Medved Vesna, Medved Sara, Skočić Hanžek Milena
Department of Psychiatry, Zagreb University Hospital Centre, Kišpatićeva 12, 10000 Zagreb, Croatia,
Psychiatr Danub. 2019 Mar;31(1):18-25. doi: 10.24869/psyd.2019.18.
Psychiatric consultation and evaluation is an important part of candidate selection for organ transplantation. Psychiatric assessment of patients undergoing transplantation procedure is done in pre- and post-transplantation periods, each one having its specifics. In the pre-transplantation period it is crucial to assess the patient's therapeutic adherence and the ability of understanding the treatment. The main prediction factor for short and long-term success is medical compliance for which thorough clarification of psychosocial support is needed. Symptoms of psychological exhaustion due to physical illness should be distinguished from psychiatric disorders. If a patient has a history of psychiatric illness, the risks of exacerbation or recurrence of a disease need to be evaluated. Pharmacokinetic and pharmacodynamics of psychotropic drugs resulting from to organ failure should be considered when deciding on treatment. Psychiatric assessment of the organ donor aims to clarify the psychological suitability and motivation. There are specific aspects of liver, kidney, heart and lung transplantation to keep in mind. Understanding psychosexual development is particularly important to children, before transplantation, as is the assessment of every family member. The consultation concludes with an overall evaluation of the patient's psychosocial strengths and limitations and recommended interventions to optimize the candidacy for transplantation. In the post-transplantation period potential psychological problems or psychiatric disorders must be identified and treated accordingly, in addition to psychiatric side effects of immunosuppressive therapy. The use of psychotropic drugs in the post-transplantation period requires knowledge of medication interactions. Overall, psychiatrists perform multiple roles in the transplantation team. The psychiatrists' goals are to meet the psychological needs of both patients and potential donors, evaluate candidates and to help other medical experts on the team with understanding underlying psychological mechanisms triggered by serious medical conditions and procedures. Finally, the most important purpose is optimal organ recruitment and recovery.
精神科会诊与评估是器官移植候选人筛选的重要组成部分。对接受移植手术的患者进行精神科评估在移植前和移植后阶段进行，每个阶段都有其特点。在移植前阶段，评估患者的治疗依从性和理解治疗的能力至关重要。短期和长期成功的主要预测因素是医疗依从性，为此需要彻底阐明社会心理支持。身体疾病导致的心理疲惫症状应与精神障碍相区分。如果患者有精神疾病史，则需要评估疾病加重或复发的风险。在决定治疗方案时，应考虑器官衰竭导致的精神药物的药代动力学和药效学。对器官捐赠者进行精神科评估旨在阐明其心理适宜性和动机。肝、肾、心和肺移植有一些需要牢记的特定方面。了解性心理发展对移植前的儿童尤为重要，对每个家庭成员的评估也是如此。会诊最后对患者的社会心理优势和局限性进行全面评估，并推荐干预措施以优化移植候选资格。在移植后阶段，除了免疫抑制治疗的精神科副作用外，还必须识别并相应治疗潜在的心理问题或精神障碍。在移植后阶段使用精神药物需要了解药物相互作用。总体而言，精神科医生在移植团队中扮演多种角色。精神科医生的目标是满足患者和潜在捐赠者的心理需求，评估候选人，并帮助团队中的其他医学专家理解严重医疗状况和手术引发的潜在心理机制。最后，最重要的目的是实现最佳的器官获取和恢复。
