Pimentel Túlio, Florêncio Maria Clara, Queiroz Ivo, Gallo Ruelas Mariano, Ferraz Roberta De Lorenzi Steiger, Ferraz Álvaro Antônio Bandeira
Federal University of Pernambuco, Recife, Brazil.
Pernambuco School of Health, Recife, Brazil.
Obes Surg. 2025 Apr 28. doi: 10.1007/s11695-025-07889-3.
Psychiatric disorders, particularly bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ), are associated with high rates of obesity and metabolic diseases. This systematic review and meta-analysis evaluates the efficacy of bariatric surgery in BD/SCZ patients, aiming to inform clinical decisions and optimize treatment strategies for this population. MEDLINE, Embase, and Cochrane databases were searched up to September 2024. A restricted maximum likelihood random-effects model with mean differences (MD) for continuous outcomes and odds ratios (ORs) for binary outcomes, along with 95% confidence intervals (CI), was used. 13 studies involving 19,662 patients, of whom 1,117 (5.7%) were diagnosed with BD or SCZ, were included. The analysis revealed no significant differences in %TWL or BMI change at 6 months, 1 year, and 2 years. BD/SCZ patients showed a significantly smaller %EWL at 6 months; however, the differences at 1 and 2 years were no longer statistically significant. Similarly, no differences were found between BD/SCZ patients and controls regarding adherence to 6-month, 1-year, and 2-year follow-up, as well as 1-year remission rates of type 2 diabetes mellitus, hypertension, obstructive sleep apnea syndrome, dyslipidemia, or 30-day readmission and reoperation rates. Data from included studies also indicated no exacerbation of psychiatric disorders after surgery. This study suggests that bariatric surgery may be similarly effective in patients with BD and SCZ, offering potential benefits for a population burdened with both psychiatric and physical health challenges.
精神障碍，尤其是双相情感障碍（BD）和精神分裂症谱系障碍（SCZ），与肥胖和代谢性疾病的高发病率相关。本系统评价和荟萃分析评估了减重手术对BD/SCZ患者的疗效，旨在为临床决策提供信息并优化该人群的治疗策略。检索了截至2024年9月的MEDLINE、Embase和Cochrane数据库。使用了限制最大似然随机效应模型，对连续结局采用平均差（MD），对二元结局采用比值比（OR），并给出95%置信区间（CI）。纳入了13项研究，涉及19662例患者，其中1117例（5.7%）被诊断为BD或SCZ。分析显示，在6个月、1年和2年时，%TWL或BMI变化无显著差异。BD/SCZ患者在6个月时的%EWL显著更小；然而，1年和2年时的差异不再具有统计学意义。同样，在6个月、1年和2年的随访依从性方面，以及2型糖尿病、高血压、阻塞性睡眠呼吸暂停综合征、血脂异常的1年缓解率或30天再入院和再手术率方面，BD/SCZ患者与对照组之间未发现差异。纳入研究的数据还表明，术后精神障碍无加重。本研究表明，减重手术对BD和SCZ患者可能同样有效，为同时面临精神和身体健康挑战的人群带来潜在益处。
