Abstract
This chapter provides an overview of the complex interface between psychiatry and surgery. We begin with a brief review of the history of consultation-liaison psychiatry, the psychiatric subspecialty that focuses on the care of patients in the general hospital setting. Subsequently, we illustrate the impact of psychiatric illness upon surgical outcomes and discuss the most common psychiatric presentations occurring in the perioperative setting. Three current main models of psychiatric services in the general hospital are described: the classic “on-demand” consultation model, the proactive consultation model, and the embedded psychiatric services.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Lipowski ZJ. Consultation-liaison psychiatry at century’s end. Psychosomatics. 1992;33(2):128–33.
Fava GA, Sonino N. Psychosomatic medicine. Int J Clin Pract. 2010;64(8):1155–61.
Lipowski ZJ. Consultation-liaison psychiatry: the first half century. Gen Hosp Psychiatry. 1986;8(5):305–15.
Henry GW. Some modern aspects of psychiatry in general hospital practice. Am J Psychiatr. 1929;86(3):481–99.
Strain JJ. Liaison psychiatry and its dilemmas. Gen Hosp Psychiatry. 1983;5(3):209–12.
Stern TA, Prager LM, Cremens MC. Autognosis rounds for medical house staff. Psychosomatics. 1993;34(1):1–7.
Strain JJ, Vollhardt BR, Langer SJ. A liaison fellowship on a hemodialysis unit. A self-funded position. Gen Hosp Psychiatry. 1981;3(1):10–5.
Small EC, Mitchell GW Jr. Practical aspects of full-time liaison psychiatry in gynecology. J Reprod Med. 1979;22(3):151–5.
Boland RJ, Rundell J, Epstein S, Gitlin D. Consultation-Liaison Psychiatry vs Psychosomatic Medicine: what’s in a name? Psychosomatics. 2018;59(3):207–10.
Diebo BG, Lavian JD, Murray DP, Liu S, Shah NV, Beyer GA, et al. The impact of comorbid mental health disorders on complications following adult spinal deformity surgery with minimum 2-year surveillance. Spine (Phila Pa 1976). 2018;43(17):1176–83.
Kalakoti P, Sciubba DM, Pugely AJ, McGirt MJ, Sharma K, Patra DP, et al. Impact of psychiatric comorbidities on short-term outcomes following intervention for lumbar degenerative disc disease. Spine (Phila Pa 1976). 2018;43(19):1363–71.
Clous EA, Beerthuizen KC, Ponsen KJ, Luitse JSK, Olff M, Goslings JC. Trauma and psychiatric disorders: a systematic review. J Trauma Acute Care Surg. 2017;82(4):794–801.
Hassidim A, Bratman Morag S, Giladi M, Dagan Y, Tzadok R, Reissman P, et al. Perioperative complications of emergent and elective procedures in psychiatric patients. J Surg Res. 2017;220:293–9.
Arya S, Lee S, Zahner GJ, Cohen BE, Hiramoto J, Wolkowitz OM, et al. The association of comorbid depression with mortality and amputation in veterans with peripheral artery disease. J Vasc Surg. 2018;68:536.
Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, et al. Psychosocial factors and surgical outcomes: are elderly depressed patients less satisfied with surgery? Spine (Phila Pa 1976). 2014;39(19):1614–9.
Aguera Z, Garcia-Ruiz-de-Gordejuela A, Vilarrasa N, Sanchez I, Bano M, Camacho L, et al. Psychological and personality predictors of weight loss and comorbid metabolic changes after bariatric surgery. Eur Eat Disord Rev. 2015;23(6):509–16.
Ozkan S, Zale EL, Ring D, Vranceanu AM. Associations between pain catastrophizing and cognitive fusion in relation to pain and upper extremity function among hand and upper extremity surgery patients. Ann Behav Med. 2017;51(4):547–54.
Melamed R, Boland LL, Normington JP, Prenevost RM, Hur LY, Maynard LF, et al. Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes. Perioper Med(Lond). 2016;5:19.
Ward N, Roth JS, Lester CC, Mutiso L, Lommel KM, Davenport DL. Anxiolytic medication is an independent risk factor for 30-day morbidity or mortality after surgery. Surgery. 2015;158(2):420–7.
Harirchian S, Zoumalan RA, Rosenberg DB. Antidepressants and bleeding risk after face-lift surgery. Arch Facial Plast Surg. 2012;14(4):248–52.
Sajan F, Conte JV, Tamargo RJ, Riley LH, Rock P, Faraday N. Association of selective serotonin reuptake inhibitors with transfusion in surgical patients. Anesth Analg. 2016;123(1):21–8.
Singh I, Achuthan S, Chakrabarti A, Rajagopalan S, Srinivasan A, Hota D. Influence of pre-operative use of serotonergic antidepressants (SADs) on the risk of bleeding in patients undergoing different surgical interventions: a meta-analysis. Pharmacoepidemiol Drug Saf. 2015;24(3):237–45.
Hyer L, Scott C, Mullen CM, McKenzie LC, Robinson JS. Randomized double-blind placebo trial of duloxetine in perioperative spine patients. J Opioid Manag. 2015;11(2):147–55.
Wong K, Phelan R, Kalso E, Galvin I, Goldstein D, Raja S, et al. Antidepressant drugs for prevention of acute and chronic postsurgical pain: early evidence and recommended future directions. Anesthesiology. 2014;121(3):591–608.
Castro-Alves LJ, Oliveira de Medeiros AC, Neves SP, Carneiro de Albuquerque CL, Modolo NS, De Azevedo VL, et al. Perioperative duloxetine to improve postoperative recovery after abdominal hysterectomy: a prospective, randomized, double-blinded, placebo-controlled study. Anesth Analg. 2016;122(1):98–104.
Goh GS, Liow MHL, Pang HN, Tay DK, Lo NN, Yeo SJ. Patients with poor baseline mental health undergoing unicompartmental knee arthroplasty have poorer outcomes. J Arthroplast. 2018;33(8):2428–34.
Zimbrean P, Emre S. Patients with psychotic disorders in solid-organ transplant. Prog Transplant. 2015;25(4):289–96.
Ravven S, Bader C, Azar A, Rudolph JL. Depressive symptoms after CABG surgery: a meta-analysis. Harv Rev Psychiatry. 2013;21(2):59–69.
Wellenius GA, Mukamal KJ, Kulshreshtha A, Asonganyi S, Mittleman MA. Depressive symptoms and the risk of atherosclerotic progression among patients with coronary artery bypass grafts. Circulation. 2008;117(18):2313–9.
Kurdyak PA, Gnam WH, Goering P, Chong A, Alter DA. The relationship between depressive symptoms, health service consumption, and prognosis after acute myocardial infarction: a prospective cohort study. BMC Health Serv Res. 2008;8:200.
Etcheson JI, Gwam CU, George NE, Virani S, Mont MA, Delanois RE. Patients with major depressive disorder experience increased perception of pain and opioid consumption following total joint arthroplasty. J Arthroplast. 2018;33(4):997–1002.
Gold HT, Slover JD, Joo L, Bosco J, Iorio R, Oh C. Association of depression with 90-day hospital readmission after total joint arthroplasty. J Arthroplast. 2016;31(11):2385–8.
Moschopoulou E, Hutchison I, Bhui K, Korszun A. Post-traumatic stress in head and neck cancer survivors and their partners. Support Care Cancer. 2018;26:3003–11.
Baranyi A, Krauseneck T, Rothenhausler HB. Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction. Health Qual Life Outcomes. 2013;11:111.
Drews T, Franck M, Radtke FM, Weiss B, Krampe H, Brockhaus WR, et al. Postoperative delirium is an independent risk factor for posttraumatic stress disorder in the elderly patient: a prospective observational study. Eur J Anaesthesiol. 2015;32(3):147–51.
Kent CD, Mashour GA, Metzger NA, Posner KL, Domino KB. Psychological impact of unexpected explicit recall of events occurring during surgery performed under sedation, regional anaesthesia, and general anaesthesia: data from the Anesthesia Awareness Registry. Br J Anaesth. 2013;110(3):381–7.
Bartels K, Fernandez-Bustamante A, McWilliams SK, Hopfer CJ, Mikulich-Gilbertson SK. Long-term opioid use after inpatient surgery - A retrospective cohort study. Drug Alcohol Depend. 2018;187:61–5.
Brummett CM, Waljee JF, Goesling J, Moser S, Lin P, Englesbe MJ, et al. New persistent opioid use after minor and major surgical procedures in US adults. JAMA Surg. 2017;152(6):e170504.
Hill MV, Stucke RS, Billmeier SE, Kelly JL, Barth RJ Jr. Guideline for discharge opioid prescriptions after inpatient general surgical procedures. J Am Coll Surg. 2018;226(6):996–1003.
Kim MP, Chan EY, Meisenbach LM, Dumitru R, Brown JK, Masud FN. Enhanced recovery after thoracic surgery reduces discharge on highly dependent narcotics. J Thorac Dis. 2018;10(2):984–90.
Girard TD, Thompson JL, Pandharipande PP, Brummel NE, Jackson JC, Patel MB, et al. Clinical phenotypes of delirium during critical illness and severity of subsequent long-term cognitive impairment: a prospective cohort study. Lancet Respir Med. 2018;6(3):213–22.
Vasunilashorn SM, Fong TG, Albuquerque A, Marcantonio ER, Schmitt EM, Tommet D, et al. Delirium severity post-surgery and its relationship with long-term cognitive decline in a cohort of patients without dementia. J Alzheimers Dis. 2018;61(1):347–58.
Skvarc DR, Berk M, Byrne LK, Dean OM, Dodd S, Lewis M, et al. Post-operative cognitive dysfunction: an exploration of the inflammatory hypothesis and novel therapies. Neurosci Biobehav Rev. 2018;84:116–33.
Thiara G, Cigliobianco M, Muravsky A, Paoli RA, Mansur R, Hawa R, et al. Evidence for neurocognitive improvement after bariatric surgery: a systematic review. Psychosomatics. 2017;58(3):217–27.
Plas M, Rotteveel E, Izaks GJ, Spikman JM, van der Wal-Huisman H, van Etten B, et al. Cognitive decline after major oncological surgery in the elderly. Eur J Cancer. 2017;86:394–402.
Zhang J, Wang G, Zhang F, Zhao Q. Improvement of postoperative cognitive dysfunction and attention network function of patients with ischemic cerebrovascular disease via dexmedetomidine. Exp Ther Med. 2018;15(3):2968–72.
Jansen L, van Schijndel M, van Waarde J, van Busschbach J. Health-economic outcomes in hospital patients with medical-psychiatric comorbidity: a systematic review and meta-analysis. PLoS One. 2018;13(3):e0194029.
Ni Mhaolain AM, Butler JS, Magill PF, Wood AE, Sheehan J. The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression. Ir J Med Sci. 2008;177(3):211–5.
Valdes-Stauber J, Bachthaler S. Care differences in a consultation and liaison service. Nervenarzt. 2017;88(11):1281–91.
Rohrig J, Nafz M, Strohm PC, Bengel J, Hodel T, Wahl S, et al. Addiction counselling in the surgical emergency room. Implementation of a brief intervention for alcohol-intoxicated patients. Unfallchirurg. 2013;116(7):610–6.
Sledge WH, Gueorguieva R, Desan P, Bozzo JE, Dorset J, Lee HB. Multidisciplinary proactive psychiatric consultation service: impact on length of stay for medical inpatients. Psychother Psychosom. 2015;84(4):208–16.
Wood R, Wand APF. The effectiveness of consultation-liaison psychiatry in the general hospital setting: a systematic review. J Psychosom Res. 2014;76(3):175–92.
Levitan SJ, Kornfeld DS. Clinical and cost benefits of liaison psychiatry. Am J Psychiatry. 1981;138(6):790–3.
Baumgartner BT, Karas V, Kildow BJ, Cunningham DJ, Klement MR, Green CL, et al. Inpatient consults and complications during primary total joint arthroplasty in a bundled care model. J Arthroplast. 2018;33(4):973–5.
das Nair R, Mhizha-Murira JR, Anderson P, Carpenter H, Clarke S, Groves S, et al. Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial. Clin Rehabil. 2018; https://doi.org/10.1177/0269215518755426.
Richards SH, Anderson L, Jenkinson CE, Whalley B, Rees K, Davies P, et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev 2017;4:CD002902.
Desan PH, Zimbrean PC, Weinstein AJ, Bozzo JE, Sledge WH. Proactive psychiatric consultation services reduce length of stay for admissions to an inpatient medical team. Psychosomatics. 2011;52(6):513–20.
Pinkhasov A, Singh D, Chavali S, Legrand L, Calixte R. The impact of designated behavioral health services on resource utilization and quality of care in patients requiring constant observation in a general hospital setting: a quality improvement project. Community Ment Health J. 2018. https://doi.org/10.1007/s10597-018-0258-4. [Epub ahead of print].
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Zimbrean, P.C. (2019). The Role of the Psychiatrist in the Perioperative Setting. In: Zimbrean, P., Oldham, M., Lee, H. (eds) Perioperative Psychiatry. Springer, Cham. https://doi.org/10.1007/978-3-319-99774-2_2
Download citation
DOI: https://doi.org/10.1007/978-3-319-99774-2_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-99773-5
Online ISBN: 978-3-319-99774-2
eBook Packages: MedicineMedicine (R0)