From the Guidelines
Post-catheterization psychosis should be managed with a combination of antipsychotic medications and supportive care, prioritizing low-dose antipsychotics such as haloperidol or atypical antipsychotics like risperidone, with careful monitoring for QT prolongation and consideration of benzodiazepines for agitation, as recommended by the most recent guidelines 1.
Key Considerations
- The condition is often transient, with symptoms typically resolving within 24-72 hours, but requires prompt and careful management to prevent complications and improve outcomes.
- Contributing factors include anesthetic agents, contrast media, hypoxia, electrolyte imbalances, and pre-existing cognitive impairment, which should be identified and addressed to prevent post-catheterization psychosis.
- Prevention strategies include identifying high-risk patients, minimizing sedation, maintaining proper oxygenation, and correcting electrolyte abnormalities, as well as environmental interventions such as frequent reorientation and early mobilization.
Management Approach
- Acute management should focus on treating the underlying cause, controlling symptoms with non-pharmacological approaches, and using medication when deemed appropriate, as outlined in the ACR Appropriateness Criteria 1.
- Antipsychotic medications should be used with caution, considering the potential risks and benefits, and with careful monitoring for side effects such as QT prolongation.
- Benzodiazepines may be used to manage agitation, but should be used with caution and in conjunction with antipsychotic medications.
Prioritizing Outcomes
- The management approach should prioritize morbidity, mortality, and quality of life outcomes, with a focus on preventing complications and improving patient outcomes.
- The most recent and highest quality evidence should be used to guide management decisions, as outlined in the ACR Appropriateness Criteria 1.
From the Research
Post Cath Psychosis
- Post-catheterization psychosis, also known as postoperative psychosis, is a condition that can occur after medical procedures, including cardiac surgery 2.
- The exact causes of post-cath psychosis are not fully understood, but it is thought to be related to a combination of factors, including the stress of the procedure, anesthesia, and underlying medical conditions 2, 3.
- Symptoms of post-cath psychosis can include delirium, agitation, confusion, and hallucinations, and can be managed with a combination of non-pharmacologic and pharmacologic interventions 2, 4, 3.
- Antipsychotic medications, such as haloperidol, olanzapine, and risperidone, are commonly used to treat post-cath psychosis, but their use must be carefully considered due to potential side effects and interactions with other medications 5, 2, 4, 6.
- The choice of antipsychotic medication can depend on a variety of factors, including the patient's medical history, the severity of symptoms, and the potential for side effects 6.
- In some cases, post-cath psychosis can be a sign of an underlying neurological or systemic disorder, such as a metabolic disorder or non-convulsive seizure, and requires careful evaluation and treatment 3.