The British Journal of Psychiatry

Abstract

An assessment of 141 patients undergoing cardiac or thoracic surgery was carried out, and psychological complications occurring both pre- and post-operatively are discussed.

Psychotic disturbances were most frequent in the two weeks after operation. Neurotic reactions were more frequent pre-operatively than at follow-up three months after surgery.

Delirium, which occurred in 25 of 60 adults following open-heart surgery, was the most disturbing complication encountered. It is considered that the post-operative environment, including abnormal sensory experience, to which these patients were subjected, tends to produce delirium. Other precipitating factors which appear significant include:

(i) hypnosis used as an adjunct to anaesthesia,

(ii) dehydration and hyponatraemia,

(iii) tracheostomy.

Significant predisposing factors include:

(i) Family history of schizophrenic or paranoid psychosis.

(ii) Previous brain damage.

(iii) Presence of rheumatic mitral valve lesion.

(iv) Marital instability.

(v) Overwhelming personal problems, unrelated to surgery.