Special Articles Fellowship Training Objectives and Readings in Consultation-Liaison Transplantation Psychiatry ANNE MARIE RIETHER, M.D., BARBARA

J.

LEWISON, B.A.

STEVEN A. COHEN-COLE, M.D., OWEN S. SURMAN, M.D. DEANE

L.

WOLCOTT, M.D., MICHAEL A. ANDRYKOWSKI, PH.D. LYNNA M. LESKO, M.D., PH.D.

T

ransplantation has rapidly become the accepted treatment for some end-stage organfailure patients unresponsive to conventional medical treatment, and issues related to identification, treatment, and prevention of psychiatric morbidity are now being addressed. Because psychiatric problems, including mood changes, organic mental disorders, substance abuse, and symptoms of anxiety, occur commonly in transplant candidates and recipients there has been a growing trend for transplant centers to include a consultation-liaison (C-L) psychiatrist on their multidisciplinary transplant teams. More than 50 university centers now offer 1- or 2-year felIowships in consultation psychiatry, and the training of C-L felIows needs standardization. In 1989 a national ad hoc task force on transplantation psychiatry, organized by the first author and composed of C-L psychiatrists with a specialty interest in transplantation, was formed to develop felIowship training objectives and reading lists in transplantation psychiatry. A similar task force, organized by the Association of Academic Psychiatry, developed training guidelines and reading lists for residency education in C-L psychiatry. Meeting at the 1990 Association of Academic Psychiatry, the Academy of Psychosomatic Medicine, and the First Working Conference on the Psychiatric Psychosocial and Ethical Aspects of Transplantation, held in Toronto in 1990, our task force produced the training objectives and readings described here. The outline lists 170 pertinent articles from VOLUME 33· NUMBER 3· SUMMER 1992

journals that should be reviewed regularly: general articles from Transplantation. Transplant Proceedings, and UNOS Update; articles on solid-organ transplants from Circulation. Heart Transplantation. Liver, Liver Transplantation, and Hepatology; and articles on bone marrow transplants from Bone Marrow Transplantation and Journal o/Cancer and Liver Oncology. The articles are coded for each specific transplantation area (B = bone marrow, G = general, H = heart, L = liver, R = renal, • = four-star articles). The 59 articles of central importance, designated by a four-star rating, should be considered minimal reading. Some older journal articles and book chapters were included if the information is not in more recent publications. This bibliography and list of training objectives wilI be updated periodicalIy to reflect the current literature and training issues for felIowship direction in C-L psychiatry.

Received October 22. 1991; revised November 13 1991; accepted November 18. 1991. From the Department of Psychiatry. Emory School of Medicine. Atlanta. GA; the Department of Psychiatry. Harvard Medical School. Boston. MA; the Department of Psychosocial Services. Cedars-Sinai Comprehensive Cancer Centers. Los Angeles. CA; the Department of Behavioral Science. University of Kentucky College of Medicine. Lexington; and the Departments of Psychiatry at Cornell University Medical Center and Memorial Sloan-Kettering Cancer Center. New York. NY. Address reprint requests to Dr. Riether. Clinical Assistant Professor of Psychiatry. 4 Concourse Parkway. Suite 160. Atlanta. GA 30328. Copyright © 1992 The Academy of Psychosomatic Medicine. 245

Readings in C-L Transplantation Psychiatry

I, TERMINAL OBJECTIVE

row transplantation: current status and future directions. Blood 62:941-964, 1983

The fellow will demonstrate competency in functioning as the psychiatric physician in an interdisciplinary transplant team. This competency includes psychiatric evaluation and treatment of patients, liaison, administration, teaching, and research. Specific enabling knowledge and skills objectives for each of these activities are described in the following.

H

Painvin GA, Frazier OH, Chandler LB, et al: Cardiac transplantation: indications, procurement, operation, and management. Cardiac Transplantation 14:484-489, 1985

B

Petersen FB, Buckner CD: Allogeneic and autologous bone marrow transplantation for acute leukemia and malignant lymphoma: current status. Hematol Oncol 5:233-243, 1987

L

Starzl TE, Demetris AJ, Van Thiel D: Liver transplantation (first of two parts). N Engl] Med 321:10141022, 1989

L

Starzl TE, Demetris AJ, Van Thiel D: Liver transplantation (second of two parts). N EnglJ Med 321:10921099, 1989

II, ENABLING KNOWLEDGE OBJECTIVES: PSYCHIATRIC EV ALUATION AND TREATMENT

A, Transplantation as a Treatment Choice I. Medical Issues Describe the history of solid-organ and bone marrow transplantation in the United States. Review the current medical indications for transplant and the available bridges to transplantation. Assess the use and complications of the immunosuppressant medications and the biology of rejection. a.

b.

History and current status (epidemiology)

Immunosuppressant medications, medical aspects

G'

G

Bantle JP, Paller MS, Boudreau RJ, et al: Long-term effects of cyclosporine on renal function in organ transplant recipients. ] Lab Clin Med 115:233-240, 1990

G'

Kahan BD: Medical intelligence: cyclosporine. N Engl ] Med 321:1725-1738,1989

G

Kreis H, Chkoff N, Chatenoud L, et al: A randomized trial comparing the efficacy of OKT3 used to prevent or to treat rejection. Transplant Proc 21 (suppl 2):3-6, 1989

G

Polson RJ, Powell-Jackson PR, Williams R: Convulsions associated with cyclosporin A in transplant recipients (letter). BM] 290: 1003, 1985

G

Randall T: Cyclosporine: vital in today's transplantation, but questions remain about tomorrow.

Dialysis, artificial assist devices R'

c.

Burton HJ, Kline SA, Lindsay RM, et al: The relationship of depression to survival in chronic renal failure. Psychosom Med 48:261-269, 1986

General medical issues G

Darby JM, Stein K, Grenvik A, et al: Approach to management of the heartbeating 'brain dead' organ donor. ]AMA 261 :2222-2228, 1989

B'

Janossy G: Bone marrow purging. Immunol Today 8:253-255, 1987

B

Mues LE: Autologous bone marrow transplantation in solid tumors. Current Concepts in Oncology 9:2-7, 1987

B' 246

Monaco AP: Transplantation: the state of the art. Transplant Proc 22:896--901, 1990

d.

O'Reilly RJ: Allogeneic bone mar-

PSYCHOSOMATICS

Riether et al.

G'

G'

e.

JAMA 264:1794-1797,1990 Starzl TE, Todo S, Fung J, et al: FK 506 for liver, kidney, and pancreas transplantation. Lancet 2: 10001004, 1989

including fetal tissue transplantation and xenografts. Review the necessary criteria for informed consent. Discuss the psychological impact of a patient refusing transplantation as a treatment option. Discuss the conflicts and challenges in taking care of a dying patient.

Starzl TE, Fung J, Jordan M, et al: Kidney transplantation under FK 506. JAMA 264:63-67,1990

Outline the legal, health services. and financial challenges of transplantation. Discuss reimbursement criteria, and current regulatory and reimbursement issues.

Immunosuppressant medications, psychiatric aspects G

Hall RCW, Popkin MK, Stickney SK: Presentation of steroid psychosis. J Nen' Ment Dis 167:229-236,

1979 G

a.

Ethical issues

(I) Organ procurement. general issues G'

Kast R: Blocking of cyclosporine immunosuppression by neuroleptics. Transplantation 47: 1095-

21:3381-3387.1989

1096, 1989 G

G

Lewes DA, Smith RE: Steroidinduced psychiatric syndromes. J Affective Disord 5:319-332. 1983 Ling MHM. Perry PJ, Tsaung MT: Side effects of corticosteroid therapy. Arch Gen Psychiatry

G

f.

R

G

Burton HJ. Kline SA. Lindsay RM, et al: The relationship of depression to survival in chronic renal failure. Psychosom Med 48:261-269. 1986

Matas AJ. Arras J, Muyskens J, et al: A proposal for cadaver organ procurement: routine removal with right of informed refusal. J Health Polit Policy Law 10:231-244. 1985

G

Viederman M: Psychogenic factors in kidney transplant rejection: a case study. Am J Psychiatry

McGough EA. Chopek MW: The physician's role as asker in obtaining organ donations. Transplant Proc 22:267-272. 1990

H

Robertson JA: Supply and distribution of hearts for transplantation: legal, ethical, and policy issues. Circulation 75:77-87, 1987

G'

Robertson JA: Patient selection for organ transplantation: age, incar-

132:957-959.1975 2.

Youngner SJ. Allen M. Bartlett ET, et al: Psychosocial and ethical implications of organ retrieval. N Engl J Med 313:321-323. 1985

(2) Organ procurement from cadaveric donors

The psychobiology of rejection R'

Loewy EH: Drunks, livers. and values. J Clin GastroenteroI9:436-

441. 1987 G

38:471-477,1981 B'G' Stiefel FC, Breitbart WS. Holland JC: Corticosteroids in cancer: neuropsychiatric complications. Cancer Invest 7:479-491,1989

Caplan AL: Problems in the policies and criteria used to allocate organs for transplantation in the United States. Transplant Proc

Ethical, Legal. and Health Services Issues Discuss the current ethical issues relating to organ and tissue donor procurement,

B =bone marrow. G =general. H = heart. L = liver, R VOLUME 33, NUMBER 3, SUMMER 1992

=renal. =four-star anicle. 247

Readings in C-L Transplantation Psychiatry

ceration, family support, and other social factors. Transplant Proc 21 :3397-3402, 1989 G

Youngner SJ, Landefeld CS, Coulton CJ, et al: 'Brain death' and organ retrieval. lAMA 261 :22052210, 1989

G

(5 ) Xenograft tissue transplantation

G

(3 ) Organ procurement from living donors

G

Batten HL, Prottas JM: Kind strangers: the families of organ donors. Health Aff(Millwood) 6:35-47, 1987

L

Busutti RW: Living-related liver donation: con. Transplantation Proc 23:43-45,1991

R

Fellner CH, Marshall JR: Twelve kidney donors. lAMA 206:27032707, 1968

R'

Fellner CH, Schwartz SH: Altruism in disrepute: medical versus public attitudes toward the living organ donor. N En[!,1 1 Med 284:582-585, 1971

R

B

L

Levey AS, Hou S, Bush HL Jr: Kidney transplantation from unrelated living donors: time to reclaim a discarded opportunity. N Engl 1 Med 314:914-916,1986 McCullough J, Bach FH, Coccia P, et al: Bone marrow transplantation from unrelated volunteer donors: summary of a conference on scientific, ethical, legal, financial, and other practical issues. Transfusion 22:78-81,1982 Singer PA, Siegler M, Whittington PF, et al: Ethics of liver transplantation with living donors. N Engl 1 Med 321 :620-622, 1989

(4) Fetal tissue transplantation

G'

248

Council on Scientific Affairs and Council on Ethical and Judicial Affairs: Medical applications of fetal tissue transplantation. lAMA 263:565-570, 1990

Shewmon DA, Capron AM, Peacock WJ, et al: The use of anencephalic infants as organ sources: a critique. lAMA 261: 1773-1781, 1989 Caplan AL: Ethical issues raised by research involving xenografts. lAMA 254:3339-3343, 1985

(6) Informed consent

B

Chauvenet AR, Smith NR: Referral of pediatric oncology patients for marrow transplantation and the process of informed consent. Med Pediatr Oncol 16:40-44, 1988

B

Lesko LM, Dermatis H, Penman D, et al: Patients', parents', and oncologists' perceptions of informed consent for bone marrow transplantation. Med Pediatr Oncol 17:181-187,1989

B

Patenaude AF, Rappeport JM, Smith SR: The physician's influence on informed consent for bone marrow transplantation. Theor Med 7: 165-179, 1986

B

Singer DA, Donnelly MS, Messerschmidt GL: Informed consent for bone marrow transplantation: identification of relevant information by referring physicians. Bone Marrow Transplant 6:431-437, 1990

(7) Treatment refusal Goldstein AM, Reznikoff M: SuiR cide in chronic hemodialysis patients from an external locus of control framework. Am 1 Psychiatry 127:1204-1207,1971 R' Neu S, Kjellstrand CM: Stopping long-term dialysis. N En[!,1 1 Med 314: 14-20, 1986 (8) Psycholo[!,ical care of the dying patient G' Cassem NH, Stewart RS: Management and care of the dying PSYCHOSOMATICS

Riether et al.

b.

patient. Int J Psychiatry Med 6:293304. 1975 Legal issues G

c.

Matas AJ, Arras J. Muyskens J. et al: A proposal for cadaver organ procurement: routine removal with right of informed refusal. J Health Polit Policy Law 10:231-243. 1985

Health services issues

B

L*

Williams JW, Vera S, Evans LS: Socioeconomic aspects of hepatic transplantation. Am J Gastroenterol 82:1115-1119.1987 (3) Regulatory and reimbursement issues

(I) Service issues

G

Inglehart JK: Transplantation: the problem of limited resources. N Engl J Med 309: 123-128. 1983

B'

McCullough J. Hansen J, Perkins H. et al: The National Marrow Donor Program: how it works, accomplishments to date. Oncology 3:63-74. 1989

G

L

G'

G

Engelhardt HT: Shattuck lectureallocating scarce medical resources and the availability of organ transplantation. N Engl J Med 311:6671.1984 Evans RW: The private sector vis-avis government in future funding of organ transplantation. Transplant Proc 22:975-979, 1990

Rapaport FT: A rational approach to a common goal: the equitable distribution of organs for transplantation (editorial). JAMA 257:3118-3119. 1987

(4) United Network for Organ Sharing

StaTZI TE. Tzakis GA, Staschak S. et al: Equitable allocation of extrarenal organs: with special reference to the liver. Transplant Proc 20:131-138. 1988

3.

(2) Socioeconomic issues

R

Welch HG. Larson EB: Cost effectiveness of bone marrow transplantation in acute nonlymphocytic leukemia. N Engl J Med 321 :807812,1989

Eggers PW: Effect of transplantation on the Medicare end-stage renal disease program. N Engl J Med 318:223-229.1988

H'

Evans RW: The economics of heart transplantation. Circulation 75:6375. 1987

R

Evans RW: Money matters: should ability to pay ever be a consideration in gaining access to transplantation? Transplant Proc 21 :3419-3423, 1989

G

StaTZI TE. Shapiro R. Teperman L: The point system for organ distribution. Transplant Proc 21 :34323436, 1989

Psychological and Sociological Issues Outline issues related to quality of life in organ failure and cancer patients. Discuss the impact of the "transplantation era" on sociologic values and the concept of "social worth" as it relates to candidate selection for transplantation.

a. Psychological issues (I) Emotional impact of organ failure or cancer and quality-of-life issues R

Abram HS: The psychiatrist. the treatment of chronic renal failure. and the prolongation of life: I. Am J Psychiatry 124:45-52. 1968

R'

Abram HS. Moore GL. Westervelt FB Jr: Suicidal behavior in chronic dialysis patients. Am J Psychiatry 127:119-124,1971

B = bone marrow, G = general, H = heart, L = liver, R = renal, • = four-star anicle. VOLUME 33· NUMBER 3· SUMMER 1992

249

Readings in C-L Transplantation Psychiatry

R

R'

R

Devins GM, Binik YM, Hutchinson TA, et al: The emotional impact of end-stage renal disease: importance of patients' perceptions of intrusiveness and control. Int] Psychiatry Med 13:327-343, 1983-84

Hong BA, Smith MD, Robson AM, et al: Depressive symptomatology and treatment in patients with endstage renal disease. Psychol Med 17:185-190,1987 Israel M: Depression in dialysis patients: a review of psychological factors. Can] Psychiatry 31 :445451,1986

R'

Kaplan De-Nour A, Czaczkes JW: The influence of patient's personality of adjustment to chronic dialysis: a predictive study.] Nen' Ment Dis 162:323-333, 1976

B'

Lesko LM, Holland JC: Psychosocial complications of leukemia, in Leukemia. edited by Henderson E, Lister TA. Orlando, FL, Grune & Stratton, 1989, pp 769-799

H,L Riether AM, Libb JW: Heart and liver transplantation, in Medical Psychiatric Practice. Volume I. edited by Stoudemire A, Fogel BS. Washington, DC, American Psychiatric Press, 1991, pp 309-346

b.

I.

Candidate Selection and the Preoperative Waiting Period Describe the process of psychiatric evaluation for transplantation, focusing specifically on factors that are thought to predict favorable or unfavorable psychiatric outcome.

a.

Psychiatric evaluation H

Brennan AF, Davis MH, Buchholz OJ, et al: Predictors of quality of life following cardiac transplantation. Psychosomatics 28:566-571, 1987

H'

Freeman AM III, Folks 00, Sokol RS, et al: Cardiac transplantation: clinical correlates of psychiatric outcome. Psychosomatics 29:4754, 1988

H

Freeman AM III, Watts 0, Karp R: Evaluation of cardiac transplant candidates: preliminary observations. Psychosomatics 25: 197-207, 1984

H

Frierson RL, Lippmann SB: Heart transplant candidates rejected on psychiatric indications. Psychosomatics 28:347-355, 1987

B'

Futterman AD, Wellisch OK, Bond G, et al: The psychosocial levels system: a new rating scale to identify and assess emotional difficulties during bone marrow transplantation. Psychosomatics 32:177-186,1991

R

Hathaway OK, Winsett RP, Peters TG: Psychosocial assessment of renal transplant recipients. Dialysis and Transplantation 16:442-444, 1987

B

Kaehler SL, Goodwin JM, Young

Sacks CR, Peterson RA, Kimmel PL: Perception of illness and depression in chronic renal disease. Am] Kidney Dis 15:31-39, 1990

Sociological issues

(I) Social cost

250

B. Candidate Selection

Evans RW, Manninen DL, Garrison LP, et al: The quality of life of patients with end-stage renal disease. N EnRI] Med 312:553-559, 1985

R

R

JS, et al: Liver transplantation in adults: an analysis of costs and benefits at the University of Pittsburgh. GastroenteroloRY 90:211-216, 1986

B'

Durbin M: Bone marrow transplantation: economic, ethical, and social issues. Pediatrics 82:774-783, 1988

L'

Van Thiel DH, Tarter R, Gavaler

PSYCHOSOMATICS

Riether et al.

LD: Bone marrow transplantation: mastering the experience despite psychological risk factors. Psychosomatics 30:337-341, 1989 G'

H

G

L

Merrican KJ, Overcast TD: Patient selection for heart transplantation: when is a discriminating choice discrimination? J Health Polit Policy Law 10:7-32, 1985 Molish HB, Kraft lA, Wiggins PY: Psychodiagnostic evaluation of the heart transplant patient. Seminars in Psychiatry 3:46-57, 1971 Olbrisch ME, Levenson JL, Hamer R: The PACT: a rating scale for the study of clinical decision-making in psychosocial screening of organ transplant candidates. Clinical Transplantation 3: 164-169, 1989 Surman OS, Dienstag JL, Cosimi AB, et al: Liver transplantation: psychiatric considerations. Psychosomatics 28:615-621, 1987

G

Fleishman SB, Lesko LM: Delirium and dementia, in Psychooncology: The Care of the Patient with Cancer, edited by Holland JC, Rowland J. New York, Oxford University Press, 1989, pp 342-355

L

Rikkers L, Jenko P, Rudman D, et al: Subclinical hepatic encephalopathy: detection, prevalence, and relationship to nitrogen metabolism. Gastroenterology 75:462469, 1978

R'

Surman OS, Parker SW: Complex partial seizures and psychiatric disturbance in end-stage renal disease. Psychosomatics 22: 1077-1080, 1981

L'

Trzepacz PT, Brenner R, Van Thiel DH: A psychiatric study of 247 liver transplantation candidates. Psychosomatics 30:147-153,1989

L'

Trzepacz PT, Brenner R, Coffman G, et al: Delirium in liver transplantation candidates: discriminant analysis of multiple test variables. BioI Psychiatry 24:3-14,1988

C. Diagnosis and Treatment of Psychiatric and Psychosocial Problems in Transplant Candidates I.

Psychiatric Difficulties in Transplant Candidates Describe the signs and symptoms, differential diagnosis, and course of common psychiatric syndromes in transplantation candidates. Outline a strategy to deal with the substance abuser or addicted patient who needs transplant.

a.

b.

Anxiety, depression, suicide R'

Craven JL, Rodin GM, Johnson L, et al: The diagnosis of major depression in renal dialysis patients. Psychosom Med 49:482-492, 1987

R'

Eisendrath R: The role of grief and fear in the death of kidney transplant patients. Am J Psychiatry 126:129-135,1969

H

Kuhn WF, Myers B, Brennan AF, et al: Psychopathology in heart transplant candidates. J Heart Transplant 7:223-226, 1988

G

Levenson JL, Olbrisch ME: Shortage of donor organs and long waits. Psychosomatics 28:399-403, 1987

Organic mental disorders L

Alfrey AC: Dialysis encephalopathy syndrome. Annu Rev Med 29:93-98, 1978

R

Dubovsky SL, Penn I: Psychiatric considerations in renal transplant surgery. Psychosomatics 21 :481491,1980

B =bone marrow, G =general, H = heart, L =liver, R = renal, • =four-star article. VOLUME 33· NUMBER 3· SUMMER 1992

25\

Readings in C-L Transplantation Psychiatry

R

c.

2.

Levy NB: Psychophannacology in patients with renal failure. Int 1 Psychiatry Med 20:325-334, 1990

Substance abuse/dependence G' Gastfriend DR, Sunnan OS, Gaffey GK, et al: Substance abuse and compliance in organ transplantation. AMERSA Substance Abuse 10: 149-153, 1989 H

Maricle RA, Hosenpud JD, Nonnan DJ, et al: Depression in patients being evaluated for heart transplantation. Gen Hosp Psychiatry II :418-424, 1989

L'

Beresford TP. Turcotte JG, Merion R: A rational approach to liver transplantation for the alcoholic patient (editorial). Psychosomatics 31:241-254,1990

G

Moss AH, Siegler M: Should alcoholics compete equally for liver transplantation? lAMA 265: 12951298, 1991

L'

Cohen C, Benjamin M, and the Ethics and Social Impact Committee of the Transplant and Health Policy Center, Ann Arbor, MI: Alcoholics and liver transplantation. lAMA 265:1299-1306,1991

D.

Diagnosis and Treatment of Psychosocial Problems in Transplant Recipients

I.

The Transplant: The Operative Experience, Psychological Stages, and General Issues Describe the general psychiatric aspects of transplantation as they relate to the operative experience and the perioperative period. Be able to fonnulate the dynamic conflicts and challenges of transplantation, including introjection of the foreign organ.

a.

Behavioral and Environmental Problems

General issues G' House RM, Thompson TL II: Psychiatric aspects of organ transplantation. lAMA 260:535-539, 1988 R

Kaehler SL, Goodwin JM, Young LD: Bone marrow transplantation: mastering the experience despite psychological risk factors. Psychosomatics 30:337-341, 1989

B

Neuser J: Personality and survival time after bone marrow transplantation. 1 Psychosom Res 32:451-455, 1988

G'

Sunnan OS: Psychiatric aspects of organ transplantation. Am 1 Psychiatry 146:972-982, 1989

B'

Wolcott DL, Fawzy FI, Wellisch DK: Psychiatric aspects of bone marrow transplantation: a review and current issues. Psychiatr Med 4:299-317, 1986

B'

Wolcott DL, Wellisch DK, Fawzy FI, et al: Psychological adjustment of adult bone marrow transplant donors whose recipient survives. Transplantation 41 :484-488, 1986

Outline strategies to deal with the behavioral problems of transplant candidates. a.

Anorexia, nausea, and vomiting G

b.

252

Lesko LM: Nausea and vomiting: physiology and phannacological management, in Psychooncology: The Care of the Patient with Cancer, edited by Holland JC, Rowland J. New York, Oxford University Press, 1989. pp 413-433

Body image changes G' Van der Velde CD: Body image of one's self and of others: developmental and clinical significance. Am 1 Psychiatry 142:527-537, 1985

b.

Psychological stages H

Allender J, Shisslak C, Kaszniak A, et al: Stages of psychological adjustment associated with heart transplantation. Heart Transplantation 12:228-231,1983 PSYCHOSOMATICS

Riether et al.

B'

H

c.

B'

Chapman CR, Hill HF: Prolonged morphine self-administration and addiction liability: evaluation of two theories in a bone marrow transplant unit. Cancer 63: 16361644, 1989

B'

Chapman CR, Hill H: Patient-controlled analgesia in a bone marrow transplant setting. Advances in Pain Research and Therapy 16:231-246, 1990

Psychiatric Morbidity After Transplantation Review the most common psychiatric symptoms after transplantation and current treatment. Discuss the neurocognitive deficits most commonly seen and the current recommendations for psychometric testing to assess these changes.

a.

Delirium and dementia

B

b.

Portnoy R, Foley KM: Management of pain, in Psychooncology: The Care of the Patient with Cancer. edited by Holland JC, Rowland J. New York, Oxford University Press, 1989, pp 369-382 Lesko LM, Kern J, Hawkins DR: Psychological aspects of patients in germ-free isolation: a review of child, adult, and patient management literature. Med Pediatr Oncol 12:43-49,1984

c.

B

Jenkins PL, Linington A, Whittaker JA: A retrospective study of psychosocial morbidity in bone marrow transplant recipients. Psychosomatics 32:65-71, 1991

H

Shapiro PA, Kornfeld DS: Psychiatric outcome of heart transplantation. Gen Hosp Psychiatry II :352-357, 1989

G'

Trzepacz PT, Levenson JL, Tringali RA: Psychopharmacology and neuropsychiatric syndromes in organ transplantation. Gen Hosp Psychiatry 13:233-243, 1991

Nonadherence G'

DeLone P, Trollinger JH, Fox N, et al: Noncompliance in renal transplant recipients: methods for recognition and intervention. Transplant Proc 21 :3982-3984, 1989

R

Didlake RH, Dreyfus K, Kerman RH, et al: Patient noncompliance: a major cause of late graft failure in cyclosporine-treated renal transplants. Transplant Proc 20 (suppl 3):63-69, 1988

Body image L'

G

Dubovsky SL, Metzner JL, Warner RB: Problems in the internalization of a transplant liver. Am J Psychiatry 136:1090-1091,1971 Castelnuovo-Tedesco P: Organ transplant, body image, psychosis. Psychoanal Q 42:349-363, 1973

B =bone marrow, G =general, H = heart, L =liver, R VOLUME 33· NUMBER 3, SUMMER 1992

Andrykowski MA, Altmaier EM, Barnett RL, et al: Cognitive dysfunction in adult survivors of allogeneic bone marrow transplantation: relationship to dose of total body irradiation. Bone Marrow Transplant 6:269-276, 1990

Anxiety, depression, suicide

Environmental difficulties B

e.

McAleer MJ, Copeland J, Fuller J, et al: Psychological aspects of heart transplantation. Heart Transplantation 4:232-233, 1985

2.

Management of postoperative pain

B

d.

Brown HN, Kelly MJ: Stages of bone marrow transplantation: a psychiatric perspective. Psychosom Med 38:439-446, 1976

=renal, • =four-star article. 253

Readings in C-L Transplantation Psychiatry

G

Orentlicher D: Denying treatment to the noncompliant patient. JAMA 265:1579-1582,1991

B

Phipps S, DeCuir-Whalley S: Adherence issues in pediatric bone marrow transplantation. J Pediatr Psychol 15:459-476, 1990

B

Patchell RA, White CL III, Clark AW, et al: Neurologic complications of bone marrow transplantation. Neurology 35:300--306, 1985

E, Quality of Life After Transplantation

L'

Vogt DP, Lederman RJ, Carey WD, et al: Neurologic complications of liver transplantation. Transplantation 45:1057-1061,1988

I.

B

G'

R

Neudorf S, Filipovich A, Ramsay N, et al: Prevention and treatment of acute graft versus host disease. Semin Hemato/21:91-IOO, 1984

Anorexia B

f.

Sullivan KM: Graft versus host disease, in Clinical Bone Marrow Transplantation, edited by Blume KG, Pete L. New York, Churchill Livingstone, 1983, pp 91-129 Laskin DL: Acyclovir: pharmacology and clinical experience. Arch Intern Med 144: 1241-1246, 1984 Shaefer MS, Stratta RJ, Markins RS, et al: Gancyclovir therapy for cytomegalovirus disease in liver transplant recipients. Transplant Proc 23:1515-1516,1991 Washer GF, Schroter GPJ, Starzl TE, et al: Causes of death after kidney transplantation. JAMA 250:4954, 1983

Cancer B

254

e.

Witherspoon RP, Fisher LD, Schoch G, et al: Secondary cancers after bone marrow transplantation

2.

Lesko LM: Anorexia, in Psychooncology: The Care of the Patient with Cancer, edited by Holland JC, Rowland J. New York, Oxford University Press, 1989, pp 434-443

Other B

Champlin RF, Gale RP: The early complications of bone marrow transplantation. Semin Hematol 21: 101-108, 1984

G'

Lesko LM: Nausea and vomiting: physiology and pharmacological management, in Psychooncology: The Care ofthe Patient with Cancer, edited by Holland JC, Rowland J. New York, Oxford University Press, 1989. pp 414-422

B

McDonald G, Sharma P, Matthews D, et al: Veno occlusive disease of the liver after bone marrow transplantation: diagnosis, incidence, and predisposing factors. Hepatology 4:1 16-122, 1984

Infection G

c.

Neurological

Rejection B'

b.

d.

Medical Issues Discuss quality-of-life issues for transplant patients, including potential medical complications, general functional status after transplantation, and the possibility for vocational rehabilitation. Discuss the current recommendations for parenthood after transplantation.

a.

for leukemia or aplastic anemia. N EnglJ Med 321:784-789, 1989

Functional Status and Employment Outline the major challenges and obstacles for the transplant recipient's return to work or other productive activities. Discuss the feasibility of rehabilitation in this patient group. B

Baker F, Cubow B. Wingard JR: Role retention and quality of life of bone marrow transplant survivors. Soc Sci Med 32:697-704, 1991 PSYCHOSOMATICS

Riether et al.

B'

Loescher LJ, Weich-McCaffrey D, Leigh SA, et al: Surviving adult cancers. Part I: Physiological effects. Ann Intern Med 111:411432,1989

L

MacDougall BRD, CaIne RY, McMaster P, et al: Survival and rehabilitation after orthotopic liver transplantation. Lancet I: 13261328, 1980

H

B'

B

3.

Samuelsson RG, Hunt SA, Schroeder JS: Functional and social rehabilitation of heart transplant recipients under age thirty. Scand J Thorac Cardiovasc Surg 18:97103, 1984 WeIch-McCaffrey D, Hoffman B, Leigh SA, et al: Surviving adult cancers. Part 2: Psychosocial implications. Ann Intern Med 111:517-524,1989 Wingard JR, Curbow B, Baker F, et al: Health, functional status, and employment of adult survivors of bone marrow transplantation. Ann Intern Med 114:113-118,1991

Eisendrath RM: The role of grief and fear in the death of kidney transplant patients. Am J Psychiatry 126:129-135,1969

H

Kuhn WF, Davis MH, Lippmann SB: Emotional adjustment to cardiac transplantation. Gen Hosp Psychiatry 10: 108-113, 1988

H

Mai FM, McKenzie FN, Kostuk WJ: Psychosocial adjustment and quality of life following heart transplantation. Can J Psychiatry 35:223-227, 1990

H'

Mai FM: Graft and donor denial in heart transplant recipients. Am J Psychiatry 143:1159-1161, 1986

R

Nadel C, Clark JJ: Psychosocial adjustment after renal retransplants. Gen Hosp Psychiatry 8:41-48,1986

R

Simmons RG, Kamstra-Hennen L, Thompson CR: Psychosocial adjustment five to nine years posttransplant. Transplant Proc 13:40-43,1981

L

Tarter RE, Erb S, Biller PA, et al: The quality of life following liver transplantation: a preliminary report. Gastroenterol Clin North Am 17:207-217, 1988

L

Wolcott D, Norquist G, Busuttil R: Cognitive function and quality of life and adult liver transplant recipients. Transplant Proc 21 :3563, 1989

B

Wolcott DL, Wellisch DK, Fawzy FI, et al: Adaptation of adult bone marrow transplant recipient long term survivors. Transplantation 41:478-484,1986

Psychosocial Adjustment Describe in general terms the expected quality of life and social functioning after transplantation.

a.

R'

Quality of life B'

B

Andrykowski MA, Altmaier EM, Barnett RL, et al: Quality of life in adult survivors of allogeneic bone marrow transplantation: correlates and comparison with matched renal transplant recipients. Transplantation 52:399-406, 1990 Baker F, Curbow B, Wingard JR: Role retention and quality of life of bone marrow transplant survivors. Soc Sci Med 32:697-704, 1991

4.

Sexuality Discuss the current literature on sexuality and fertility after transplantation. Outline

B = bone marrow, G =general, H = heart, L = liver, R =renal, VOLUME 33· NUMBER 3· SUMMER 1992

=four-star article. 255

Readings in C-L Transplantation Psychiatry

the current recommendations on pregnancy after transplantation. a.

Fertility/impotence B

R

B

B

R

B

G'

b.

Auchincloss S: Sexual dysfunction in cancer patients: issues in evaluation and treatment, in Handbook of Psychooncology: Psychological Care of the Patient with Cancer. edited by Holland JC, Rowland J. New York, Oxford University Press, 1989, pp 383-413 Brannen GE, Peters TG, Hambidge KM, et al: Impotence after kidney transplantation. Urology 15:138146, 1990 Mumma G, Mashberg D, Lesko LM: Long-term psychosocial adjustment of acute leukemia survivors: impact of bone marrow transplantation vs conventional chemotherapy. Gen Hosp Psychiatry 14:43-55, 1991 Ostroff J, Lesko LM: Psychosexual adjustment of patients undergoing bone marrow transplantation: clinical research issues and intervention programs, in Bone Marrow Transplantation: Principles. Practice. edited by Whedon M. Monterey, CA, Jones and Bartlet Pub, 1991 Salvatierra 0, Fortmann JL, Belzer FO: Sexual function in males before and after renal transplantation. Uro/(Jgy 5:64-66, 1975 Sanders JE, Buckner CD, Amos D, et al: Ovarian function following marrow transplantation for aplastic anemia or leukemia. J Clin Oncol 6:813-818,1988 Schover L, Jensen S (eds): Sexuality and Chronic Illness: A Comprehensive Approach. New York, Guilford, 1988

Pregnancy R

256

nancy in renal transplant recipients. J Reprod Med 27: 613-621, 1982

Davison JM, Lindheimer MD: Preg-

R,H Penn I, Makowski EL, Harris P: Parenthood following renal and hepatic transplantation. Transplantation 30:397-400, 1980 R

Weil R III, Barfield N, Schroter GPJ, et al: Children of mothers with kidney transplants. Transplant Proc 17:1569-1572,1985

III, ENABLING KNOWLEDGE OBJECTIVES: LIAISON

A. Psychiatrist as a Member of the Transplant Team I.

The Liaison Psychiatrist Describe the liaison psychiatrist's role and functioning on the multidisciplinary transplant team.

2.

G

Soloff PH: The liaison psychiatrist in cardiovascular rehabilitation: an overview./nt J Psychiatry Med 8:393- 402, 1977-78

G'

Wolcott DL: Organ transplant psychiatry: psychiatry's role in the second gift of life. Psychosomatics 31 :91-97, 1990

Communicating Findings Discuss the process of integrating and communicating biological, psychological, and social aspects of care. H

Mai FM: Liaison psychiatry in the heart transplant unit. Psychosomatics 28:44-46, 1987

B'

Patenaude AF, Rappeport JM: Collaboration between hematologists and mental health professionals on a bone marrow transplant team. Journal of Psychosocial Oncology 2:81-92,1984

B

Rappaport BS: Evolution of consultation-liaison services in bone marrow transplantation. Gen Hosp Psychiatry 10:346-351, 1988

PSYCHOSOMATICS

Fellowship training objectives and readings in consultation-liaison transplantation psychiatry.

Special Articles Fellowship Training Objectives and Readings in Consultation-Liaison Transplantation Psychiatry ANNE MARIE RIETHER, M.D., BARBARA J...
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