[Mental and neurological disorders associated with heart operations. Pre- and postoperative studies].

Long before the era of heart surgery began, "cardiac psychoses" were known and described. They do not differ at all from postoperative psychoses after heart-surgery. On the other hand heart-surgery carries a far higher incidence of psychiatric complications than general surgery (general surgery 0,1--1,0%; heart surgery 10--60%). There is no reason to believe that the intensive care unit plays a decisive role in the origin of postoperative cardiac psychoses. Among 150 patients there were 60=40%, who did not show any psychiatric symptoms after surgery. These were exposed to the same environment of the intensive care unit as were the patients who developped symptoms. There were however correlations of statistical significance between "cardiac psychoses" and 1. an occurrence of endogenous psychoses in the family with first degree relatives or in the life history of the patient himself, 2 higher grade of severity of heart disease, 3. extra corporal circulation, 4. higher age, 5. male sex. Postoperative cardiac psychoses are mainly of the type of exogenous psychoses (akuter exogener Reaktionstyp Bonhoeffer). There is no doubt that psychological, reactive and environmental factors do play a certain role too. This is shown by the character of delusions and hallucinations which frequently reflect the postoperative situation. Persecutory delusions with the fear of being killed and ideas and fears of severe body mutilation are the most common motives. Similar motives are frequently observed in postoperative dreams. The manifestations of mental disease in the family or personal history of the patient is considered a significant presupposition of developing a cardiac psychosis of the type of endogenous depression, acute delirium or with schizophrenia like delusions.