Journal Article Annotations
2020, 1st Quarter

Transplant Psychiatry

Paula Zimbrean, MD
March 31, 2020

Mental health and chemical dependency services at US transplant centers.

Also of interest:

Serotonin syndrome following left ventricular assist device implantation: A report and institution-specific strategy for prevention.

PUBLICATION #1 — Transplant Psychiatry

Mental health and chemical dependency services at US transplant centers.

Niazi SK, Spaulding A, Vargas E, Schneekloth T, Crook J, Rummans T, Taner CB.

Abstract: Am J Transplant.2020 Apr;20(4):1152-1161. doi: 10.1111/ajt.15659. Epub 2019 Dec 1.

The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017-2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital- and health services area-level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients’ ability to access comprehensive psychosocial care and whether this affects patient outcomes.

KEYWORDS:
ethics and public policy; health services and outcomes research; mental health; organ transplantation in general; quality of care/care delivery; quality of life

PMID:31612625

Annotation

The finding:
85% of hospitals with a transplant centre offered mental health services and 37% offered chemical dependency services.

Strength and weaknesses:
The paper reports the results of a cross sectional assessment of hospital related mental health services, as resulted from the American Hospital Association (AHA) 2017-2018 Annual Survey Hospital and form the 2017-2018 Area Health Resource File county level database. The authors analysed the availability of mental health services and chemical dependency services in hospital based on the types of transplants offered, ownership, number of hospital beds, government payment percentages and other public health parameters.

Relevance:
When new transplant programs begin evaluating candidates or when established programs expand, administrators and transplant physicians often assume that existing mental health services at that hospital will meet the needs for psychiatric assessment and care for liver transplant candidates, recipients and organ donors. This study shoes that in many cases these hospitals do not have mental health service established. This study did not evaluate if the existing mental health services meet the needs of the transplantation centres, as many psychiatric clinics find it difficult to provide services to patients with severe medical conditions. The results of this study are helpful for all psychiatrists who collaborate with the transplant centres as it supports the need for integrated mental health care for transplant candidates and recipients

Type of study:
(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401):

Also of interest – Publication #2 — Transplant Psychiatry

Serotonin syndrome following left ventricular assist device implantation: A report and institution-specific strategy for prevention.

Katzianer D, Chism K, Qureshi AM, Watson R, Massey HT, Boyle AJ, Reeves G, Danelich I..

Abstract: J Cardiol Cases.2019 Sep

Serotonin syndrome is a potentially lethal complication of antidepressant therapy. Cardiac surgical patients are at particularly high risk of serotonin syndrome due to the prevalence of depression in patients with advanced cardiac disease, many of whom receive multiple serotonergic agents in the perioperative period. Here, we describe a case of postoperative serotonin syndrome following methylene blue administration for perioperative vasoplegia during left ventricular assist device implantation. We additionally describe an institution-specific strategy to minimize future occurrences of serotonin syndrome in this high-risk population. <Learning objective:Antidepressant medication use is prevalent in advanced heart failure patients. With serotonergic antidepressants, perioperative drug interactions may potentiate serious adverse drug events such as serotonin syndrome. In this report, we describe a case of serotonin syndrome following treatment of perioperative vasoplegia with methylene blue and describe steps our institution has implemented to prevent future occurrences.>.

KEYWORDS:
Heart failure; Mechanical assist device; Serotonin syndrome; Vasoplegic syndrome

PMID:31762837

Annotation (unstructured)

This is a case report describing a 62y/o man with a history of depression, on 50 mg of sertraline, who developed serotonin syndrome following administration of methylene blue for perioperative vasoplegia during left ventricular disease implantation. Depression has a high prevalence among patients with heart disease however it can also be difficult to diagnose when patients have neurovegetative symptoms due to their medical illness. Cl psychiatrists often must differentiate between normal illness behaviour and clinical depression. Treatment for depression typically improves quality of life and may improve medical outcomes after LVADs or transplantation, however it is important to consider the risks of antidepressant treatment in the perioperative setting, as illustrated by this case report. When psychotherapy is not indicated or feasible, delaying the start of an antidepressant or holding the antidepressant in the perioperative setting can be considered.

Type of study:
(http://ebm.bmj.com/content/early/2016/06/23/ebmed-2016-110401):