Preoperative Psychiatric Diagnosis Research Articles

Does a Preoperative Mental Health Diagnosis Affect Pain Management in Patients with Adolescent Idiopathic Scoliosis Undergoing Surgery?

Patients with adolescent idiopathic scoliosis (AIS) are typically treated surgically with posterior spinal fusion (PSF) when the curve continues to progress beyond 45 to 50 degrees. In adult patients, studies have shown that preoperative psychiatric diagnoses are associated with poorer clinical outcomes after lumbar spine surgery. This study aims to address whether a preoperative mental health disorder affects outcomes in pediatric patients with AIS treated with PSF. We conducted a retrospective study of pediatric patients with a history of AIS requiring operative treatment with PSF at a single center with a minimum of 2-year follow-up. These patients were split into 2 groups: a subset that had a mental health disorder (MHD), and a control group. The MHD subset included patients with anxiety disorder, major depressive disorder, bipolar disorder, manic disorder, obsessive-compulsive disorder, attention deficit hyperactivity disorder, and stress disorder. The 2 groups were compared using independent student t-test and χ2 analysis. A total of 417 patients were included in the study. Ninety-three patients were included in the MHD group, and 324 patients were included in the control group. The mean pain score for the MHD group was greater (3.93) compared with the control group (3.34). The PCA demands during inpatient stay for the MHD group were also greater (236.7) compared with the control group (140.0). There was no significant difference in the length of stay in the hospital between the MHD group (4.7 days) and the control group (4.6 days). There was a greater number of patients in the MHD cohort (25.8%) still using narcotic pain medication at first follow-up compared with the control group (12.0%). This study suggests that patients with AIS with a preoperative mental health disorder undergoing PSF experience more pain after surgery and require more pain medication during their recovery. III. This is a retrospective review of pediatric patients with adolescent idiopathic scoliosis and a preoperative mental health diagnosis and their pain management requirements during the recovery period from posterior spinal fusion.

Development of De novo Functional Seizures after Epilepsy Surgery (S35.010)

<h3>Objective:</h3> The purpose of this evaluation was to identify the frequency and risk factors of de novo FS in patient after epilepsy surgery. <h3>Background:</h3> Functional seizures (FS) (also known as psychogenic non-epileptic seizures (PNES) or dissociative seizures) are seizures that mimic an epileptic seizure but have no associated epileptogenic EEG changes and are thought to have a psychological basis. Epilepsy surgery can be an effective means of treatment for patients with drug refractory seizures, but it is important to understand the complications that can arise from surgery. <h3>Design/Methods:</h3> The surgical data based showed 1116 patients who underwent epilepsy surgery from 1998 to 2022. The clinic notes were reviewed and identified 37 patients who developed de novo FS post-surgery. They were characterised by their age, sex, age of surgery, duration of epilepsy before surgery, pre-operative psychiatric co-morbidities, type/site of surgery, and post-operative complications <h3>Results:</h3> 37 patients were identified (30F, 7M). The mean age at the time of surgery was 36.2 (17–52 years). 31 patients had documented post-operative de novo FS. 16 patients had a documented pre-operative psychiatric diagnosis. 10 patients developed immediate post-operative complications and de novo FS an average of 9.8 months after surgery. 4 patients with no past psychiatric issues developed psychosis following immediate post-operative complications. Patient with no immediate post-operative complications with or without pre-operative psychiatric diagnosis developed de novo FS on average of 29.4 months after epilepsy surgery <h3>Conclusions:</h3> 1) The rate of development of de novo FS after epilepsy surgery is low (2.77%). 2) The patients who have de novo FS after surgery have high rates of pre-operative psychiatric diagnoses (43.2 %), are predominantly female (81.1%) , and have immediate post-op complications (27%). 3) Immediate post-operative complications can result in new functional seizures developing less a year after surgery <b>Disclosure:</b> Dr. Manoj has nothing to disclose. Dr. Yogarajah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for MEWA. Dr. Yogarajah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Forensic Access. Dr. Yogarajah has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Eopinex. The institution of Dr. Yogarajah has received research support from MRC. Dr. Yogarajah has received publishing royalties from a publication relating to health care. Dr. Huda has nothing to disclose. Ms. De Tisi has nothing to disclose. John Duncan has nothing to disclose.

The Association Between Mood and Anxiety Disorders With Perioperative Outcomes Following Radical Cystectomy

ObjectiveTo identify associations between preoperative psychiatric diagnoses and perioperative outcomes after RC. MethodsThe Florida Inpatient Data File was used to identify patients who underwent RC from 2013 to 2019. ICD-10 codes for a mood or anxiety disorder were identified and analyzed as a 3-level variable: neither, one of these, or both. Outcomes included inpatient mortality, non-home discharge, in-hospital complications, and length of stay. Mixed-effects logistic regression (accounting for clustering within hospitals) and negative binomial regression models were utilized. ResultsWe identified 4396 RC patients, including 306 (7.0%) with a mood disorder and 389 (8.8%) with an anxiety disorder. After multivariable adjustment, there was no significant association between mood and/or anxiety disorders with mortality or the presence or number of in-hospital complications. However, a mood or anxiety disorder was significantly associated with increased odds of non-home discharge (OR 1.60, 95% CI 1.20-2.14) and longer length of stay (IRR 1.13, 95% CI 1.07-1.19); these associations were also increased among patients with both mood and anxiety disorder diagnoses (non-home discharge OR 2.66, 95% CI 1.61-4.38; length of stay IRR 1.12, 95% CI 1.01-1.24). ConclusionPatients with mood and/or anxiety disorders undergoing RC had longer length of stay and increased odds of discharge to a non-home facility despite similar risks of perioperative complications. These data suggest an opportunity for perioperative intervention to address these disparities in postoperative outcomes. However, further work is needed to determine the underlying causes of these differences and to develop effective interventions.

Impact of Psychiatric Diagnoses and Treatment on Postoperative Outcomes Among Patients Undergoing Surgery for Colorectal Cancer.

Psychiatric diagnoses may be a risk factor for poor colorectal cancer (CRC) surgery outcomes. The authors investigated the risk of psychiatric diagnoses and benefit of mental health treatment for surgery outcomes among CRC patients. This retrospective cohort study of patients undergoing CRC surgery in the 2000-2014 period identified documentation of psychiatric diagnosis and mental health treatment (no treatment, medication only, psychotherapy only, or both medication and psychotherapy) 30 days before surgery. Associations between psychiatric diagnoses, mental health treatment, and postoperative outcomes (postoperative complications, length of stay [LOS], and 90-day readmission rate) were evaluated with multivariable generalized estimating equations. Among 58,961 patients undergoing CRC surgery, 9,029 (15.3%) had psychiatric diagnoses, 4,601 (51.0%) of whom received preoperative mental health treatment (90.0% psychiatric medication, 6.7% psychotherapy, and 3.0% medication and psychotherapy). Patients with psychiatric diagnoses had an increased risk for postoperative complications (odds ratio [OR]=1.09, 95% confidence interval [CI]=1.03-1.15) and 90-day readmission (OR=1.11, 95% CI=1.06-1.17) compared with patients without psychiatric diagnoses. Patients with psychiatric diagnoses who received no mental health treatment or only medication had a 7%-17% increased risk for postoperative complications and 90-day readmission compared with patients without psychiatric diagnoses. Patients who received medication only also had a 4% increase in LOS relative to patients without psychiatric diagnoses. Patients with psychiatric diagnoses receiving only psychotherapy and patients without psychiatric diagnoses had similar postoperative outcomes. Preoperative psychiatric diagnoses were associated with worse postoperative outcomes. Surgical quality-improvement efforts should focus on identifying patients with preoperative psychiatric diagnoses and addressing these conditions presurgery.

260. Preoperative medical comorbidities do not affect minimum clinically important difference (MCID) for lumbar fusion in grade one spondylolisthesis

BACKGROUND CONTEXT Medical comorbidities, particularly anxiety or depression, may potentially influence how patients perceive clinical benefit after surgery. The current study defined and compared minimum clinically important difference (MCID) thresholds in patients with and without anxiety/depression and obesity undergoing fusion for grade 1 degenerative spondylolisthesis. PURPOSE To determine if preoperative psychiatric diagnoses, more than obesity, alters the MCID threshold in patients undergoing fusion for spondylolisthesis. STUDY DESIGN/SETTING Retrospective analysis of multicenter, prospective database. PATIENT SAMPLE Patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis from January 2014 to August 2017 enrolled in the Quality Outcomes Database (QOD). OUTCOME MEASURES Oswestry Disability Index (ODI), EuroQOL5D (EQ-5D), back (BP, 0-10) and leg pain (LP, 0-10) scores METHODS The QOD was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis from January 2014 to August 2017. Patient Reported Outcomes (PROs) included ODI, EQ-5D, BPand LP scores. Both anchor-based and distribution-based methods for MCID calculation were used. RESULTS Of 462 eligible cases, 356 (77%) had complete baseline and 12-month PROs. The MCID values for ODI were similar in patients with and without a diagnosis of obesity (20.58 and 20.69, respectively), and with and without anxiety/depression (24.72 and 22.56, respectively). The MCID values for BP, LP, and EQ-5D were also similar among all groups regardless of method used to determine MCID. CONCLUSIONS MCID thresholds for ODI, EQ5D, back pain and leg pain in patients with and without anxiety/depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis are similar. Preoperative clinical and shared decision-making may be improved by understanding that preop medical comorbidities do not affect how patients determine an important clinical change postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Surveying the Literature

Surveying the Literature

Psychiatric Diagnoses and Weight Loss Among Adolescents Receiving Sleeve Gastrectomy.

Severe obesity is associated with higher risk of psychiatric difficulties. Bariatric surgery is the most effective treatment of severe obesity. Few guidelines exist regarding the association of psychiatric diagnoses in adolescents and outcomes after surgery because of the lack of longitudinal research. Our objective is to evaluate the rates of psychiatric diagnoses in adolescents undergoing surgery compared with those not receiving surgery and the association of preoperative psychiatric diagnoses with postsurgical weight loss outcomes. Adolescents (N = 222) referred for psychological evaluation at one institution for bariatric surgery (2009-2017) completed semistructured clinical interviews to assess the presence and number of psychiatric diagnoses. Comparison analyses were conducted between those who did not end up receiving surgery (N = 53) and those who did (N = 169). Using longitudinal modeling, we assessed the association of preoperative diagnoses with weight loss outcomes between 3 and 12 months after surgery. Seventy-one percent of adolescents qualified for a psychiatric disorder. There were no differences in rates of specific disorders or numbers of diagnoses between those receiving surgery and those not receiving surgery. The presence or absence or number of diagnoses before surgery was not associated with weight loss outcomes after surgery. Psychiatric diagnoses are prevalent among adolescents with severe obesity. These diagnoses are not associated with weight loss outcomes. The presurgical psychological evaluation serves as an opportunity to identify adolescents experiencing psychiatric problems and provide them with care but should not necessarily be considered a contraindication to surgery.

Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients

BackgroundPsychosocial factors contribute to poorer weight loss outcomes following bariatric surgery; however, findings on associations between preoperative psychiatric diagnoses, psychological testing, and weight loss are inconsistent. ObjectivesExamine associations between presurgical psychiatric diagnoses derived from a semi-structured clinical interview and test scores from the Minnesota Multiphasic Personality-Inventory−2 – Restructured Form (MMPI-2-RF) and 5-year Body Mass Index (BMI) outcomes. SettingCleveland Clinic Bariatric and Metabolic Institute Methods446 consecutively consented patients who underwent a Roux-en-Y gastric bypass (RYGB) at least 5 years prior were included in the study. A majority were women (74.2%) and Caucasian (66.2%). Patients’ mean presurgical BMI was 49.14 kg/m2 [SD = 9.50 kg/m2]. Psychiatric diagnoses were obtained from a presurgical, semi-structured clinical interview and all participants were administered the MMPI-2-RF at their presurgical evaluations. BMIs were collected at 4 postoperative time points across a 5-year trajectory. This prospective design utilized latent growth curve modeling. ResultsOlder patients evidenced a slower rate of BMI reduction over time. A presurgical diagnosis of Binge Eating Disorder predicted higher BMIs at the 5-year outcome. Scores on MMPI-2-RF measures of emotional and behavioral dysfunction domains incrementally predicted poorer weight loss outcomes. ConclusionPreoperative indicators of psychopathology, notably indicators that are dimensional in nature, are important in predicting postoperative outcomes. Closer follow-up with patients who evidence presurgical psychological factors, both before and after surgery, may help improve outcomes.

De novo psychogenic nonepileptic attacks after adult epilepsy surgery: An underestimated entity

We retrospectively assessed all patients in a large cohort of patients with epilepsy surgery at the National Hospital for Neurology and Neurosurgery (NHNN) over 12years, to identify patients with postoperative psychogenic nonepileptic attacks (PNEA). Twenty-nine patients (23 women) were identified of a total of 790 patients, a frequency of 3.7%. Female gender and presurgical psychiatric diagnosis, other than psychosis, were significant risk factors for PNEA development. In female patients with a preoperative psychiatric diagnosis the chance of developing PNEA after epilepsy surgery was 8.5%. PNEA developed between 2weeks and 10years after epilepsy surgery, independently of outcome of epileptic seizures. In most cases, PNEA differed from the present or past epileptic seizures, and motor symptoms were the most common manifestations. Seizures after epilepsy surgery should be carefully evaluated. Physicians should consider the possibility of PNEA, especially in female patients with preoperative psychiatric comorbidity developing "atypical" seizures with motor manifestations postoperatively, even many years after epilepsy surgery.

Post-traumatic Stress Symptoms After Elective Lumbar Arthrodesis are Associated With Reduced Clinical Benefit

Prospective cohort study. To assess the impact of postoperative post-traumatic stress disorder (PTSD) symptoms on clinical outcomes after lumbar arthrodesis. Postoperative PTSD symptoms occur among many patients who underwent elective lumbar fusion. Although adverse impact of preoperative depression and psychiatric distress has been described, no reports have assessed the impact of postoperative PTSD symptoms on clinical outcomes after lumbar arthrodesis. Seventy-three patients undergoing elective lumbar spinal arthrodesis completed the PTSD Checklist-Civilian Version (PCL-C) at 3, 6, 9, and 12 months postoperatively. Short-Form 36 and the Oswestry Disability Index (ODI) were completed preoperatively and at 1 year postoperatively. Impact of postoperative PTSD symptoms, preoperative psychiatric diagnoses, and mental composite scores on clinical outcome scores and likelihood of reaching minimal clinically important difference for ODI and physical composite score (PCS) was evaluated. PTSD symptoms were reported in 22% of the cohort, with significantly reduced surgical benefit as measured by final (P < 0.0001 and P = 0.003) and total change (P = 0.013 and P = 0.032) in ODI and PCS scores, respectively. Likelihood of reaching minimal clinically important difference for both ODI and PCS was also reduced for patients reporting PTSD symptoms (P = 0.009 and P = 0.001, respectively). A preoperative psychiatric diagnosis correlated only with final ODI score (P = 0.008). Preoperative mental composite scores were significantly correlated with final ODI and PCS scores, as well as final change from preoperative and likelihood of reaching minimal clinically important difference for PCS, but not for ODI scores. Postoperative psychological distress was strongly correlated with reduced clinical benefit among patients who underwent elective lumbar arthrodesis, and seemed to be a stronger predictor of reduced clinical benefit than either major psychiatric diagnosis or preoperative mental composite scores. Efforts to reduce postoperative psychological distress may offer an opportunity to enhance patient reported clinical outcomes from elective spine surgery. 2.

Predictors of psychiatric and seizure outcome following temporal lobe epilepsy surgery

Neurosurgery is an effective therapy for selected individuals with medically refractory temporal lobe epilepsy (TLE). De novo psychopathology may complicate the postsurgical outcome. Our aims were to identify predictors of de novo psychiatric and seizure outcome following TLE surgery. Medical records of 280 patients who underwent TLE surgery were reviewed. Preoperative and postoperative psychiatric diagnoses were identified, in addition to information on seizure recurrence and neuropsychological status. Logistic regression analysis was used to identify predictors of having a de novo psychiatric diagnosis and remaining seizure-free within 4 years following surgery. One hundred five patients (38%) had significant psychiatric problems within 4 years following TLE surgery. Fifty-one patients (18%) developed de novo psychopathology; half of cases presented within 6 months and 90% of psychopathologies persisted 6 months or longer. A preoperative history of secondary generalized tonic-clonic seizure(s) (SGTCS) was an independent predictor of de novo psychopathology (odds ratio [OR] 2.73, 95% confidence interval [CI] 1.14-6.59, p = 0.02). From patients with available seizure data, 49% (127 of 258) remained seizure-free for 4 years after surgery. Patients with a history of SGTCS (OR 0.47, 95% CI 0.25-0.90, p = 0.02) and those with a preoperative psychiatric diagnosis (OR 0.53, 95% CI 0.28-0.98, p = 0.04) were significantly less likely to remain seizure-free. De novo psychopathology is a significant complication of TLE surgery. Inclusion of neuropsychiatric assessments in the presurgical evaluation may lead to increase in the power of prognostic models used to predict the neurologic outcome of TLE surgery.

Symptoms of Post-traumatic Stress Following Elective Lumbar Spinal Arthrodesis

A prospective cohort study with 100% follow-up. To assess incidence and risk factors for development of post-traumatic stress disorder (PTSD) symptoms after elective lumbar arthrodesis. Invasive medical care results in substantial physical and psychological stress to patients. The reported incidence of PTSD after medical care delivery in patients treated for trauma, cancer, and organ transplantation ranges from 5% to 51%. Similar data after elective lumbar spinal arthrodesis have not been reported. A consecutive series of 73 elective lumbar spine arthrodesis patients were evaluated prospectively, using the PTSD checklist-civilian version at 6 weeks, 3 months, 6 months, 9 months, and 12 months after surgery. Patient's sex, age, education level, job status, marital status, psychiatric history, prior surgery with general anesthetic, surgical approach, blood loss, postoperative intubation, length of intensive care unit and hospital stay, and occurrence of perioperative complications were analyzed as predictors of PTSD symptoms, using χ analyses. The overall incidence of symptoms of PTSD identified at at least 1 time point was 19.2% (14 of 73). At each time point, the percentage of the population that was positive was 7.5% (6 wk), 11.6% (3 mo), 7.8%, (6 mo), 13.6% (9 mo), and 11.0% (12 mo). The presence of a prior psychiatric diagnosis proved to be the strongest predictor of postarthrodesis symptoms of PTSD (odds ratio [OR] = 7.05, P = 0.002). Occurrence of a complication also proved to be significantly correlated with the development of PTSD symptoms (OR = 4.33, P = 0.04). Age less than 50 years, blood loss of more than 1 L, hospital stay of more than 10 days, and diagnosis trended toward but failed to reach statistical significance. None of the remaining variables approached statistical significance. Positive PTSD symptoms occurred at least once in 19.2% of patients after elective lumbar arthrodesis, with 7.5% to 13.6% of patients experiencing these symptoms at any 1 time point postoperatively. In this patient cohort, preoperative psychiatric diagnosis was the strongest predictor among tested variables of occurrence of PTSD symptoms, although occurrence of a perioperative complication was also significantly correlated with PTSD symptoms. Spine surgeons should be aware of the potential impact of lumbar arthrodesis surgery on patients' psychological state. Further investigation focusing on the impact of PTSD symptoms on clinical outcomes as well as on potential means of reducing the postoperative incidence of this disorder seems warranted.

Psychiatric co-morbidity in 75 patients undergoing epilepsy surgery: Lack of correlation with pathological findings

Psychiatric disorders may occur in patients with intractable partial epilepsy after surgical treatment. Previous reports attributed the presence of psychological adverse events to specific pathological entities such as dysembryoplastic neuroepithelial tumors (DNETs) and gangliogliomas. The rationale for the present study is to evaluate the importance of the surgical pathology in individuals undergoing epilepsy surgery. The patients were separated into three groups based on the surgical pathology: group I ganglioglioma (N=25), group II DNETs (N=25), and group III mesial temporal sclerosis (N=25). Thirteen of the 75 patients (17.3%) had a preexisting psychiatric disorder. The most common preoperative psychiatric diagnosis was depression (N=4). Sixty-three of the lesions (84%) were restricted to the temporal lobe. The operative strategy included resection of the lesion and epileptogenic cortex. Sixty-two of the 75 patients (83%) were rendered seizure-free. Eight of the 75 patients (10.7%) had an acquired psychiatric illness following surgical treatment. A mood disorder developed in three patients after surgery. No statistical difference emerged in preoperative psychiatric co-morbidity (no group difference; p=1.0) or in newly diagnosed postoperative psychiatric disease (group I vs. II, p=0.67; group I vs. III, p=1.0; and group II vs. III, p=0.67) within the three surgical pathology groups. This study indicates that the presence of psychiatric disease before and after surgery for intractable partial epilepsy, predominantly of temporal lobe origin, was independent of the pathological findings.

Quality of Life in Morbidly Obese Patients after Surgical Weight Loss

Laparoscopic adjustable gastric banding (LAGB) is seen as a safe surgical procedure in individuals with morbid obesity, with satisfactory weight loss and significant postoperative improvement in quality of life (QoL). The present study investigates the predictive value of various parameters such as age, gender, weight loss, and preoperative psychiatric disorders with regard to QoL after LAGB. 300 obesity surgery patients were sent questionnaires to assess a variety of personal parameters. QoL was assessed using the Ardelt-Moorehead Quality of Life Questionnaire. Questionnaires were completed by 140 (63%) female patients and 36 (45%) male patients. Average weight loss in both sexes was 14.7 kg/m2; however, not all patients successfully lost weight. No difference was seen in satisfaction with weight loss among the age groups. Some correlations were seen between the amount of weight loss and QoL scores in females, but not in males. Greater weight loss showed a statistically significant positive correlation to self-esteem, physical activity, social relationships, sexuality, and eating pattern. Obese females with no preoperative psychiatric diagnosis had better self-esteem, more physical activity, and more satisfying social and sexual relationships than those with psychiatric diagnoses at follow-up. A majority of morbidly obese patients show psychological and interpersonal improvement after surgery. However, some obese patients, particularly those having a preoperative psychiatric or personality disorder, need more individual strategies for psychosocial intervention than do obese individuals with no psychiatric disorder.

Personality disorders as predictors of severe postsurgical psychiatric complications in epilepsy patients undergoing temporal lobe resections

Purpose. Psychiatric disorders emerging after temporal lobe resections are a serious problem threatening the surgical success of patients with epilepsy. The present study aims to find psychiatric predictors that would indicate patients’ risk to developing severe psychiatric complications after surgery. Methods. One hundred adult patients who had temporal lobe resections were followed prospectively over 2 years. Preoperative psychiatric diagnoses and postoperative development of the patients were documented. As a criterion of severe postoperative complication, admission to a psychiatric hospital was chosen. Results. Patients with personality disorders are at higher risk of suffering from postoperative psychiatric complications as compared with patients with other preoperative psychiatric conditions (such as depression) or with patients with no preoperative psychiatric diagnosis whatsoever. Conclusions. Personality disorders are caused by organic dispositions and negative environmental influence. They indicate a high mental vulnerability and compromise the brain’s ability to combat stress. As a consequence patients with personality disorders are prone to suffer from severe psychiatric complications after epilepsy surgery. To minimize the negative influence of personality disorders in the process of surgical interventions, psychotherapeutic efforts are needed to reduce perisurgical stress factors and to strengthen the self-efficacy and social skills of these patients.

Nonepileptic seizures after resective epilepsy surgery.

To identify factors that are associated with the emergence of nonepileptic seizures (NES) after resective epilepsy surgery. Twenty-two patients with medically refractory epilepsy in whom NESs were documented by EEG after resective surgery were compared with a larger series of epilepsy surgery patients on demographic, neurologic, and psychiatric variables. NES tended to become apparent in the first few months after surgery. Patients who developed NESs did not differ from other epilepsy surgery patients in terms of age, IQ, or preoperative psychiatric diagnoses. However, surgical NES patients' neurologic problems and seizures began later in life, the NES group included a larger proportion of female subjects and patients with right hemisphere surgery, and NES patients were more likely to develop non-NES psychiatric problems after surgery. The heterogeneous collection of behaviors subsumed under the label NESs are determined by multiple factors. Several variables were found to be specifically associated with the development of NES after resective epilepsy surgery: A disproportionate number of postsurgical NES patients are female, they have primary neurologic dysfunction in the right hemisphere, and their epileptic seizures often began after adolescence. We propose that at least one group of patients with somatoform tendencies develop NESs as part of the psychiatric instability that occurs often in the few months after resective surgery.

Psychosocial Adjustment and Quality of Life following Heart Transplantation

This article describes the pre-operative psychosocial and quality-of-life adjustment of a consecutive series of 27 heart transplant recipients and the adjustment of the 24 survivors at 12 months follow-up. Pre-operatively, 14 had a psychiatric diagnosis and this figure had dropped to five at 12 months follow-up. Those patients without a psychiatric diagnosis preoperatively had not developed one at follow-up. There was a significant correlation between pre-operative psychiatric diagnosis and a rating of poor medical compliance. Ratings of physical activity, employment and questionnaire ratings of psychological adjustment also showed highly significant improvement at follow-up and the majority of patients were active sexually. It is concluded that heart transplantation in selected subjects with terminal heart disease results in a substantial improvement in psychosocial adjustment and quality-of-life 12 months following surgery.