Psychiatric complications of cardiac surgery postoperative delirium syndrome.

Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. Psychiatric, neurologic and electroencephalographic evaluation was made pre- and postoperatively, in addition to haemodynamic, echocardiographic, angiographic and regional cerebral blood flow studies. Nine of the 50 patients had significantly reduced perfusion of certain cerebral lobes in single photon emission computed tomography, and in six of them the psychiatric tests indicated postoperative delirium; three of these six also had moderate electroencephalographic changes. The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.

Bulimia in a male alcoholic: a symptom substitution in alcoholism.

In recent years, evidence points to a relation between bulimia nervosa and alcoholism. A significant number of bulimics have been reported to abuse alcohol and drugs. Additionally, there is a high prevalence of alcoholism in the families of bulimic patients. In the light of the proposed hypothesis concerning symptom substitution between the dyscontrol syndromes, we present an alcoholic patient who developed bulimic symptoms in the abstinence period. In this patient bulimic manifestations disappeared as he restarted drinking again, suggesting that these two symptoms serve as a substitute for each other.