ABSTRACT
ABSTRACT Background Psychosocial assessment is a key component in evaluation for liver transplantation and may affect survival rates and outcomes. Objective The primary aim of this study was to investigate the impact of previous mental disorders and impulsivity on the 2-year surviving rate after liver transplantation. Methods: We performed a prospective cohort study assessing end-stage liver disease individuals with and without psychiatric comorbidities for 2 years post-transplant. Psychiatric diagnosis was carried out through Mini-Plus 5.0.0 and impulsivity by using Barratt Impulsiveness Scale in the pre-transplant phase. We followed patient's status for 2 years after transplantation. The main outcome was death. We used a logistic regression to evaluate the association of psychiatric comorbidities with death and performed a survival analysis with Kaplan-Meier and Cox regression models. Results: Between June 2010 and July 2014, 93 out of 191 transplant candidates received transplants. From the 93 transplant patients, 21 had psychiatric comorbidities and 72 had not. 25 patients died during the study. The presence of psychiatric comorbidities (P=0.353) and high impulsivity (P=0.272) were not associated to 2-year post transplant death. Conclusion: This study found no evidence that the presence of mental disorders and impulsivity worsened prognosis in post-liver transplantation.
RESUMO Contexto: A avaliação psicossocial é essencial na avaliação para transplante hepático; ela pode afetar as taxas de sobrevida e outros desfechos. Objetivo: O objetivo principal deste estudo foi investigar o impacto de transtornos mentais prévios e impulsividade nos índices de sobrevivência após o transplante hepático. Métodos: Foi realizado um estudo prospectivo de coorte com indivíduos em estágio avançado da doença hepática com e sem comorbidades psiquiátricas no pré-transplante, acompanhados por 2 anos após o transplante. Na fase pré-transplante foi realizado o diagnóstico psiquiátrico através do Mini-Plus 5.0.0 e avaliada a impulsividade através da Escala de Impulsividade Barratt. Os pacientes foram acompanhados por 2 anos após o transplante. O desfecho principal foi óbito. Foi utilizada regressão logística para avaliar a associação entre comorbidades psiquiátricas e óbito. Também foi realizada análise de sobrevida com Kaplan-Meier e modelo de regressão Cox. Resultados: Entre junho de 2010 e julho de 2014 foram transplantados 93 pacientes entre os 191 candidatos. Dos 93 pacientes transplantados, 21 tinham comorbidade psiquiátrica e 72 não tinham. Durante o período de acompanhamento houve 25 óbitos. A presença de comorbidade psiquiátrica (P=0.353) e alta impulsividade (P=0.272) não foram associadas a óbito pós-transplante até segundo ano de cirurgia. Conclusão: Este estudo não encontrou evidências de que a presença de transtorno mental e impulsividade pioram o prognóstico pós-transplante hepático.
ABSTRACT
ABSTRACT BACKGROUND: Liver transplantation is the main therapeutic alternative for patients with advanced liver disease. These patients have high prevalence of psychiatric comorbidities that may negatively interfere in clinical outcomes and quality of life. It is not clear in the literature whether the different etiologies of hepatic disease have the same prevalence of psychiatric disorders. OBJECTIVE: The aim of this study was to investigate whether patients in the liver transplant list showed differences in psychiatric characteristics, medical variables and quality of life among different etiological groups. METHODS: This is a cross-sectional study that evaluates quality of life, psychiatric and clinical comorbidities through the application of validated questionnaires and instruments in 248 patients who were on transplant waiting list from 2010 to 2014, assisted in a University Hospital and in a Private Hospital in Salvador/Bahia, Brazil. The patients were evaluated through the Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) and Medical Outcomes Short-Form Health Survey (SF-36). RESULTS: The etiology of the most prevalent liver disease was hepatitis C virus. A prevalence of 50.8% of at least one mental disorder was identified. When alcohol abuse/dependence was excluded, the prevalence was 25.8%. Mental health did not show a statistically significant difference in the diverse etiological groups, but a higher prevalence of psychiatric comorbidities was detected among women and younger than 40 years. No cases of psychotic disorders were detected, possibly by exclusion prior to listing. There was no difference in the quality of life domains in the different liver etiological groups. CONCLUSION: A high-prevalence of psychiatric disorders was found among all clinical conditions most associated with indication for liver transplantation. Attention is drawn to the absence of patients with psychotic disorders, which suggests that transplantation may not have been indicated for this group of patients. For these reasons, professionals caring for liver transplant candidates should be highly vigilant for the presence of mental disorders, regardless of the etiology of liver disease. Specialized care is recommended to minimize the early exclusion of patients with no other therapeutic possibilities, as well as care of all people with mental disorders.
RESUMO CONTEXTO: O transplante hepático é a principal alternativa terapêutica para pacientes com doença hepática avançada. Esses pacientes apresentam alta prevalência de comorbidades psiquiátricas que podem interferir negativamente nos desfechos clínicos e qualidade de vida. Não está claro na literatura se as diferentes etiologias de doença hepática têm a mesma prevalência de transtornos psiquiátricos. OBJETIVO: O objetivo deste estudo foi investigar se os pacientes na lista de transplante hepático apresentavam diferenças nas variáveis psiquiátricas, variáveis clínicas e qualidade de vida em diferentes grupos etiológicos. MÉTODOS: Estudo transversal que avalia as comorbidades psiquiátricas e clínicas e as variáveis de qualidade de vida por meio da aplicação de questionários e instrumentos validados em 248 pacientes inseridos em lista de espera para transplante hepático no período de 2010 a 2014, acompanhados no Hospital Universitário Professor Edgard Santos e Hospital Português (Salvador, BA). Os pacientes foram avaliados através da aplicação do Mini International Neuropsychiatric Interview (M.I.N.I. PLUS 5.0) e Medical Outcomes Short-Form Health Survey (SF-36). RESULTADOS: A etiologia da doença hepática mais prevalente foi o vírus da hepatite C. Prevalência de 50,8% de pelo menos um transtorno mental foi identificada. Quando o abuso/dependência de álcool foi excluído, a prevalência foi de 25,8%. A saúde mental não apresentou diferença estatisticamente significante nos diversos grupos etiológicos. Maior prevalência de comorbidades psiquiátricas foi detectada entre mulheres e menores de 40 anos. Não foram detectados casos de transtornos psicóticos, possivelmente pela não inclusão destes pacientes na lista. Não houve diferença nos domínios de qualidade de vida nos diferentes grupos etiológicos. CONCLUSÃO: Uma alta prevalência de transtornos psiquiátricos foi encontrada nos pacientes com todas as condições clínicas mais associadas à indicação de transplante hepático. Chama a atenção a ausência de pacientes com transtornos psicóticos, o que sugere que possivelmente o transplante não tem sido indicado para esse grupo de pacientes. Por esses motivos, os profissionais que cuidam de candidatos ao transplante de fígado devem ser altamente vigilantes para a presença de transtornos mentais, independentemente da etiologia da doença hepática. A atenção especializada é recomendada para os pacientes com transtornos mentais, com minimização de exclusão precoce da lista de pacientes sem outras possibilidades terapêuticas.
Subject(s)
Humans , Male , Female , Adult , Young Adult , Quality of Life/psychology , Waiting Lists , Liver Transplantation/psychology , Mental Disorders/psychology , Psychiatric Status Rating Scales , Socioeconomic Factors , Prevalence , Cross-Sectional Studies , Middle AgedABSTRACT
Abstract Human T-cell lymphotropic virus type 1 (HTLV-1) has low prevalence rates, but is endemic in some regions of the world. It is usually a chronic asymptomatic infection, but it can be associated with serious neurologic and urinary conditions. Hepatitis C virus (HCV) is broadly spread out worldwide. The majority of these infections have a chronic course that may progress to cirrhosis and hepatocellular carcinoma. Objectives: To compare sociodemographic and mental health (risk behaviors, depression, and suicide) aspects, and quality of life among patients with HCV or HTLV-1. Methods: Observational, comparative and cross-sectional study involving outpatients with HCV or HLTV-1 infection. Sociodemographic characteristics, risk behaviors and quality of life were assessed through the questionnaires Mini International Neuropsychiatric Interview - MINI Plus (depression and suicide) and Medical Outcomes Study 36-Item Short-Form Health Survey (quality of life). Univariate and multivariate statistical analyses (hierarchical logistic regression) were conducted. Results: 143 individuals with HCV and 113 individuals with HTLV-1 infection were included. Males were predominant in the HCV group (68.8%) and females in the HTLV-1 group (71.7%). The frequency of risk behaviors (sexual and drug use) was greater in those with HCV (p < 0.05). A past depressive episode was more common in the HTLV-1 group (p = 0.037). Quality of life was significantly worse in the physical functioning, vitality, mental health, and social functioning domains in those with HTLV-1 (p < 0.05). HTLV-1 infection remained independently associated with worse quality of life in multivariate analysis. Conclusions: Risk behaviors are frequent among those infected with HCV. Additionally, despite HTLV-1 being considered an infection with low morbidity, issues related to mental health (depressive episode) and decreased quality of life are relevant.