Relationship between symptoms of attention deficit hyperactivity disorder in childhood and mood in patients applying for bariatric surgery

Objective: Obesity has recently been reported as an important health problem. Comorbid psychiatric disorders and mood characteristics in obese patients have an important role in the effectiveness of treatment for weight loss. The correlation of obesity and dependency has recently been indicated with biological studies. Clinical and psychopathological studies of the correlation of obesity and dependency focus on attention deficit hyperactivity disorder (ADHD) and mood characteristics. Cyclothymic temperament is dominant in patient with obesity, and self-stimulating behaviors and seeking stimulus in these patients affect eating behaviors and may cause obesity. Reported studies show that ADHD is more common in obese patients than in the healthy population. In addition, patients with ADHD resort to drug abuse to deal with demoralization, fatigue and depression. The self-medication hypothesis is used to understand the relationship with ADHD and dependency. In childhood and adult ADHD patients, cyclothymic temperament is more common. (3) However, there is no research to evaluate ADHD patients and their personal characteristics. The aim of this study is to analyze the relationship between childhood ADHD and personal characteristics in morbid obese patients who apply for bariatric surgery.

Methods: The population of this study is selected from patients who applied for bariatric surgery at Bursa Sevket Yilmaz Training and Research Hospital between January and November 2014, and 89 of them were suitable for surgery and were included in this research. Adult ADHD Self-Report Scales (ASRS-v1.1), Wender–Utah Rating Scale-25 (WURS-25), Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS) and Beck Depression Inventory, Beck Anxiety Inventory and The Eating Attitudes Test-40 were are applied to them.

Results: Eighty-nine patients in the study include 69 female and 20 male individuals. Average age of this population is 34.84±9.93, average education years 9.4±3.5 and average BMI is 46.42±5.34. According to WURS-25 test, 13 patients (14.60%) are diagnosed with childhood ADHD with a score of 36 points or more. According to Beck Depression Inventory and Beck Anxiety Inventory, childhood ADHD patients have more depressive (p=0.002), cyclothymic (p<0.001), irritable (p=0.013) and anxious (p=0.008) temperament features than the control group, and these findings are statistically significant. No significant relation was found between the patients with ADHD and the control group in terms of eating attitude (p=0.058). Positively significant correlations are found among the depressive, cyclothymic, irritable, anxious subscales of WUR-25 and TEMPS. Moreover, positively significant correlations were obtained among all the subtypes of temperament in ASRS and TEMPS.

Conclusion: The relation between obesity and dependency has been recently indicated with clinical studies (1). High incidence of cyclothymic temperament and ADHD is observed in patients who apply for bariatric surgery (2). In our study, it was found that ADHD and cyclothymic temperament demonstrate significantly high correlations. The dependency ratio is reported high in patients with ADHD and cyclothymic temperament. The assessment of psychopathological characteristics related with dependency can be helpful in the treatment and follow-up of obese patients