Post-traumatic stress disorders, mood disorders, and quality of life in transplant recipients with acute liver failure.

OBJECTIVE: The objective of this study was to assess post-traumatic stress disorder (PTSD), depression, anxiety, and quality of life among acute hepatitis patients undergoing liver transplantation. METHOD: Twenty-four patients underwent transplantation due to acute liver failure. After a brief anamnestic interview to gather demographic and clinical information, each participant underwent a psychological assessment using the SF-36 Health Survey (SF-36), Impact of Events Scale-Revised (IES-R), Hospital Anxiety and Depression (HAD) Scale, as well as Beck Depression Inventory (BDI). RESULTS: The average age of the patients was 41.17 years (±17.03); the mean time after transplantation was 13.50 ± 13.80 months; 83% of the subjects were women. Anxiety symptoms were observed in 33.2% of the participants and depression in 16.7% by HAD and 45.8% by BDI. By IES-R 46.2% of patients presented high to severe levels of stress. The majority of participants (54.2%) showed good quality of life scores. A correlation analysis indicated a significant negative association between SF-36 score and other scales (from -0.514 to -0.681). Upon a comparative analysis, a significant difference between groups was only noted in SF-36 score (P = .032). CONCLUSION: The results led us to conclude that anxiety, depression, and PTSD were negatively associated with quality of life in this population. These symptoms also contributed directly to determine well-being among these patients.

Neuropsychological assessment in kidney and liver transplantation candidates.

INTRODUCTION: Chronic renal and liver diseases are associated with cognitive and intellectual impairment, which can be irreversible even after kidney or liver transplantation. OBJECTIVE: We sought to investigate the presence of cognitive deficits in organ transplantation candidates. METHODS: From May 2005 to March 2006, 35 organ transplantation candidates, of mean age 46.71 (+/- 13.01) years, 54.3% including females and 7.29 (+/- 4.22) years mean formal schooling. Of those, 27 (77%) were renal and 8 (23%), liver transplantation candidates. All subjects underwent a neuropsychological assessment battery designed to evaluate attention performance, executive functions, memory, language, visuaospatial, and intellectual skills. RESULTS: We found impairments in attention performance (attention span [34.3%], sustained attention [76.5%], and divided attention [77.8%]), executive functions (category formation [58.3%], errors [61.5%], and perseverative errors [30.4%]), memory (working memory [57.1%], verbal [37.1%] and visual short-term memory [31.4%], verbal [25.7%] and visual long-term memory [51.4], verbal learning [42.9%], interference susceptibility [42.9%], and verbal recognition memory [20.6%]), language (comprehension [38.1%], and vocabulary [30.8%]), visuaospatial (45.8%), and intellectual skills (50.0%). CONCLUSION: Neuropsychological (cognitive) deficits in transplant candidates are frequent, regardless of the kind of transplantation. The deficits involve several cognitive skills, such as attentional processes, executive functions, memory, language, visuaospatial, and intellectual skills. Therefore, we concluded that a pretransplant neuropsychological assessment is an important measure to detect impairments and to help understand how these difficulties can interfere with patient self-care before and after transplantation.

Psychosocial profile of patients on the liver transplant list.

INTRODUCTION: Researchers have shown that psychosocial factors influence adherence to treatment and, consequently, prognosis. Psychosocial assessment during the preoperative outpatient phase has allowed physicians to make better treatment decisions. OBJECTIVES: We sought to describe the psychosocial profile of patients on the liver transplant list referred for psychological assessment. METHOD: We reviewed all files of patients referred for pretransplant psychological assessment over a 14-month period. RESULTS: The sample included 73 patients: mean age 49.46 +/- 11.18 years and; mean formal schooling 7.35 +/- 4.65 years. Of those, 56.1% reported a cognitive complaint; 33%, symptoms of anxiety, and 17%, depression. Of the sample, 45.8% were referred for alcohol use, and 37.5% for mood changes. During the assessment, 15.9%, 34.4%, and 1.6%, of patients reported using alcohol, tobacco, or some other type of drug, respectively. Of patients, 53.6% reported having used alcohol at some point in their life-26% tobacco and 10.9% some other type of drug. After the assessment, the main referrals were 35.6% to family counseling, 32.1% to cognitive assessment, and 28.5% to psychological counseling. CONCLUSION: This study highlighted the prevalence of cognitive complaints and current/previous use of chemical substances. These findings were identified through psychological inquiry, which was able to direct the individual treatments. Although these conditions prevailed among this population, their early detection allowed for early intervention to improve adherence and minimize possible intervening problems.