Intervención psiquiátrica en programa de trasplantes / Psychiatric intervention in a transplantation program

En los últimos años la Psiquiatría de Enlace e Interconsulta ha experimentado un salto cualitativo, acercándose al espacio común del resto de las especialidades médicas: el hospital general. La participación de psiquiatras en programas clínicos específicos como las unidades de trasplantes de órganos sólidos tiene fundamentaciones técnicas precisas dada la correlación entre síntomas psíquicos y las características clínicas específicas de las enfermedades médicas que requieren de este procedimiento. Cada vez hay una mayor preocupación en los clínicos y cirujanos en relación a los factores psíquicos que obstaculizan la adherencia a los tratamientos e indicaciones médicas tanto antes como después de efectuado el trasplante. La población de pacientes pre y post-trasplantados exhiben elevadas tasas de cuadros psiquiátricos específicos que ameritan un tratamiento coordinado multidisciplinario. El objetivo de este trabajo es mostrar la experiencia inicial que estamos desarrollando en la Unidad de Trasplantes de Clínica Las Condes.

In recent years consultation-liaison psychiatry has experienced a quantum leap closer to the common space of the other medical specialties: the general hospital. The participation in clinical programs such as the units of solid organ transplants have required technical arguments given the correlation between psychiatric symptoms and the clinical features of specific medical illness that require this procedure. During the last time, there have been and increasingly concern among clinicians and surgeons in regard to the psychological factors that affect the adherence to treatment and medical advice before and after transplant. The population concerning pre and post transplantation issues, exhibits significant rates of specifics psychiatric disorders which require evaluation and drug treatment specialist coordination. The aim of this paper is to show the initial experience we have developed in the transplant unit of Clínica Las Condes, concerning psychiatric and psychosocial issues.

The Incidence and Risk Factors of Psychiatric Complications in Electrical Injury

PURPOSE: Electrical injuries may cause many psychiatric complications such as depression, acute stress disorder, post-traumatic stress disorder (PTSD), etc. The purpose is to search the incidence of psychiatric complications in electrical injury and to compare its associated risk factors with other burn and trauma. METHODS: We reviewed the medical records of 709 electrically injured patients who were admitted to Hanil General Hospital from 2002 to 2007. Psychiatric complications were defined as depression, acute stress disorder and PTSD according to DSM-IV. We sorted the medical records into demographics, hospitalization, electrical voltage, injured type, extent or site of burn and type of amputation. RESULTS: Total incidence of psychiatric complications was 27.5% (Depression; 15.8%, acute stress disorder or PTSD; 17.6%). High voltage injured patients had psychiatric complications 2.38 times higher than low voltage. Incidence of psychiatric complications were 1.83 times in 6~10% of BSA, 2.01 times in 11~20% and 2.41 times in 21~30% higher than in 0~5% of BSA. If the site of burn included face, psychiatric complications occurred 1.96 times more than other sites. Patients with history of minor and major amputation showed 2.39 and 7.70 times incidence of psychiatric complications, respectively. CONCLUSION: The risk factors of psychiatric complications were high voltage electrical injury, facial burn, extent of burn and history of amputation. If the patients have risk factors, earlier psychiatric consultation may help to manage the psychiatric complications of electrical injury.