Role of psychological factors in the clinical course of heart transplant patients

Supportive psychotherapy for patients with heart transplantation or ventricular assist devices☆☆☆

“…For both patient groups, the importance of screening for and treatment of psychosocial problems and mental disorders to optimize compliance and survival has been acknowledged [6,7]. This may be even more important, as psychological factors exert direct effects on physiologic functions (e.g., on immunologic and coagulation systems) and on behavior (e.g., on activity and adherence to therapy) [8].…”

“…Patients who are listed for transplant experience a pretransplant referral phase followed by an, often-long, waiting list period [8]. Confronted with the necessity of transplant, the patient has to acknowledge the severity of the illness and that transplant is the only option to survive.…”

What they say versus what we see: “Hidden” distress and impaired quality of life in heart transplant recipients

“…2 In the transplantation literature, "distress" refers to psychiatric diagnoses such as depression, anxiety and psychosis. [8][9][10][11][12][13][14][15][16] Although distress is often medicalized and interpreted as depression, anxiety, post-traumatic stress disorder 17 or psychosis, 8 -16 this explanation remains incomplete to many clinicians. Recent attention has turned to sociologic, 18 anthropologic 19 and philosophical approaches 20 to reconceptualize transplantation and its outcomes.…”

Qualitative interviews vs standardized self-report questionnaires in assessing quality of life in heart transplant recipients

“…The majority of psychosocial outcome studies have relied on quantifiable, selfreport questionnaires with increased use of validated instruments over the past decade, 2 demonstrating that, although the majority of heart transplant recipients (HTRs) demonstrate improvement in QoL post-transplant, approximately 20% to 30% have documented poor QoL on self-report measures. 1,3,4 The International Society for Heart and Lung Transplantation (ISHLT) has recently called for more and better quality research in this area. 2 Most studies have focused on a medicalized interpretation of HTR distress with psychiatric diagnoses, such as depression, anxiety, post-traumatic stress or psychosis, using quantitative methodology.…”

“…2 Most studies have focused on a medicalized interpretation of HTR distress with psychiatric diagnoses, such as depression, anxiety, post-traumatic stress or psychosis, using quantitative methodology. 1,3,4 Many clinicians and social science researchers find this perspective incomplete and have turned to qualitative research informed by anthropology, 5,6 sociology 7 and philosophy 8 -10 in an attempt to understand this distress from a broader perspective. They argue that recipients face the much greater task of incorporating the transplanted heart psychically or philosophically into their sense of self and that this may account for a significant part of the reported distress in QoL studies.…”