Download Section of General Surgery Phone: (603) 650-7913

Section of General Surgery
Bariatric Surgery Program
Kenneth W. Burchard, M.D, Director
Paul Kispert, M.D.
William Laycock, M.D.
Thadeus Trus, M.D.
Phone: (603) 650-7913
Fax: (603) 650-8030
Maureen Quigley, MS, ARNP
Jennifer Letendre, MS, RD, LD
Kandy Seace, RN
Amy Sackett, Program Secretary
CONSULTATION REQUEST FOR COMPREHENSIVE PSYCHOLOGICAL EVALUATION
Dear Mental Health Care Professional:
A psychological evaluation of our patient is requested, with respect to emotional stability and suitability for
Roux-en-Y gastric bypass surgery for morbid obesity. This is also requested for the purpose of assisting in the
diagnosis, treatment, or management of a patient’s possible psychopathology or behavioral problem.
Gastric Bypass is a major surgical operation, performed either by open or laparoscopic technique. A small
stomach pouch is created and connected to the jejunum; bypassing 90% of the distal stomach and the duodenum. The
gastric pouch will hold approximately one ounce of food initially, and matures to hold approximately 5-9 ounces of
food six months after surgery. Gastric bypass limits food intake by restriction, and patients experience an early
sensation of fullness. Because gastric bypass also works by malabsorption, patients need to take vitamin and mineral
supplements for life, including Vitamin B12, calcium and multivitamins.
The operation serves as a powerful support for alteration in eating behavior, but is a tool, not a cure for
obesity. Patients need to make lifelong lifestyle changes, with a focus on a healthy diet and regular exercise. Patients
typically lose 50-65% of their excess body weight, and rarely achieve their ideal body weight. After gastric bypass,
some patients will experience dumping syndrome, which can consist of nausea, dizziness, nausea, vomiting, abdominal
cramping and diarrhea after eating foods high in fat and concentrated sweets. Patients can undo the work of the surgery
by continually snacking, eating soft foods or drinking high calorie liquids. There is no guarantee for successful weight
loss after gastric bypass.
The evaluation should include the following information:
1. Past psychiatric history
2. Alcohol/drug/ substance use history
3. Psychosocial history
4. Family psychological history
5. Education/employment history
6. Supports
7. Mental status exam
8. Provisional diagnosis
9. Treatment plan/ summary
Also, comments regarding the following are helpful:
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Patient’s insight into eating triggers.
Adverse psychiatric conditions: binge eating, bulimia, self-induced vomiting, diuretic or laxative use to lose
weight, psychosis, severe neurosis, schizophrenia, uncontrolled depression, borderline personality, and active
suicidal ideation.
severe behavioral disorder, which might contraindicate surgery
Unrealistic expectations, or goals of gastric bypass
Understanding of the risks and discomforts of surgery
Ability to handle the stress of the period that follows surgery and the counselor’s willingness to follow and treat
the patient in the post-operative period if needed.
Ability to understand and comply with instructions and recommendations for daily vitamin and mineral
supplements for life, and regular follow-up with the Bariatric Surgery Program.
Ability to make lifestyle changes, comply with a restricted diet and get regular exercise.
Understanding that non-compliance may put the patient at risk.
Recommendations regarding daily psychiatric medications (if any) during the early post-operative period.
Results of Minnesota Multiphasic Personality Inventory-2 testing, if felt to be indicated for this patient.
The results of your evaluation will assist in determining the patient’s suitability for surgery from a mental health
perspective, as well as planning post-operative care and follow-up. This information may be made available to an
insurance carrier as part of our Bariatric Surgery Program evaluation criteria.
Thank you, for your assistance. Please feel free to contact me if you have any questions at (603) 650-7913.
Information regarding gastric bypass is available on our website at Hitchcock.org, listed under “departments and
services”.
Sincerely,
Maureen Quigley, ARNP