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Psychiatric Aspects of Heart Transplantation

Published online by Cambridge University Press:  02 January 2018

François M. Mai
François M. Mai*
Affiliation:
Department of Psychiatry, Ottawa General Hospital, Ottawa, Ontario K1H 8L6, Canada
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Abstract

There are many practical psychiatric, social, and ethical problems which accompany heart transplantation. These include pre- and postoperative anxiety and depressive conditions, postoperative delirium, and social and family dysfunctional syndromes. This paper reviews the literature critically in the following five areas: pre-transplant evaluation, coping with surgery, postoperative sequelae, rehabilitation, and management. Although most recipients have a good outcome from the physical and psychiatric points of view, a substantial minority experience family conflicts and sexual dysfunction after surgery. An average of 45% of patients from all studies returned to full-time employment. The distinctive role and contribution of the psychiatrist on the transplant team is discussed and important areas for future research are outlined.

Type
Review Articles
Information
The British Journal of Psychiatry , Volume 163 , Issue 3 , September 1993 , pp. 285 - 292
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Baron, D. W., Kelly, R. P., O'Rourke, M. F., et al (1985) Patient selection for cardiac transplantation. Australia and New Zealand Journal of Medicine, 15, 691–696.Google Scholar
Baulac, M., Smadja, D., Cabrol, A., et al (1989) Cyclosporin and convulsions after cardiac transplantation. Revue neurologique, 145, 393–397.Google Scholar
Beck, A. T., Ward, C. H., Mendelson, M., et al (1961) An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Bergeret, A., Dureau, G., Chuzel, M., et al (1987) Qualité de vie et réinsertion social après transplantation cardiaque. La Presse Médicale, 16, 2207–2210.Google Scholar
Bornstein, R., Starling, R. & Myerowitz, P. (1992) Neuropsychological function before and after cardiac transplantation. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 419–424. London: Kluwer Academic.Google Scholar
Brennan, A. F., Davis, M. H., Buckholz, D. J., et al (1987) Predictors of quality of life following cardiac transplantation. Psychosomatics, 28, 566–571.Google Scholar
Bullinger, M., Angermann, C. & Kemkes, B. (1992) Psychological well-being of heart transplant patients - cross-sectional and longitudinal results. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 445–456. London: Kluwer Academic.Google Scholar
Bunzel, B., Grundböck, A. & Wollenek, C. (1992) Quality of life and satisfaction after heart transplant. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 501–506. London: Kluwer Academic.Google Scholar
Caine, N., Sharples, L. & Wallwork, J. (1992) Quality of life before and after heart transplantation. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 491–500. London: Kluwer Academic.Google Scholar
Christopherson, L. K. & Lunde, D. T. (1971) Selection of cardiac transplant recipients and their subsequent psychosocial adjustment. Seminars in Psychiatry, 3, 1.Google Scholar
Copeland, J. G., Emery, R. W., Levinson, M. M., et al (1987) Selection of patients for cardiac transplantation. Circulation, 75, 3–9.Google Scholar
Craven, J. (1990) Postoperative organic mental syndromes in lung transplant recipients. Journal of Heart Transplant, 9, 129–132.Google Scholar
Evans, R. W. (1987) The economics of heart transplantation. Circulation, 75, 63–76.Google Scholar
Evans, R. W. (1992) Psychosocial aspects of heart transplantation: a comparative analysis. In Quality of Life After Open heart Surgery (ed. Walter, P.), pp. 469–482. London: Kluwer Academic.Google Scholar
Freeman, A. M., Folks, D. G., Sokol, R. S., et al (1988) Cardiac transplantation: clinical correlates of psychiatric outcome. Psychosomatics, 29, 47–54.Google Scholar
Frierson, R. L. & Lippmann, S. B. (1987) Heart transplant candidates rejected on psychiatric indications. Psychosomatics, 28, 347–355.Google Scholar
Frierson, R. L. & Lippmann, S. B., Tabler, J. B., Lippmann, S. B., et al (1990) Patients who refuse heart transplantation. Journal of Heart Transplant, 9, 385–391.Google Scholar
Gier, M. D., Levick, M. D. & Blazina, P. J. (1988) Stress reduction with heart transplant patients and their families: a multidisciplinary approach. Journal of Heart Transplant, 7, 342–347.Google Scholar
Grant, D. R., Stiller, C. R., Duff, J. H., et al (1986) Experience of a Canadian multi-organ transplant service. Canadian Medical Association Journal, 135, 197–203.Google Scholar
Groen, P., de Aksamit, A., Rakela, J., et al (1987) Central nervous system toxicity after liver transplantation: the role of cyclosporine and cholesterol. New England Journal of Medicine, 317, 861–866.CrossRefGoogle ScholarPubMed
Grondböck, A., Bunzel, B., & Schubert, M. T. (1992) Changes in partnership after cardiac transplantation. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 483–490. London: Kluwer Academic.Google Scholar
Gutkind, L. (1988) Life after transplantation. Transplant Proceedings, 20 (suppl. 1), 1092–1099.Google ScholarPubMed
Harvison, A., Jones, B. M., McBride, M., et al (1988) Rehabilitation of heart transplantation: the Australian experience. Journal of Heart Transplant, 7, 337–341.Google Scholar
Hecker, J. E., Norvell, N. & Hills, H. (1989) Psychologic assessment of candidates for heart transplantation: towards a normative base. Journal of Heart Transplant, 8, 171–176.Google Scholar
Hotson, J. R. & Enzmann, D. R. (1988) Complications of cardiac transplantation. Neurologic Clinics, 6, 349–365.Google Scholar
Jones, B. M., Chang, V. P., Esmore, D., et al (1988) Psychological adjustment after cardiac transplantation. Medical Journal of Australia, 149, 118–122.Google Scholar
Jones, B. M., Chang, V. P., Esmore, D., Taylor, F. J., Wright, O. M., et al (1990) Quality of life after heart transplantation in patients assigned to double or triple-drug therapy. Journal of Heart Transplant, 9, 392–396.Google Scholar
Jones, B. M., Chang, V. P., Esmore, D., Taylor, F. J., Wright, O. M., Downs, K., et al (1992) Long-term follow-up of the emotional adjustment of patients after heart transplantation. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 427–437. London: Kluwer Academic.Google Scholar
Kay, J. & Bienenfeld, D. (1991) The clinical assessment of the cardiac transplant candidate. Psychosomatics, 32, 78–87.Google Scholar
Kay, J. & Bienenfeld, D., Slomovitz, M., et al (1991) Use of tricyclic antidepressants in recipients of heart transplants. Psychosomatics, 32, 165–170.Google Scholar
Kornveld, D., Zimberg, S. & Malm, J. (1965) Psychiatric complications of open heart surgery. New England Journal of Medicine, 273, 287–292.Google Scholar
Kriet, J. M. & Kaye, M. P. (1990) The registry of the international society for heart transplantation. Journal of Heart Transplant, 9, 323–330.Google Scholar
Kuhn, W. F., Myers, B., Brennan, A. F., et al (1988a) Psychopathology in heart transplant candidates. Journal of Heart Transplant, 7, 223–226.Google Scholar
Kuhn, W. F., Myers, B., Brennan, A. F., Davis, M. H. & Lippmann, S. B. (1988b) Emotional adjustment in cardiac transplantation. General Hospital Psychiatry, 10, 108–113.Google Scholar
Kuhn, W. F., Myers, B., Brennan, A. F., Davis, M. H. & Lippmann, S. B., Myers, B. & Davis, M. H. (1988c) Ambivalence in cardiac transplantation candidates. International Journal of Psychiatry in Medicine, 18, 305–314.Google Scholar
Kutner, N., Brogan, D. & Kuttner, M. (1986) End stage renal disease treatment modality and patient's quality of life. American Journal of Nephrology, 6, 396–402.Google Scholar
Lipowski, Z. (1990) Postoperative delirium. In Delirium: Acute Confusional States, pp. 442–462. Oxford: Oxford University Press.Google Scholar
Lunde, D. T. (1969) Psychiatric complications of heart transplants. American Journal of Psychiatry, 126, 369–373.Google Scholar
Magni, G. & Borgherini, G. (1992) Psychosocial outcomes after heart transplantation. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 457–468. London: Kluwer Academic.Google Scholar
Mai, F. M. (1986) Graft and donor denial in heart transplant recipients. American Journal of Psychiatry, 143, 159–161.Google Scholar
Mai, F. M. (1987) Liaison psychiatry in the heart transplant unit. Psychosomatics, 28, 44–46.Google Scholar
Mai, F. M. (1988) Psychiatric problems in heart transplant recipients. Hospital Therapy, 13, 48–58.Google Scholar
Mai, F. M., McKenzie, F. N. & Kostuk, W. J. (1984) Liaison psychiatry in the heart transplant unit. Psychosomatic Medicine, 46, 80–81.Google Scholar
Mai, F. M., McKenzie, F. N. & Kostuk, W. J., & Burley, J. (1985) Psychosocial aspects of heart transplantation. Transplantation Today, 2, 16–19.Google Scholar
Mai, F. M., McKenzie, F. N. & Kostuk, W. J., & Burley, J. (1986) Psychiatric aspects of heart transplantation: preoperative evaluation and post operative sequelae. British Medical Journal, 292, 311–313.Google Scholar
Mai, F. M., McKenzie, F. N. & Kostuk, W. J., & Burley, J. (1990) Psychosocial adjustment and quality of life following heart transplantation. Canadian Journal of Psychiatry, 35, 223–227.Google Scholar
McAleer, M. J., Copeland, J., Fuller, J., et al (1985) Psychological aspects of heart transplantation. Heart Transplant, 4, 232–233.Google Scholar
McDowell, J. & Newell, C. (1987) Measuring Health: A Guide to Rating Scales and Questionnaires, pp. 204–208. Oxford: Oxford University Press.Google Scholar
Meister, N. D., McAleer, M. J., Meister, J. S., et al (1986) Returning to work after heart transplantation. Journal of Heart Transplant, 5, 154–161.Google Scholar
Mulligan, T., Sheehan, H. & Hanrahan, J. (1991) Sexual dysfunction after heart transplantation. Journal of Heart and Lung Transplant, 10, 125–128.Google Scholar
Newman, S. P., Klinger, L., Venn, G., et al (1989) Subjective reports of cognition in relation to assessed cognitive performance following coronary bypass surgery. Journal of Psychosomatic Research, 33, 227–233.Google Scholar
Niset, G., Constry-Degre, C. & Degre, S. (1988) Psychosocial and physical rehabilitation after heart transplantation. Cardiology, 75, 311–317.Google Scholar
O'Brien, B., Buxton, M. & Ferguson, B. (1987) Measuring the effectiveness of heart transplant programs: quality of life data and their relationship to survival analysis. Journal of Chronic Disease (suppl. 1) 40, 37S–153S.Google Scholar
Phipps, L. (1991) Psychiatric aspects of heart transplantation. Canadian Journal of Psychiatry, 36, 563–568.Google Scholar
Robins, L. N., Helzer, J. E. & Croughton, J., et al (1981) National Institute of Mental Health: Diagnostic Interview Schedule: its history characteristics and validity. Archives of General Psychiatry, 38, 381–389.CrossRefGoogle ScholarPubMed
Rodin, G., Voshart, K., Cattran, D., et al (1986) Cadaveric renal transplant failure: the short-term sequelae. International Journal of Psychiatry in Medicine, 15, 357–364.Google Scholar
Rovelli, M., Palmeri, D., et al (1989) Non-compliance in organ transplant recipients. Transplant Proceedings, 21, 833–834.Google Scholar
Ruzevich, S. A., Swartz, M. T., Reedy, J. E., et al (1990) Retrospective analysis of the psychologic effects of mechanical circulatory support. Journal of Heart Transplant, 9, 209–212.Google Scholar
Samuelson, R., Hunt, S. & Schroeder, J. (1984) Functional and social rehabilitation of heart transplant recipients under age thirty. Scandinavia Journal of Thoracic and Cardiovascular Surgery, 18, 97–103.Google Scholar
Schroeder, J. S. (1979) Current status of cardiac transplantation, 1978. Journal of the American Medical Association, 241, 2069–2071.Google Scholar
Shapiro, P. A. (1990) Life after heart transplantation. Progress in Cardiovascular Diseases, 32, 405–418.Google Scholar
Shapiro, P. A. (1991) Nortryptiline treatment of depressed cardiac transplant recipients. American Journal of Psychiatry, 148, 371–373.Google Scholar
Shapiro, P. A. & Kornveld, D. S. (1989) Psychiatric outcome of heart transplantation. General Hospital Psychiatry, 11, 352–357.Google Scholar
Shaw, P. (1992) The intellectual function of patients after coronary bypass surgery. In Quality of Life After Open Heart Surgery (ed. Walter, P.), pp. 141–153. London: Kluwer Academic.Google Scholar
Shipley, C., Dineen, T. & Steiger, M. (1983) Adjustment to renal transplantation. Psychosomatics, 24, 825–831.Google Scholar
Simmons, R., Klein, S. & Simmons, R. (1977) Gift of Life. New York: John Wiley.Google Scholar
Simmons, R., Klein, S. & Simmons, R., Abress, L. & Anderson, C. (1988) Quality of life after kidney transplantation. Transplantation, 45, 415–421.Google Scholar
Smith, P. L. (1988) The cerebral complications of coronary artery bypass surgery. Annals of the Royal College of Surgeons of England, 70, 212–216.Google Scholar
Smith, P. L., Treasure, T., Newman, S. P., et al (1986) Cerebral consequences of cardiopulmonary bypass. Lancet, i, 823–825.Google Scholar
Surman, O. (1989) Psychiatric aspect of organ transplantation. American Journal of Psychiatry, 146, 972–982.Google Scholar
Tabler, J. B. & Frierson, R. L. (1990) Sexual concerns after heart transplantation. Journal of Heart Transplant, 9, 397–403.Google Scholar
Tollemar, J., Ringden, O., Ericzon, B., et al (1988) Cyclosporin associated central nervous system toxicity. New England Journal of Medicine, 318, 788–789.Google Scholar
Treasure, T., Smith, P. L., Newman, S. P., et al (1989) Impairment of cerebral function following cardiac and other major surgery. European Journal of Cardio-Thoracic Surgery, 3, 216–221.Google Scholar
Trzepacz, P., Brenner, R., Coffman, G., et al (1988) Delirium in liver transplantation candidates: discriminant analysis of multiple test variables. Biological Psychiatry, 24, 3–14.Google Scholar
Walden, J. A., Stevenson, L. W., Dracup, K., et al (1989) Heart transplantation may not improve the quality of life for patients with stable heart failure. Heart and Lung, 18, 497–506.Google Scholar
Wing, J. K., Cooper, J. E. & Sartorius, N. (1974) Measurement and Classification of Psychiatric Symptoms: An Instruction Manual for the PSE and Catego Program. Cambridge: Cambridge University Press.Google Scholar
Worcester, M. C. (1988) Psychosocial aspects of cardiac transplantation. Medical Journal of Australia, 149, 115–116.Google Scholar
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