Unusual Psychosis Seen in Gastric Bypass Patient

Case report identifies rapid weight reduction and hyperemesis as probable cause

MONDAY, Jan. 9 (HealthDay News) -- Potentially life-threatening psychiatric complications can occur after gastric bypass surgery and may be associated with rapid weight reduction and hyperemesis, according to a case report in the January issue of the American Journal of Psychiatry.

Wei Jiang, M.D., of Duke University Medical Center in Durham, N.C., and colleagues described the case of a 39-year-old man who became acutely psychotic 52 days after surgery and after a three-day course of transdermal scopolamine to control nausea during a cruise. He was hospitalized for 13 weeks in a locked psychiatric ward.

The physicians debated whether the patient had Wernicke's encephalopathy or another form of psychotic disorder. Because of the patient's age, absence of a past psychiatric history and complete recovery without antipsychotic medications, however, the doctors ruled out a primary psychotic disorder.

"Patients who have received gastric bypass surgery or have other reasons for rapid weight reduction should be considered at risk for thiamine deficiency or Wernicke's encephalopathy," the authors conclude. "At the same time, focusing on Wernicke's encephalopathy as the only diagnosis of psychosis after gastric bypass surgery may lead the physician to overlook other potential causes of psychosis. In our patient, correction of hyperemesis and optimization of caloric and nutritional intake to restore his ideal weight, in addition to supplementation of thiamine, were correlated with resolution of his psychosis."

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