Open Heart Surgery: The Psychiatric Point of View
Cardiac surgery, especially open-heart surgery, is followed by psychiatric complications more often than the other major operations. According to the different reports, the incidence of delirium varies, ranging from about 20% to 40% (Lipowski 1980a). The other psychiatric syndromes reported to follow cardiac surgery are hallucinosis, the paranoid-hallucinatory syndrome and the mixed affective syndrome, with varying combinations and degrees of depression, elation, anxiety and apathy. Apart from the clinical description and classification of the disturbances, there are also classifications based on a factor-analytic examination of symptoms. Quinlan (1974) found two factors which he called “disorientation” and “dysphoria”. Freyhan (1971) observed three factors, which he termed the “delirious syndrome”, the “paranoid-hallucinatory syndrome” and the “mood disorder syndrome”. Gotze and Dahme (1980), using the cluster analytical approach, were able to find five groups: “unremarkable”, a “slight psycho-organic syndrome with affective and psychomotor disturbances”, a “severe psycho-organic syndrome with disturbances of perception psychomotility”, a “paranoid-hallucinatory syndrome with affective emotional and psychomotor disturbances” and a “delirious syndrome”. Among the preoperative somatic conditions related to the postoperative psychopathological phenomena, the nature of the heart disease is often cited, as are also the severity of the heart disease rated according to the N.Y.H.A. and the correlation with the duration of the illness (Speidel et al 1980).
KeywordsIntermediate Period Psychiatric Complication Preoperative Interview Emotional Withdrawal Cluster Analytical Approach
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- Gotze, P., Dahme, B., Flemming, B., Huse-Kleinstoll, G., Meffert, H.J., Reimer, Ch. and Speidel, H.: Psychopathological syndromes following open-heart surgery and therapeutic consequences. Paper presented at the Second International Symposium on Psycho-pathological and Neurological Dysfunctions Following Open Heart Surgery, Milwaukee, USA, 3.-7. 3. (1980).Google Scholar
- Kimball, C.P.: Psychological Responses to the Experience of Open-Heart Surgery; in Moos, Coping with Physical Illness, pp. 113133 ( Plenum Medical Book Co., New York 1977 ).Google Scholar
- Lipowski, Z.J.: Delirium. Acute Brain Failure in Man (Charles C. Thomas, Springfield, Ill. (1980a).Google Scholar
- Lipowski, Z.J.: Cardiovascular Disorders; in Kaplan, Freedman and Sadock, Comprehensive Textbook of Psychiatry, 3rd ed., vol. II, pp. 1891–1907 ( Williams & Wilkins, Baltimore/London, 1980b ).Google Scholar
- Mohlen, K., Davies-Osterkamp, S., Muller, H., Scheld, H.H. and Siefen, I G.: Relationship between pre-operative coping styles, immediate f post-operative reactions and some aspects of the psycho-social situation of open-heart-surgery-patients one year after the operation. Paper presented at the Second International Symposium on Psychopathological and Neurological Dysfunctions Following Open Heart Surgery, Milwaukee, USA,3.-7. 3. (1980).Google Scholar
- Quinlan, D.M., Kimball, C.P. and Osborne, F.: The experience of open-heart surgery IV. Disorientation and dysphoria following cardiac surgery. Archs Gen. Psychiat. 31: 241–244 (1974).Google Scholar
- Speidel, H. and Rodewald, G. (eds.): Psychic and Neurological Dysfunctions After Open-Heart Surgery ( Georg Thieme Verlag, Stuttgart 1970 ).Google Scholar