Psychiatric Disease & Substance Abuse Health Assessment Quiz

Psychiatric Disease

• 10% of men and 20% of women experience major depression, with minor depression being difficult to quantify
• Mood and cognitive symptoms of psychiatric diseases are common, including OCD, panic disorders, anxiety disorders, phobias, and bipolar disease
• Psychoses like schizophrenia can occur

Medical Problems Leading to Psych

• Hypothyroidism
• Cushing syndrome
• AIDS
• Seizure disorders
• Brain tumors
• Encephalitis
• Nutritional deficiency
• Toxic substance poisoning

Psych Assessment

• Determining if the patient is legally able to give consent
• Determining medical versus non-medical power of attorney
• Understanding that psych diseases are only managed, not cured
• Identifying the length and effectiveness of treatments is key

Psych Drugs

• SSRIs: continued perioperative use, potent inhibitors of CYP4502D6 (think opioids)
• TCAs: can slow cardiac conduction (ECG), exaggerated responses to pressors
• MAOIs: can produce serotonin syndrome, hypertension, coma, and death, continued perioperative use
• Symptoms of serotonin syndrome include hypertension, coma, and death

Atypical Antidepressants

• Increased risk of seizures (lower threshold), used for chronic pain treatment
• Impact on NDNMB

Substance Abuse

• Identified by the WHO as a pandemic in nature, both a social and public health problem
• Usually occurs with a psych diagnosis
• Ranked: alcohol > prescription drugs > marijuana > cocaine

Substance Abuse: Alcohol

• Medical implications affect ALL organ systems
• CNS: atrophy, tremor
• CV: dilated cardiomyopathy, HTN, PVD
• GI: gastritis, esophageal varices, ulcers, pancreatitis, hepatitis, and cirrhosis
• Preoperative workup includes ECG, coags, CBC, and consideration for blood products
• ACUTE vs. CHRONIC alcohol use

Substance Abuse: Marijuana

• Acute intoxication and anesthesia interactions are rare
• Chronic use impacts ANS (tachycardia & increased CO)
• Synergy with other sedatives
• Acute intoxication CAN lead to direct myocardial depression
• Avoid use 1 week prior to anesthesia

Substance Abuse: Cocaine

• Never perform an elective anesthetic on someone acutely intoxicated on cocaine
• Direct and profound depression on LV function
• Slowing of cardiac conduction
• AT LEAST 1 week of no cocaine use; some recommend 30 days
• Avoid ketamine

Substance Abuse: Heroin

• Rapidly converted to morphine in the plasma
• As with other chronic opioid users, be mindful of the last dose and compliance with treatment
• Avoid elective anesthesia when acutely intoxicated on heroin
• Preoperative assessment focused on treatment of heroin addiction