Psychiatric aspects of cardiac surgery.

Surgical management for some of the cardiac conditions including heart transplantation has gained a momentum in the world during the past 25 years. But in India such facilities are seen mainly in medical teaching institutions. Since the surgical procedure with the heart has morbidity and mortality risk, it has an impact on the emotional life of the individuals undergoing it. Hence it had become rather customary to assess pre- and postoperatively the psychiatric and psychological consequences [1, 2, 4–9, 12, 15, 16] most probably in an effort to prove the efficacy of a given technique. As against the vast literature outside India on the psychiatric and psychological aspects of cardiovascular surgery, the authors are aware of only two studies [13, 14] in India which elicited psychiatric and psychological aspects of surgery for mitral stenosis. None of these studies demonstrated postoperative personality changes in patients. The behavioral concomitants and consequences of cardiac surgery have not been explored in India either by cardiac surgeons or by behavioral scientists. To explore these aspects a study was initiated jointly with the Department of Cardio-thoracic Surgery [10]. The study aims to assess the personality and behavioral changes following open-heart surgery and does not consider the neuropsychological deficits since it has already been suggested [6, 9, 15] that successful cardiac surgery restores severely reduced cerebral blood flow and cerebral hypoxia and brings about subsequent improvement in the cognitive status of individuals so affected.

The data presented here are part of the International Study and based upon the standard measuring techniques of the study. One aim of our project was to describe patients with missing data after coronary bypass surgery. Drop-out of subjects from the time of the pretest to posttest must be minimized and monitored to identify sources of bias in the data. Incomplete data due to subject fatigue, pain, death or refusal are common sources of error. Our experience suggests that the greatest amount of missing data occurs in the most impaired subjects. According to Bashein et al. [1], one approach to this problem is to set missing values in the data to the worst possible score, so that the most impaired patients are not dropped from statistical analyses. Woidera et al. [2] describe 13 per cent of their patients as having missing data after cardiac surgery.

The Neurologic, Psychiatric and Psychologic Aspects of Cardiac Surgery

Excerpt In 1976Annals of Internal Medicinepublished a series of suggested readings for physicians reviewing medicine and its subspecialty fields, including neurology and dermatology, in preparation...

Heart disease is the leading cause of mortality in the USA and accounts for 17% of healthcare expenses, with projected costs of cardiovascular disease expected to triple in the next two decades. Psychiatric conditions such as depression, anxiety, and delirium, among others, are common in patients with cardiovascular disease, and their presence has been linked to worse medical outcomes and higher healthcare costs. In this book chapter, we will discuss the effects of different psychiatric conditions in patients undergoing coronary artery bypass grafting, cardiac valvular surgery, left ventricular assist device implantation, and in patients with automatic implantable cardiac defibrillators.

PSYCHIATRIC ASPECTS OF CARDIAC SURGERY IN A CHILD