Psychiatric disorders in patients undergoing intestinal transplantation

Abstract

Background: Psychiatric disorders are common in chronic disease states; intestinal transplantation recipients may therefore be at high risk for psychiatric disorder (PD). We sought to investigate the frequency and type of PD in our cohort of patients undergoing transplantation between 2007 and 2012.

Results: The notes of 25 patients who had undergone transplantations since 2007 were available for analysis. Five of 25 patients had died at the time of data collection. Pretransplantation, 14 of 25 patients had a history of a single psychiatric disorder (SPD) (depression). Two of 25 had double psychiatric diagnoses (DPD; depression with anxiety), and 1 had three PDs. Three of 25 patients suffered from chronic pain syndrome and 1 patient had this as an isolated diagnosis without any other PD. Post-transplantation, 10 of 14 patients still had an SPD; however, 3 of 14 had acquired a second diagnosis (DPD; anxiety with depression) with suicidal ideation in 2 cases. Those with DPD preoperatively did not improve. Depression resolved in 1 of 14 after transplantation. One patient without a history of psychiatric issues developed DPD during the postoperative course. Only 3 of 25 surviving patients are free of any psychological diagnosis post-transplantation. The presence of other problems in the cohort such as chronic pain syndrome in 4 of 25, medical noncompliance in 3 of 25, cyclizine dependency in 2 of 25, and recreational drug use suspected in 1 were also identified. Problems with body image relating to the stoma were experienced by 2 of 25 patients.

Conclusion: The incidence of psychiatric disorder in patients embarking on transplantation is high and relates to their history of chronic illness. The additional stress of the transplantation operation and the long in-hospital rehabilitation period takes its toll on patients' emotional health and many acquire further psychiatric diagnoses. Managing the psychiatric health of patients is important for successful rehabilitation and their long-term health and wellbeing.