Psychiatric characteristics of consecutively evaluated outpatient renal transplant candidates and comparisons with consultation-liaison inpatients

Psychosocial Assessments and Outcomes in Organ Transplantation

A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.

Prevalence of depression in chronic kidney disease: systematic review and meta-analysis of observational studies

Prevalence estimates of depression in chronic kidney disease (CKD) vary widely in existing studies. We conducted a systematic review and meta-analysis of observational studies to summarize the point prevalence of depressive symptoms in adults with CKD. We searched MEDLINE and Embase (through January 2012). Random-effects meta-analysis was used to estimate the prevalence of depressive symptoms. We also limited the analyses to studies using clinical interview and prespecified criteria for diagnosis. We included 249 populations (55,982 participants). Estimated prevalence of depression varied by stage of CKD and the tools used for diagnosis. Prevalence of interview-based depression in CKD stage 5D was 22.8% (confidence interval (CI), 18.6-27.6), but estimates were somewhat less precise for CKD stages 1-5 (21.4% (CI, 11.1-37.2)) and for kidney transplant recipients (25.7% (12.8-44.9)). Using self- or clinician-administered rating scales, the prevalence of depressive symptoms for CKD stage 5D was higher (39.3% (CI, 36.8-42.0)) relative to CKD stages 1-5 (26.5% (CI, 18.5-36.5)) and transplant recipients (26.6% (CI, 20.9-33.1)) and suggested that self-report scales may overestimate the presence of depression, particularly in the dialysis setting. Thus, interview-defined depression affects approximately one-quarter of adults with CKD. Given the potential prevalence of depression in the setting of CKD, randomized trials to evaluate effects of interventions for depression on patient-centered outcomes are needed.

Psychosocial aspects of living-related donor renal transplantation: Quality of life and mood in recipients, donors and controls

Due to the high frequency of living-related donor renal transplantation (LRDRT) in our country, we were concerned both about the recipient and the donor quality of life and psychological well-being. We investigated HRQL and mood in LRDRT recipients, donors, and controls using the Beck Depression Inventory, Beck Anxiety Inventory, and 36-item Short Form Health Survey. The recipient group consisted of 69 individuals who underwent renal transplantation between August 2002 and June 2004. The donor group consisted of 35 and the control group 45 healthy individuals. Multivariate analysis of variance and the post hoc (Tukey) test were used to assess and to analyze differences among and between the three groups. The depression scores of the recipients were higher than donors (P < 0.05) but were similar to controls. The recipient scores indicated poorer physical functioning (P < 0.001), greater physical limitation on roles (P < 0.001), and lower levels of general health (P < 0.01) compared to controls. The donor scores indicated higher vitality (P < 0.01), better social functioning (P < 0.05) and greater mental health (P < 0.01) than controls. Poorer health and mood status among the recipient group might reflect the various negative impacts of chronic debilitating disease. It is therefore recommended to screen recipients regularly for clinically relevant HRQL impairments after transplantation.

[Renal transplantation, anxiety and depressive disorders and quality of life]

Until now there are few data in the literature describing psychiatric comorbidity in patients waiting for renal transplantation. We have conducted a cross sectional study estimating the prevalence of anxiety and depressive disorders in three groups of renal transplant patients, before transplantation, six months and one year after. The MINI was used to estimate the prevalence of anxiety and depressive disorders. Anxiety and depressive symptoms were assessed using the HAD. Patients' quality of life was also assessed using the SF-36. This study did not find any major impact of renal transplantation on the prevalence of structured psychiatric disorders. Indeed, the prevalence of depressive and anxiety disorders did not differ significantly between the three groups. The mean scores of anxiety did not differ significantly between the three groups in contrast to the mean scores of depression, which differed significantly between the group "before transplantation" and the group "one year after transplantation". We did not find any significant difference concerning the scores of patient's quality of life between the three groups, except for the item "health perceived by the patients themselves". Health perceived by the patients was greater in the group "after transplantation". The quality of life of dialysed or transplant patients was strongly correlated with anxiety and depressive symptoms scores, emphasizing the major interest of a multidisciplinary approach for these patients.

Saúde mental nas práticas em saúde: a experiência do PROLIG

O presente trabalho apresenta o relato de experiências do Serviço de Atenção Psicossocial Integrada em Saúde (SAPIS) nos Programas de Ligação (PROLIG). O SAPIS foi implantado em junho de 2002, no Hospital São Paulo (HSP), com o objetivo de promover uma atenção mais ampla às necessidades gerais e específicas do hospital no que diz respeito aos aspectos psicossociais bem como de reorganizar a inclusão de profissionais de saúde mental nas enfermarias e ambulatórios. Esse estudo tem como objetivo descrever a atuação do psicólogo como profissional de ligação em saúde mental no atendimento às demandas específicas de unidades do HSP. A tarefa do profissional de ligação em saúde mental envolve a assistência psicológica ao paciente e seu familiar assim como o desempenho do papel de especialista em saúde mental junto à equipe multiprofissional. Temos encontrado em nossa prática, no entanto, algumas dificuldades para a implementação e a manutenção de algumas propostas. Concluímos que a atuação do psicólogo como profissional de ligação de saúde mental tem promovido mudanças nos cuidados em saúde nessa instituição, porém ainda exige uma profunda reflexão e maior envolvimento da instituição e de políticas de saúde que viabilizem mudanças estruturais para a construção de uma efetiva prática integral e integrada nessa área.

The psychosocial impact of renal transplantation on living related donors and recipients: preliminary report

We investigated the psychosocial and demographic features of living related kidney donors and recipients during follow-up visits between August 2002 and March 2003 using two new questionnaires, one for donors and one for recipients. The surveys were distributed to 22 donors and 55 recipients, 18 (81.8%) donors and 49 (89.1%) recipients completed their questionnaires. Concerning level of satisfaction with quality of life after transplantation, 93.9% of the recipients and 72.2% of the donors were "highly satisfied". Almost all donors (94.4%) said that they would make the same decision again and would also strongly encourage others to donate. Issues related to donor dissatisfaction involved beliefs that preoperative information was inadequate and perceived negative effects of transplantation on personal health at the time the survey was conducted. Only 6.1% of the recipients said they were dissatisfied with their quality of life after the operation. The main issues were psychiatric morbidity and beliefs that preoperative information was inadequate. Overall, the vast majority of donors and recipients reported that they had a positive transplantation experience. Only a small proportion of the subjects developed psychosocial morbidity or were dissatisfied with their quality of life. These results are preliminary, but it appears that better psychological preparation for the transplantation process and close psychiatric follow-up would reduce negative outcomes.

Psychosocial assessments and outcomes in organ transplantation

A qualitative review was conducted to define the term psychosocial as applied to transplant patients and to summarize evidence regarding the role and impact of psychosocial assessments and outcomes across the transplant process. English-language case series and empirical studies from January 1970 through April 1990 that were abstracted in Medline and Psychological Abstracts or listed in publications' bibliographies were used as data sources. A qualitative analysis was performed to determine the depth of the case reports and whether the empirical reports obtained statistically reliable, clinically significant findings. The authors conclude that psychosocial assessments differ in content and application to candidate selection depending on the transplant program. Psychosocial status before transplant does not consistently affect medical outcomes after transplant. Psychosocial status generally improves with transplant, although difficulties are prevalent in psychological adjustment and in compliance with medical regimens. Psychiatric history can predict psychological outcomes after transplant but does not consistently predict compliance. Social supports and coping strategies strengthen psychosocial outcomes. Posttransplant psychosocial outcomes may predict physical morbidity and mortality.

The Structured Interview for Renal Transplantation--SIRT

Despite the fact that the demand for psychiatric evaluations of organ transplant recipients is increasing, there is not a commonly agreed upon protocol that can guide clinicians. A standard psychiatric interview, although necessary, is not sufficient when interviewing transplant candidates. In addition, it is important to acquire information specific to the medical regimen associated with renal disease and renal transplantation. The purpose of this paper is to present the Structured Interview for Renal Transplantation (SIRT). The SIRT was developed as a tool to guide clinicians through the interview process by providing a comprehensive structure while still allowing for flexibility. There are many advantages of using the SIRT--it is a tool that facilitates a clinician's ability to conduct a thorough evaluation in a time-efficient manner. It is also an excellent instrument for training clinicians, and the structure of the interview is appropriate for use in research.

Psychiatric assessment in transplantation

The implementation of the presumptive donor law in Brazil is expected to increase the availability of organs for transplantation. As medical management of end-stage organ dysfunction continues to improve, increasing numbers of potential transplant recipients will be available to meet this supply. There is mounting evidence that supports the involvement of skilled psychiatric practitioners in the selection of transplant candidates. Data supporting the influence of psychosocial factors on compliance and therefore medical outcomes continues to grow. The literature review allows delineating the components and rationale for comprehensive psychosocial evaluations as a component of preoperative transplantation evaluation.