Severe Psychiatric Disturbances in the Post-Operative Period—A Five-Year Survey of Belfast Hospitals

Psychosis in hypoparathyroidism

Recently there has been a resurgence of interest in the subject of hypoparathyroidism and it has become increasingly clear that psychiatric symptoms may frequently be found in patients with hypoparathyroidism, even where no evidence of tetany is present. It is significant that in a survey, in the Cardiff area, of 82 patients who had had a thyroidectomy, Davis et al. (1961) found that mental symptoms (defined as a feeling of uneasiness, tension and anxiety, sometimes with attacks of panic, often with depression) occurred in 66 per cent. of 26 patients whose plasma calcium was below 9·3 mgms/cent, in 51 per cent. of 31 patients whose plasma calcium lay between 9·3 and 9·8 mgms./cent. and in 35 per cent. of 23 patients whose plasma calcium was above 9 · 8 mgms./cent. They estimated that at least 24 per cent. of the patients showed partial parathyroid insufficiency, and that this apparently accounted for many minor but disabling symptoms, particularly depression and lassitude. They found that often these symptoms could be cured by the administration of calcium.

Surgical stress and transient postoperative psychiatric disturbances in aged patients studied using the Yamaguchi University Mental Disorder Scale

Psychiatric disturbances often occur in aged patients after surgery, but there is no easy or precise method of predicting their occurrence. We devised an easy mental test, the Yamaguchi University Mental Disorder Scale (YDS), based on the surgical perspective. Using both this new method and the Hasegawa mental disorder scale (HDS), we examined 106 patients who had undergone general anesthesia. HDS only was used in 70 cases, while 36 cases were examined by the newly devised YDS and were then compared with the findings obtained by HDS. On the HDS examination, factors affecting postoperative psychiatric disturbances were, in order of frequency: entering the ICU, amount of bleeding, and duration of surgery. Aged patients who experienced severe surgical stress had a higher risk of developing transient postoperative psychiatric disturbances. On the YDS examination, the relationship between surgical stress and transient postoperative psychiatric disturbances was clearly indicated, as was the case with HDS. Postoperative delirium was seen in a significant proportion of patients with low preoperative scores on YDS (P < 0.05), while no significant difference was observed between the mean preoperative scores on HDS and postoperative delirium. In the preoperative evaluation using YDS, postoperative delirium was found to be predictable, and YDS is thus considered to be a more valuable tool in managing aged patients.

Effects of surgery on the mental status of older persons. A meta-analytic review

The data bases of 18 empirical studies were combined into one comprehensive data set and subjected to meta-analysis. The following trends were observed: (1) surgery has a significantly decompensating impact on the mental status of older persons, and the average effect size observed is modest (r = .37); (2) for all mental status measures included in the review (cognition, delirium and affect), effect size appears to be significantly moderated by patient age; (3) patient sex may be predictive of the kind of mental impairment that is most likely to occur within an older surgery population, with women manifesting a greater affinity for delirious and men for cognitive decompensation; (4) most existing research within this domain of study is either purely descriptive or anecdotal: of 46 studies reviewed, only 18, or 39.1% of the total published output, were of sufficient methodologic rigor to allow for scientifically valid effect-size computations. The implications of these findings for future research are discussed.

Psychiatric morbidity in elderly surgical patients

One hundred patients aged 65 and over were psychiatrically assessed before and in the first week after elective surgery. Thirteen were psychiatrically ill before operation and 21 developed post-operative illness. Post-operative confusional states (14 patients) were associated with physical complications but not with environmental or pre-operative psychiatric variables. Affective disorders either improved following successful surgery (5 patients) persisted or developed after operation in association with continuing physical illness (6 patients).

Agitation, disorientation, and hallucinations in patients on cimetidine: a report of three cases and literature review

Cimetidine, the first of a new class of pharmacologic agents that dramatically inhibit basal gastric acid secretion, is achieving widespread use for the treatment of such acid peptic disorders as duodenal ulcers, gastritis, and reflux esophagitis. Three patients are presented who experienced agitation, disorientation, and hallucinations while being treated with cimetidine. A review of the literature revealed that central nervous system side effects of cimetidine can occur within 24 hours of treatment with the drug; are often unrecognized or misdiagnosed by clinicians, and are reversed within 12 to 48 hours after the discontinuation of the medication.

A practical approach to preparing children for dermatologic surgery

This paper presents a series of stratagems designed to minimize the potential psychological problems of children who require dermatological surgery. After discussing the "normal" critical periods of childhood, the selective approaches to children at different ages are presented. General and specific suggestions are made for pre- and postoperative management for both office and hospital surgical procedures.

Sleep disturbances after open heart surgery

This study was designed to document quantitatively the sleep disturbances that occur after open heart surgery and to investigate a group of patients who underwent a thoracic surgical procedure not involving cardiopulmonary bypass. Nine patients were studied, six after open heart surgery and three after partial or complete pneumonectomy. In each patient, sleep patterns were recorded with use of all night polygraphy before and after operation and for up to 5 weeks on follow-up studies. After open heart surgery, patients manifested considerable suppression of both rapid eye movement and slow wave sleep patterns. In the three patients subjected to thoracotomy these sleep indexes returned to preoperative levels much earlier. Evidence of stage 2 sleep was present in one of the three patients with thoracotomy on the first postoperative night, and in two of the three both rapid eye movement and slow wave sleep returned to preoperative levels by the time of hospital discharge. It is concluded that patients undergoining open heart surgery experience both acute and chronic disruptions of sleep that last well beyond the hospital period of convalescence. These sleep disturbances have considerable relevance for postoperative management.

Stress, cardiac activity and sleep

An overview is presented of the relationship between cardiovascular activity and sleep, emphasizing the interrelations between stage of sleep and cardiovascular dysfunction. Possible implications of the data are discussed, especially in relation to stress-related factors and possible treatment regimens.

PSYCHIATRIC ASPECTS OF MITRAL VALVOTOMY

The psychiatric aspects of mitral valvotomy have received relatively little detailed study, and this is all the more surprising since clinicians have commented on the frequency with which mental disturbance appears to follow the operation. This investigation was undertaken in an attempt to establish more precisely than heretofore the extent and nature of the relationship.