Trzepacz P T, Maue F R, Coffman G, Van Thiel D H
Int J Psychiatry Med. 1986;16(2):101-11. doi: 10.2190/h39m-5utc-hy87-bpx9.
Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.
40名连续的肝移植候选者接受了标准的精神评估，作为多学科术前检查的一部分。使用《精神疾病诊断与统计手册》第三版（DSM-III）标准确定精神疾病诊断，并对精神疾病诊断与床边认知检查结果、肝功能生化指标以及脑电图结果之间进行相关性分析。尽管一半患者处于严重内科疾病的终末期，且因能否被接受进行肝移植的不确定性而倍感压力，但仍无法给出具体的精神疾病诊断。在被给出精神疾病诊断的20名患者中，60%被发现有谵妄，35%患有适应障碍。谵妄与血清白蛋白低于3.0 g/dl、脑电图1至3级节律异常、简易精神状态评分低于24分或连线测验受损有关。此外，进行了判别分析以确定哪些测试组合能最好地区分谵妄患者。在这些患者中发现了一种独特的心理社会应激源模式，其中大多数患者的总体压力和职业功能障碍的严重程度较高，但据报告家庭和社会关系受影响较小。
