Tsutsui Junko, Oshibuchi Hidehiro, Kobayashi Sayaka, Yamanaka Motoharu, Endo Natsumi, Ichihara Yuki, Akaho Rie, Nishimura Katsuji
Department of Psychiatry, Tokyo Women's Medical University, Tokyo, JPN.
Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, JPN.
Cureus. 2024 Nov 16;16(11):e73828. doi: 10.7759/cureus.73828. eCollection 2024 Nov.
Ventricular assist device (VAD) serves as either a bridge to transplantation (BTT) or destination therapy (DT) for end-stage heart failure. In Japan, the extended wait time for heart transplants can make VAD usage for BTT comparable in duration to DT in other countries. Previous studies suggest that while DT patients experience improved quality of life post-VAD implantation, BTT patients often see a decline after two years. This study aims to explore the association between scores of the Japanese version of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT-J), adverse medical events (AMEs) and psychiatric disorders, particularly adjustment disorder (AD), in Japanese BTT patients.
A retrospective analysis was conducted on 24 Japanese patients who underwent VAD implantation for BTT between August 2014 and December 2019. The SIPAT-J, which evaluates the patient's readiness level, social support system, psychological stability and psychopathology, and lifestyle and effects of substance use, was applied to medical records. Psychiatric diagnoses were reviewed to identify AMEs, AD and other conditions. Patients were grouped by AMEs and AD status, and SIPAT-J scores were dichotomized at the median to examine potential associations. Statistical analysis was performed using Fisher's Exact test.
There were no significant associations found between SIPAT-J scores and the development of AD or AMEs, likely due to the small sample size and varied observation periods, and differences in timing between diagnosis, evaluation, and VAD implantation. However, more than half of the patients developed psychiatric symptoms after VAD implantation, with delirium and insomnia being the most common. Identified stressors for AD included deteriorating family relationships, difficulty accepting heart disease, and future uncertainty. AMEs, which have been linked to AD onset in previous research, were also present in several cases.
This study is the first to examine the relationship between any version of SIPAT and psychiatric outcomes in BTT patients. The results suggest that while SIPAT-J captures important psychosocial factors, additional factors related to VAD-induced lifestyle changes and family dynamics may be crucial for predicting AD risk. Therefore, future research should consider a more detailed psychosocial evaluation to capture patient expectations about post-VAD life. Although preliminary, this study underscores the need for comprehensive psychosocial screening in BTT patients to facilitate early intervention and support for those at risk of AD.
心室辅助装置（VAD）可作为终末期心力衰竭患者的移植过渡（BTT）或目标治疗（DT）手段。在日本，心脏移植等待时间延长，使得VAD用于BTT的持续时间与其他国家用于DT的持续时间相当。此前的研究表明，虽然接受目标治疗的患者在植入VAD后生活质量有所改善，但接受移植过渡的患者在两年后生活质量往往会下降。本研究旨在探讨日本移植过渡患者中，日本版斯坦福移植综合心理社会评估量表（SIPAT-J）得分、不良医疗事件（AMEs）与精神障碍，特别是适应障碍（AD）之间的关联。
对2014年8月至2019年12月期间24例因移植过渡接受VAD植入的日本患者进行回顾性分析。将评估患者准备程度、社会支持系统、心理稳定性和精神病理学以及生活方式和物质使用影响的SIPAT-J应用于病历。回顾精神科诊断以确定不良医疗事件、适应障碍和其他情况。根据不良医疗事件和适应障碍状态对患者进行分组，并将SIPAT-J得分在中位数处进行二分法划分，以检查潜在关联。使用Fisher精确检验进行统计分析。
未发现SIPAT-J得分与适应障碍或不良医疗事件的发生之间存在显著关联，这可能是由于样本量小、观察期不同以及诊断、评估和VAD植入之间的时间差异所致。然而，超过一半的患者在植入VAD后出现精神症状，谵妄和失眠最为常见。确定的适应障碍应激源包括家庭关系恶化、难以接受心脏病以及未来的不确定性。在之前的研究中与适应障碍发病相关的不良医疗事件在一些病例中也有出现。
本研究首次探讨了任何版本的SIPAT与移植过渡患者精神科结局之间的关系。结果表明，虽然SIPAT-J捕捉到了重要的心理社会因素，但与VAD引起的生活方式改变和家庭动态相关的其他因素可能对预测适应障碍风险至关重要。因此，未来的研究应考虑进行更详细的心理社会评估，以了解患者对VAD植入后生活的期望。尽管本研究是初步的，但它强调了对移植过渡患者进行全面心理社会筛查的必要性，以便为有适应障碍风险的患者提供早期干预和支持。
