Psychiatric Disorders and Function in Adolescents with d-Transposition of the Great Arteries

Abstract

Objective To compared adolescents with with d-transposition of the great arteries (d-TGA) with healthy adolescents with respect to prevalence of psychiatric disorders and global psychosocial functioning. Study design Subjects, consisting of 139 adolescents with d-TGA (16.1±0.5 years) and 61 healthy adolescents (15.3±1.1 years) without known risk factors for brain disorders, underwent a battery of assessments, including semi-structured psychiatric interviews; self-report measures of depressive, anxiety, and disruptive behavior symptoms; and brain magnetic resonance imaging. Previous cognitive functioning and parental stress assessments at age eight as well as parental post-traumatic stress at age 16 years were explored as potential risk factors predictive of overall psychiatric functioning. Results Compared with healthy adolescents, adolescents with d-TGA had higher lifetime prevalence of structured interview-derived ADHD (19% versus 7%, P=0.03), along with reduced global psychosocial functioning (80.6±11.2 versus 87.2±7.1, P<0.001) as well as significant increases in self-reported depressive (P=0.01), anxiety (P=0.02), and disruptive behavior symptoms (parent P<0.001 and adolescent P=0.03). Nevertheless, these youth scored in the non-clinical range on all self-report measures. Level of global psychosocial functioning was positively related to cognitive functioning (P<0.001) and negatively related to parental stress (P=0.008). Conclusions Although adolescents with d-TGA demonstrate significant resilience to known neuropsychological and academic deficits, they show increased rates of ADHD and reduced psychosocial functioning. Impaired cognitive functioning and parental stress at younger age emerged as significant risk factors for psychiatric impairment.

Psychiatric Disorders in Adolescents With Single Ventricle Congenital Heart Disease

“…We hypothesized that adolescents with single ventricle, compared with referent adolescents, would have a higher incidence of psychiatric disorders. In line with findings of a previous report on adolescents with d-transposition of the great arteries (d-TGA), 17 we predicted that anxiety disorder and ADHD would be among the most prevalent diagnoses in our cohort. We further expected that patients without genetic abnormalities would have less psychiatric morbidity than those with genetic abnormalities.…”

“…15–16 In contrast, few data are available on mental health outcomes of critical CHD survivors in adolescence. 17–18 …”

“…Studies suggest that adolescents with critical CHD display higher incidence of ADHD, 5,8,14 but this literature is limited by reliance on parent- and self-report measures. Although the prevalence of clinician-diagnosed psychiatric disorders, e.g., anxiety and depression, have been investigated in other CHD populations, 17,20 few studies focus on patients with single ventricle. Patients with single ventricle CHD may have associated genetic abnormalities that adversely impact not only neurodevelopmental outcomes 3,5 but also psychiatric functioning.…”

Organizational topology of brain and its relationship to ADHD in adolescents with d‐transposition of the great arteries

“…(2014) and Bellinger et al. (2011) who earlier showed worse scores in Parent‐report CADS index scores in the entire BCAS cohort.…”

Congenital cardiac anomalies and white matter injury

“…The neurodevelopmental outcome of adolescents born with d-transposition of the great arteries (d-TGA) who underwent surgical correction was recently reported [3]. Despite a history of special academic services and psychotherapeutic counseling, these adolescents performed significantly lower than the population mean on a battery of tests scoring academic achievement, general memory, visual-spatial skills, social cognition, and attention [3,38]. A significant correlation between neurodevelopmental deficits in CHD patients and WM injury determined by conventional imaging techniques has not been identified [32,39].…”