In a study of postoperative psychosis after open heart surgery three psychopathological syndromes were identified which had different psychological predictors. Predictors of postoperative emotional disturbances are family problems and the lack of plans for the future, whereas patients with postoperative disorientations seem to have difficulties in their jobs and therefore feel distressed preoperatively. Predictors of the paranoid syndrome after the operation are: a high degree of fear in awaiting the operation and little confidence in the doctors. The social surroundings of these patients are often unstable and although they have no precise plans for the future they object to start working again after operation.

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A total of 168 patients underwent thorough psychological investigation before and after open-heart surgery. The pre-operative psychological status and the psychosocial situation of the patients were studied by means of questionnaires and semi-standardized interviews. The post-operative psychic status was documented daily on the first four post-operative days and once after discharge from the intensive care unit, by means of a slightly modified version of the AMP rating scale. We found significant correlations between psychosocial problems, the patients’ ability to cope with their illness, the surgical stress and the environmental stress of the intensive care unit, and post-operative psychic disturbances. The results lead to deliberations on therapeutic consequences.

Some new predictors of postoperative psychosis in open-heart surgery have been identified in a multifactorial study of somatic and psychological factors: Somatic predictors are lower body weight, higher blood levels of urea nitrogen and creatinine, preoperative use of tranquilizers, especially in patients with double valve replacement or congenital heart disease and preoperative cerebral embolism in mitral valve disease. Bypass-time has not proved to be a valid predictor. Psychological predictors are distress provoked by severity and duration of illness, repeated delay of surgery as well as the manner of psychological coping with the illness.

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