Psychiatric complications during the course of surgical treatment are well recognized and may include psychosis, depression, mania, disruptive ward behavior or addiction. Postoperative psychosis is associated with increased morbidity and requires acute management. We present a case of paranoid psychosis developed after orthopedic surgery that lasted for 3 months.

A 42-year-old woman without known significant past medical or psychiatric history was submitted to surgical correction of humeral fracture. Three hours after the surgery, she exhibited disruptive behavior associated with auditory and visual hallucinations, paranoid delusions and experiences of self-reference. the patient was acutely treated with haloperidol and diazepam and discharged five days later without psychotic symptoms. Three months after discharge was admitted to a psychiatric unit presenting persecutory delusions and experiences of self-reference. She was treated with paliperidone 9mg/day with good response.

Although the exact cause of postoperative psychosis has not been identified, awareness of this diagnosis and knowledge on its management are critical to provide better care to patients.