The Psychopathology and Cognitive Disorder Syndrome (PCD) in Open-Heart Surgery Patients

Summary

In a follow-up study of 100 patients consecutively scheduled for open-heart surgery, Rabiner and Willner found strikingly different mortality rates during the 5 years after hospital discharge in two groups of patients. Patients who had two different types of abnormality, psychopathology before hospital discharge and devastated scores on the Conceptual Level Analogy Test (CLAT), had a significantly and substantially higher mortality rate than patients who had only one or neither abnormality.

We designate patients with both abnormalities as having the psychopathology and cognitive disorder (PCD) syndrome. The psychopathology of PCD syndrome patients differs from the psychopathology of PCD syndrome patients differs from the psychopathology of patients without cognitive disorder (non-PCD) in several ways:

• 1. The mortality rate in PCD patients is almost six times as high (63% vs 11%) as it is in patients with non-PCD psychopathology, during the 5 years after hospital discharge.

• 2. Patients who have either depression and/or organic brain syndrome have more than three as high (82% vs 25%) an incidence of PCD than do patients with neither depressive nor organic psychopathology.

These observations are consistent with a hypothesis that the PCD syndrome is a manifestation of an often unsuspected preoperative organic brain syndrome. We maintain that the PCD syndrome indicates a vulnerability factor which results in many PCD patients developing psychopathology even before the additional stress of open-heart surgery is imposed. The greater incidence of depression and organic brain syndromes in PCD patients than in those having psychopathology but not cognitive disorder is consistent with explanation in terms of hypoxic symptoms in the PCD group. (Cognitive disorder and depression are well recognized symptoms of cerebral hypoxia.) The underlying organic brain syndrome is assumed to be a result of cerebral hypoxia related to reduced cerebral circulation.

The basic approach here is to use scores on a special (CLAT) analogy test as external points of reference in distinguishing two different psychopathological groups.

Several case illustrations will be discussed.