Psychiatrists play a critical role in determining which patients in need of an organ should get one and whether patients are adhering to their immunosuppression regimens.
There is a widespread move under way in the United States to better integrate psychiatry into the larger world of medicine. To help prepare psychiatrists for these collaborations, the APA journal Focus: The Journal of Lifelong Learning in Psychiatryhasdevoted its latest issue to articles that update psychiatrists about areas of medicine in which they can contribute their expertise and that ease their transition into working in integrated-care teams.
One of the articles, for example, illuminates the psychiatric aspects of organ transplantation. The lead author is Andrea DiMartini, M.D., an associate professor of psychiatry at the University of Pittsburgh, and the article describes several critical roles that psychiatrists can play on organ transplantation teams. Among them:
Conducting psychosocial evaluations of prospective donors, who can range from close relatives to individuals with little or no previous connection to the transplant candidate. This can involve obtaining demographic information, determining the individual’s cognitive capacity, ascertaining the individual’s mental health and reasons for wanting to donate an organ, and reviewing with the potential donor the financial considerations of donating an organ.
Contributing to the decision of which patients in need of an organ are the best candidates. Since there are no national guidelines on this issue, each transplant team makes its own decisions, particularly regarding patients with complex mental health or substance abuse disorders.
Providing psychotherapy to help organ transplant candidates, especially during the waiting period for an organ. Among the psychotherapies that have been developed for organ-transplant patients, for example, is quality-of-life therapy, which is a cognitive-behavioral intervention that has been found, in individuals waiting for a kidney or lung, to reduce psychological distress, increase social intimacy, and improve the quality of life.
Helping patients who after transplantation have psychological difficulty accepting the foreign organ that is now a part of them. Psychiatrists can help in uncovering guilt, indebtedness, or other deeply felt emotions that the patient has trouble verbalizing. They can also assist patients in dealing with such emotions, which can be crucial since psychological rejection of an implanted organ has been found to lead to poorer survival.
Assessing whether posttransplant neuropsychiatric symptoms could be due to immunosuppressive medications. For example, corticosteroids that are used soon after transplant surgery to augment immunosuppression and treat episodes of acute rejection may produce mood lability, insomnia, or cognitive disturbances. Contrary to common belief, the authors noted, such symptoms are not more frequent in patients with preexisting psychiatric disorders.
Participating in strategies to foster adherence to immunosuppressive medications. One way that psychiatrists and others on the organ transplantation team can bolster adherence is by sending automated text-message reminders to patients. ■
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