Conclusions

Surgery is a potentially curative and traumatic event whose outcome may importantly be affected by psychiatric and psychological factors. The emotional state and psychiatric status of potential surgical patients may contribute to their symptom presentation, clinical course, and outcome from surgery. Somatizing and factitious disorders may confound the diagnostic process and result in unnecessary surgery. Cognitive functioning should be assessed carefully preoperatively in all surgical patients, both because of the risks of cognitive impairment with surgery and to ensure that the capacity for informed consent is present. Systematic psychoeducational interventions and specific techniques to reduce anxiety may be helpful in the preoperative period. Most psychotropic agents can be continued until the time of surgery, with the exception of monoamine oxidase inhibitors which should usually be discontinued for 7 to 14 days prior to surgery. Delirium, agitation, cognitive impairment, and functional disability are the most common psychiatric postoperative complications. Preventive interventions in the preoperative period and prompt attention to these problems in the postoperative period may help to decrease their frequency and associated morbidity.

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