Incidence of impulsive suicide attempts following surgery: a case report

Abstract

Background. Postoperative impulsive behavior and suicide in patients without pre-existing psychiatric disorders are rare but clinically significant and potentially dangerous phenomena that warrant close attention from the medical and surgical teams. Methods. This case report describes a 36-year-old female, a mother of three with no prior history of psychiatric disorders. The patient developed severe anxiety, aggressive outbursts, and prominent suicidal tendencies immediately following Bartholin's cyst surgery. She made 3 suicide attempts within a single week. Although she exhibited active suicidal ideation, no major depressive symptoms were present. Neurological assessment, including brain MRI, was unremarkable. However, psychometric testing revealed characteristics consistent with Dependent Personality Disorder. Pharmacological treatment was initiated with quetiapine, which was later switched to aripiprazole. Concurrently, the patient underwent a course of 6 sessions of bitemporal electroconvulsive therapy (ECT). Subsequently, lithium carbonate was added to the treatment regimen to further enhance impulse control. Results. Suicidal thoughts diminished significantly following the very first ECT session. The patient was eventually discharged with a diagnosis of "Other Specified Disruptive-Control and Conduct Disorder" while maintained on aripiprazole. The addition of lithium carbonate resulted in a further marked improvement in her impulsivity and overall behavioral regulation. Conclusion. This case highlights the complex neuropsychiatric sequelae that can unexpectedly arise after minor surgical procedures in psychiatrically healthy individuals, emphasizing the importance of prompt psychiatric consultation and the potential efficacy of combined pharmacological and ECT interventions in managing refractory postoperative impulse-control disturbances. Practical Implications. This study underscores the necessity for swift evaluation of psychiatric and therapeutic interventions in the sudden onset of impulsive suicidal behaviors following surgery.

Keywords: Impulsive suicide, Electroconvulsive Therapy, Surgery, Case report