Volume 3 Issue 6 June, 2013
Consultation Liaison Psychiatry Focus : Cardiothoracic Surgery
Being a cardiac surgeon, we come across the colleagues in psychiatry less frequently. For us the important aspect what we would be looking would be the cardiac state and whether patient is fit for surgery or not and also in the follow up whether there is any post operative complication.
It would be necessary to take the opinion of the psychiatrist during the following phases of management. Pre operative phase, postoperative phase and during the follow ups.
In the preoperative phase: When the patient is suggested for the surgery there are lot queries for the patient and the family members are apprehensive about the procedure and their recovery. This is usual phenomenon observed and during the process and it needs to be explained to them. If we tend to see the depressive symptoms and anxiety symptoms which are beyond the usual concern, then an opinion of the psychiatrist is taken. In certain cases they have history of psychiatric illness or currently are on treatment for the same, and then the opinion of psychiatrist is of paramount importance. Studies have consistently shown that when patients are recognized early, intervention will have positive impact on recovery. It is also true that comprehensive cardiac care should ideally involve evaluation and management of nicotine abuse, alcohol dependence, adverse life style and stress management, which is rarely carried out even in advanced centers.
In the post operative phase: Compared to other surgery cardiac surgery is the one that has delirium as a common complication in the post operative period. Many freely use the term ICU psychosis!! In those patients especially with history of alcohol abuse and metabolic disorder, the probability of patients having the delirium postoperatively is quiet high. It becomes very difficult to manage the delirious cases in the post operative ward as they can try to injure themselves and lot of nursing care is required. Hence emphasis should be on seeking psychiatrist opinion. It is noticed that those patients who had delirium take longer duration of stay and recovery phase is slow.
In the follow up phase: When the patient comes for follow up, often reports of lack of energy, decreased interest, excessive pain or other symptoms which cannot be explained and they are not able to carry out the normal daily activities. Since recovery is slow, one should have high suspicion about depression before a battery of investigations are carried out. When those reports are within normal limits, then patient should be encouraged to seek psychiatrist opinion.
In these modern days every patient is loaded with lot of information and convincing the patients is very difficult. With the availability of consultant psychiatrist in the tertiary care the management of cardiac patients having the co‐morbid illness will benefit and there may be more meaning in comprehensive cardiac care.
Dr P.K. Sunil , M.B.B.S, M.S, M.Ch (CTVS), Consultant Cardiothoracic surgeon and Associate Professor, Sri Jayadeva Institute of Cardiovascular Sciences and Research Center. Bangalore.
