Psychiatric manifestations in a patient after surgical management of aortic stenosis of systemic lupus erythematosus of stasis over lung fields, oedema of lower extremities, or a temperature. Body mass: 102.5 kg, RR 130/80 mmHg, HR 100/m, sinus rhythm. In laboratory investigation: creatinine concentration (CREA) – 3.61 mg/dl, urea (UREA) – 98 mg/dl, glomerular filtration rate (GFR) – 45 ml/min. Electrolytes: Na (s) 141 mmol/L, K (s) 5.15 mmol/l, Cl (s) 112 mmol/l. Due to recurrent nephrotic syndrome, the patient continued immuno- suppressive treatment (prednisone 10 mg/24 h). Moreover, due to higher concentrations of potassium for a week-long period, the nephrologist taking care of the patient prescribed mycophenolate mofetil (MMF) in 540 mg/bd. In preoperative echocardiographic examination a complex organic aortic valve disease in the form of bicuspid aortic valve stenosis (SA) with the gradient max. 70-71 mmHg, aortic incompetence (IA) I/II° and left heart ventricle hypertrophy (LV) was confirmed. Furthermore, a small secondary mitral incom- petence (IM) I°, trace tricuspid valve incompetence (IT), poor gradient of aortic coarctation (Ao descending V max. 2.75 m’s, grad. max. 30 mmHg), as well as a lack of a segment contractility EF 59% were revealed (21.07.2009). On 22.07.2009, on schedule, an operation of aortic valve exchange was performed in the conditions of extracorporeal circulation, with implantation of an artificial aortic valve – ATS 21 A. During the surgery, from disconnection of the extracorporeal circulation apparatus, and for the first 48 h after the operation, the patient called for catecholamine support (adrenaline, dopamine) in modified doses. The patient was deintubated in the 6th h after the intervention. Self-, efficient respiration. Accord- ing to nephrologists’ recommendations, the steroid Solu-Medrol (Pfizer, Belgium) in 1 × 40 mg dosing was restored (it had been stopped for the time of the operation). The early post-operative period (10 h at the intensive care unit [ICU]) was complicated by transient AV block III°, with the necessity of temporary, 10-h stimulation with an external pacemaker. Control Holter examination did not indicate any sinusal inhibitions or AV transmission disorders. On the third day after the operation (50th h of ICU stay), the patient demonstrated acute psychotic symptoms. The patient had visual hallucinations and expressed persecutory delusions and mistaken identification of people (he claimed that medicines in the form of intravenous infusion were poisons killing him, and the medical staff were evil power assistants intending to annihilate him). The patient was conscious, properly auto- and allopsychically oriented, strongly psychomotorly agitated, actively aggressive in relation to himself, his family and medical staff. Due to the patient’s aggressive behaviour directly threatening his own and others’ health and life (the patient removed from himself a venous catheter, operational wound dressing and electrodes monitoring heart work, and beat the nurse trying to intervene) he required intravenous pharmaco- logical sedation (haloperidol 5 mg iv, diazepam 20 mg iv) and administration of temporary (a few hours) physical restraint. During the following 6 h, three-fold repetition of pharmacotherapy with haloperidol and benzodiazepine was necessary. There were two episodes of similar symptoms in the patient’s history. The last incident took place 2 years before and it followed an increase of steroid dose in the situation of nephritic syndrome recession. On 25.07.2009 the patient was consulted by psychiatrists. The consulting psychiatrist diagnosed an acute psychotic disorder caused by a somatic disease. As the psychotic symptoms continued, although without strong motor agitation, the therapy with haloperidol per os was modified and continued for the subsequent 4 × 24 h. Four days later (29.07.2009) regression of productive symptoms was reported together with the normalization of a motor drive. On 30 July the patient was discharged from the ICU of the Department of Anaesthesiology and Intensive Cardiac Surgery Care in a good general condition. Discussion Mental disorders such as delirium are frequent complications following cardiac surgery (16.3%) [5, 6]. However, the above-mentioned psychotic disorders appearing in the post-operative period are rarely described in the medical literature. Risk factors of these disturbances are also less known. The case report presented here and single case reports indicate that the essential role in post- operative paranoid syndrome occurrence might be played by a specific somatic and neurological load. They are: hyperthyroidism and hypothyroidism, Cushing’s syndrome, Addison’s disease, multiple sclerosis, Huntington’s disease and systemic diseases [7]. In the above-described patient with SLE, additional factors, possibly predisposing to occurrence of postoperative mental disorders, arose. They are: increased concentration of urea and creatinine, heart arrhythmia, accompanying steroid therapy and administration of MMF. It was indicated that the above biochemical disorders and heart arrhythmia are independent risk factors of post-cardiac surgery delirium [8, 9]. Of interest, though, is whether these disorders could have contributed to the psychotic disturbances in our patient. Although steroid treatment can provoke psychotic symptoms, this factor, up till now, has not been reported as Arch Med Sci 2, April / 2011 343