Psychological Risks of Coronary Bypass Surgery

Heart surgery is still a relatively recent advance in medical technology. The first open-heart procedure was closure of an atrial septal defect in a child at the University of Minnesota Hospital in 1953. This issued in a life-saving advance, the use of which has expanded enormously to in­ clude treatment of many areas of cardiac disease. Not unexpectedly, surgical techniques allowed through the use of the heart-lung machine (open-heart surgery) came to be applied in 1967 to the major killer of Americans, namely, coronary artery disease. This operation, known as coronary artery bypass, has become one of the most common surgical operations. Coronary artery disease, with the possibility of total incapacitation or sudden death from a heart attack, can alter severely the personality of the patient. Corrective surgery can sometimes intensify rather than ame­ liorate a patient's fears. To the surgeon, occupied by increasing numbers of patients, there is not time enough to give the preoperative attention that might be helpful. Also, the surgeon and cardiologist are limited in their ability to recognize those patients near the breaking point. The research outlined in these chapters by Drs. Pimm, Feist, and their associates is welcomed by cardiologists and cardiac surgeons. It provides insight into what appears to be reliable recognition of those patients likely to have an adversely affected mental status by coronary bypass surgery and "crisis intervention" to avert this effect and allow the complete benefit of returning the patient to a normal life.

1 Introduction and Overview.- 1 Introduction and Overview.- References.- Section I: Coronary Bypass Surgery: Medical, Nursing, and Psychological Factors.- 2 Coronary Heart Disease: Etiology, Diagnosis, and Surgical Treatment.- Cause and Prevention of Coronary Heart Disease.- Clinical Picture.- Diagnosis and Selection of Patients for Surgery.- Preparation of the Patient for Surgery.- The Operation.- Immediate Results.- Postoperative Results.- References.- 3 Coronary Bypass Surgery: The Role of the Patient-Educator.- Specific Functions of the Patient-Educator.- Before Surgery.- Initial Preoperative Period.- Preparation for Discharge.- Reference.- 4 The Million Behavioral Health Inventory: Its Utilization in Assessment and Management of the Coronary Bypass Patient.- Search for Relevant Psychological Dimensions in Physical Health.- Construction of the Millon Behavioral Health Inventory.- The Use of the MBHI with Coronary Bypass Patients.- The Management of Phillip R..- Postoperative Course and Long-Term Follow-up.- The Case of James N..- Postoperative Course and Long-Term Follow-up.- The Treatment of George C..- Postoperative Course and Long-Term Follow-up.- Summary.- References.- Section II: Techniques for Working with the Coronary Bypass Patient.- 5 Crisis Intervention and Coronary Bypass Surgery.- to Crisis Intervention.- Crisis Intervention Applied in Coronary Bypass Cases.- Medical Stages of Coronary Bypass Surgery.- Preoperative Stage.- After Surgery.- Psychological Stages of Heart Surgery Patients.- Before Surgery.- In the Surgical Intensive Care Unit.- After Intensive Care.- After Discharge.- Counseling and Assessment.- Before Surgery.- In the Surgical Intensive Care Unit.- After Intensive Care.- Preparation for Discharge and Postdischarge Counseling.- Prerequisites, Training, and Supervision of the Counselor.- References.- Section III: Research on Crisis Intervention and Coronary Bypass Surgery.- 6 Crisis Intervention and Coronary Bypass Patients: Patient Characteristics, Methodology, and Research Design.- The Patients.- Medical Description.- Research Procedure.- Evaluation Methods.- References.- 7 Crisis Intervention and Coronary Bypass Patients: Outcome and Research Predictions.- Overview of Outcome and Predictions.- Equivalency of Treatment and Control Groups before Surgery.- Depression Outcome.- Predicting the Benefit of Crisis Intervention Counseling.- Using This Analysis: Tough Way.- Using This Analysis: Easy Way.- Millon Behavioral Health Inventory and Depression following Coronary Bypass Surgery.- Time and Treatment Effects on Psychological Measures Other than Depression.- Pretesting Effects.- References.- Appendix A: Presurgical Interaction with Depression Outcome.- Appendix B: Presurgical Variables Predictive of Depression.- Reference.- Appendix C: Correlations between the MBHI and Other Measures.- 8 Depression, Crisis Intervention, and Coronary Bypass Surgery.- Depression in Heart Attack Victims.- Intervention Studies.- Intervention Studies with Heart Surgery Patients.- Crisis Intervention and Heart Surgery Patients.- Measurement of Depression.- Theories of Depression.- Denial and Depression.- Behavioral Definitions of Depression.- Case Histories.- Patient A (Control Group).- Patient B (Treatment Group).- References.- 9 The Psychology of Coronary Bypass Patients.- Stress.- Recent Life Events.- Life Events and Coronary Bypass Patients.- Locus of Control.- Type A.- Measurement of Type A Behavior.- Relationship of Type A to Coronary Heart Disease.- Type A and the Sympathetic Nervous System.- Psychological Variables and Their Relationship to Medical Variables.- SCL-90 R.- Patient Selection for Crisis Intervention.- Case Histories.- Patient X (Treatment Group).- Patient Y (Control Group).- References.- 10 Conclusions and Recommendations.