Article Review: Cardiac Surgery and Psychosis

Individuals undergoing open heart surgery are at risk of experiencing both delirium and psychosis.  Rates of delirium after such surgery are estimated to fall between 8-23%, but rates of psychosis have not been as clearly identified.  In addition, the factors which make it more likely for individuals to experience psychosis have also not been explored in as much detail as risk factors for delirium.


This study (Giltay, et al., 2006) included more than 8000 patients from a Danish hospital over an 8 year period to identify how many patients experienced hallucinations or delusions following heart surgery, and what factors associated with their health, age or complications from the procedure increased the likelihood of experiencing psychosis. The mean age of participants was 65, though participants ranged in age from 9-91. 71% were men.


Results indicated that 2% of participants experienced psychosis following surgery.  Older age and a prior diagnosis of Chronic Obstructive Pulmonary Disease (COPD) were both associated with a higher likelihood of psychosis.  In addition, cardiac arrythmias prior to surgery and cardiovascular disease (narrow blood vessels leading to the heart) also put patients at higher risk of experiencing psychosis.  Finally, lab work or treatment suggesting other body systems were not functioning well, such as high creatine levels, a history of dialysis and low preoperative hemoglobulin levels also increased the likelihood of experiencing psychosis.


In addition, there were more complications from surgery for those who went on to experience psychosis than those who did not. For example, multiple organ failure and cardiopulmonary resuscitation rates for individuals who later experienced psychotic symptoms were much higher.  These patients stayed in intensive care longer and were more likely to pass away shortly after surgery.


The researchers conclude that overall health prior to cardiac surgery is important to predicting the likelihood of experiencing psychosis after surgery, and advanced age, which is often associated with other health problems is a very strong predictor of post-surgical psychosis.


Giltay, E. J., Huijskes, R. V., Kho, K. H., Blansjaar, B. A., & Rosseel, P. M. (2006). Psychotic symptoms in patients undergoing coronary artery bypass grafting and heart valve operation. European Journal of Cardio-Thoracic Surgery30(1), 140-147.


Maria Stacy, MA
WKPIC Doctoral Intern



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