DOI: http://dx.doi.org/10.18203/2349-2902.isj20183192

Perioperative mental status assessment of patients undergoing general surgical procedures

Prem Kumar A., Raksha Nadig, Shashikala V., Vikram Arunachalam

Abstract


Background: The past few decades have seen an enormous increase in the number of patients undergoing curative and palliative surgical procedures. The objective of the present study was to assess the mental status in a patient undergoing a general surgical procedure perioperatively.

Methods: 105 patients admitted in a surgical ward, posted to undergo an elective surgical procedure were evaluated to assess their psychological status. Each patient was subjected to a Brief Psychiatric Rating Scale questionnaire twice, once preoperatively and postoperatively. Both sessions were conducted in a calm environment and the patient was administered adequate analgesia to eliminate bias due to pain. The preoperative and postoperative scores were calculated and compared.

Results: BPRS is a psychiatric rating scale used in various psychiatric conditions. Using this scale, we were able to detect the presence of a baseline low mood in a patient undergoing a surgical procedure. The average score preoperatively was 35.84 and postoperatively was 32.68. These scores were higher in patients undergoing surgeries for malignant conditions and also in those with co-morbid conditions like diabetes mellitus. Although there was an improvement in the postoperative scores, there was no significant difference between the preoperative and postoperative scores.

Conclusions: A surgical procedure puts a patient through immense psychological stress manifested as low mood and reduced motivation on the part of the patient to participate in their own rehabilitation programme. This affects the overall outcome of a surgical procedure and increases the morbidity. Knowledge of this on part of the operating surgeon and thus proper counselling of the patient, addressing both the psychological and surgical aspects of the disease process will help improve the overall surgical experience.


Keywords


BPRS, General surgery, Mental status, Perioperative, Psychiatric assessment

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References


Gawande A. Two hundred years of surgery. N Eng J Med. 2012;366(18):1716-23.

Abrams TE, Vaughan-Sarrazin M, Rosenthal GE. Influence of psychiatric comorbidity on surgical mortality. Arch Surg. 2010;145(10):947-53.

Srivastava K, Brig DS, Chaudhury S, Capt SG, Col DB, Basannar D. A study of psychological correlates after amputation. Med J Armed Forces India. 2010;66(4):367-73.

Atherton R, Robertson N. Psychological adjustment to lower limb amputation amongst prosthesis users. Disability Rehab. 2006;28(19):1201-9.

Ferreira da Mata LR, da Cunha AC, de Souza Lima Ziviani C, et al. Psychological morbidity and implications for the recovery of adults after oncology surgery. Cogitare Enfermagem. 2018;23(1).

Singh G. Pre-surgical psychiatric evaluation: 6 considerations: a patient with an inadequately treated psychiatric disorder and/or poor social support is not a good candidate for surgery. Cur Psychiatry. 2010;9(10):96.

Lenze EJ, Skidmore ER, Dew MA, Butters MA, Rogers JC, Begley A, et al. Does depression, apathy or cognitive impairment reduce the benefit of inpatient rehabilitation facilities for elderly hip fracture patients?. General Hosp Psychiatry. 2007;29(2):141-6.

Faustman W, Overall J. Brief Psychiatric Rating Scale. In: Maruish. The Use of Psychological Testing for Treatment Planning and Outcomes Assessment. 2nd ed. Mahwah, NJ: Lawrence Erlbaum Associates Inc; 1999:791-830.

Overall JE, Pfefferbaum B. The Brief Psychiatric Rating Scale for Children. Psychopharmacol Bulletin. 1982;18(2):10.

10. Lachar D, Randle SL, Harper RA, et al. The brief psychiatric rating scale for children (BPRS-C): Validity and reliability of an anchored version. J Am Acad Child Adolesce Psychiatry. 2001;40(3):333-40.

Weiss AJ, Elixhauser A. Overview of Hospital Stays in the United States, 2012. HCUP Statistical Brief #180. October 2014. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb180-Hospitalizations-United-States-2012.pdf.

Sangwan M, Sangwan V, Garg M, et al. Abdominal wall hernia in a rural population in India-Is spectrum changing?. Open J Epidemiol. 2013;3(03):135.

Mishra S, Ali I, Singh G. A study of epidemiological factors and clinical profile of primary varicose veins. Med J Dr. DY Patil University. 2016;9(5):617.

Overall JE, Gorham DR. The brief psychiatric rating scale. Psychol Reports. 1962;10(3):799-812.

Mustafa MA, Fawzy AR. Psychiatric morbidity and consultations among medical and surgical inpatients in a general hospital in Kuwait. Arab J Psychiatry. 2009;20(2):87-108.