FREQUENCY AND PREDICTORS OF PERIOPERATIVE PSYCHIATRIC SYMPTOM WORSENING IN PATIENTS WITH SCHIZOPHRENIA SPECTRUM DISORDERS
Authors: Matsumoto *Yoshihiro , Ayani Nobutaka , Oya Nozomu , Kitaoka Riki , Watanabe Anri , Yoshii Hiroko , Kitaura Yuichi , Inoue Shinichiro , Narumoto Jin 
Published: February 2025

Abstract

Background
Schizophrenia spectrum disorders (SSDs), including schizophrenia, are serious and chronic illness. Schizophrenia patients are two- to three-times more likely to die early than the general population, and disparities in their access to treatment for physical illnesses have been associated with higher mortality rates. However, patients may not receive adequate treatment due to inadequate medical resources in such cases. Factors related to psychiatric symptom worsening in patients with SSDs are unclear.

Aims & Objectives
we conducted this study to determine the frequency of perioperative psychiatric symptom worsening and factors associated with such worsening in patients with SSDs who require surgery. These results may help with the selection of appropriate hospitalization based on the risk of psychiatric symptom worsening and improve accessibility to appropriate physical treatment sites for patients with SSDs.

Method
This retrospective cohort study included SSD patients with psychiatric involvement who were admitted to and surgically treated at three tertiary care hospitals in urban Japan during a 4-year period from April 1, 2017 to March 31, 2021. The primary outcome of this study was the proportion of patients who experienced perioperative worsening of psychiatric symptoms, which in a previous study1) was defined as follows: change in admission status (from general ward admission to psychiatric ward admission and/or from voluntary admission to involuntary admission) and perioperative prescription adjustment (increase in the psychotropic drug dose or new psychotropic drug prescription) at the discretion of a psychiatrist.

Results
The final sample included 217 patients with SSDs. The median chlorpromazine equivalent of antipsychotics administered was 400 mg (IQR, 200–800 mg). The median operative time was 131 min (IQR, 86–208 min).The proportion of patients with worsening perioperative psychiatric symptoms was 11.1% (24/217). Of these patients, 17 (7.8%) were managed with psychotropic drug adjustment.
However, for 7 (3.2%) patients, the adjustment was not sufficient, and they required a change in their admission status. A univariate analysis of the factors contributing to worsening psychiatric symptoms showed significant differences in emergency surgery (p = 0.002), surgery lasting &gt;180 min (p = 0.003), use of the intensive care unit (p = 0.02), and transfer from a psychiatric hospital (p = 0.04). A logistic regression analysis showed that surgery lasting &gt;180 min (p = 0.01) and emergency surgery (p = 0.001) significantly increased the risk of perioperative psychiatric symptom worsening. This trend was also observed among patients transferred from psychiatric hospitals, but the difference was not significant ( p = 0.09), likely due to the small sample size.

Discussion & Conclusion
During this study, approximately 90% of SSD patients were discharged from the hospital after surgery without worsening psychiatric symptoms. Of the approximately 10% who experienced worsening, 70% could be managed with psychotropic drug adjustments; therefore, only 3% of all patients required a change in their admission status.

References
1)Matsumoto Y, Ayani N, Narumoto J. Frequency and predictors of perioperative psychiatric symptom worsening among patients with psychiatric disorders. Compr Psychiatry. 2019 Nov;95:152138.