Neuroendocrine and psychological variables relating to post-operative psychosis after open-heart surgery

Post-operative psychosis is a frequent complication after open-heart surgery. To investigate relationships between psychopathological outcome and endocrine and psychological variables, serum levels of cortisol, beta-endorphin, norepinephrine, TSH, and cholesterol were measured in 23 male patients undergoing aortic valve replacement from the day before operation (OP) until the seventh day after OP. State and trait anxiety, stress appraisal and the use of coping styles also were assessed. After OP, eight patients suffered from post-OP psychosis and nine from minor psychopathological symptoms. Post-OP psychopathology was significantly correlated with pre-OP psychopathological score as well as with state anxiety, pre- and post-OP stress, and the use of a self-controlling coping style. Serum cortisol, beta-endorphin, norepinephrine, and TSH levels were markedly elevated after OP. Cholesterol levels showed a decline. With regard to endocrine variables, the eight psychotic patients did not differ from 15 non-psychotic subjects, but a subgroup of three major depressed patients had distinctly elevated levels of cortisol and norepinephrine. For all 23 patients, pre-OP cholesterol correlated with pre-OP psychopathology and post-OP depression. Furthermore, post-OP depression was significantly correlated with both post-OP cortisol and norepinephrine. These results indicate the stressful nature of the OP and suggest a multifactorial association of endocrine and psychological variables with psychiatric complications after open-heart surgery.