Abstract

Citation: Leonardo M. Psychotherapy for surgery-related psychiatric symptoms. Open J Clin Med Images. 2024; 4(1): 1177.

Short report

This work aims at giving some insights into the psychological implications of surgery and at proposing psychotherapeutic approaches to mitigate perioperative stress and long-term psychiatric sequelae.

The role of anxiety, depression and catastrophic thoughts in spine surgery was examined by Dunn et al. (2018). The authors enrolled patients undergoing spine surgery who were assessed in the pre-operatory period through the Verbal Rating Scale (VRS), Pain Catastrophizing Scale (PCS), Hospital Anxiety and Depression Scale (HADS), and Oswestry Disability Index (ODI). It was concluded that it is strongly advisable to preoperatively evaluate anxiety and depression by utilizing a validated tool both to identify patients at risk and to early administer psychological intervention that might reduce pain severity and improve general clinical outcome [1].

With the aim of shedding new light on postoperative neuropsychiatric complications, a work examined the contribution of cardiac surgery in inducing brain ischemia, thus potentially complicating the post-operative period. It was pointed out that neuropsychiatric consequences of cardiac surgery, including depressive disorders, post-traumatic stress disorders, cognitive decline may be related to silent brain infarcts following the surgery procedure [2].

A review by Sorel et al. (2020) investigated the effects of perioperative interventions targeting psychological distress for patients receiving Total Knee Arthroplasty (TKA) and found that they could be beneficial for postoperative pain, function, and quality of life [3].

It has also been examined the relationship between preoperative pain-catastrophizing thoughts and clinical outcome in people undergoing spinal surgery. When comparing Cognitive Behaviour Therapy (CBT) with educational/exercise control interventions in patients with high levels of pain catastrophizing, the former proved to be effective in improving general outcome after spinal surgery [4].

Similarly, the computer-assisted cognitive behaviour therapy has been proven effective in reducing psychosomatic responses in patients undergoing functional endoscopic sinus surgery and, in turn, in improving post-operative outcomes. Yang et al. (2021) studied 50 individuals receiving cognitive behavioral therapy and 50 matched controls being administered usual care. Participants were assessed for psychiatric parameters including anxiety and insomnia and anesthesiological measurements such as heart rate and blood pressure before and after surgery. It was found that in those receiving CBT their psychosomatic responses and perioperative outcomes improved compared to people not receiving the treatment [5].

To highlight the growing interest in psychotherapy employment in the perioperative period, Kappen et al. (2021) developed a study protocol to assess the effectiveness of the music rule in improving surgery-related stress. They compared two different groups of individuals undergoing neurosurgery: the one receiving recorded music through an overhear headphone before, during and after surgery until postoperative day 3, and the second being administered traditional care. Delirium was assessed through DSM-5 criteria. The authors hypothesized that delirium incidence after neurosurgery may be mitigated by music, and this, in turn, could exert a beneficial effect on clinical outcomes [6].

Regarding pediatric surgery, perioperative stress is known to be particularly important in predicting surgery outcomes in children [7]. In this framework, a recent meta-analysis pointed out the importance of distraction techniques in reducing preoperative anxiety in children [8].

Globally, psychotherapy appears to play an important role in mitigating perioperative stress and improving clinical outcomes. According to our opinion, attention should also be paid to the preparation of the patients before arriving at the operating room, and to proper calming approaches in the minutes and hours before surgery, including psychotherapeutic and pharmacological strategies. This, from one side, could reduce stressrelated surgery and, from the other side, prevent the future development of acute stress disorders.

Conflict of interests: None.

References

1. Dunn LK, Durieux ME, Fernández LG, Tsang S, Smith-Straesser EE, et al. Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. J Neurosurg Spine. 2018; 28(1): 119-126. doi: 10.3171/2017.5.SPINE1734.
2. Indja B, Seco M, Seamark R, Kaplan J, Bannon PG, et al. Neurocognitive and Psychiatric Issues Post Cardiac Surgery. Heart Lung Circ. 2017; 26(8): 779-785. doi: 10.1016/j.hlc.2016.12.010.
3. Sorel JC, Overvliet GM, Gademan MGJ, den Haan C, Honig A, et al. The influence of perioperative interventions targeting psychological distress on clinical outcome after total knee arthroplasty. Rheumatol Int. 2020; 40(12): 1961-1986. doi: 10.1007/s00296-020-04644-y.
4. Scarone P, Smeets AYJM, van Kuijk SMJ, van Santbrink H, Peters M, et al. A randomized controlled TRIal of cognitive BEhavioral therapy for high Catastrophizing in patients undergoing lumbar fusion surgery: The TRIBECA study. BMC Musculoskelet Disord. 2020; 21(1): 810. doi: 10.1186/s12891-020-03826-w.
5. Yang Y, Li Y, Zhang H, Xu Y, Wang B. The efficacy of computerassisted cognitive behavioral therapy (cCBT) on psychobiological responses and perioperative outcomes in patients undergoing functional endoscopic sinus surgery: A randomized controlled trial. Perioper Med (Lond). 2021; 10(1): 28. doi: 10.1186/s13741-021-00195-3.
6. Kappen P, Jeekel J, Dirven CMF, Klimek M, Kushner SA, et al. Music to prevent deliriUm during neuroSurgerY (MUSYC) Clinical trial: A study protocol for a randomised controlled trial. BMJ Open. 2021; 11(10): e048270. doi: 10.1136/bmjopen-2020-048270.
7. Fortier MA, Del Rosario AM, Martin SR, Kain ZN. Perioperative anxiety in children. Paediatr Anaesth. 2010; 20(4): 318-22. doi: 10.1111/j.1460-9592.2010.03263.x.
8. Wu J, Yan J, Zhang L, Chen J, Cheng Y, et al. The effectiveness of distraction as preoperative anxiety management technique in pediatric patients: A systematic review and meta-analysis of randomized controlled trials. Int J Nurs Stud. 2022; 130: 104232. doi: 10.1016/j.ijnurstu.2022.104232.