Psychiatric Issues in Surgical Patients Part I: General Issues

Psychiatric disorders are quite common in surgical patients. However, surgeons are less likely to refer patients to psychiatrists than other physicians, who also have a tendency to under-recognize psychiatric disorders among their patients. Therefore, a large proportion of psychopathology in surgical patients is either undiagnosed or misdiagnosed and not optimally treated, if treated at all. This column focuses on common psychiatric issues that generally arise in surgical patients and reviews psychiatric issues specific to specialized surgical settings and patients (eg, burn units, obesity surgery). In the preoperative period, surgeons frequently request psychiatric consultation regarding several common psychosocial issues, including informed consent and assessment of the patient’s decision-making capacity (most often requested when patients refuse diagnostic procedures or surgery) as well as the presence of disruptive symptoms and behaviors reflecting underlying psychopathology. Surgeons tend to under-recognize psychiatric disorders until they interfere with evaluation and treatment. Preoperative anxiety and health-related phobias, such as fear of anesthesia, needles, sight of blood, and contamination from blood transfusions, are common in surgical patients. Psychiatric consultation may focus o