Postoperative Psychiatric Disorder After Laparoscopically Assisted Vaginal Hysterectomy in a Patient With Parkinson’s Disease: A Case Report [Conference Winner Abstract]

Introduction Parkinson's disease (PD) affects over 6.1 million people globally. Postoperative psychiatric complications, including PD psychosis, increase morbidity [1]. We present a postoperative psychiatric disorder following laparoscopically assisted vaginal hysterectomy (LAVH) in a PD patient, highlighting the need for early recognition and management. Case Presentation A 78-year-old female with PD (Levodopa/Benserazide 1tab x3) underwent LAVH and vaginal wall/perineal reconstruction for 2nd-3rd degree uterine prolapse and ovarian cysts. On postoperative day one, she developed auditory and visual hallucinations, spatial disorientation, mild confusion, rigid thinking, and emotional distress. A psychiatrist diagnosed F06.8 and prescribed Quetiapine 12.5 mg x3 and Bromazepam 3 mg x1. Her condition improved by the next morning, and she was discharged on day four. Discussion Our patient developed acute postoperative psychosis with hallucinations, disorientation. PD psychosis affects 26– 82.7% of patients, more commonly in women, those with cognitive decline, and on dopaminergic therapy. Unlike gradual-onset PD psychosis, this case had a sudden onset, likely triggered by surgery, anesthesia. Visual hallucinations occur in 22–38% of PD cases, auditory hallucinations are rarer (0–22%) [2]. Risk factors included advanced age and levodopa use. Low-dose short-term quetiapine (12.5 mg x 3) effectively managed the psychosis with minimal impact on motor function [2]. Preoperative risk assessment should include MMSE, MoCA, Fried Frailty Criteria, and MNA. Medication optimization and avoiding high anticholinergic burden are crucial. Predictive models may enhance perioperative management [3]. To prevent postoperative psychosis, prefer regional anesthesia, resume anti-Parkinsonian drugs early, avoid dopamine agonists, and prioritize NSAIDs, paracetamol for pain, and ondansetron for nausea. A multidisciplinary team can optimize recovery and reduce complications [4]. Conclusions This case emphasizes the need for recognizing and managing postoperative psychiatric disturbances in PD. Quetiapine effectively managed symptoms without worsening motor function. Preoperative risk stratification, medication management, and a multidisciplinary approach are key to reducing postoperative psychosis in PD.