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1.
J Acad Consult Liaison Psychiatry ; 64(4): 357-370, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37003570

RESUMO

We present Academy of Consultation Liaison Psychiatry best practice guidance on depression in solid organ transplant (SOT) recipients, which resulted from the collaboration of Academy of Consultation Liaison Psychiatry's transplant psychiatry special interest group and Guidelines and Evidence-Based Medicine Subcommittee. Depression (which in the transplant setting may designate depressive symptoms or depressive disorders) is a frequent problem among SOT recipients. Following a structured literature review and consensus process, the Academy of Consultation Liaison Psychiatry transplant psychiatry special interest group proposes recommendations for practice: all organ transplant recipients should be screened routinely for depression. When applicable, positive screening should prompt communication with the mental health treating provider or a clinical evaluation. If the evaluation leads to a diagnosis of depressive disorder, treatment should be recommended and offered. The recommendation for psychotherapy should consider the physical and cognitive ability of the patient to maximize benefit. The first-line antidepressants of choice are escitalopram, sertraline, and mirtazapine. Treating depressive disorders prior to transplantation is recommended to prevent posttransplant depression. Future research should address the mechanism by which transplant patients develop depressive disorders, the efficacy and feasibility of treatment interventions (both pharmacological and psychotherapeutic, in person and via telemedicine), and the resources available to transplant patients for mental health care.


Assuntos
Depressão , Transplante de Órgãos , Humanos , Antidepressivos/uso terapêutico , Depressão/diagnóstico , Depressão/terapia , Saúde Mental , Transplante de Órgãos/efeitos adversos , Psicoterapia/métodos
2.
Transplant Rev (Orlando) ; 36(2): 100694, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35537285

RESUMO

Transplant patients are frequently treated with substances that have dependence potential and/or they may have a history of substance use disorders. The Psychosocial and Ethics Community of Practice of the American Society of Transplantation formed a Drug Testing Workgroup with participation from members of the Pharmacy Community of Practice and members of the Academy of Consultation-Liaison Psychiatry. The workgroup reviewed the literature regarding the following issues: the role of drug testing in patients with substance use disorders, for patients prescribed controlled substances, legal, ethical and prescription drug monitoring issues, financial and insurance issues, and which patients should be tested. We also reviewed current laboratory testing for substances. Group discussions to develop a consensus occurred, and summaries of each topic were reviewed. The workgroup recommends that transplant patients be informed of drug testing and be screened for substances prior to transplant to ensure optimal care and implement ongoing testing if warranted by clinical history. While use of certain substances may not result in the exclusion for transplantation, an awareness of the patient's practices and possible risk from substances is necessary, allowing transplant teams to screen for substance use disorders and ensure the patient is able to manage and minimize risks post-transplant.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Consenso , Humanos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Estados Unidos
3.
Crit Care Clin ; 24(4): 949-81, x, 2008 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-18929948

RESUMO

Intensive care unit teams are a critical part of the solid organ transplant process. The psychosocial issues involved during critical periods of transplantation are important for intensive care physicians and clinicians to understand to provide comprehensive care to transplant patients. This article provides a brief overview of transplant epidemiology, followed by a review of the psychosocial issues relevant to the phases of the transplant process. Considered are the pretransplant evaluation phase, psychiatric disorders in transplant patients, and cognitive impairments and delirium with additional issues specific to particular organs. Also covered are the side effects of immunosuppressive medications and special issues arising with living donors.


Assuntos
Transtornos Cognitivos/diagnóstico , Transtornos Cognitivos/etiologia , Cuidados Críticos/métodos , Unidades de Terapia Intensiva/organização & administração , Doadores Vivos/psicologia , Transtornos Mentais/etiologia , Transplante de Órgãos/psicologia , Psicotrópicos/uso terapêutico , Condicionamento Pré-Transplante/métodos , Condicionamento Pré-Transplante/psicologia , Listas de Espera , Transtornos Cognitivos/classificação , Humanos , Doadores Vivos/estatística & dados numéricos , Doadores Vivos/provisão & distribuição , Transtornos Mentais/tratamento farmacológico , Transtornos Mentais/psicologia , Transplante de Órgãos/estatística & dados numéricos , Estados Unidos/epidemiologia
6.
Clin Infect Dis ; 40 Suppl 5: S286-91, 2005 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-15768336

RESUMO

BACKGROUND: Recent studies suggest that most patients with hepatitis C virus (HCV) infection commonly present to medical clinics with active psychiatric and substance use disorders. However, routine screening for these disorders is generally not done. OBJECTIVES: The purpose of our study was to assess prospectively the frequency of psychiatric and substance use disorders in patients presenting for initial assessment of a positive HCV antibody test result. METHODS: A sample of 293 patients represented the majority of patients scheduled for their initial hepatology clinic visit at the Portland Veterans Affairs Medical Center between September 2002 and September 2003. The patient screening questionnaire, Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and the Beck Depression Inventory (BDI-II) were administered to all patients. RESULTS: At screening, 93% of the patients had a current or past history of at least 1 psychiatric disorder, and 73% had >or=2 disorders. The most common disorders included depression (81%), posttraumatic stress disorder (62%), any substance use disorder (58%), bipolar disorder (20%), and other psychotic disorders (17%). One hundred two patients (35%) had baseline BDI-II scores in the moderate-to-severe range of depression (>19), and 61 (21%) had AUDIT-C scores indicating current heavy alcohol use (>or=4). CONCLUSIONS: Psychiatric and substance use disorders are highly prevalent among veterans with chronic hepatitis C. Thirty-five percent have significant symptoms of depression before the initiation of treatment with interferon (IFN). Routine screening for underlying psychiatric and substance use disorders and early treatment intervention before initiating antiviral therapy is essential to prevent worsening of depression and to optimize the outcome of treatment with IFN. Comanagement treatment models involving mental health care may expand the pool of patients eligible to receive treatment with IFN, as well as enhance treatment outcomes.


Assuntos
Hepatite C/epidemiologia , Programas de Rastreamento , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas , Comorbidade , Atenção à Saúde , Depressão/classificação , Gerenciamento Clínico , Feminino , Hepatite C/complicações , Hepatite C/terapia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Programas de Rastreamento/normas , Transtornos Mentais/complicações , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Oregon/epidemiologia , Estudos Prospectivos , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários , Veteranos
7.
Psychosomatics ; 45(4): 354-60, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15232051

RESUMO

Immunosuppressants are prescribed to prevent rejection of transplanted tissues and organs and are also used in the treatment of autoimmune disorders. Consultation-liaison psychiatrists increasingly encounter patients taking these agents as the number of transplant recipients increases and the indications for the use of immunosuppressants expands. These drugs have potentially deleterious physical, mental, and biochemical side effects. In addition, transplant recipients and patients with autoimmune disorders commonly have comorbid illnesses that require pharmacologic treatment. The management of these patients is challenging secondary to the severity of these illnesses, the number of medications prescribed, and the potential for adverse drug-drug interactions. Knowledge of the pharmacokinetic properties of these drugs and the potential for serious drug-drug interactions that cause alterations in serum levels of the immunosuppressant medications is essential. Increased serum levels may cause serious toxic effects and decreased serum levels may lead to rejection of the transplanted organ or worsening of the autoimmune disorder. Adverse events may also occur when serum levels of medications prescribed for comorbid illnesses are altered by administration of immunosuppressants. The pharmacokinetic drug-drug interaction profiles of the glucocorticoids, cyclosporine, tacrolimus, sirolimus, mycophenolate mofetil, azathioprine, and monoclonal antibodies are discussed in this review.


Assuntos
Imunossupressores/efeitos adversos , Imunossupressores/farmacocinética , Psicotrópicos/efeitos adversos , Interações Medicamentosas , Humanos
8.
Psychiatr Clin North Am ; 25(1): 195-209, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11912940

RESUMO

It is unfortunate that LT is not the ultimate sobering experience. LT patients can and do relapse; however, relapse to alcohol or substance use should no more be considered a failure of LT than the recurrence of HCV after LT. It is a phenomenon of their addiction. As a group, the survival and outcomes of patients undergoing LT for ALD are not significantly different from those undergoing LT for other causes. The fact that few patients return to heavy and deleterious alcohol or substance use attests to the success of programs in selecting patients capable of caring for themselves and their livers after LT. In the pre-LT phase, establishing the correct addiction diagnosis is essential so that those at highest risk can be carefully monitored. Although information is emerging about other risk factors for relapse, the authors caution against considering patients with these characteristics as being categorically unfit for LT. Each individual is unique, and such factors should guide clinical decision making rather than being absolute contraindications. After LT, clinical interviews, preferably by a trained psychiatric physician or clinician, are essential to monitoring alcohol and substance use, and surveillance early on is required. Much work needs to be done with respect to substance use and relapse after LT because few studies have explored these issues. In addition, the special treatment needs of those who relapse has not been addressed. Treatment research is underway but has relied on traditional strategies that are not always applicable to LT recipients. Further areas to improve clinical care include improving health behaviors, specifically, smoking cessation. The authors anticipate that, in the near future, the ongoing work in this area will provide information and guidance to physicians and clinicians caring for these unique patients.


Assuntos
Alcoolismo/reabilitação , Drogas Ilícitas , Transplante de Fígado/psicologia , Abuso de Substâncias por Via Intravenosa/reabilitação , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Alcoolismo/psicologia , Ensaios Clínicos como Assunto , Humanos , Drogas Ilícitas/efeitos adversos , Recidiva , Fatores de Risco , Abuso de Substâncias por Via Intravenosa/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Temperança/psicologia
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