96-39.38 for ≥2 compared to 0 diagnoses). Although the risk of suicide is low, psychiatric disorders, male sex, and gastric bypass procedure seem to increase the risk of suicide after bariatric surgery, indicating a role for tailored preoperative psychiatric evaluation and postoperative surveillance.

Indian Subcontinent's First Proximal Forearm Level Double Upper Extremity Transplantation.

Introduction Vascularized composite allotransplantation (VCA) has added another step to the reconstructive ladder, leading to a paradigm shift in the approach toward management of cases of upper limb amputations. In this article, we discuss in detail the technical aspects of proximal forearm level transplantation, as well as the immediate posttransplant monitoring and immunosuppression protocols. Materials and Methods A 24-year-old male victim of an electric injury presented with a bilateral proximal forearm level amputation. After the mandatory preoperative psychiatric and immunological evaluation, the patient underwent a proximal forearm level double upper extremity transplantation. He was then put on a stringent immunosuppression and physical rehabilitative regime. Discussion Conceptually, the proximal forearm level transplantation is significantly different from distal forearm level transplant. This transplant “reestablishes” the “donor extremity length,” maintains the normal functional length of the donor muscles, and the functional return happens only after the newly transplanted donor muscles are reinnervated over a period of time. Conclusion As the sequence of surgical repair and associated decision making could be quite confusing for this level of transplantation, it is highly advisable to do mock cadaver surgical dissections in order to standardize the procedure and make the team familiar with it.

Skin picking in patients with obesity: Associations with impulsiveness and self-harm.

Previous studies suggest elevated prevalence rates of skin picking and self-harm in patients with obesity compared to individuals in the general population. Hence, further studies should investigate prevalence rates and correlates of skin picking in this population - especially its differentiation to self-harm. Skin picking and obesity are both associated with specific facets of impulsiveness. This relation should be explored to shed light on potentially shared mechanisms in etiology. Therefore, the present study examined the occurrence of skin picking and its associations with impulsiveness and self-harm in a sample of pre-bariatric surgery patients with obesity class II/III. Within the routine preoperative psychiatric evaluation, a total of 139 bariatric surgery candidates (78% female, BMIrange35-69) completed a self-report questionnaire assessing sociodemographic variables, anxiety, depression, self-harm, impulsiveness, and skin picking severity (urges: frequency, intensity, controllability; behavior: frequency, intensity, controllability; resistance, emotional distress, impairment, and avoidance). Ten participants (7.2% of the sample) reported recurrent skin picking leading to skin damage, repeated attempts to decrease skin picking, and psychosocial impairment (emotional distress, impairment in functional areas, avoidance) due to skin picking. In line with previous findings, skin picking severity shows a medium correlation with attentional impulsiveness. The majority of self-harm types were not associated with skin picking severity. The current study reveals a high occurrence of skin picking compared to the general population. The results indicate an association between skin picking severity and attentional impulsiveness. Further research is needed to investigate the differentiation of skin picking and self-harm in more detail.

Psychosocial Effects on Heart Transplantation Candidate Selection and Postoperative Outcomes

Introduction Heart Transplant (HT) remains the most effective therapy for patients with stage D heart failure (HF). Multiple quantitative parameters are used to define medical risk, and while a general consensus exists regarding medical criterial for transplant listing, substantial heterogeneity is present when assessing psychosocial risks. No consensus exists on how to quantitatively assess psychosocial risk or if quantitative risk stratification may better predict adverse events. We hypothesize that a quantitative psychosocial risk profile can be developed for advanced HF patients, and that this model may predict post-HT complications. Methods We retrospectively reviewed the records of all patients presented to the HT selection committee at the University of Maryland between 2013-2016. Standardized preoperative psychiatric evaluations assigned low, medium, and high risk for: history of psychiatric disorders, adherence to medical therapies, substance abuse history, and strength of support network. Scores were coded using 0 for low, 1 for medium, and 2 for high risk features, then summed to form a cumulative risk score. Two-sample T tests and ANOVA were performed to compare cumulative risk scores to committee decisions and 1-year mortality data including: survival to one year, readmissions, need for hemodialysis, ICU bed, intubation, non-adherence, missed office visits, and tacrolimus trough outside goal. Results A total of 104 patients were studied Committee decisions included: 67 patients accepted, 15 rejected, and 22 deferred for HT, of whom 10 were accepted on representation. Overall 49 patients underwent HT and survived to discharge. Patients accepted on first presentation had an average cumulative risk score of 0.756. Higher risk scores were associated with committee rejection (1.667, p=0.033) and deferment (1.682, p Conclusions Several studies have demonstrated the impact of psychological functioning, medication adherence, and social support on post-HT morbidity and mortality. We developed a score to quantify psychosocial comorbidities which was significantly associated with HT committee decisions. However, there was no association between higher risk scores and 1-year outcomes. Our quantitative assessment of psychosocial risk revealed patients with higher psychosocial comorbidities may be listed for heart transplantation without increased 1-year morbidity and mortality.

Adherence to Psychiatric Follow-up Predicts 1-Year BMI Loss in Gastric Bypass Surgery Patients.

The objective of this study was to investigate the effects of adherence to postoperative recommended psychiatric follow-up on weight loss in morbid obesity patients with psychiatric disorders 1 year after gastric bypass. Three hundred eighteen morbidly obese patients were retrospectively reviewed. They were divided into four groups according to preoperative psychiatric evaluations and adherence to psychiatric follow-up 1 year after their bypass surgery. The first group included patients who did not meet the referral criteria (NMRC). The second group consisted of patients who did not meet the psychiatric diagnostic criteria (NMDC). The third group was patients who met criteria for a psychiatric disorder and were nonadherent (NA) to psychiatric follow-up. The fourth group consisted of patients who met criteria for a psychiatric disorder and were adherent (A) to psychiatric follow-up. The A group exhibited higher % change in BMI than the NA and NMRC groups at 1 year after bypass surgery. Regression analyses to examine the effects of the grouping variable on % change in BMI were performed by controlling the effects of age, gender, educational level, and preoperative BMI. The regression coefficient for the grouping variable was 0.175 (p = .003) at the 6-month and 0.133 (p = .027) at the 1-year % change in BMI. Our preliminary data suggest that adherence to postoperative psychiatric follow-up is associated with greater postoperative weight loss. However, evidence from studies with a longer follow-up is required to justify this therapeutic approach.

P02-118 - Psychopathologic aspects of obesity: Psychodiagnostic evaluations of bariatric surgery applicants

IntroductionPsychiatrists play an important role as members of the bariatric surgery team. A preoperative psychiatric evaluation is considered as part of a mandatory workup before approving surgery.AimsThis evaluation focuses on the identification of any pre-existing psychiatric disorders among candidates for TOGa[1], a new experimental technique of bariatric surgery, and their correlations with post surgical weight loss.Method45 obese patients underwent a psychiatric interview and several psycho diagnostic questionnaires (SCL-90; HAM-D; HAM-A; EDI; TAS).A follow-up was set each 3 months.ResultsWe found that 34.1% of surgery candidates had a current diagnosis of depression; the majority showed anxiety symptoms. We also documented dissatisfaction about body shape, desire of slimness, fear of maturity, perfectionism, bulimia and binge eating disorder. Other frequent psychiatric symptoms were somatization, sensitivity, obsession and compulsion. After 3 months from surgery we found that the best weight loss was associated to low score in HAM-A, high score in hanger-hostility item (SCL-90) and low score in sensitiveness item (SCL-90).ConclusionThe diagnosis of a psychiatric pathology during the pre-surgical evaluation can be considered a predictive negative factor for the outcome of the surgery. The predictive positive factors are firstly the nonexistence of psychiatric symptoms, secondly the high score in sensitiveness-insight item (SCL-90) and the high score in the ability to express feelings. [1] (TransOral Gastroplasty)

Congruence between clinical and research-based psychiatric assessment in bariatric surgical candidates

Background Mental health professionals have become increasingly involved in working with bariatric surgical candidates, particularly in performing preoperative psychological evaluations to clear candidates for surgery. The objective of the present study was to examine the concordance of the psychiatric diagnoses obtained during routine clinical evaluation before bariatric surgery and the diagnoses obtained separately at a research facility using the Structured Clinical Interview for DSM (Diagnostic and Statistical Manual of Mental Disorders)-IV axis I disorders. Methods The study included 68 consecutively enrolled bariatric surgical candidates who had participated in the Longitudinal Assessment of Bariatric Surgery-3 study. The Structured Clinical Interview for DSM disorders data obtained from the research assessments were compared with the diagnostic data from the routine preoperative psychiatric evaluations. The congruence of the current and lifetime diagnoses was assessed using Cohen's coefficient kappa. Results Considerable variability was found among the major diagnostic categories, with generally poor agreement found for the current diagnoses. The kappa coefficients tended to be larger for the lifetime diagnoses. The agreement was moderate for any lifetime mood disorder, with a kappa value of 0.45. Regarding any lifetime anxiety, substance use, and eating disorder, the clinical diagnoses rarely concurred with the results from the Structured Clinical Interview for DSM disorders, with a kappa statistic of 0.30, 0.36, and 0.32, respectively. Conclusion The congruence between the diagnoses assigned during the routine clinical psychiatric evaluations and research assessment using the Structured Clinical Interview for DSM disorders was surprisingly low. These conclusions should be considered tentative, given the interval and the possibility of treatment having occurred between the 2 evaluations. Overall, these data raise interesting questions concerning the use of unstructured psychiatric evaluations before bariatric surgery.

Mood disorders in laparoscopic sleeve gastrectomy patients: does it affect early weight loss?

Background Research has demonstrated that laparoscopic Roux-en- Y gastric bypass patients with a lifetime history of a mood disorder have a lower percentage of excess weight loss (%EWL) compared with patients without this lifetime history. No studies have examined the effect of psychiatric history on postoperative outcomes among laparoscopic sleeve gastrectomy (LSG) patients. The objectives of the present study were to determine whether mood disorders relate to the first year of weight loss for patients undergoing LSG at an academic medical center. Methods A total of 104 patients (78.6% white and 71.2% women), with a median body mass index of 60.35 kg/m 2 (range 31.37–129.14) underwent LSG. The patients were prospectively followed up at 1, 3, 6, 9, and 12 months. The semistructured preoperative psychiatric evaluations demonstrated that 43.1% had a current, and 62.5% a lifetime, diagnosis of a mood disorder. Results LSG patients with current mood disorders had a significantly lower %EWL than patients without a psychiatric diagnosis at the 1-, 3-, 6-, and 9-month follow-up visits. LSG patients with a lifetime history of a mood disorder had a significantly lower %EWL than patients without psychiatric diagnosis at the 1-, 9-, and 12-month follow-up examinations. However, after removing patients with bipolar disorder from the analyses, no significant differences were found in the %EWL between patients with and without a lifetime history of depressive disorders. Conclusion Consistent with the laparoscopic Roux-en- Y gastric bypass findings, a lifetime history of mood disorders appears to be associated with significantly less weight loss in LSG patients. These findings highlight the importance of the psychiatric assessment in bariatric patients. Additionally, patients with a current or lifetime history of mood disorders might need additional pre- and postoperative care to improve their outcomes.

A Patient with Personal Control of the Adjustable Gastric Band and Bulimia: A Psychiatric Complication

Self-adjustment of the gastric band for control of intake is a potential problem. Preoperative psychiatric evaluation is desirable to identify and treat eating disorders and depression, and to indicate surveillance.

The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?

Body dysmorphic disorder (BDD) is classified in DSM IV as a somatoform disorder. The main features of this condition are a persistent preoccupation with a supposed physical defect or the presence of a slight imperfection in appearance. If a real defect should exist, the importance given to this in determining self-appreciation causes an important impairment in social, affective, or other functioning areas. This affection causes the patient to ask for multiple esthetic treatments. In most cases such interventions do not produce positive results in improving symptoms and may induce a chronic situation. The aim of this report is to aid in recognition of BDD in patients requesting esthetic improvements and to study psychopathological comorbidities. A counseling service was established, and 56 patients (11 men, 45 women) were seen. There were two specific interviews, one for personality, psychotic, and mood disorders and the other for the diagnosis of BDD (SCID II 2.0 and MINIPLUS 5.0). The findings in this study confirm those reported previously: BDD is more frequent in this selected population than in the general population (53.6%). There is a high prevalence of mood and anxiety disorders. Among personality disorders the most frequent are borderline and obsessive-compulsive types. We emphasize the importance of increasing the collaboration between the esthetic surgeon and the psychiatrist to determine the true motivation for surgical improvement and to avoid esthetic surgery on patients with psychiatrist disorders.

"The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?" by V. Vindigni et al.

"The importance of recognizing body dysmorphic disorder in cosmetic surgery patients: do our patients need a preoperative psychiatric evaluation?" by V. Vindigni et al.

Anaesthetic management and outcome in right-lobe living liver-donor surgery.

We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma--four lesions, involving both liver lobes--of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h(-1) and sufentanil 0.3 microg kg(-1) intravenously; cisatracurium, 0.15 mg kg(-1), was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780)min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25)h after arrival. The estimated blood loss was 967 (550-1,600)mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1,472 (700-3100)mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately postoperative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0)gdL(-1), respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1)gdL(-1). The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

Anaesthetic management and outcome in right-lobe living liver-donor surgery

Background and objective: We reviewed retrospectively the anaesthetic management and perioperative course of eight right hepatectomies for living liver donation. Methods: After preoperative psychiatric evaluation, eight ASA I-II individuals donated the right lobe of their liver to a family member. A graft-recipient body weight ratio of 0.8-1.0% was required for patient selection. Indications for liver transplantation were: hepatitis C viral-related cirrhosis in six patients; combined hepatitis C and B viral cirrhosis in one patient; multifocal hepatocellular carcinoma - four lesions, involving both liver lobes - of hepatitis C viral-related cirrhosis in another patient. Indication for adult-to-adult living-donor liver transplantation was retained in the latter because of rapid deterioration of liver disease, rare recipient's blood group and extended, unresectable hepatocellular carcinoma. Hepatitis C viral-related cirrhosis was casually the primary indication for adult-to-adult living-donor liver transplantation in this group. The condition of the donated hepatic lobe was optimized by appropriate drug and perfusion management. Preoperative investigations included: blood tests (full cell count and film, thyroid function tests, pregnancy tests, full virological tests and bacteriological cultures, and immunological typing), chest radiograph, electrocardiogram plus Doppler cardiac ultrasound, spirometry, aminopyrine breath test, liver Doppler examination, magnetic resonance imaging, angiography and cholangiography and a volumetric study of the whole liver and the right lobe. Haemoglobin and lactate concentrations, liver function tests and international normalized ratio were measured before and after operation. The volume and weight of the resected right lobe was calculated. Anaesthesia was induced with propofol 300 mL h−1 and sufentanil 0.3 μg kg−1 intravenously; cisatracurium, 0.15 mg kg−1, was given to facilitate tracheal intubation. Anaesthesia was maintained during normocapnic ventilation of the lungs with oxygen 40% in air, isoflurane 1-1.5 MAC and sufentanil. Routine anaesthetic monitoring included electrocardiography, pulse oximetry, invasive blood pressure, central venous pressure, urine output, state of neuromuscular blockade and core temperature. Periods of hypotension (<80% of the preoperative blood pressure) or haemodynamic instability (requiring inotropic or vasoactive support) were registered. Total blood loss and transfusion (homologous, autologous or cell-saver blood) requirements were measured; volume replacements were derived. Results: Data are presented as mean (range). There was no morbidity or mortality and no periods of intraoperative hypotension or haemodynamic instability. The operation time averaged 619 (525-780) min. Four donors were extubated in the operating room immediately after surgery; the others were extubated in the intensive care unit, where the mean extubation time was 16.3 (5-25) h after arrival. The estimated blood loss was 967 (550-1600) mL. No homologous blood was administered; five donors received autologous blood, intraoperatively; three donors received a cell-saver blood transfusion. Intraoperative fluid replacement was with crystalloids, colloids and 4% albumin. Total urine output was 1472 (700-3100) mL. Although intraoperative hypothermia occurred all subjects were normothermic at the end of operation. The pre- and immediately post-operative haemoglobin concentration averaged 13.6 (9.8-15.6) and 10.5 (6.9-13.0) g dL−1, respectively. On the first postoperative day, the haemoglobin was 11.7 (8.4-15.1) g dL−1. The donors' liver function tests were transiently elevated in the initial postoperative period. The intensive care unit discharge time was 2 (1-3) days. The hospital stay was 13 (7-17) days. There was no morbidity or mortality. Conclusions: The study demonstrates that right-lobe living-donor surgery was well tolerated, without intraoperative hypotension or haemodynamic instability, without perioperative anaesthetic or surgical complications, and with an excellent general outcome.

Epilepsy surgery in patients with additional psychogenic seizures.

To assess whether surgery to reduce or control epileptic seizures is safe and effective in patients known to have additional psychogenic seizures. We reviewed our computerized database of 1342 patients examined for epilepsy surgery and identified 13 patients with both epileptic and psychogenic seizures on whom postoperative outcome data were available. Data were gathered from the patients' records. Mean postoperative follow-up was 56 months. Epilepsy surgery led to clinically relevant improvements in 11 of 13 patients. Seven patients became free of epileptic and psychogenic seizures, 2 patients became free of epileptic seizures but continued to have infrequent psychogenic seizures, 1 patient reported more than an 80% improvement in epileptic seizure frequency and an abolishment of psychogenic attacks, and in 1 patient nondisabling epileptic seizures persisted at lower frequency but psychogenic seizures stopped. In 2 of 13 patients, epilepsy surgery failed to produce notable improvements. Although 1 patient became free of epileptic attacks and the other had fewer than 3 epileptic seizures per year, the severity or frequency of psychogenic seizures and pseudo-status epilepticus increased postoperatively. One of these patients had a preoperative diagnosis of somatization disorder; in the other, pathological illness behavior had been noted. A diagnosis of additional psychogenic seizures should not be considered an absolute contraindication to epilepsy surgery, although patients should undergo careful preoperative psychiatric evaluation.

The who, what, when, and why of cosmetic surgery: do our patients need a preoperative psychiatric evaluation?

The who, what, when, and why of cosmetic surgery: do our patients need a preoperative psychiatric evaluation?

Indication for anterior temporal lobectomy in patients with temporal lobe epilepsy and psychopathology.

The chronicity and severity of epilepsy, as well as the presence of temporal lobe toci, appear to correlate with psychopathology. A high prevalence of psychopathology has been reported among patients who are candidates for anterior temporal lobectomy (ATL). A review of the literature indicates that episodic psychosis may diminish when patients become free of seizures after surgery and that chronic psychosis neither improves notr worsens after ATL. If this is the case, patients with episodic psychosis may benefit from ATL. Patients with chronic psychosis may benefit if they become free from seizures after the operation, even if the psychosis persists. Case reports of maladjustment to seizure-free life after surgery, and de novo psychopathology, underline the importance of preoperative psychiatric evaluation and postoperative psychiatric intervention in patients undergoing epilepsy surgery. Although there is a need for each epilepsy center to state its policy with regard to patients with psychopathology who undergo epilepsy surgery, it would be unwise to make a decision on whether to reject a patient simply on the grounds of psychosis. A detailed psychiatric evaluation of each individual patient is required.

Group psychotherapy with female-to-male transsexuals in Turkey.

The change in Turkish law to allow local sex reassignment surgery was passed in May 1988. By law, a candidate for such surgery must obtain a medical certificate attesting that the operation is necessary. However, the law does not specify conditions for granting such a certificate, so any physician can give a certificate based on his own criteria. Sex reassignment surgery can therefore be performed without preoperative psychiatric evaluation and preparation. This is a report of 40 female-to-male transsexuals. They had completed psychiatric assessment and participated in group therapy. These meetings provided a valuable setting for getting to know transsexuals and their families. Participants' long, regular attendance and low dropout rate demonstrate high group cohesion. The aim of the study is to report characteristics of a group of transsexuals living in a different cultural setting from other studies of this patient population in order to identify problems of Turkish transsexuals and advocate changes in current Turkish laws for sex reassignment.