The British Journal of Psychiatry
Psychological Disturbances Associated with Open Heart Surgery


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.