THE '4 Ds': ADDRESSING MENTAL HEALTH ISSUES IN HEART AND LUNG TRANSPLANT RECIPIENTS

ABSTRACT

Mental health (MH) issues related to COVID-19 can arise at each of the following stages Onset (managing fear, uncertainty, stigma) and re-emerging MH problems;Acute (managing panic, fear, delirium, isolation);Long COVID (managing the cognitive, emotional, physical sequelae of COVID-19 and differentiating from pre- COVID 'unfinished emotional business' that has arisen;and Recovery (adjusting to full recovery or a 'new normal'). This talk will address the issues seen in post-COVID-19 follow-up in relation to these stages. Consultation-liaison psychiatry's role throughout the transplant journey from assessment to post-transplant management. This has grown in importance as the range of potential recipients has grown to include people who are older, and with more evidence of the '4 Ds' (depression, disordered personality, delirium, decline in cognitive function). Several innovations to the assessment process have improved outcomes in predicting delirium, survival, and intensive care unit (ICU)/hospital stays. First, addition of frailty assessment and the effects of adding depression and cognitive capacity to the standard frailty score. While depression improves post-transplantation, cognitive function tends not to. Similarly, patients with high scores on the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) are at increased risk of adverse outcomes (delirium, poor post-transplant adherence and increased ICU/hospital stays). Findings: The implications of these findings will be discussed.