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Lipids, Hormones, and Gastric Bypass

To the Editor: I read with great interest the case presentation by Wei Jiang, M.D., and colleagues on psychosis after gastric bypass surgery (1). As a member of the house staff at their institution, I briefly assisted in the care of the patient and recall him as among the more acutely psychiatrically ill patients I have seen. Outside of the discussed concerns, additional questions were raised in regard to this case. I present the following two related points as worthy of further discussion.

First, brain tissue is composed largely of lipids (2). Although we know the effect of rapid weight loss on serum lipids and adipose tissue (3, 4), I am unaware of reports on the effects of bariatric surgeries and subsequent rapid weight loss on nervous tissue, especially in the central nervous system (CNS).

Second, adipose tissue is highly involved in many areas of steroid metabolism and other endocrine processes (5, 6), which also affect psychiatric illness and behavior. In addition, bariatric surgery is responsible for direct changes in hormones (7, 8), but there are few studies investigating its potential impact on the CNS.

Gastric bypass surgery is generally relatively well tolerated, and many of the changes result in improvements in general health, but we know little about the effect on psychiatric illness and behavior (9, 10). It is conceivable that the processes mentioned above may also have adversely affected the patient in the study by Dr. Jiang and colleagues, and these processes warrant further research.

References

1. Jiang W, Gagliardi JP, Raj YP, Silvertooth EJ, Christopher EJ, Krishnan KRR: Acute psychotic disorder after gastric bypass surgery: differential diagnosis and treatment. Am J Psychiatry 2006; 163:15–19[Free Full Text]
2. Sastry PS: Lipids of nervous tissue: composition and metabolism. Prog Lipid Res 1985; 24:69–176[CrossRef][Medline]
3. Silvestre V, Ruano M, Dominguez Y, Castro R, Garcia-Lescun MC, Rodriguez A, Marco A, Garcia-Blanch G: Morbid obesity and gastric bypass surgery: biochemical profile. Obes Surg 2004; 14:1227–1232[CrossRef][Medline]
4. Luyckx FH, Scheen AJ, Desaive C, Dewe W, Gielen JE, Lefebvre PJ: Effects of gastroplasty on body weight and biological abnormalities in morbid obesity. Diabetes Metab 1998; 24:355–361[Medline]
5. Tchernof A, Labrie F, Belanger A, Despres JP: Obesity and metabolic complications: contribution of dehydroepiandrosterone and other steroid hormones. J Endocrinol 1996; 150:S155-S164
6. Kokkoris P, Pi-Sunyer FX: Obesity and endocrine disease. Endocrinol Metab Clin North Am 2003; 32:895–914[CrossRef][Medline]
7. Ram E, Vishne T, Diker D, Gal-Ad I, Maayan R, Lerner I, Dreznik Z, Seror D, Vardi P, Weizman A: Impact of gastric banding on plasma ghrelin, growth hormone, cortisol, DHEA and DHEA-S levels. Obes Surg 2005; 15:1118–1123[CrossRef][Medline]
8. Clements RH, Gonzales QH, Long CI, Wittert G, Laws HL: Hormonal changes after Roux-en Y gastric bypass for morbid obesity and the control of type-II diabetes mellitus. Am Surg 2004; 70:1–5[Medline]
9. Dixon JB, Anderson M, Cameron-Smith D, O’Brien PE: Sustained weight loss in obese subjects has benefits that are independent of attained weight. Obes Res 2004; 12:1895–1902[Medline]
10. Stunkard AJ, Stinnett JL, Smoller JW: Psychological and social aspects of the surgical treatment of obesity. Am J Psychiatry 1986; 143:417–429[Abstract/Free Full Text]

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