Predictive value of psychosocial assessment for the mortality of patients waiting for liver transplantation

Selecting suitable candidates for liver transplantation is the most challenging task of pre-transplant evaluation. In addition to somatic assessment, psychosocial evaluation has been proven important in identifying patients at high risk of potential failure. The Transplant Evaluation Rating Scale (TERS) is a widely used rating instrument for the assessment of psychosocial risk factors before liver transplantation. The aim of this study was to explore the predictive value of TERS for mortality in liver transplant patients before and after transplantation. The medical records of patients referred for psychiatric evaluation before liver transplantation between 2003 –2013 were analysed. Administering TERS was part of the pre-transplant evaluation. The TERS scores of patients who died before and after transplantation were compared with those who survived following transplantation. One hundred and sixteen patients were referred for pre-transplant psychiatric evaluation. Patients with successful liver transplants scored significantly lower on TERS than those who died before transplantation (30.65 ± 6.06 vs. 34.75 ± 8.25, p = .031). Patients who died after transplantation scored significantly better on TERS than those who died before transplantation (28.79 ± 2.81 vs. 34.75 ± 8.25, p = .003). There was no significant difference between the deceased and surviving transplanted patients’ TERS scores (28.79 ± 2.81 vs. 31.19 ± 6.66, p = .365). TERS appears to be a suitable rating instrument to help select candidates who have higher chance to survive prior to transplantation but it could not predict post-transplant mortality.     

A Psychometric Normative Database for Pre-Lung Transplantation Evaluations

This study describes the quality of life and psychological characteristics of a large sample (N = 201) of adult patients evaluated for lung transplantation. In light of the interdisciplinary nature of pre-lung transplant evaluations, establishing norms for measures commonly used in the assessment of transplant candidates has been a priority for the University of Florida transplant programs. Forty-eight percent of the patients reported symptoms of mild to moderate depression. Although quality of life indices were associated with disease severity and exercise tolerance, psychosocial measures generally were not. These data contribute uniquely to the transplant literature and provide valuable normative information on the largest lung transplant cohort reported to date.     

A biopsychosocial approach to liver transplant evaluation in two patients with Wilson's disease

Wilson's disease (WD) is characterized by hepatic, neurological, and/or psychiatric disturbances. In some cases, liver transplantation is indicated. Because psychologists and other health care workers play an increasing role in the evaluation of individuals presenting for transplant, an understanding of the heterogeneous phenotype of WD is important for mental health professionals working in medical settings. This article reviews two cases of patients with WD (one probable, one confirmed) presenting for liver transplantation and a biopsychosocial assessment approach is demonstrated. Patients are presented in terms of medical, psychiatric, and psychosocial history, neuropsychological examination results, and the subsequent indications for liver transplantation. Both patients exhibited neurocognitive and psychiatric symptoms. One patient was determined to be a marginally suitable candidate for transplantation, whereas the other was considered at high risk for negative outcome post-transplant. This article demonstrates the importance of considering phenotypic presentation, neurocognitive function, psychiatric status, and psychosocial circumstances in assessing transplant readiness in patients with WD. A comprehensive and integrative biopsychosocial assessment approach is appropriate for evaluating patients with WD presenting for liver transplantation.     

Effect of a Single Session of a Yogic Meditation Technique on Cognitive Performance in Medical Students: A Randomized Crossover Trial

Medical students confront enormous academic, psychosocial, and existential stress throughout their training, leading to a cascade of consequences both physically and psychologically. The declined cognitive function of these students interferes in their academic performance and excellence. The purpose of this study was to examine the effectiveness of a yogic meditation technique, mind sound resonance technique (MSRT), on cognitive functions of University Medical students in a randomized, two-way crossover study. In total, 42 healthy volunteers of both genders (5 males and 37 females) with mean age of 19.44 ± 1.31 years were recruited from a medical college in South India, based on the inclusion and exclusion criteria. A 10-day orientation in the technique of MSRT was given to all the recruited subjects after which each subject underwent both MSRT and supine rest (SR) sessions. All participants were randomized in a 1:1 ratio to receive a session of either MSRT or SR. After a day of washout, participants crossed over to receive the alternative intervention. The cognitive functions were assessed using 2 paper-pencil tasks called Digit Letter Substitution Test (DLST) and Six-Letter Cancelation Task (SLCT), before and immediately after both sessions. Both the groups showed significant improvement in net attempt of both DLST and SLCT, but the magnitude of change was more in the MSRT group than in the SR group. The MSRT group demonstrated significantly enhanced net scores in both SLCT (p < 0.001) and DLST (p < 0.001). The result of the present study suggests that a single session of MSRT, a Mind–Body Practice, may positively impact the performance in cognitive tasks by the University Medical Students.     

围手术期负荷剂量他汀对急性ST段抬高型心肌梗死患者预后的影响

为了探讨围手术期给予阿托伐他汀负荷剂量对急性ST段抬高型心肌梗死（STEMI）患者急诊经皮冠状动脉介入治疗（PCI）后对心血管事件的影响。选取因STEMI行急诊PCI术患者160例,其中80例于PCI术前给予阿托伐他汀负荷剂量40mg,80例术前未给予阿托伐他汀负荷剂量进行研究。分析两组患者住院期间肌酸激酶同工酶与超敏C反应蛋白值,PCI术后与术后1个月心功能情况。结果显示围手术期阿托伐他汀负荷剂量组主要心血管事件发生率优于非阿托伐他汀组（P〈0．05）。因此,围手术期给予负荷剂量的阿托伐他汀可以降低住院期间不良心血管事件的发生率,改善患者预后。     

Quality of Life in Women Following Various Surgeries of Body Manipulation: Organ Transplantation, Mastectomy, and Breast Reconstruction

This study aimed to determine biopsychosocial differences (anxious-depressive symptomatology and quality of life) among three groups of patients who underwent surgical interventions related to body manipulation, as well as to assess the clinical significance of these results versus reference values. Four groups were compared: women who underwent organ transplant (n = 26), mastectomy for breast cancer (n = 36), breast reconstruction (n = 36), and general population (n = 608). The Hospital Anxiety and Depression Scale and the EORTC QLQ-C30 were used. Women who underwent mastectomy showed the highest anxious-depressive symptomatology and quality-of-life impairment in comparison to the remaining groups, and they also displayed the most clinically significant deterioration in the majority of dimensions (large effect sizes). In contrast, the group with implantation of a healthy organ (transplantation) only showed higher biopsychosocial impairment than the group with reconstruction of an organ (breast reconstruction) in gastrointestinal dysfunctions and in the global self-perception of health.     

Psychische Betreuung von Patienten und Angehörigen in der Transplantationsmedizin

During the decision making process and waiting period before organ transplantation patients and their families often suffer from psychological distress. After transplantation a subgroup of patients keeps showing psychological symptoms and also impairments of quality of life. Psychological treatment manuals are often demanded, but are rarely achieved. This study describes the experience with a low frequent (8 sessions/year) therapeutic group for lung transplant candidates. The group, which is based on a cognitive behavioural concept, is lead by a physician (internal medicine), a psychotherapist and a physiotherapist. This therapeutic group has been continuously offered for patients and their caregivers for the past 7 years. About 50% of all patients participated in this program before transplantation, after transplantation only a few patients visited the group sessions. On average 12 patients and 8 caregivers visited each session. One problem for these patients with severe lung-disease was the long distance between patient’s homes and the hospital. This has been the reason for self-help organisations to demand better psychotherapeutic outpatient support for patients and their families before and after organ transplantation.     

Psychosocial Factors in Noncompliance During Liver Transplant Selection

This exploratory study attempted to identify characteristics of patients selected for transplant compared to those who had not demonstrated 6 months alcohol, drug and tobacco abstinence at the time of candidacy assessment. In a consecutive sample of 112 patients referred for liver transplant, almost half failed this criteria. Comparisons on psychometric measures of coping, social support, and health status revealed noncompliant patients to be significantly less authority abiding, less concerned about their illness, and less spiritually-oriented. Persisting alcohol use was paradoxically associated with greater psychosocial support whereas depression was related to smoking. Prior drug use was associated with more cognitive symptom complaints, emotional constriction, a vulnerability to feel dejection and a proneness to abuse medications These findings were discussed as a possible opportunity to identify and address characteristics of transplant candidates to reduce their risk of perpetuating noncompliance while competing for a life saving intervention.     

Impact of outpatient non-myeloablative haematopoietic stem cell transplantation in quality of life vs. conventional therapy

The role of outpatient hematopoietic stem cell transplantation (HSCT) as a therapeutic tool has been strengthened significantly because of the increasing number of patients undergoing this treatment. Due the very nature of this procedure, one of the aspects that should not be overlooked is the quality of life (QOL) of patients undergoing HSCT. Thus, one must consider not only health status after treatment, but also, the psychosocial implications for the patient. This is an observational, longitudinal, and prospective study to assess QOL in patients undergoing outpatient HSCT vs. similar patients receiving medical treatment (MxTx). By applying the COOP/WONKA charts on five occasions (pre-HSCT/initial, post-HSCT/first month, and at 3, 6, and 9 months), thirty-eight patients were analysed, 19 with HSCT and 19 with MxTx with no differences in age, gender or diagnosis. The initial survey found significant differences only in pain perception, which was higher in the HSCT group (p = .08); at the first month, there was a greater tendency for feelings of depression or anxiety in the HSCT group (p = .016), with more limitations in social (p = .003) and daily (p = .044) activities. From 3 months post-HSCT, the results were very similar. The differences persisted only in the area of social activities. Four patients developed graft-versus-host disease with no significant difference in the scores obtained compared to other transplant patients at 3, 6, and 9 months (p = .26) of follow-up.     

The dermatology life quality index (DLQI) and the hospital anxiety and depression (HADS) in Chinese rosacea patients

The study aims to investigate the quality of life (QOL) and the psychological situation in Chinese patients with rosacea. A total of 196 healthy controls and 201 rosacea patients were involved in the final analysis. The general information, the Dermatology Life Quality Index (DLQI) and the Hospital Anxiety and Depression Scale (HADS) were collected. Significantly higher DLQI, anxiety and depression score were observed in the rosacea group compared to the control group (p < .01). Total DLQI score of patients was positively related with anxiety (r = .526, p < .001) and depression scores (r = .399, p < .001) in HADS. Rosacea had significant psychological impact on Chinese patients and had substantial influence on their QOL. Physicians should address the psychosocial needs of rosacea patients as much as its physical symptoms.     

Parental Problem-Solving Abilities and the Association of Sickle Cell Disease Complications with Health-Related Quality of Life for School-Age Children

Children with sickle cell disease (SCD) are at risk for poor health-related quality of life (HRQOL). The current analysis sought to explore parent problem-solving abilities/skills as a moderator between SCD complications and HRQOL to evaluate applicability to pediatric SCD. At baseline, 83 children ages 6–12 years and their primary caregiver completed measures of child HRQOL. Primary caregivers also completed a measure of social problem-solving. A SCD complications score was computed from medical record review. Parent problem-solving abilities significantly moderated the association of SCD complications with child self-report psychosocial HRQOL (p = .006). SCD complications had a direct effect on parent proxy physical and psychosocial child HRQOL. Enhancing parent problem-solving abilities may be one approach to improve HRQOL for children with high SCD complications; however, modification of parent perceptions of HRQOL may require direct intervention to improve knowledge and skills involved in disease management.     

Acceptance of Illness Among Patients Pursuing Transplantation or Left Ventricular Assist Device

Acceptance of illness is related to better mental health among patients with chronic illness; however, this construct has not been evaluated as part of routine transplantation evaluations. The purpose of this study was to create a brief measure of acceptance of illness for patients pursuing organ transplantation and examine how acceptance is related to distress. Retrospective medical record reviews were conducted for 290 patients who completed a routine psychosocial evaluation prior to transplant listing which included the Illness Acceptance Scale (IAS). Internal consistency for the IAS was excellent (Cronbach’s alpha?=?.92). Illness acceptance was negatively correlated with depression, anxiety, and catastrophizing and was not related to health literacy or health numeracy. The IAS is a reliable and valid measure for patients who are pursuing thoracic transplant or left ventricular assist device. Clinicians may want to screen transplant candidates for illness acceptance and refer those with lower levels to psychological interventions.

     

浅谈肝移植术后患者长期随诊的临床意义

回顾性分析肝移植术后随访中的临床与非临床因素对移植物和受体长期存活的影响。选择术后3年以上病例,在并发症的诊断处理、患者各种非医疗不良因素（依从性）方面调查分析和总结。结果多数术后患者均能有良好的依从性,配合移植医师的术后治疗、随访及心理健康指导,但有些患者因为个人、医院等原因不能很好地得到随访,发生并发症及不能及时处...     

The Adaptation of Patients During the Hospitalization Period of Bone Marrow Transplantation

A longitudinally study was conducted among 42 bone marrow transplantation (BMT) patients to investigate the association between pretransplant psychosocial variables and psychophysiological outcomes during the immediate convalescence period. Family relationships (cohesion, expressiveness, and conflict) and coping resources (cognitive, social, emotional, spiritual/philosophical, and physical resources) were assessed on the admission day (Day –7 Time 1). Data on psychological distress and pain intensity were obtained on Day +7 (Time 2) and Day +14 (Time 3). The average scores at Times 2 and 3 were computed to indicate the overall adjustments of the patients during the hospitalization period after the day of actual transplant (Day 0). It was shown that higher expressiveness family relationships and higher resources to cope effectively with stressful situations were associated with less psychological distress during the above period. Both pretransplant psychosocial variables were not associated with pain intensity during hospitalization. Allogeneic transplant patients reported higher pain intensity than did autologous transplant patients. Psychological distress and pain intensity were positively correlated with each other. Our findings show that pretransplant family relationships and coping resources associate moderately with psychological distress during the immediate convalescent period of BMT. The present findings support the family-centered approach to BMT care and provide a scientific basis for pretransplant psychosocial interventions.     

II. Symposium für Empirische Forschung in der Forensischen Psychiatrie, Psychologie und Psychotherapie am 25. und 26. Oktober 2012 in Hamburg

The Second Symposium for Empirical Research in Forensic Psychiatry, Psychology and Psychotherapy was held on 25th–26th of October 2012 in Hamburg. The symposium offers young scientists in the field the opportunity to present their research studies. In total 15 papers were presented at the symposium which will be briefly described in this article. The following four topics were discussed:

1. Innovative measurement tools for violent and sexual offenders,
2. Risk assessment tools for violent and sexual offenders,
3. Physiological and neuropsychological assessment of violent and sexual offenders,
4. Treatment approaches for violent and sexual offenders.

The conference is organized annually either by the University Medical Center Hamburg-Eppendorf (Institute for Sex Research and Forensic Psychiatry), the Saarland University Medical Center (Institute for Forensic Psychology and Psychiatry) or the Asklepios Medical Center Göttingen (Ludwig-Meyer-Institute for Forensic Psychiatry and Psychotherapy). The best three research presentations are honoured with the Ludwig Meyer Award of the Asklepios Psychiatry Niedersachsen GmbH, the Eberhard Schorsch Award of the German Society for Sex Research and the Hermann Witter Award of the Southwest German Academy of Forensic Psychiatry. The proceedings of the conference are expected to be published in autumn 2013 by the Wissenschaftliche Verlagsgesellschaft Berlin.     

活体肝移植伦理相关问题的质性研究

活体肝移植术虽部分解决了供肝短缺问题,但需从活的供体身上切取部分肝脏,使其承担手术创伤甚至死亡的风险,故存在诸多伦理问题。本文应用质性研究,对7名与活体肝移植相关的不同领域专家及6名手术相关者进行访谈,采用 Nvivo9．0软件辅助对访谈资料进行了分析。探讨活体肝移植的伦理审查、供体选择及心理评估的相关伦理问题。结果显示,尽管活体肝移植手术仍在全国多家医院进行,目前政府对活体肝移植伦理审查和监管更加严格,伦理审查缺少对供体、受体的心理综合评估。因此,建议建立健全并推广死亡器官捐赠注册系统以增加肝源,减少活体肝移植对供体带来的健康风险,并开发适用的心理综合评估工具,评估结果应列入伦理审查范围。     

Psychological assessment of quality of life following liver transplantation

Administered measures of functional status, psychological distress, and quality of life to a consecutive series of 48 liver transplant recipients in follow-up clinic. Results showed that nearly total functional recovery was the norm. Thirty-six patients (75%) had a Karnofsky Performance Status (KPS) score of 80–100. Twelve transplant recipients had KPS scores below 80; none were employed, and most had been transplanted within 1 year. In spite of their impaired financial status, eight of these 12 reported being mostly satisfied on the self-report Quality-of-Life Scale (QLS). For the posttransplant sample as a whole, 83% were mostly satisfied with their quality of life. Pre- and posttransplant patient samples were not significantly different in reporting mild emotional distress. Results for the small subgroup with significant objective or subjective problems in achieving acceptable quality of life following liver transplantation were reviewed. Higher than normal emotional distress on the Symptom Checklist (SCL-90-R) was consistently reported by these patients. Prospective studies are needed to identify predictor variables of quality-of-life problems and to develop prevention and rehabilitation interventions.     

Body-image,quality of life and psychological distress: a comparison between kidney transplant patients and a matching healthy sample

The purpose of the current study was to assess the uniqueness of the condition of kidney transplant recipients in comparison to a sample of matching healthy peers in relation to body-image dissatisfaction and identification, quality of life and psychological distress. Participants were 45 kidney transplant recipients who were under follow-up care at a Transplant Unit of a major Medical Center, and a sample of 45 matching healthy peers. Measures were taken using self-report questionnaires [Body-Image Ideals Questionnaire (BIIQ), Body Identification Questionnaire (BIQ), Brief Symptoms Inventory (BSI), and the SF-12]. The major findings were the following: (i) kidney transplant recipients reported lower levels of quality of life and higher levels of PsD when compared to their healthy peers; (ii) no difference in body-image dissatisfaction was found between the two studied groups; (iii) significant correlations between body-image dissatisfaction quality of life and PsD were found only in the kidney transplant recipients. The kidney transplantation condition has a moderating effect in the association between body-image dissatisfaction PsD but not in the association between body-image dissatisfaction and quality of life; (iv) kidney transplant recipients experienced higher levels of body identification than did their healthy peers. Taken together, these findings highlight the unique condition of kidney transplant recipients, as well as the function that body-image plays within the self.     

Group Psychotherapy in France

This article discusses group therapy as part of a multidisciplinary approach to the management of the various psychological and physical rehabilitation concerns posed by kidney and liver transplant candidates and recipients at Howard University Hospital in Washington, DC. The group's history, format, intervention foci, and roles of clinicians and patients attending the group are described and evaluated. Given the relative paucity of research literature in this area, the authors offer recommendations for empirical evaluation of the benefits of multidisciplinary group psychotherapy in ameliorating physical and emotional suffering and prolonging life among transplant patients.