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Eftekar M, Pun P. Psychiatric risk factors predicting post-liver transplant physical and psychiatric complications: a literature review. Australas Psychiatry 2016; 24:385-92. [PMID: 26879076 DOI: 10.1177/1039856215627400] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES The psychiatric assessment of potential liver transplant recipients is becoming increasingly common in clinical practice. In such assessments, the psychiatrist is invited by the transplant team to assess the patient prior to the patient receiving a transplant liver to identify factors that could predict an unsuccessful post-transplant course, whether this is from a psychiatric or physical perspective. This review examined published research from 2000 to 2014 on psychological risk factors predicting post-transplant physical and psychiatric complications. CONCLUSIONS Based on the strength of the evidence available, our review identified four risk factors: mood disorders; social supports; substance misuse; and alcohol dependence. These factors could potentially provide a framework to guide the evaluation and prediction of psychological and physical complications post-liver transplantation.
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Affiliation(s)
- Mahdod Eftekar
- Consultation Liaison Psychiatrist, Consultation Liaison Psychiatry Department, Princess Alexandra hospital, Woolloongabba, QLD, Australia
| | - Paul Pun
- Consultation Liaison Psychiatrist, Consultation Liaison Psychiatry Department, Princess Alexandra hospital, Woolloongabba, QLD, Australia
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Mohamed S, Sabki ZA, Zainal NZ. Depression and psychosocial correlates of liver transplant candidates: a systematic review. Asia Pac Psychiatry 2014; 6:447-53. [PMID: 25132651 DOI: 10.1111/appy.12145] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 06/09/2014] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Liver transplant candidates are vulnerable to develop depression. This paper aims to ascertain the prevalence of depression in liver transplant candidates and its psychosocial factors in a systematic review. METHODS An extensive review via electronic databases (PubMed, EMBASE, CINAHL) and hand search were carried out to retrieve published articles up to December 15, 2013, using (Incidence OR Prevalence) AND Depress* AND liver transplant as the keywords. Information on the study design, patient characteristics, prevalence of depression, and its associated risk factors were extracted from included studies. RESULTS There were 22 studies included in this review with a total of 3055 patients. The prevalence of depression in the liver transplant candidates ranges between 2% and 80%. Studies that used diagnostic tools found a narrower range of prevalence (4.5-43%) as compared to the self-administered questionnaires (2-80%). Studies that used Beck Depression Inventory reported a higher prevalence than those studies which used Hospital Anxiety and Depression Scale (median = 28%, range = 2-80% versus median 17%, range 6.1-25.8%). A number of socio-demographic factors, illness-related and psychosocial factors were found to be associated with depression. CONCLUSION Prevalence of depression in liver transplant candidates is high, and early detection will improve survival and quality of life.
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Affiliation(s)
- Salina Mohamed
- Department of Psychological and Behavioural Medicine, Faculty of Medicine, University of Technology MARA (UITM), Batu Caves, Selangor, Malaysia
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Errichiello L, Picozzi D, de Notaris EB. Prevalence of psychiatric disorders and suicidal ideation in liver transplanted patients: a cross-sectional study. Clin Res Hepatol Gastroenterol 2014; 38:55-62. [PMID: 24051064 DOI: 10.1016/j.clinre.2013.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Revised: 06/16/2013] [Accepted: 07/10/2013] [Indexed: 02/04/2023]
Abstract
AIM Liver transplantation is the first choice treatment for terminal liver disease, but its success is strictly related to the adherence to immunosuppressive therapy. Psychiatric disorders can decrease both adherence and quality of life of liver transplanted patients. We aimed to assess prevalence of post-transplant psychiatric disorders in liver transplanted patients and its association with quality of life, adherence, suicidal ideation. METHODS Psychiatric examination was performed with an internationally validated structured clinical interview: Mini International Neuropsychiatric Interview Plus. Quality of life was assessed using The Short Form (36) Health Survey (SF36). Adherence was established by the Siegal scale, a 7-point self-reported scale, and by collateral reports of relatives and transplant clinicians. The Scale for Suicide Ideation (SSI) was used for suicidal risk assessment. RESULTS Fifty-one liver transplanted patients (mean age: 60.06 years, SD: 6.49) were enrolled. Thirty patients (58.82%) suffered from one or more psychiatric disease. Patients diagnosed with psychiatric disease displayed worse scores at SSI (P=0.032) and at several SF36 items: physical health (P=0.038), vitality (P=0.012), social activities (P=0.027), emotional state (P=0.031), mental health (P=0.014). Both patients with major depression and patients with two or more psychiatric disorders displayed lower adherence (P≤0.001 and P=0.002). Diagnosis of major depression was associated with female sex (P=0.021), aggressiveness (P=0.042), chronic rejection (P=0.011). CONCLUSIONS We confirm the high prevalence of psychiatric disease in our cohort of liver transplanted patients. The presence of psychiatric disease is associated with decreased quality of life and increased suicide ideation. Patients with major depression should be considered significantly at risk for non-adherence.
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Affiliation(s)
- Luca Errichiello
- Section of psychotherapy, Department of Neurological Sciences, "Federico II" University, Via Pansini 5, 80131 Napoli, Italy.
| | - Domenico Picozzi
- Section of psychotherapy, Department of Neurological Sciences, "Federico II" University, Via Pansini 5, 80131 Napoli, Italy.
| | - Enrico Beniamino de Notaris
- Section of psychotherapy, Department of Neurological Sciences, "Federico II" University, Via Pansini 5, 80131 Napoli, Italy.
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Grover S, Sarkar S. Liver transplant-psychiatric and psychosocial aspects. J Clin Exp Hepatol 2012; 2:382-92. [PMID: 25755459 PMCID: PMC3940381 DOI: 10.1016/j.jceh.2012.08.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 08/17/2012] [Indexed: 12/12/2022] Open
Abstract
Liver transplantation is a life saving surgical procedure that is associated with improved longevity and enhanced quality of life. The number of successful liver transplants is growing worldwide. The procedure requires a dedicated and trained team of experts. A psychiatrist plays an important role in such a team. Psychiatric and psychosocial assessment is considered imperative to evaluate the candidate's suitability as a transplant recipient. Many psychiatric disorders may lead to the need for liver transplant, and if kept unchecked can adversely affect outcomes. Psychiatric problems arising in the post-transplant period may also require intervention of the psychiatrist. The donor too needs to be evaluated adequately to assess for psychological fitness for the procedure. This article provides broad overview of the various psychiatric and psychosocial issues pertaining to liver transplantation.
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Affiliation(s)
- Sandeep Grover
- Address for correspondence: Dr. Sandeep Grover, Assistant Professor, Department of Psychiatry, Postgraduate Institute of Medical Education & Research, Chandigarh 160012, India. Tel.: +91 172 2756807 (O); fax: +91 172 2744401, +91 172 2745078.
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Gorevski E, Succop P, Sachdeva J, Scott R, Benjey J, Varughese G, Martin-Boone J. Factors influencing posttransplantation employment: does depression have an impact? Transplant Proc 2012; 43:3835-9. [PMID: 22172856 DOI: 10.1016/j.transproceed.2011.08.107] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 08/29/2011] [Indexed: 12/20/2022]
Abstract
BACKGROUND Depressive disorders are the leading cause of disability in the United States. Liver transplant recipients often have significant psychiatric morbidity, including depression. One of the potential consequences of depression is the inability to work. OBJECTIVE The objective of this study was to determine if there is any relationship between depression and posttransplantation employment status in liver transplant recipients. METHODS Patients, 18 years of age or older, who had received liver transplants from January 2007 to July 2009 were identified for the retrospective analysis. Individual posttransplantation patient charts were reviewed for patient demographics, transplantation indication, employment history, depression diagnosis, and medications. The pretransplantation charts were used to obtain family psychiatric history, patient psychiatric history, past drug, alcohol, and tobacco use, and pretransplantation employment status. RESULTS A total of 91 patients were evaluated, of which 59.3% were males and 40.7% were females, with a mean age of 56 years. In our sample, 23% and 29% of patients were depressed pretransplantation and posttransplantation, respectively. The number of unemployed patients also increased from 10.9%-23.1%. A logistic regression was performed to identify the factors influencing employment posttransplantation, which indicated pretransplantation employment, gender (males more likely to return to work), and depression post transplantation as significant factors with odds rations of 128, 4.1, and 11.5 and corresponding P values of <.0001, .04 and .008, respectively. CONCLUSION Posttransplantation depression is significantly associated with post-liver transplantation unemployment. Improved management of depression may facilitate a patient's return to work after transplantation.
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Affiliation(s)
- E Gorevski
- James L Winkle College of Pharmacy, University of Cincinnati, Department of Pharmacy, University Hospital, Cincinnati, Ohio 45267-0004, USA.
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Corruble E, Barry C, Varescon I, Durrbach A, Samuel D, Lang P, Castaing D, Charpentier B, Falissard B. Report of depressive symptoms on waiting list and mortality after liver and kidney transplantation: a prospective cohort study. BMC Psychiatry 2011; 11:182. [PMID: 22103911 PMCID: PMC3231871 DOI: 10.1186/1471-244x-11-182] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 11/21/2011] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Little research has explored pre-transplantation psychological factors as predictors of outcome after liver or kidney transplantation. Our objective is to determine whether report of depressive symptoms on waiting list predicts outcome of liver and kidney transplantation. METHODS Patients on waiting list for liver or kidney transplantation were classified for report or non-report of depressive symptoms on waiting list. 339 were transplanted 6 months later on average, and followed prospectively. The main outcome measures were graft failure and mortality 18 months post-transplantation. RESULTS Among the 339 patients, 51.6% reported depressive symptoms on waiting list, 16.5% had a graft failure and 7.4% died post-transplantation.Report of depressive symptoms on waiting list predicted a 3 to 4-fold decreased risk of graft failure and mortality 18-months post-transplantation, independently from age, gender, current cigarette smoking, anxiety symptoms, main primary diagnosis, UNOS score, number of comorbid diagnoses and history of transplantation. Data were consistent for liver and kidney transplantations. Other baseline predictive factors were: for graft failure, the main primary diagnosis and a shorter length since this diagnosis, and for mortality, older age, male gender and the main primary diagnosis. CONCLUSION Further studies are needed to understand the underlying mechanisms of the association between report of depressive symptoms on waiting list and decreased risk of graft failure and mortality after transplantation.
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Affiliation(s)
- Emmanuelle Corruble
- INSERM U 669, Paris XI University, Psychiatry Department of Bicetre University Hospital, Assistance Publique-Hopitaux de Paris; 94275 Le Kremlin Bicêtre, France
| | - Caroline Barry
- INSERM U 669, Bicetre University Hospital, Assistance Publique-Hopitaux de Paris; 94275 Le Kremlin Bicêtre, France
| | - Isabelle Varescon
- Paris V University, Hepatology and Surgery department of Paul Brousse University Hospital, France
| | - Antoine Durrbach
- INSERM U542, Nephrology Department of Bicetre University Hospital, Assistance Publique-Hopitaux de Paris
| | - Didier Samuel
- Head of the hepatology department of Paul Brousse University Hospital, Assistance Publique-Hopitaux de Paris, France
| | - Philippe Lang
- Nephrology Department of Creteil University Hospital, Assistance Publique-Hopitaux de Paris, France
| | - Denis Castaing
- Head of the surgery department of Paul Brousse University Hospital. Assistance Publique-Hopitaux de Paris, France
| | - Bernard Charpentier
- INSERM U542, Nephrology Department of Bicetre University Hospital, Assistance Publique-Hopitaux de Paris, France
| | - Bruno Falissard
- INSERM U669, Paris XI University, Department of Biostatistics and Public Health, Paul Brousse Hospital, Assistance Publique-Hôpitaux de Paris; 94800 Villejuif, France
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Sotil EU, Gottstein J, Ayala E, Randolph C, Blei AT. Impact of preoperative overt hepatic encephalopathy on neurocognitive function after liver transplantation. Liver Transpl 2009; 15:184-92. [PMID: 19177446 DOI: 10.1002/lt.21593] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In the current Model for End-Stage Liver Disease allocation system, patients are at risk of suffering repeated episodes of hepatic encephalopathy (HE) while waiting for an orthotopic liver transplantation (OLT); the posttransplantation impact of these episodes has not been well explored. We evaluated the cognitive function and quality of life in a group of OLT recipients (n = 25) who had suffered from overt HE prior to their procedure (HE-PreLT group) and compared their performance to that of a similar group of patients (n = 14) without overt HE (No HE-PreLT group) as well as to controls. Patients were selected from a cohort of 280 patients who underwent OLT during this period; the presence of clinical confounders excluded many of the remaining subjects. Demographic and clinical characteristics were balanced among groups. At an average of 18 months after OLT, we administered 2 neuropsychological batteries [Psychometric Hepatic Encephalopathy Score (PHES) test battery and Repeatable Battery for the Assessment of Neuropsychological Status (RBANS)]; a pyschophysiological test (critical flicker frequency); and the SF-36 quality of life score. The HE-PreLT group scored below controls in 5 of 6 cognitive domains tested by RBANS, 3 of 6 PHES subtests, as well as the critical flicker frequency test. The No HE-PreLT group scored below the controls in 1 of the 6 cognitive domains tested by RBANS. The more severe neurocognitive abnormalities seen in the HE-PreLT group did not appear to affect quality of life, as lower values than normative data were only found in 1 of the 8 SF-36 scales. In conclusion, neurocognitive abnormalities were more severe in liver transplant recipients that had suffered from overt HE prior to OLT. Prospective studies of neurocognitive function pre-OLT and post-OLT are needed to fully determine the impact of such abnormalities.
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Affiliation(s)
- Eva U Sotil
- Division of Hepatology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
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Telles-Correia D, Barbosa A, Mega I, Direitinho M, Morbey A, Monteiro E. Psychiatric differences between liver transplant candidates with familial amyloid polyneuropathy and those with alcoholic liver disease. Prog Transplant 2008. [PMID: 18615979 DOI: 10.7182/prtr.18.2.1xml5421646x0377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Psychiatric diagnoses are very common in liver transplant candidates, and such diagnoses are predictive of a poor clinical evolution and quality of life after transplantation. Also, nonadherence before the transplant is predictive of nonadherence after the transplant. METHODS We studied the psychiatric and psychosocial profiles of 85 liver transplant candidates, comprising consecutive patients attending outpatient clinics of a liver transplantation unit at a public hospital. Interviews and questionnaires were used to measure personality traits, symptoms of anxiety and depression, social support, and adherence. These patients were broken into 3 groups: patients with familial amyloid polyneuropathy (n = 20), patients with alcoholic liver disease (n = 33), and patients with other liver diseases (n = 32). RESULTS About 58% of patients had a current psychiatric diagnosis (24.8%, major depressive disorder, 22.3% generalized anxiety disorder, 8.3% adaptive disorder, 2.3% abuse of or dependence on substances other than alcohol). Current psychiatric diagnosis did not differ between patients with familial amyloid polyneuropathy and patients with alcoholic liver disease. Patients with alcoholic liver disease showed lower scores for 2 protective personality traits, social support and adherence to medication, than other patients. Patients with familial amyloid polyneuropathy showed higher scores for those traits. CONCLUSIONS All patients waiting for a liver transplant should undergo psychiatric and psychological assessment. Some psychological characteristics such as personality traits and social support differ between clinical groups, so it may be useful to design different approaches for each group. Patients with alcoholic liver disease may require a special approach to improve adherence to medication.
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Abstract
Metabolic encephalopathy is an acute disturbance in cellular metabolism in the brain evoked by conditions of hypoxia, hypoglycaemia, oxidative stress and/or inflammation. It usually develops acutely or subacutely and is reversible if the systemic disorder is treated. If left untreated, however, metabolic encephalopathy may result in secondary structural damage to the brain. Most encephalopathies are present with neuropsychiatric symptoms, one in particular being depression. However, mood disorders are often co-morbid with cardiovascular, liver, kidney and endocrine disorders, while increasing evidence concurs that depression involves inflammatory and neurodegenerative processes. This would suggest that metabolic disturbances resembling encephalopathy may underscore the basic neuropathology of depression at a far deeper level than currently realized. Viewing depression as a form of encephalopathy, and exploiting knowledge gleaned from our understanding of the neurochemistry and treatment of metabolic encephalopathy, may assist in our understanding of the neurobiology of depression, but also in realizing new ideas in the pharmacotherapy of mood disorders.
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Affiliation(s)
- Brian H Harvey
- Unit for Drug Research and Development, Division of Pharmacology, School of Pharmacy, North-West University, Potchefstroom, South Africa.
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Telles-Correia D, Barbosa A, Mega I, Direitinho M, Morbey A, Monteiro E. Psychiatric Differences between Liver Transplant Candidates with Familial Amyloid Polyneuropathy and Those with Alcoholic Liver Disease. Prog Transplant 2008; 18:134-9. [DOI: 10.1177/152692480801800211] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Psychiatric diagnoses are very common in liver transplant candidates, and such diagnoses are predictive of a poor clinical evolution and quality of life after transplantation. Also, nonadherence before the transplant is predictive of nonadherence after the transplant. Methods We studied the psychiatric and psychosocial profiles of 85 liver transplant candidates, comprising consecutive patients attending outpatient clinics of a liver transplantation unit at a public hospital. Interviews and questionnaires were used to measure personality traits, symptoms of anxiety and depression, social support, and adherence. These patients were broken into 3 groups: patients with familial amyloid polyneuropathy (n=20), patients with alcoholic liver disease (n=33), and patients with other liver diseases (n=32). Results About 58% of patients had a current psychiatric diagnosis (24.8%, major depressive disorder, 22.3% generalized anxiety disorder, 8.3% adaptive disorder, 2.3% abuse of or dependence on substances other than alcohol). Current psychiatric diagnosis did not differ between patients with familial amyloid polyneuropathy and patients with alcoholic liver disease. Patients with alcoholic liver disease showed lower scores for 2 protective personality traits, social support and adherence to medication, than other patients. Patients with familial amyloid polyneuropathy showed higher scores for those traits. Conclusions All patients waiting for a liver transplant should undergo psychiatric and psychological assessment. Some psychological characteristics such as personality traits and social support differ between clinical groups, so it may be useful to design different approaches for each group. Patients with alcoholic liver disease may require a special approach to improve adherence to medication.
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Affiliation(s)
| | - A. Barbosa
- University of Lisbon (DTC, AB) and Curry Cabral Hospital, Lisbon, Portugal
| | - Inês Mega
- University of Lisbon (DTC, AB) and Curry Cabral Hospital, Lisbon, Portugal
| | - M. Direitinho
- University of Lisbon (DTC, AB) and Curry Cabral Hospital, Lisbon, Portugal
| | - A. Morbey
- University of Lisbon (DTC, AB) and Curry Cabral Hospital, Lisbon, Portugal
| | - E. Monteiro
- University of Lisbon (DTC, AB) and Curry Cabral Hospital, Lisbon, Portugal
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Martins PD, Sankarankutty AK, Silva ODCE, Gorayeb R. Psychological distress in patients listed for liver transplantation. Acta Cir Bras 2006; 21 Suppl 1:40-3. [PMID: 17013512 DOI: 10.1590/s0102-86502006000700010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
PURPOSE: To assess the level of depression in patients listed for liver transplantation. METHODS: Sixty-four adult patients, listed for liver transplantation, were submitted to psychological evaluation, including assessment of depression by means of the Beck Depression Inventory. RESULTS: Twenty-two percent of the patients had mild/major depression. The group consisted mainly of male patients aged 47 on average, with a history of alcohol abuse and a Meld (Model for End-Liver Disease) value of 14.5. Patients that had been awaiting liver transplant longer presented less severe liver disease according to the Child-Pugh criteria. CONCLUSION: It is extremely important to assess psychological distress in patients listed for liver transplantation. An interdisciplinary approach is essential to improve the patients' quality of life both in the pre- and post-transplant periods.
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