Major Psychiatric Complications of Cardiac Surgery

Abstract

Neurocognitive and psychiatric conditions after cardiac surgery are frequent and have an impact on postoperative recovery, adherence to pharmacological and rehabilitation therapy, and, ultimately, a significant effect on mortality. In a broader framework, neuropsychiatric disorders affect both patient’s socio-occupational functioning and quality of life. Patients requiring cardiac surgery could have significant risk factor for developing neuropsychiatric disorder or already show subthreshold conditions or diagnosed disorders that could worsen after the intervention. All these factors need to be acknowledged and targeted to improve the overall outcome. In the postoperative period, patients may experience several complications including depressive disorders, anxiety disorders, post-traumatic stress disorder, delirium, and neurocognitive damage. These conditions have all been related to general and specific pathological factors, both modifiable and non-modifiable, that will be discussed in this chapter. A brief review of recent etiological theories has also been provided for the major neuropsychiatric complications. The complex assessment of neurological and psychiatric problems will also be discussed in order to justify the heterogeneity in prevalence estimates of these conditions and to increase the awareness of the clinician involved in the care management of this delicate category of patients. Moving from the strictly scientific perspective, this chapter will further provide an overview of the general and specific intervention needed to improve the outcome of patients undergoing cardiac surgery and presenting with neuropsychiatric complications [98]. In conclusion, this chapter advocates for a better understanding of the impact, the role, and the therapeutic strategies of neuropsychiatric complications of cardiac surgery, providing a general reference for clinicians.