Skip to main content
SpringerLink
Log in

Biopsychosoziale Auswirkungen herzchirurgischer Eingriffe – eine relevante konsiliarpsychiatrische Herausforderung

  • Schwerpunkt konsiliarpsychiatrie
  • Published:
Psychiatrie und Psychotherapie

Summary

Clinical strategies for detecting and treating heart surgery-related mental disorders represents an increasingly important challenge to consultation – liaison (C– L) psychiatry. In this context a variety of short-term, intermediate-term, and long-term studies examining psychiatric and psychosocial outcome of patients of cardiac surgery employing cardiopulmonary bypass (CPB) have to be considered. To sum up, major cardiac surgery with CPB such as coronary artery bypass graft surgery (CABG) is associated with significant improvements in health-related quality of life (HRQOL) relative to the preoperative period. On the other hand, impairments in HRQOL were found in a subgroup of post-CABG patients with evidence of depression, posttraumatic stress syndrome, or cognitive deficits in the short-, intermediate-, and longterm course. We therefore underscore the need for early and comprehensive bio-psycho-social diagnosis and therapy of post-CABG patients. Close collaboration between cardiac surgeons, C – L psychiatrists, medical psychologists, psychotherapists, clinical psychologists, and internists will be necessary.

Zusammenfassung

Zunehmend stärker ist ein klinisches Engagement des Konsiliarpsychiaters in herzchirurgischen Stationen gefordert. In diesem Kontext sind eine Reihe von Untersuchungen zur psychiatrischen Komorbidität und gesundheitsbezogenen Lebensqualität bei Patienten nach Herz-operation unter Einsatz der Herz-Lungen-Maschine im Kurzzeit-, Mittelzeit- und Langzeitverlauf zu berücksichtigen. In der Zusammenschau kann festgehalten werden, dass Monate nach dem koronarchirurgischen Eingriff (CABG) die betroffenen Patienten signifikant verbesserte Lebensqualitätswerte im Vergleich zu den Werten unmittelbar vor der Herzoperation zeigen. Andererseits finden sich Einbußen in der gesundheitsbezogenen Lebensqualität bei denjenigen CABG-operierten Patienten, welche unter Depressionen, posttraumatischen Belastungssyndromen oder kognitiven Defiziten im Kurzzeit-, Mittelzeit- und Langzeitverlauf leiden. Folglich raten wir frühzeitig zu einer umfänglichen bio-psycho-sozialen Diagnostik und Therapie von CABG-operierten Patienten. Hierbei ist eine enge Zusammenarbeit zwischen Herzchirurgen, Konsiliarpsychiatern, medizinischen Psychologen, Psychotherapeuten, klinischen Psychologen und Internisten wesentlich.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Literatur

  1. Salzberg SP, Adams DH and Filsoufi F. (2005). Coronary artery surgery: conventional coronary artery bypass grafting versus off-pump coronary artery bypass grafting. Curr Opin Cardiol 20: 509–516

    Article  PubMed  Google Scholar 

  2. Emmrich K. (1998). Aortokoronare Bypass-Operationen – Determinanten für ihre Langzeitresultate. Internist 39: 749–753

    Article  Google Scholar 

  3. Li Y, Zheng Z and Hu S. (2008). Early and long-term outcomes in the elderly: comparison between off-pump and on-pump techniques in 1191 patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 136: 657–664

    Article  PubMed  Google Scholar 

  4. Yusuf S, Zucker D, Peduzzi P, Fisher LD, Takaro T, Kennedy JW, Davis K, Killip T, Passamani E and Norris R. (1994). Effect of coronary artery bypass graft surgery on survival: overview of 10-year results from randomised trials by the Coronary Artery Bypass Graft Surgery Trialists Collaboration. Lancet 344: 563–570

    Article  CAS  PubMed  Google Scholar 

  5. Caplan LR, Hurst JW and Chimowitz MI. (1999). Clinical Neurocardiology. Marcel Dekker, NewYork

    Google Scholar 

  6. Rothenhäusler HB. (2005). Pharmako- und psychotherapeutische Ansätze bei depressiven Patienten mit somatischen Krankheiten. Psychother Psychiatr Psychotherapeut Med Klin Psychol 10: 195–204

    Google Scholar 

  7. Genardini N, Wilson SJ, Lawrence JA and Hare DL. (2008). Patterns of psychosocial adjustment following cardiac surgery. J Cardiopulm Rehabil Prev 28: 397–401

    PubMed  Google Scholar 

  8. Bullinger M. (1997). Gesundheitsbezogene Lebensqualität und subjektive Gesundheit. Psychother Psychosom Med Psychol 47: 76–91

    CAS  PubMed  Google Scholar 

  9. World Health Organization. International classification of impairments, disabilities, and handicaps. A manual of classification relating to the consequences of disease. Geneva: WHO, 1980.

  10. Bullinger M, Schmidt S, Morfeld M. Lebensqualität bei körperlichen Erkrankungen. In: Arolt V, Diefenbacher A (Hrsg) Psychiatrie in der klinischen Medizin. Darmstadt: Steinkopff, 2004.

  11. Ware JE and Sherbourne CD. (1992). The MOS 36-Item Short-Form Health Status Survey (SF-36): 1: conceptual framework and item selection. Med Care 30: 473–483

    Article  PubMed  Google Scholar 

  12. Hunt SM, McKenna SP, McEwen J, Williams J and Papp E. (1981). The Nottingham Health Profile: subjective health status and medical consultations. Soc Sci Med [A] 15: 221–229

    CAS  Google Scholar 

  13. Hillers TK, Guayatt GH, Oldridge N, Crowe J, Willan A, Griffith L and Feeny D. (1994). Quality of life after myocardial infarction. J Clin Epidemiol 47: 1287–1296

    Article  CAS  PubMed  Google Scholar 

  14. Dempster M, Donnelly M and O‘Loughlin C. (2004). The validity of the MacNew Quality of Life in heart disease questionnaire. Health Qual Life Outcomes 2: 6

    Article  PubMed  Google Scholar 

  15. Höfer S, Lim L, Guyatt G and Oldridge N. (2004). The MacNew Heart Disease health-related quality of life instrument: a summary. Health Qual Life Outcomes 8: 2–3

    Google Scholar 

  16. Rothenhäusler HB, Stepan A, Hetterle R and Trantina-Yates A. (2010). Prospektive Untersuchung zu den Auswirkungen aortokoronarer Bypassoperationen auf die gesundheitsbezogene Lebensqualität, cognitive Performanz und emotionale Befindlichkeit im 6-Monats-Verlauf: Ergebnisse einer konsiliarpsychiatrischen Follow-up Studie. Fortschr Neurol Psychiatr 78: 343–354

    Article  PubMed  Google Scholar 

  17. Koch CG, Li L, Shishehbor M, Nissen S, Sabik J, Starr NJ and Blackstone EH. (2008). Socioeconomic status and comorbidity as predictors of preoperative quality of life in cardiac surgery. J Thorac Cardiovasc Surg 136: 665–672

    Article  PubMed  Google Scholar 

  18. Phillips-Bute B, Mathew J, Blumenthal JA, Welsh-Bohmer K, White WD, Mark D, Landolfo K and Newman MF. (2003). Female gender is associated with impaired quality of life 1 year after coronary artery bypass surgery. Psychosom Med 65: 944–951

    Article  PubMed  Google Scholar 

  19. Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, Rothenhäusler HB, Kreuzer E, Reichart B and Peter K. (2000). Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 120: 505–512

    Article  CAS  PubMed  Google Scholar 

  20. Lee GA. (2009). Determinants of quality of life five years after coronary artery bypass graft surgery. Heart Lung 38: 91–99

    Article  PubMed  Google Scholar 

  21. Regier DA, Narrow WE, Rae DS, Manderscheid RW, Locke BZ and Goodwin FK. (1993). The de facto US mental and addictive disorders service system. Epidemiologic catchment area prospective 1-year prevalence rates of disorders and services. Arch Gen Psychiatry 50: 85–94

    CAS  PubMed  Google Scholar 

  22. Jacobi F, Wittchen HU, Holting C, Höfler M, Pfister H, Müller N and Lieb R. (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychol Med 34: 597–611

    Article  CAS  PubMed  Google Scholar 

  23. Wittchen HU and Pittrow. D. (2002). Prevalence, recognition and management of depression in primary care in Germany: the Depression 2000 study. Hum Psychopharmacol 17: 1–11

    Article  Google Scholar 

  24. Rothenhäusler HB and Kapfhammer HP. (2003). Depression bei körperlichen Erkrankungen – Diagnose und Therapie vor konsiliarpsychiatrischem Hintergrund. Fortschr Neurol Psychiat 71: 358–365

    Article  PubMed  Google Scholar 

  25. Rothenhäusler HB. (2006). Psychische Erkrankungen im Allgemeinkrankenhaus. Psychiatr Danub 18: 183–192

    PubMed  Google Scholar 

  26. Rothenhäusler HB. (2006). Klinik, Diagnostik und Therapie epilepsieassoziierter depressiver Verstimmungen und Psychosen. Nervenarzt 77: 1381–1392

    Article  PubMed  Google Scholar 

  27. Rothenhäusler HB. Organische psychische Störungen bei wichtigen somatischen Erkrankungen. In: Möller HJ, Laux G, Kapfhammer HP (Hrsg) Psychiatrie und Psychotherapie. Berlin Heidelberg New York: Springer, 2008.

  28. Haskett RF. (1985). Diagnostic categorization of psychiatric disturbance in Cushing’s syndrome. Am J Psychiatry 142: 911–916

    CAS  PubMed  Google Scholar 

  29. Sano M, Stern Y, Williams J, Cote L, Rosenstein R, Mayeux R. Coexisting dementia and depression in Parkinson‘s disease. Arch Neurol, 46:1284-1286, 1989.

    Google Scholar 

  30. Musselman DL, Evans DL and Nemeroff CB. (1998). The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 55: 580–592

    Article  CAS  PubMed  Google Scholar 

  31. Pignay-Demaria V, Lespérance F, Demaria RG, Frasure-Smith N and Perrault LP. (2003). Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg 75: 314–321

    Article  PubMed  Google Scholar 

  32. Connerney I, Shapiro PA, McLaughlin JS, Bagiella E and Sloan RP. (2001). Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study. Lancet 358: 1766–1771

    Article  CAS  PubMed  Google Scholar 

  33. Burg MM, Benedetto MC and Soufer R. (2003). Depressive symptoms and mortality two years after coronary artery bypass graft surgery (CABG) in men. Psychosom Med 65: 508–510

    Article  PubMed  Google Scholar 

  34. Blumenthal JA, Lett HS, Babyak MA, White W, Smith PK, Mark DB, Jones R, Mathew JP and Newman MF (2003). NORG Investigators. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet 362: 604–609

    Article  PubMed  Google Scholar 

  35. Rothenhäusler HB, Stepan A, Baranyi A. Diagnostik und Psychopharmakotherapie depressiver Erkrankungen bei Herz-Kreislauf-Patienten vor konsiliarpsychiatrischem Hintergrund – Teil 3: Wirksamkeit und mögliche Arzneimittelinteraktionen moderner Antidepressiva bei depressiven Herz-Kreislauf-Patienten. Psychosom Konsiliarpsychiatr, 1:193-197, 2007.

    Google Scholar 

  36. Rothenhäusler HB, Grieser B, Nollert G, Reichart B, Schelling G, Kapfhammer HP. Psychiatric and psychosoial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow- up study. Gen Hosp Psychiatry, 27:18-28, 2005.

    Google Scholar 

  37. Rothenhäusler HB, Täschner KL. Kompendium Praktische Psychiatrie. Wien New York: Springer, 2007.

  38. Frommberger U. Akute und chronische posttraumatische Belastungsstörung. Fortschr Neurol Psychiatr, 72:411-424, 2004.

    Google Scholar 

  39. Schelling G, Stoll C, Haller M, Briegel J, Manert W, Hummel T, Lenhart A, Heyduck M, Polasek J, Meier M, Preuss U, Bullinger M, Schüffel W, Peter K. Health-related quality of life and posttraumatic stress disorder in survivors of the acute respiratory distress syndrome. Crit Care Med, 26:651-659, 1998.

    Google Scholar 

  40. Kapfhammer HP, Rothenhäusler HB, Krauseneck T, Stoll C and Schelling G. (2004). Posttraumatic stress disorder and health-related quality of life in long-term survivors of acute respiratory distress syndrome. Am J Psychiatry 161: 45–52

    Article  PubMed  Google Scholar 

  41. Kapfhammer HP. (2008). Posttraumatische Belastungsstörung nach ARDS und septischem Schock. Psychosom Konsiliarpsychiatr 2: 220–227

    Article  Google Scholar 

  42. Kessler RC, Sonnega A, Bromet E, Hughes M and Nelson CB. (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52: 1048–1060

    CAS  PubMed  Google Scholar 

  43. Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC and Andreski P. (1998). Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55: 626–632

    Article  CAS  PubMed  Google Scholar 

  44. Maercker A, Forstmeier S, Wagner B, Glaesmer H and Brähler E. (2008). Posttraumatische Belastungsstörungen in Deutschland. Ergebnisse einer gesamtdeutschen epidemiologischen Untersuchung. Nervenarzt 79: 577–586

    Article  CAS  PubMed  Google Scholar 

  45. Krauseneck T, Rothenhäusler HB, Schelling G and Kapfhammer HP. (2005). Posttraumatische Belastungsstörungen bei somatischen Erkrankungen. Fortschr Neurol Psychiat 73: 206–217

    Article  CAS  PubMed  Google Scholar 

  46. Rothenhäusler HB and Kapfhammer HP. (2006). Posttraumatische Belastungssymptome als Folge schwerer körperlicher Erkrankungen – eine zunehmend relevantere konsiliarpsychiatrische Herausforderung. Psychiatrie & Psychotherapie 2: 15–20

    Article  Google Scholar 

  47. Schelling G. (2008). Post-traumatic stress disorder in somatic disease: lessons from critically ill patients. Prog Brain Res 167: 229–237

    Article  PubMed  Google Scholar 

  48. Doerfler LA, Pbert L and DeCosimo D. (1994). Symptoms of posttraumatic stress disorder following myocardial infarction and coronary artery bypass surgery. Gen Hosp Psychiatry 16: 193–199

    Article  CAS  PubMed  Google Scholar 

  49. Schelling G, Richter M, Roozendaal B, Rothenhäusler HB, Krauseneck T, Stoll C, Nollert G, Schmidt M and Kapfhammer HP. (1994). Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med 31: 1971–1980

    Article  Google Scholar 

  50. Schelling G, Kilger E, Roozendaal B, de Quervain DJ, Briegel J and Dagge A (2004). Rothenhäusler HB, Krauseneck T, Nollert G, Kapfhammer HP. Stress doses of hydrocortisone, traumatic memories, and symptoms of posttraumatic stress disorder in patients after cardiac surgery: a randomized study Biol Psychiatry 55: 627–633

    Article  CAS  PubMed  Google Scholar 

  51. Weis F, Kilger E, Roozendaal B, de Quervain DJ, Lamm P, Schmidt M, Schmölz M, Briegel J, Schelling G. Stress doses of hydrocortisone reduce chronic stress symptoms and improve health-related quality of life in high-risk patients after cardiac surgery: a randomized study. J Thorac Cardiovasc Surg, 131:277-282, 2006.

    Google Scholar 

  52. Lauter H. Psychosyndrom, organisches. In: Müller C (Hrsg) Lexikon der Psychiatrie. Berlin Heidelberg New York: Springer, 1973.

  53. Naugle R, Cullum CM, Bigler ED. Introduction to Clinical Neuropsychology. A Casebook. Austin: Pro-Ed, 1998.

  54. Gibbon JH Jr. (1954). Application of mechanical heart and lung apparatus to cardiac surgery. MinnMed 37: 171–180

    Google Scholar 

  55. Ehrenhaft J and Claman M. (1961). Cerebral complications of open-heart surgery. J Thorac Cardiovasc Surg 41: 503–506

    CAS  PubMed  Google Scholar 

  56. Meyendorf R. (1976). Psychische und neurologische Störungen bei Herzoperationen – Prä- und postoperative Untersuchungen. Fortschr Med 94: 315–320

    CAS  PubMed  Google Scholar 

  57. Meyendorf R. (1976). Hirnembolie und Psychose. J Neurol 213: 163–177

    Article  CAS  PubMed  Google Scholar 

  58. Meyendorf R. (1977). Zur Frage psychischer und neurologischer Störungen bei Herzoperationen. Thoraxchirurgie 25: 339–344

    CAS  Google Scholar 

  59. Meyendorf R. (1979). Psychopathology in heart disease aside from cardiac surgery: A historical perspective of cardiac psychosis. Compr Psychiatry 20: 326–331

    Article  CAS  PubMed  Google Scholar 

  60. Wong DH. (1991). Perioperative stroke. Part II: Cardiac surgery and cardiogenic embolic stroke. Can J Anaesth 38: 471–488

    Article  CAS  PubMed  Google Scholar 

  61. Nollert G, Reichart B. Cardiopulmonary bypass and cerebral injury in adults. Shock, 16 (Suppl 1):S16-S19, 2001.

  62. Roach GW, Kanchuger M, Mangano CM, Newman M, Nussmeier N, Wolman R, Aggarwal A, Marschall K, Graham SH, Ley C. Adverse cerebral outcomes after coronary bypass surgery. Multicenter Study of Perioperative Ischemia Research Group and the Ischemia Research and Education Foundation Investigators. N Engl J Med 1996; 335:1857-1863.

    Google Scholar 

  63. Smith LW and Dimsdale JE. (1989). Postcardiotomy delirium: conclusions after 25 years?. Am J Psychiatry 146: 452–458

    CAS  PubMed  Google Scholar 

  64. van der Mast RC, van der Broek WW Fekkes D, Pepplinkhuizen L and Habbema JD. (1999). Incidence of and preoperative predictors for delirium after cardiac surgery. J Psychosom Res 46: 479–483

    Article  PubMed  Google Scholar 

  65. Ferguson TB Jr, Hammill BG, Peterson ED, DeLong ER, Grover FL; STS National Database Committee. A decade of change--risk profiles and outcomes for isolated coronary artery bypass grafting procedures, 1990-1999: a report from the STS National Database Committee and the Duke Clinical Research Institute. Society of Thoracic Surgeons. Ann Thorac Surg, 73:480-489, 2002.

  66. Walzer TA and Herrmann M. (1998). Neuropsychologische und psychopathologische Veränderungen nach kardiochirurgischen Eingriffen. Fortschr Neurol Psychiat 66: 68–83

    Article  CAS  PubMed  Google Scholar 

  67. Newman MF, Kirchner JL, Phillips-Bute B, Gaver V, Grocott H, Jones RH, Mark DB, Reves JG and Blumenthal JA (2001). Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N Engl J Med 344: 395–402

    Article  CAS  PubMed  Google Scholar 

  68. Thornton EW, Groom C, Fabri BM, Fox MA, Hallas C, Jackson M. Quality of life outcomes after coronary artery bypass graft surgery: relationship to neuropsychologic deficit. J Thorac Cardiovasc Surg, 130:1022-1027, 2005.

    Google Scholar 

  69. Phillips-Bute B, Mathew JP, Blumenthal JA, Grocott HP, Laskowitz DT, Jones RH, Mark DB, Newman MF. Association of neurocognitive function and quality of life 1 year after coronary artery bypass graft (CABG) surgery. Psychosom Med, 68:369-375, 2006.

    Google Scholar 

  70. Sandau KE, Lindquist RA, Treat-Jacobson D and Savik K. (2008). Health-related quality of life and subjective neurocognitive function three months after coronary artery bypass graft surgery. Heart Lung 37: 161–172

    Article  PubMed  Google Scholar 

  71. Newman MF. Open heart surgery and cognitive decline. Cleve Clin J Med, 74 (Suppl 1):S52-S55, 2007.

Download references

Author information

Authors and Affiliations

  1. Universitätsklinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036, Graz, Österreich

    Hans-Bernd Rothenhäusler

Authors
  1. Hans-Bernd Rothenhäusler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hans-Bernd Rothenhäusler.

Additional information

Eingelangt am 22. März 2010, angenommen am 9. November 2010

Biopsychosocial consequences of cardiac surgical procedures – an important challenge to consultation-liaison psychiatry

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rothenhäusler, HB. Biopsychosoziale Auswirkungen herzchirurgischer Eingriffe – eine relevante konsiliarpsychiatrische Herausforderung. psychiatr. psychother. 6, 202–209 (2010). https://doi.org/10.1007/s11326-010-0132-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11326-010-0132-7

Schlüsselwörter

Keywords

Search

Navigation