Advances in Therapy

, Volume 23, Issue 2, pp 325–331 | Cite as

Postsurgical psychosis: Case report and review of literature

  • Mahdi S. Abdullah
  • Noori S. Al-Waili
  • Nawras K. Baban
  • Glenn J. Butler
  • Laith Sultan
Article

Abstract

A wide range of behavioral symptoms may occur following surgery, including depression, hallucinations, true psychosis, mania, and impulsivity. Psychoses, including those that occur postoperatively, are among the most frequent indications for hospitalization in the United States and are associated with a substantially increased rate of morbidity. The exact cause of postoperative psychosis has not been identified. A 59-year-old woman who developed acute psychosis after cholecystectomy is described here. The patient was brought to Mount Vernon Hospital in New York because she exhibited acute disruptive behavior following endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy performed on 2 consecutive days. The patient was psychotic and was unable to be managed; she was disorganized, confused, and perplexed. Findings of computed tomography of the head, electroencephalography, and chemical and hematologic tests were normal. The patient was treated with lorazepam 1 mg every 6 h, olanzapine 5 mg at bedtime, and clonazepam 1 mg at bedtime. She experienced a mixture of auditory and visual hallucinations with a paranoid perspective and was then treated with haloperidol 5 mg, diphenhydramine chloride 25 mg, and divalproex sodium 500 mg. After 1 wk, the patient was described as acutely psychotic; antipsychotic medication dosages were readjusted and the patient’s condition stabilized. The association between surgical procedures and psychosis is thoroughly reviewed here. Awareness, ability to diagnose, and an understanding of the cause of psychotic symptoms that emerge following surgery must be established if physicians are to provide better care and more effective treatment.

Keywords

surgery psychosis cholecystectomy postoperative 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Burn DJ, Troster AI. Neuropsychiatric complications of medical and surgical therapies for Parkinson’s disease.J Geriatr Psychiatry Neurol. 2004; 17: 172–180.PubMedCrossRefGoogle Scholar
  2. 2.
    Anderson KE, Mullins J. Behavioral changes associated with deep brain stimulation surgery for Parkinson’s disease.Curr Neurol Neurosci Rep. 2003; 3: 306–313.PubMedCrossRefGoogle Scholar
  3. 3.
    McCarter RJ, Walton NH, Rowan AF, Gill SS, Palomo M. Cognitive functioning after subthalamic nucleotomy for refractory Parkinson’s disease.J Neurol Neurosurg Psychiatry. 2000; 69: 60–66.PubMedCrossRefGoogle Scholar
  4. 4.
    Gruber-Baldini AL, Zimmerman S, Morrison RS, et al. Cognitive impairment in hip fracture patients: timing of detection and longitudinal follow-up.J Am Geriatr Soc. 2003; 51: 1227–1236.PubMedCrossRefGoogle Scholar
  5. 5.
    Turns D. Psychosocial issues: pelvic exenterative surgery.J Surg Oncol. 2001; 76: 224–236.PubMedCrossRefGoogle Scholar
  6. 6.
    Tsoh JM, Leung HC, Ungvari GS, Lee DT. Brief acute psychosis following hysterectomy in ethnopsychiatric context.Singapore Med J. 2000; 41: 359–362.PubMedGoogle Scholar
  7. 7.
    Chandra PS. Post-ovariectomy and oestrogen therapy related recurrence of oestrogen withdrawal associated psychosis.Acta Psychiatr Scand. 2002; 106: 76PubMedCrossRefGoogle Scholar
  8. 8.
    Mahe V, Montagnon F, Nartowski J, Dumane A. Post-abortion mania.Br J Psychiatry. 1999; 175: 389–390.PubMedGoogle Scholar
  9. 9.
    Davidson K, Clare AW. Psychotic illness following termination of pregnancy.Br J Psychiatry. 1989; 154: 559–560.PubMedGoogle Scholar
  10. 10.
    Nadelson T. The psychiatrist in the surgical intensive care unit. I. Postoperative delirium.Arch Surg. 1976; 111: 113–117.PubMedGoogle Scholar
  11. 11.
    Jagmin MG. Postoperative mental status in elderly hip surgery patients.Orthop Nurs. 1998; 17: 32–42.PubMedCrossRefGoogle Scholar
  12. 12.
    Kanemoto K, Kim Y, Miyamoto T, Kawasaki J. Presurgical postictal and acute interictal psychoses are differentially associated with postoperative mood and psychotic disorders.Neuropsychiatry Clin Neurosci. 2001; 13: 243–247.Google Scholar
  13. 13.
    Dean C. The emotional impact of mastectomy.Br J Hosp Med. 1988; 39: 30–32.PubMedGoogle Scholar
  14. 14.
    Blazer DG 2nd, Petrie WM, Wilson WP. Affective psychoses following renal transplant.Dis Nerv Syst. 1976; 37: 663–667.PubMedGoogle Scholar
  15. 15.
    Kuhlback B, Lilius P. Delayed renal and extrarenal complications following primarily successful renal transplantation.Scand J Urol Nephrol Suppl. 1977; 42: 170–172.PubMedGoogle Scholar
  16. 16.
    Sato K. [Psychiatric problems after kidney transplantation (author’s transl).]Seishin Shinkeigaku Zasshi. 1978; 80: 65–83.PubMedGoogle Scholar
  17. 17.
    Viswanathan R, Glickman L. Clonazepam in the treatment of steroid-induced mania in a patient after renal transplantation.N Engl J Med. 1989; 320: 319–320.PubMedCrossRefGoogle Scholar
  18. 18.
    Lee PC, Hung CJ, Lei HY, Tsai YC. Suspected acute post-transplant neuropsychosis due to interaction of morphine and cyclosporin after a renal transplant [letter].Anaesthesia. 2000; 55: 827–828.PubMedCrossRefGoogle Scholar
  19. 19.
    Kasiske BL, Cangro CB, Hariharan S, et al. The evaluation of renal transplantation candidates: clinical practice guidelines.Am J Transplant. 2002; 1: 1–95.Google Scholar
  20. 20.
    David HP, Rasmussen NK, Holst E. Postpartum and postabortion psychotic reactions.Fam Plann Perspect. 1981; 13: 88–89,91–92.PubMedCrossRefGoogle Scholar
  21. 21.
    Musella V, Passannanti G, Pellicano M, et al. Postpartum psychoses. A case report.Minerva Ginecol. 1996; 48: 377–382.PubMedGoogle Scholar
  22. 22.
    Reardon DC, Cougle JR, Rue VM, Shuping MW, Coleman PK, Ney PG. Psychiatric admissions of low-income women following abortion and childbirth.CMAJ. 2003; 13: 1253–1256.Google Scholar
  23. 23.
    Spaulding JG, Cavenar JO Jr. Psychoses following therapeutic abortion.Am J Psychiatry. 1978; 135: 364–365.PubMedGoogle Scholar
  24. 24.
    Brewer C. Incidence of post-abortion psychosis: a prospective study.Br Med J. 1977; 1: 476–477.PubMedGoogle Scholar
  25. 25.
    Hopker SW, Brockington IF. Psychosis following hydatidiform mole in a patient with recurrent puerperal psychosis.Br J Psychiatry. 1991; 158: 122–123.PubMedGoogle Scholar
  26. 26.
    Gilchrist AC, Hannaford PC, Frank P, Kay CR. Termination of pregnancy and psychiatric morbidity.Br J Psychiatry. 1995; 167: 243–248.PubMedGoogle Scholar
  27. 27.
    Karhunen U, Orko R. Psychiatric reactions complicating cataract surgery: a prospective study.Ophthalmic Surg. 1982; 13: 1008–1012.PubMedGoogle Scholar
  28. 28.
    Sekimoto M, Hayasaka S, Noda S, Iijima M, Setogawa T. Psychiatric complications after ocular surgery.Ophthalmologica. 1993; 206: 113–114.PubMedCrossRefGoogle Scholar
  29. 29.
    Mikkelsen EJ, Reider AA. Post-parathyroidectomy psychosis: clinical and research implications.J Clin Psychiatry. 1979; 40: 352–357.PubMedGoogle Scholar
  30. 30.
    Yang SJ, Wang SY, Chen CC. Acute psychotic state due to hyperthyroidism following excision of a mandible bone tumor: a case report.Kaohsiung J Med Sci. 2003; 19: 29–32.PubMedCrossRefGoogle Scholar
  31. 31.
    Schweitzer I, Hirschfeld JJ. Postrhytidectomy psychosis: a rare complication.Plast Reconstr Surg. 1984; 74: 419–422.PubMedCrossRefGoogle Scholar
  32. 32.
    Nassif JM, Ritter MA. Indomethacin-induced postoperative psychosis.J Arthroplasty. 1999; 14: 769–770.PubMedCrossRefGoogle Scholar
  33. 33.
    Lasater KL, Grisanti DJ. Postcardiotomy psychosis: indications and interventions.Heart Lung. 1975; 4: 724–729.PubMedGoogle Scholar
  34. 34.
    Chessick RD. Psychosis after open heart surgery: a phenomenological study.Am J Psychother. 1995; 49: 171–179.PubMedGoogle Scholar
  35. 35.
    Sveinsson IS. Postoperative psychosis after heart surgery.J Thorac Cardiovasc Surg. 1975; 70: 717–726.PubMedGoogle Scholar
  36. 36.
    Olympio MA. Postanesthetic delirium: historical perspectives.J Clin Anesth. 1991; 3: 60–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Hanania M, Kitain E. Melatonin for treatment and prevention of postoperative delirium.Anesth Analg. 2002; 94: 338–339.PubMedCrossRefGoogle Scholar
  38. 38.
    Golinger RC. Delirium in surgical patients seen at psychiatric consultation.Surg Gynecol Obstet. 1986; 163: 104–106.PubMedGoogle Scholar
  39. 39.
    Hale M, Koss N, Kerstein M, Camp K, Barash P. Psychiatric complications in a surgical ICU.Crit Care Med. 1977; 5: 199–203.PubMedCrossRefGoogle Scholar
  40. 40.
    Inoue Y, Mihara T. Psychiatric disorders before and after surgery for epilepsy.Epilepsia. 2001; 42(suppl 6): 13–18.PubMedGoogle Scholar
  41. 41.
    Mace CJ, Trimble MR. Psychosis following temporal lobe surgery: a report of six cases.J Neurol Neurosurg Psychiatry. 1991; 54: 639–644.PubMedGoogle Scholar
  42. 42.
    Koch-Weser M, Garron DC, Gilley DW, et al. Prevalence of psychologic disorders after surgical treatment of seizures.Arch Neurol. 1988; 45: 1308–1311.PubMedGoogle Scholar
  43. 43.
    Krahn LE, Rummans TA, Peterson GC. Psychiatric implications of surgical treatment of epilepsy.Mayo Clin Proc. 1996; 71: 1201–1204.PubMedGoogle Scholar
  44. 44.
    Kanemoto K. Psychiatric disorders following and preceding temporal lobectomy.Rinsho Shinkeigaku. 1999; 39: 81–82.PubMedGoogle Scholar
  45. 45.
    Hilty DM, Lim RF, Hales RE. The psychotic patient.Prim Care. 1999; 26: 327–348.PubMedGoogle Scholar
  46. 46.
    NCHS. 1999 National Hospital Discharge Survey: Annual Summary with Detailed Diagnosis and Procedure Data. Available at: www.cdc.gov/nchs. Accessed April 18, 2006.Google Scholar
  47. 47.
    Abbott KC, Agodoa LY, O’Malley PG. Hospitalized psychoses after renal transplantation in the United States: incidence, risk factors, and prognosis.J Am Soc Nephrol. 2003; 14: 1628–1635.PubMedCrossRefGoogle Scholar
  48. 48.
    James EA, Demian AZ. Acute psychosis in a trauma patient due to ciprofloxacin.Postgrad Med J. 1998; 74: 189–190.PubMedGoogle Scholar
  49. 49.
    Sternbach H, State R. Antibiotics: neuropsychiatric effects and psychotropic interactions.Harv Rev Psychiatry. 1997; 5: 214–226.PubMedCrossRefGoogle Scholar
  50. 50.
    Kunimatsu T, Misaki T, Hirose N, et al. Postoperative mental disorder following prolonged oral surgery.J Oral Sci. 2004; 46: 71–74.PubMedCrossRefGoogle Scholar
  51. 51.
    Biffoli F, Piacentino V, Meconcelli G, et al. The effect of anesthesiologic technique on the mental state of elderly patients submitted for orthopedic surgery of the lower limbs.Minerva Anestesiol. 1998; 64: 13–19.PubMedGoogle Scholar
  52. 52.
    Schindler H, Schanda H. An acute psychotic episode following adrenalectomy in Cushing’s syndrome.Wien Klin Wochenschr. 1975; 87: 650–652.PubMedGoogle Scholar

Copyright information

© Health Communications Inc 2006

Authors and Affiliations

  • Mahdi S. Abdullah
    • 1
  • Noori S. Al-Waili
    • 1
  • Nawras K. Baban
    • 1
  • Glenn J. Butler
    • 1
  • Laith Sultan
    • 1
  1. 1.Methodist Medical Center The Mount Vernon HospitalLife Support Technology GroupsMount Vernon

Personalised recommendations