Psychological Adjustment and Psychiatric Complications Following Open Heart Surgery

A consecutive series of 110 adult open heart surgical patients were evaluated to assess postoperative psychiatric complications. This evaluation included psychological, social, and medical factors in the preoperative and postoperative periods. Psychological factors were assessed with the Minnesota Multiphasic Personality Inventory (MMPI). Many of the predisposing and precipitating factors studied were found to be differentially contributory among subgroups of male and female patients. This suggested certain hypotheses concerning the inter-relationships between psychological factors and the other factors which appear to play an important role in postoperative psychiatric complications. Male open heart surgery patients revealed a high rate of postoperative psychiatric complications. These were found to be related to age, type of surgical procedures, and a clinical picture characterized by depression, anxiety and physical complaints. Female open heart surgery patients revealed a lower incidence of postoperative psychiatric complications than male patients. Their complications were found to be significantly associated with a history of family or marital problems, or problems requiring psychiatric care, and with a significant incidence of brain damage following surgery. Correlated psychological data indicated symptoms and complaints of depression, anger, interpersonal discord, and unusual or bizarre feelings and experiences. It was hypothesized that good psychological adjustment prior to surgery may preclude a postoperative reaction and/or make it easier for a person to accept and effectively adjust to disturbing emotional experiences following surgery whatever their etiology. Some degree of psychological maladjustment would raise the probability for a postoperative reaction, but its ultimate occurrence would be dependent on other factors, such as age and/or type of operation, whose effects seem different in male and female patients. Some of the difficulties involved in the delineation of the role of psychological factors in open heart surgery were discussed, with specific attention called to the lack of clarity and consensus among the various definitions of postoperative psychiatric problems, and the lack of comparable methods used in quantifying psychological or behavioral factors. The importance of the assessment of preoperative psychiatric symptomatology was stressed in relation to both expectations of complications and to a basis for possible ameliorative preoperative procedures.