Pre-Surgical Psychiatric Evaluation

Pre-Surgical Evaluation Components

When we conduct a pre-surgical psychological evaluation, we look at a variety of different aspects of your life.

These areas include:

• Behavioral
• Cognitive
• Emotional
• Developmental
• Current Life Situation
• Psychosocial Risk Factors
• Personal Motivations
• Ability to Follow Through
• Post-op Expectations

Behavioral Evaluation

Your pre-surgical evaluation will look at your current behaviors, such as coping skills and lifestyle habits, which contribute to how well you are likely to do during post-op recovery and beyond.

For patients who are seeking a surgery that will permanently alter their body or that involves implanting a device, it is crucial to assess that person’s behavioral risk factors. These risk factors have been shown in studies to directly affect a patient’s outcome after surgery.

Being flexible and adaptive in stressful situations is a positive and helpful trait that can help you after surgery. If one type of treatment or medication is not working as well as expected, a flexible patient can accept that reality and call their surgeon to seek out a new solution to the problem at hand.

Another aspect of a successful behavioral evaluation is to learn about your strengths and areas for growth when it comes to dealing with stress. Major surgery can upend a person’s life, and an evaluation will assess whether you’re ready to cope with this eventuality. There will be pain after surgery that will cause physical, emotional, and mental stress.

We’ll also look at how you normally respond to others when you’re stressed or in pain. Do you lash out in anger? Do you do breathing exercises and meditation to relax? There are dozens of options here, but the most important thing we are looking for is healthy and helpful responses to coping with physical pain.

A behavioral evaluation also includes looking at your response to sudden changes in life.

• Do you become stressed when situations or plans are out of your control?
• Do you go with the flow and adapt to the changes?
• Are you open to learning how to better adapt and cope?
• Are you stuck in your ways?

Major surgery can present you with sudden changes that may fall outside of your expectations. Learning about how you’ve responded to major changes in other life areas can give us a glimpse into how you might react in a similar situation post-operatively.

If you have any behavioral risk factors that we are concerned about, we will let you know and then provide you with ways to learn how to overcome them. One example would be seeing a therapist to expand your coping skills so that you have the best chance at a successful surgical outcome.

For example, if you need a behavioral evaluation prior to bariatric surgery, we would look at a variety of factors affecting your current and past eating habits and the changes that would need to be made after surgery. A history of your weight loss, dieting patterns, and eating behaviors will give us a better picture of your cognitions regarding eating. 

A pattern of weight loss and regain would provide us with insight into the adaptive (positive) habits you’ve used to achieve weight loss as well as any maladaptive eating habits that have contributed to weight gain.  

If you are an emotional eater who responds to stress by turning to food for comfort, then we will help you identify that and learn new ways to cope with stress. One of the best ways to overcome emotional eating is to know your triggers and to have a plan for how to respond.

We can help you learn new coping strategies through one-on-one therapy. One of the therapy modalities that we use at Pacific Pain & Wellness Group is cognitive behavioral therapy, or CBT. This type of treatment helps you to identify unhelpful thoughts and adjust them so that you can make the changes you want to make. The end goal with doing CBT is to help you achieve long-term success after major surgery. 

Another area that we look at is in regards to how much physical activity you engage in. Physical activity can help you with the recovery process after surgery, increase mobility, reduce post-operative pain, and help you maintain a positive state of mind.

When someone engages in regular exercise, and they are doing so for their health, this is a good sign that any physical therapy requirements after surgery are more likely to be complied with. 

Cognitive Evaluation

Older patients who need major surgery, such as heart surgery, need to be carefully evaluated for certain cognitive risk factors. Study evidence shows that having surgery can exacerbate existing memory and thinking issues and contribute to cognitive decline in some older patients. As such, it is crucial to conduct a full cognitive assessment to rule out serious conditions such as dementia.  

According to several studies, around 81% of older patients who are showing signs of dementia have never received a diagnosis from a medical professional. If a patient with dementia undergoes a major surgery, they are more likely to experience postoperative delirium, cognitive decline, and to stay in the hospital longer than the average patient.  

Therefore, it is extremely important to perform a pre-surgical evaluation on these patients to be aware of increased risks for poor surgical outcomes and to prepare for those outcomes with a comprehensive postoperative surgical plan. 

A pre-surgical evaluation includes assessing the following cognitive functional areas: 

• Awareness of current situation (insight) 
• Perception of reality 
• Short term and long term memory capabilities 
• Ability to make good judgments and decisions
• Degree of impulsivity 
• History of suicidal ideation or attempts
• Expectations after surgery 
• General outlook on life (optimistic/pessimistic)  

A cognitive evaluation prior to surgery can help us determine how likely you are to respond positively to surgery. With that information in mind, we can provide you and your surgeon with recommendations for creating a post-op plan. This can help you comply with post-op instructions, adhere to your medication schedule, and help you recover as quickly as possible. 

Emotional Evaluation

Your emotional health is an important part of the post surgical process. A psychological screening will assess your emotional health in several areas including your ability to regulate emotions, identify how you respond to emotional situations, and the coping skills you use to calm down. 

This can be especially important after surgery as your emotions will be taxed, there will be more stress for you and your family, and tensions can run high. Evaluating your emotional health and self-regulation skills can help us identify improvements that can help you stay emotionally well after surgery.

We can help you learn self-regulation tools and coping skills to help you manage the added stress and emotions that come with major surgery. 

Developmental Evaluation

A developmental evaluation looks at your developmental history including the presence of a learning disorder, psychological concerns, mental health disorders or diagnoses, and any delays you may have experienced as a child.

By identifying these risk factors, we can help you and your surgeon anticipate a variety of post-op challenges. Once identified, we will provide you with recommendations to help you have the best possible outcome after surgery.  

Current Life Situation

Taking a look at your current life situation can provide us with a good idea of how you may respond after major surgery.

Areas that we assess include: 

• Financial stability 
• Who you live with 
• Who will help take care of you after surgery  
• If you have transportation to attend post-op appointments 
• Whether you can take enough time off work to recover  

Psychosocial Risk Factors

Psychosocial risk factors are psychological and social concerns that could compromise your mental well-being and physical recovery. These are especially important areas to look at because major surgery will require you to have lots of social support and a healthy state of mind.  

We will assess you in many different areas including: 

• How happy you are with your job 
• History of workers compensation claims 
• History of or current legal issues or lawsuits 
• Helpfulness and support from an intimate partner (if applicable)
• Social support available to you  
• History of abusive relationships 
• Experiences with abandonment 
• Current/prior substance use or addiction issues 
• Psychological concerns (current or prior) 
• History of mental health disorder(s)
• Current diagnoses (i.e., depression, anxiety, etc.)
• Pain tolerance threshold (low or high) 

A high number of psychosocial risk factors in a person’s life could indicate that they are more likely to have a poor outcome after surgery in one or more areas. This could include poor healing, risk of developing severe depression or anxiety, and an impaired ability to cope with post-operative stressors.

During your pre-op evaluation, we will measure the number of psychosocial risk factors present, and then help you find ways to overcome those risks wherever possible.

Personal Motivations

Part of our pre-surgical psychological evaluation includes looking into your personal motivations for wanting surgery. It is important for us to learn what your expectations are regarding post-op results. For example, do you expect surgery to completely eliminate your back pain? Or do you understand that a perfect resolution is not always possible?  

We will also evaluate the reasons why you want to have surgery. The following are just a few of the many positive motivations we look for in patients: 

• You want to feel better 
• You want to make positive changes in your life 
• You want to get back to enjoying the people and activities you love  
• You see surgery as a beginning point rather than a "fix" 

Ability to Follow Through

One of the most important aspects of postoperative recovery is your ability to follow through with your surgeon's recommendations. Prior to surgery, it is important to assess whether you are willing to work hard to recover your physical wellness and strength after surgery.

We will determine whether you understand what realistic post-operative recovery may look like. Recovery could require multiple visits over a period of months of physical therapy and other treatments to help you regain functionality. A psychological evaluation will help us determine whether you are ready to commit to following through with post-op treatment requirements. 

Another aspect of assessing your ability to follow through is whether you are willing and able to comply with post-operative lifestyle changes that may be required. Some surgeries require extensive lifestyle changes in order to maintain results. We will assess whether you understand the impact of those changes and are willing to make them.  

For example, if you were being assessed for a spinal cord stimulation device, it would be important for us to evaluate whether you are willing to reduce your oral pain medication for a time to fully assess the positive impact that the device is having on reducing your pain levels.  

Post-Op Expectations

Realistic post op expectations can help patients maintain a healthy state of mind throughout recovery. We will assess your expectations about regaining mobility, how much time it will take to heal, how much pain you can expect to feel, and the amount of physical therapy required to get you back to optimal functionality. 

Post-op expectations also include what you imagine life will look like after surgery:

• Do you expect to have zero issues after surgery?
• Are you realistically planning for and expecting setbacks?
• Can you remain flexible if things don’t turn out as you expected?

These are all important questions that will be considered and discussed during your pre-surgical screening.

Pre-Surgical Psychological Evaluation in Torrance, Los Angeles

Our psychiatric specialists are here to help you get evaluated for major surgery. We offer comprehensive evaluations that meet the rigorous standards set by major insurance companies.

With our experienced mental health professionals, you don’t have to worry about going back and forth with unfinished paperwork to get your surgery approved. We are here to help you get your evaluation and paperwork handled properly the first time around.

At Pacific Pain & Wellness Group, we care about you as much as you do. Our goal is to help you feel better so you can live better. Call us today at (310) 437-7399 to schedule your pre-surgical psychological evaluation.