The Role of the Psychiatrist in the Perioperative Setting

  • Paula C. ZimbreanEmail author


This chapter provides an overview of the complex interface between psychiatry and surgery. We begin with a brief review of the history of consultation-liaison psychiatry, the psychiatric subspecialty that focuses on the care of patients in the general hospital setting. Subsequently, we illustrate the impact of psychiatric illness upon surgical outcomes and discuss the most common psychiatric presentations occurring in the perioperative setting. Three current main models of psychiatric services in the general hospital are described: the classic “on-demand” consultation model, the proactive consultation model, and the embedded psychiatric services.


Consultation-liaison psychiatry Proactive psychiatric consultation Postsurgical posttraumatic stress symptoms Postoperative cognitive impairment 


  1. 1.
    Lipowski ZJ. Consultation-liaison psychiatry at century’s end. Psychosomatics. 1992;33(2):128–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64(8):1155–61.PubMedCrossRefGoogle Scholar
  3. 3.
    Lipowski ZJ. Consultation-liaison psychiatry: the first half century. Gen Hosp Psychiatry. 1986;8(5):305–15.PubMedCrossRefGoogle Scholar
  4. 4.
    Henry GW. Some modern aspects of psychiatry in general hospital practice. Am J Psychiatr. 1929;86(3):481–99.CrossRefGoogle Scholar
  5. 5.
    Strain JJ. Liaison psychiatry and its dilemmas. Gen Hosp Psychiatry. 1983;5(3):209–12.PubMedCrossRefGoogle Scholar
  6. 6.
    Stern TA, Prager LM, Cremens MC. Autognosis rounds for medical house staff. Psychosomatics. 1993;34(1):1–7.PubMedCrossRefGoogle Scholar
  7. 7.
    Strain JJ, Vollhardt BR, Langer SJ. A liaison fellowship on a hemodialysis unit. A self-funded position. Gen Hosp Psychiatry. 1981;3(1):10–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Small EC, Mitchell GW Jr. Practical aspects of full-time liaison psychiatry in gynecology. J Reprod Med. 1979;22(3):151–5.PubMedGoogle Scholar
  9. 9.
    Boland RJ, Rundell J, Epstein S, Gitlin D. Consultation-Liaison Psychiatry vs Psychosomatic Medicine: what’s in a name? Psychosomatics. 2018;59(3):207–10.PubMedCrossRefGoogle Scholar
  10. 10.
    Diebo BG, Lavian JD, Murray DP, Liu S, Shah NV, Beyer GA, et al. The impact of comorbid mental health disorders on complications following adult spinal deformity surgery with minimum 2-year surveillance. Spine (Phila Pa 1976). 2018;43(17):1176–83.CrossRefGoogle Scholar
  11. 11.
    Kalakoti P, Sciubba DM, Pugely AJ, McGirt MJ, Sharma K, Patra DP, et al. Impact of psychiatric comorbidities on short-term outcomes following intervention for lumbar degenerative disc disease. Spine (Phila Pa 1976). 2018;43(19):1363–71.CrossRefGoogle Scholar
  12. 12.
    Clous EA, Beerthuizen KC, Ponsen KJ, Luitse JSK, Olff M, Goslings JC. Trauma and psychiatric disorders: a systematic review. J Trauma Acute Care Surg. 2017;82(4):794–801.PubMedCrossRefGoogle Scholar
  13. 13.
    Hassidim A, Bratman Morag S, Giladi M, Dagan Y, Tzadok R, Reissman P, et al. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res. 2017;220:293–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Arya S, Lee S, Zahner GJ, Cohen BE, Hiramoto J, Wolkowitz OM, et al. The association of comorbid depression with mortality and amputation in veterans with peripheral artery disease. J Vasc Surg. 2018;68:536.PubMedCrossRefGoogle Scholar
  15. 15.
    Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, et al. Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976). 2014;39(19):1614–9.CrossRefGoogle Scholar
  16. 16.
    Aguera Z, Garcia-Ruiz-de-Gordejuela A, Vilarrasa N, Sanchez I, Bano M, Camacho L, et al. Psychological and personality predictors of weight loss and comorbid metabolic changes after bariatric surgery. Eur Eat Disord Rev. 2015;23(6):509–16.PubMedCrossRefGoogle Scholar
  17. 17.
    Ozkan S, Zale EL, Ring D, Vranceanu AM. Associations between pain catastrophizing and cognitive fusion in relation to pain and upper extremity function among hand and upper extremity surgery patients. Ann Behav Med. 2017;51(4):547–54.PubMedCrossRefGoogle Scholar
  18. 18.
    Melamed R, Boland LL, Normington JP, Prenevost RM, Hur LY, Maynard LF, et al. Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes. Perioper Med(Lond). 2016;5:19.CrossRefGoogle Scholar
  19. 19.
    Ward N, Roth JS, Lester CC, Mutiso L, Lommel KM, Davenport DL. Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery. Surgery. 2015;158(2):420–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Harirchian S, Zoumalan RA, Rosenberg DB. Antidepressants and bleeding risk after face-lift surgery. Arch Facial Plast Surg. 2012;14(4):248–52.PubMedCrossRefGoogle Scholar
  21. 21.
    Sajan F, Conte JV, Tamargo RJ, Riley LH, Rock P, Faraday N. Association of selective serotonin reuptake inhibitors with transfusion in surgical patients. Anesth Analg. 2016;123(1):21–8.PubMedCrossRefGoogle Scholar
  22. 22.
    Singh I, Achuthan S, Chakrabarti A, Rajagopalan S, Srinivasan A, Hota D. Influence of pre-operative use of serotonergic antidepressants (SADs) on the risk of bleeding in patients undergoing different surgical interventions: a meta-analysis. Pharmacoepidemiol Drug Saf. 2015;24(3):237–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Hyer L, Scott C, Mullen CM, McKenzie LC, Robinson JS. Randomized double-blind placebo trial of duloxetine in perioperative spine patients. J Opioid Manag. 2015;11(2):147–55.PubMedCrossRefGoogle Scholar
  24. 24.
    Wong K, Phelan R, Kalso E, Galvin I, Goldstein D, Raja S, et al. Antidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions. Anesthesiology. 2014;121(3):591–608.PubMedCrossRefGoogle Scholar
  25. 25.
    Castro-Alves LJ, Oliveira de Medeiros AC, Neves SP, Carneiro de Albuquerque CL, Modolo NS, De Azevedo VL, et al. Perioperative duloxetine to improve postoperative recovery after abdominal hysterectomy: a prospective, randomized, double-blinded, placebo-controlled study. Anesth Analg. 2016;122(1):98–104.PubMedCrossRefGoogle Scholar
  26. 26.
    Goh GS, Liow MHL, Pang HN, Tay DK, Lo NN, Yeo SJ. Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthroplast. 2018;33(8):2428–34.CrossRefGoogle Scholar
  27. 27.
    Zimbrean P, Emre S. Patients with psychotic disorders in solid-organ transplant. Prog Transplant. 2015;25(4):289–96.PubMedCrossRefGoogle Scholar
  28. 28.
    Ravven S, Bader C, Azar A, Rudolph JL. Depressive symptoms after CABG surgery: a meta-analysis. Harv Rev Psychiatry. 2013;21(2):59–69.PubMedPubMedCentralCrossRefGoogle Scholar
  29. 29.
    Wellenius GA, Mukamal KJ, Kulshreshtha A, Asonganyi S, Mittleman MA. Depressive symptoms and the risk of atherosclerotic progression among patients with coronary artery bypass grafts. Circulation. 2008;117(18):2313–9.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Kurdyak PA, Gnam WH, Goering P, Chong A, Alter DA. The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study. BMC Health Serv Res. 2008;8:200.PubMedPubMedCentralCrossRefGoogle Scholar
  31. 31.
    Etcheson JI, Gwam CU, George NE, Virani S, Mont MA, Delanois RE. Patients with major depressive disorder experience increased perception of pain and opioid consumption following total joint arthroplasty. J Arthroplast. 2018;33(4):997–1002.CrossRefGoogle Scholar
  32. 32.
    Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplast. 2016;31(11):2385–8.CrossRefGoogle Scholar
  33. 33.
    Moschopoulou E, Hutchison I, Bhui K, Korszun A. Post-traumatic stress in head and neck cancer survivors and their partners. Support Care Cancer. 2018;26:3003–11.PubMedCrossRefGoogle Scholar
  34. 34.
    Baranyi A, Krauseneck T, Rothenhausler HB. Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction. Health Qual Life Outcomes. 2013;11:111.PubMedPubMedCentralCrossRefGoogle Scholar
  35. 35.
    Drews T, Franck M, Radtke FM, Weiss B, Krampe H, Brockhaus WR, et al. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study. Eur J Anaesthesiol. 2015;32(3):147–51.PubMedCrossRefGoogle Scholar
  36. 36.
    Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry. Br J Anaesth. 2013;110(3):381–7.PubMedCrossRefGoogle Scholar
  37. 37.
    Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend. 2018;187:61–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504.PubMedCrossRefGoogle Scholar
  39. 39.
    Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226(6):996–1003.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim MP, Chan EY, Meisenbach LM, Dumitru R, Brown JK, Masud FN. Enhanced recovery after thoracic surgery reduces discharge on highly dependent narcotics. J Thorac Dis. 2018;10(2):984–90.PubMedPubMedCentralCrossRefGoogle Scholar
  41. 41.
    Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018;6(3):213–22.PubMedCrossRefGoogle Scholar
  42. 42.
    Vasunilashorn SM, Fong TG, Albuquerque A, Marcantonio ER, Schmitt EM, Tommet D, et al. Delirium severity post-surgery and its relationship with long-term cognitive decline in a cohort of patients without dementia. J Alzheimers Dis. 2018;61(1):347–58.PubMedCrossRefGoogle Scholar
  43. 43.
    Skvarc DR, Berk M, Byrne LK, Dean OM, Dodd S, Lewis M, et al. Post-operative cognitive dysfunction: an exploration of the inflammatory hypothesis and novel therapies. Neurosci Biobehav Rev. 2018;84:116–33.PubMedCrossRefGoogle Scholar
  44. 44.
    Thiara G, Cigliobianco M, Muravsky A, Paoli RA, Mansur R, Hawa R, et al. Evidence for neurocognitive improvement after bariatric surgery: a systematic review. Psychosomatics. 2017;58(3):217–27.PubMedCrossRefGoogle Scholar
  45. 45.
    Plas M, Rotteveel E, Izaks GJ, Spikman JM, van der Wal-Huisman H, van Etten B, et al. Cognitive decline after major oncological surgery in the elderly. Eur J Cancer. 2017;86:394–402.PubMedCrossRefGoogle Scholar
  46. 46.
    Zhang J, Wang G, Zhang F, Zhao Q. Improvement of postoperative cognitive dysfunction and attention network function of patients with ischemic cerebrovascular disease via dexmedetomidine. Exp Ther Med. 2018;15(3):2968–72.PubMedPubMedCentralGoogle Scholar
  47. 47.
    Jansen L, van Schijndel M, van Waarde J, van Busschbach J. Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0194029.PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Ni Mhaolain AM, Butler JS, Magill PF, Wood AE, Sheehan J. The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression. Ir J Med Sci. 2008;177(3):211–5.PubMedCrossRefGoogle Scholar
  49. 49.
    Valdes-Stauber J, Bachthaler S. Care differences in a consultation and liaison service. Nervenarzt. 2017;88(11):1281–91.PubMedCrossRefGoogle Scholar
  50. 50.
    Rohrig J, Nafz M, Strohm PC, Bengel J, Hodel T, Wahl S, et al. Addiction counselling in the surgical emergency room. Implementation of a brief intervention for alcohol-intoxicated patients. Unfallchirurg. 2013;116(7):610–6.PubMedCrossRefGoogle Scholar
  51. 51.
    Sledge WH, Gueorguieva R, Desan P, Bozzo JE, Dorset J, Lee HB. Multidisciplinary proactive psychiatric consultation service: impact on length of stay for medical inpatients. Psychother Psychosom. 2015;84(4):208–16.PubMedCrossRefGoogle Scholar
  52. 52.
    Wood R, Wand APF. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014;76(3):175–92.PubMedCrossRefGoogle Scholar
  53. 53.
    Levitan SJ, Kornfeld DS. Clinical and cost benefits of liaison psychiatry. Am J Psychiatry. 1981;138(6):790–3.PubMedCrossRefGoogle Scholar
  54. 54.
    Baumgartner BT, Karas V, Kildow BJ, Cunningham DJ, Klement MR, Green CL, et al. Inpatient consults and complications during primary total joint arthroplasty in a bundled care model. J Arthroplast. 2018;33(4):973–5.CrossRefGoogle Scholar
  55. 55.
    das Nair R, Mhizha-Murira JR, Anderson P, Carpenter H, Clarke S, Groves S, et al. Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial. Clin Rehabil. 2018; Scholar
  56. 56.
    Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev 2017;4:CD002902.Google Scholar
  57. 57.
    Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011;52(6):513–20.PubMedCrossRefGoogle Scholar
  58. 58.
    Pinkhasov A, Singh D, Chavali S, Legrand L, Calixte R. The impact of designated behavioral health services on resource utilization and quality of care in patients requiring constant observation in a general hospital setting: a quality improvement project. Community Ment Health J. 2018. [Epub ahead of print].

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Surgery (Transplant)Yale University School of Medicine, Yale UniversityNew HavenUSA

Personalised recommendations