PSYCHIATRIC ASPECTS OF MITRAL VALVOTOMY

Coming out of intensive care crazy: dreams of affliction

The impetus for this article was the author's experience of illness, necessitating 5 months of hospitalization, 7 weeks of which were spent in a coma in an intensive care unit (ICU). The origins and general characteristics of ICUs are noted. A pastiche of illness narrative is constructed to allow for the author's own comment on his experience. The intensive care syndrome (ICS), a permeable category, continuing the aftermath of surgery and the social, psychological, mechanical, and pharmaceutical effects of the unit itself, is discussed. Dreams of affliction, a component of the ICS, are explored; the prior sociological history of the neglect of dreams, an essential universal, is also pointed out. The author's dream forms and their shamanistic parallels are explored. In Foucauldian language, they are considered a product of the fragmentation of the cosmological spirit, whereas the author was a medical object and mechanical appendage. Nursing is in a strategic position to make patients' dream narratives their own as an aid for understanding illness.

Delirium after cardiac surgery: a critical review

Numerous articles have been published investigating the incidence of and risk factors for delirium after cardiac surgery. Smith and Dimsdale reviewed the literature on postcardiotomy delirium in 1987 using a meta-analysis of 44 research studies. However, doubts about their methods and results caused the authors to re-examine the literature using these 44 references as well as computerized literature searches to gather research and review papers from medical journals. Delirium after cardiac surgery appeared to be ill-defined in most of these studies. The methods and instruments used to assess delirium proved to be very different, and the patient samples were rather heterogeneous. Therefore, in most cases, the results are not comparable. Only a small number of the studies that were examined fit the criteria for statistical meta-analysis. On the basis of our analysis, a tentative conclusion may be drawn that the incidence of postcardiotomy delirium has declined slightly and that no strong risk factors have yet been identified.

Psychological factors and recovery from cardiac surgery

21 Subjects awaiting open-heart surgery were given personality and attitude questionnaires. They were re-tested six months after the operation, when they were divided into "completely recovered" (I) and "not completely recovered" (II) groups, according to the New York Heart Association classification. Results showed that Group I was significantly less depressed, more optimistic about the future and had a more positive attitude towards others. Group II realised they had been very ill and had a more negative attitude towards their spouses. Group I was found to be much better adjusted, vocationally and psychosexually, than Group II.

The emotional impact of surgery and the value of informed consent

The process of obtaining consent detailed here contains within it most of the therapeutic techniques useful in the prevention and treatment of usual postoperative psychological complications. You will note that at various points the physician will have; given information, utilized suggestions, reflected feelings, allowed ventilation and catharsis, clarified, desensitized, increased self-esteem, given reassurance, fostered identification, supported healthy defenses, encouraged autonomy, control, and responsibility, and done some social engineering. These psychotherapeutic techniques have been built into the content and process of eliciting consent. In addition, and most importantly, the process has fostered the growth of the doctor-patient relationship, the ultimate therapeutic weapon in managing most postoperative psychological reactions.

Ego-supportive care in open-heart surgery

Open heart surgery has been shown to have a rate of occurrence of postoperative psychopathological phenomena (9 percent-57 percent) many times greater than that of general surgery (1/1500). These phenomena result from an interplay of organic, environmental, psychological, and social factors which act on the integrative and coping capacity of the ego.

Treatment is accomplished through support of the ego by: 1) establishment of a relationship, 2) reassurance, 3) environmental support, 4) consultative relationships with staff, 5) ventilation of feelings, 6) medical measures in support of somatic function, and 7) anti-anxiety drugs. Such supportive measures are usually effective in bringing about a rapid remission of these psychopathological phenomena.

Psychological adjustment and response to open-heart surgery: some methodological considerations

Psychological factors have long been posited as having a role in determining a person's response to open-heart surgery. As early as 1956 Bolton and Bailey reported a high correlation between a history of psychiatric problems and psychiatric complications following cardiac surgery.

Psychological reactions to cardiac operations: an historical perspective

The impact of heart surgery has many ramifications for the patient. With studies of mitral commissurotomies in the early 1950's, we begin to learn of man's response to newer surgical and medical procedures which radically change the course of life. In the area of heart surgery, the dramatic and prevalent postoperative psychoses occurring in intensive care units have been discussed, along with the intimate relationship existing between preoperative emotional slate and postoperative outcome. The symbolism of the heart, as the life-sustaining organ, the meaning of death, and the importance of the motivation to live are three interrelated facets representative of man's response to having his heart operated on. New technology in physical medicine leads to new insights in psychological medicine and thereby underscores the pressing need for greater collaboration amongst all specialists concerned with patient care.