Kidney transplantation and liaison psychiatry, part II: A case of dissociative identity disorder

[Renal transplantation, anxiety and depressive disorders and quality of life]

Until now there are few data in the literature describing psychiatric comorbidity in patients waiting for renal transplantation. We have conducted a cross sectional study estimating the prevalence of anxiety and depressive disorders in three groups of renal transplant patients, before transplantation, six months and one year after. The MINI was used to estimate the prevalence of anxiety and depressive disorders. Anxiety and depressive symptoms were assessed using the HAD. Patients' quality of life was also assessed using the SF-36. This study did not find any major impact of renal transplantation on the prevalence of structured psychiatric disorders. Indeed, the prevalence of depressive and anxiety disorders did not differ significantly between the three groups. The mean scores of anxiety did not differ significantly between the three groups in contrast to the mean scores of depression, which differed significantly between the group "before transplantation" and the group "one year after transplantation". We did not find any significant difference concerning the scores of patient's quality of life between the three groups, except for the item "health perceived by the patients themselves". Health perceived by the patients was greater in the group "after transplantation". The quality of life of dialysed or transplant patients was strongly correlated with anxiety and depressive symptoms scores, emphasizing the major interest of a multidisciplinary approach for these patients.

Improved Mental Health Status in the First 2 Weeks After Kidney Transplantation

There is controversy whether mental health actually improves among kidney transplant recipients. The aim of this study was to investigate whether there was any significant change in mental status during the first 2 weeks after kidney transplantation. This cohort study involved 97 individuals who were transplantation candidates between 2003 and 2004. During the pretransplantation assessment, each individual completed the General Health Questionnaire (GHQ-28) and the Minnesota Multiphasic Personality Inventory, short form (MMPI). Posttransplantation subjects completed the GHQ-28 again. There were significant differences between mean total GHQ raw scores before and at 2 weeks after transplantation. Significant correlations were detected between a history of referral to a psychiatrist and a change in each of the 4 GHQ subscale scores. Our findings suggest that most kidney recipients show improved mental health in the early phase (first 14 days) after surgery. However, the results were not as positive as expected. Patients with a history of psychiatrist referral require special psychological attention.

Attitudes of patients before and after transplantation towards various allografts

BACKGROUND

The presence of an allogeneic graft inside the body may have psychological impact on transplant patients. It was the aim of this study to evaluate the attitude of patients before and after different types of organ transplantation towards organ allografts.

METHODS

A total of 1,049 patients (722 patients after and 327 patients on the waiting list for either kidney, liver, heart, or lung transplantation) under care of a single transplant center were studied using a questionnaire with blinded analysis of the data. Mental condition of the patients, their attitude towards the allograft and its donor, emotional stress caused by a graft, and correlation of the attitudes with clinical and demographic parameters were analyzed.

RESULTS

The self-reported mental condition of the patients was markedly and consistently better after organ transplantation; 27% of patients before and 60% after transplantation were in good mental condition. Sixty-two percent of transplant patients considered the graft as their own organ, 37% regarded it as a foreign organ now belonging to their body, and 1% considered it as a foreign body; among waiting list patients, 40%, 55%, and 5% assumed they would perceive their graft accordingly. The graft caused considerable emotional stress for 2% of transplant patients, whereas for 70% it did not cause any stress; the latter was assumed by 47% of patients before transplantation. Eleven percent of transplant patients frequently think about the origin of their graft, and 30% would like to have information about their donor. Knowledge about different religion, opposite sex, homosexuality, suicidal death, and age above 65 years of their donor would be of moderate or major concern for 0%, 3%, 21%, 24%, and 38% of the patients, respectively.

CONCLUSIONS

The comprehensive survey shows that transplant patients incorporate their graft well into their body image. Emotional stress caused by the graft is very low and is generally less than assumed before transplantation. Knowledge about certain characteristics of the donor may cause increased concerns in some patients.