Paradoxical Depression in Renal Transplant Recipients

Postoperative Delayed Paradoxical Depression After Uncomplicated Unruptured Intracranial Aneurysm Surgery

BACKGROUND

Postoperative delayed paradoxical depression (PDPD) is a psychiatric condition described in patients without a history of mood disorders who undergo major surgery without complications and become clinically depressed. PDPD has been recognized in major surgical interventions, including coronary artery bypass surgery. We sought to determine the incidence and potential factors associated with PDPD after surgical treatment of unruptured intracranial aneurysms.

METHODS

The cohort of 105 patients was derived from a prospective observational data set of 3788 consecutive cases of intracranial aneurysms accrued from 1991 to 2015. Starting in 2010, patients with PDPD were identified, and psychiatric treatment and outcomes were documented. Incidence of PDPD and baseline characteristics were analyzed. Multivariate logistic regression was performed to analyze associations of variables with PDPD. Patients with preoperative depression or bipolar disorder were excluded.

RESULTS

Of 105 patients, 10.5% (n = 11) were found to have newly diagnosed major depressive disorder after surgical treatment of intracranial aneurysms. By univariate and multivariate analysis, the only significant difference between the 2 groups was full return to daily activities (P = 0.017 and P = 0.029, odds ratio = 0.06, 95% confidence interval [0.00, 0.70]), which was a result and not a cause of PDPD. All 11 patients with PDPD recovered fully, 9 after psychotherapy and/or pharmacotherapy and 2 without intervention.

CONCLUSIONS

PDPD after uncomplicated unruptured aneurysm surgery can be surprising to the neurosurgeon and the patient and should be promptly identified and addressed to achieve a full recovery. PDPD can be interpreted as a mild variant of post-traumatic stress disorder.

Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

Organ trafficking is officially banned in several countries and by the main Nephrology Societies. However, this practice is widespread and is allowed or tolerated in many countries, hence, in the absence of a universal law, the caregiver may be asked for advice, placing him/her in a difficult balance between legal aspects, moral principles and ethical judgments.In spite of the Istanbul declaration, which is a widely shared position statement against organ trafficking, the controversy on mercenary organ donation is still open and some experts argue against taking a negative stance. In the absence of clear evidence showing the clinical disadvantages of mercenary transplantation compared to chronic dialysis, self-determination of the patient (and, with several caveats, of the donor) may conflict with other ethical principles, first of all non-maleficence. The present paper was drawn up with the participation of the students, as part of the ethics course at our medical school. It discusses the situation in which the physician acts as a counselor for the patient in the way of a sort of "reverse" informed consent, in which the patient asks advice regarding a complex personal decision, and includes a peculiar application of the four principles (beneficence, non-maleficence, justice and autonomy) to the donor and recipient parties.

Psychiatric consultation after kidney transplantation: a 10-year single-center study including outpatients in Japan

BACKGROUND

The aim of this study was to elucidate the clinical characteristics and frequency of psychiatric consultation in a routine clinical setting after kidney transplantation.

METHODS

Subjects were 1,139 consecutive recipients who received kidney transplantation at our hospital between January 1997 and September 2006. The hospital patient database was searched to determine whether these recipients received psychiatric consultation after their transplantation during this period.

RESULTS

Among 1,139 recipients, 118 (10%) received psychiatric consultation after their transplantation. There were significantly more women among these recipients (p = 0.036). Many of the recipients had received psychiatric consultation before transplantation (p < 0.0001) and had received dialysis for a long time (p = 0.018). There were three main psychiatric diagnoses according to ICD-10 diagnostic criteria in these 118 recipients: 42 (36%) had neurotic, stress-related, and somatoform disorders (F4); 35 (30%) had organic, including symptomatic, mental disorders (F0); and 27 (23%) had mood (affective) disorders (F3). The median length of time between kidney transplantation and initial psychiatric consultation was 57 days (interquartile range: 10-650 days). The lengths were 7 days (6-17 days) for F0, 75 days (18-650 days) for F4, 243 days (35-1,004 days) for F3, and 253 days (10-1,393 days) for other diagnostic groups. Significant differences were observed among these four groups (Jonckheere-Terpstra test, p < 0.001).

CONCLUSION

Our results show that appropriate psychiatric intervention is necessary not only in early stages after kidney transplantation but also over the long term.