Schizophrenic Patients Who Develop Postoperative Confusion Have an Increased Norepinephrine and Cortisol Response to Surgery

Abstract

The purpose of this study was to investigate the relationship between postoperative confusion and the plasma norepinephrine (NE), adrenocorticotropin (ACTH) or cortisol response to surgery in schizophrenic patients. We studied 50 schizophrenic patients and 35 control patients who underwent orthopedic surgery and perioperatively measured plasma NE, ACTH and cortisol levels. Postoperative confusion during 72 h after the end of the operation occurred in 14 of 50 schizophrenic patients (28%) and in 2 of 35 control patients (6%). Plasma NE levels 15 min after skin incision, the next day, the second day and the third day after operation in schizophrenic patients with postoperative confusion (668.0 ± 59.2, 522.0 ± 96.5, 463.2 ± 71.2 and 398.9 ± 56.2 pg/ml, respectively) were significantly higher than those in schizophrenic patients without confusion (524.1 ± 62.6, 342.4 ± 38.6, 311.2 ± 58.3 and 314.1 ± 77.1 pg/ml, respectively). Plasma cortisol levels 15 min after the skin incision and the next and second days after operation in schizophrenic patients with postoperative confusion (23.6 ± 3.2, 21.1 ± 4.3 and 19.9 ± 4.4 µg/dl, respectively) were significantly higher than those in schizophrenic patients without confusion (15.2 ± 4.5, 14.3 ± 5.1 and 13.8 ± 3.8 µg/ dl, respectively). In conclusion, the occurrence of postoperative confusion in schizophrenic patients is associated with an increase in plasma norepinephrine and cortisol levels during and after surgery.

Influence of Psychiatric Comorbidity on Surgical Mortality

“…It is important to consider our results in the context of the current literature. Several reports [12][13][14][15][16][17][18][19][20][21][27][28][29][30][31][32][33] have examined associations between psychiatric comorbidity and surgical patient outcomes; however, it is difficult to in- fer valid conclusions because of the heterogeneity of the studies regarding the temporal relationship of psychiatric comorbidity identified (eg, psychiatric illness identified before or after surgical admission), type of psychiatric comorbidity studied, and types of outcomes considered.…”

“…For example, in a study of pediatric trauma patients, Gaines et al 32 found that children with a preexisting psychiatric illness had increased ICU and overall hospital-related lengths of stay and were more likely to be discharged to a location other than home. Next, in a further series of studies, Kudoh et al [12][13][14][15][16][17][18][19] examined patients undergoing abdominal and orthopedic surgery and compared a number of outcomes (eg, pain responses to analgesic agents, postoperative psychosis or confusion after anesthesia, and rates of postoperative depression after anesthesia) in cohorts with or without depression or schizophrenia. None of these studies examined mortality as an outcome.…”

“…[8][9][10][11] Associations between psychiatric comorbidity and mortality have largely been limited to patients admitted for the treatment of medical (ie, nonsurgical) conditions [1][2][3][4][5][6][7] ; thus, making valid inferences regarding associations between surgical outcomes and psychiatric comorbidity is limited by the paucity and heterogeneity of available research. For example, studies examining associations between psychiatric comorbidity and surgical mortality are limited to a few studies [12][13][14][15][16][17][18][19][20] of surgical patients with schizophrenia or depression. Studies on a broader range of psychiatric conditions, such as bipolar illness, posttraumatic stress disorder [PTSD], and/or anxiety illness, among surgical patients are nonexistent, to our knowledge.…”

A randomised controlled study of risperidone and olanzapine for schizophrenic patients with neuroleptic-induced acute dystonia or parkinsonism

“…BPRS 41Plasma cortisol 21.00–Kaneda et al (2002)53Chronically medicated inpatients. Anxiety similar to controlsPlasma cortisol 06.00–07.00Kudoh et al (2002)50FGA treated, stable chronic SCHPlasma cortisol timed in relation to anaesthesia for orthopaedic surgery–Shirayama et al (2002)28Neuroleptics. In and outpatients with an absence of positive sx.…”

Postoperative confusion in schizophrenic patients is affected by interleukin-6

“…We previously reported that chronic schizophrenic patients had decreased plasma cortisol response to surgical stress, 6 and the occurrence of postoperative confusion in schizophrenic patients is associated with an increase in plasma cortisol concentrations during and after surgery. 7 Thus, it may be important, in schizophrenic patients, to decrease plasma cortisol concentrations during and after surgery. Epidural administration of local anesthetics can attenuate elevation of secretion of cortisol.…”