Psychiatric counselling for heart transplantation: Preoperative and postoperative psychosocial evaluation

OBJECTIVE: The improvements in surgical and postsurgical management, and especially the introduction of new immunosuppressive agents, have led to greatly enhanced survival of heart transplant recipients. Increasing numbers of heart transplantations are performed and patients who have received heart transplants are returning to the community, living an almost normal life. The aim of this study was to assess psychiatric symptomatology among heart transplant candidates, to investigate whether the existence of psychiatric symptoms has implications for their post-operative course and to identify the nature of the preoperative family burden. METHOD: Of the 78 patients selected for heart transplantation between 1992 and 1995 52 underwent pre-operative psychosocial evaluation and assessment of the family burden. In addition to the clinical psychiatric interview, the methodology included the diagnostic criteria for psychiatric disturbances according to the ICD-10, the symptom check list SCL-90R of 90 items, the Eysenck Personality Questionnaire EPQ and the family burden scale of Madianos-Economou. RESULTS: Somatic complaints and depressive and obsessive compulsive symptoms were prominent among the 52 candidates. No relationship was demonstrated between the personality characteristics and the presence of these symptoms. Of their families, 0% had a serious degree of family burden especially of the economic type. Five of the patients finally underwent successful heart transplantation. In this small sample of patients, the depressive symptoms and somatic complaints showed a statistically significant reduction postoperatively. None of these patients faced post-operatively any serious psychosocial problems. CONCLUSIONS: The psychosocial evaluation and the efficient management of the preoperative depressive symptoms of heart-transplant candidates as well as the ambivalent feelings of their relatives may increase the need for the involvement of Consultation Liaison Psychiatry in heart transplantation programs.