In Transplantation

The prevalence of psychiatric issues in transplant patients is probably comparable to the prevalence of other serious medical illnesses. However, as we will discuss later differences in end organ damage and their etiologies may make for differences. Baseline psychological factors surrounding suffering from early onset type 1 diabetes mellitus may raise the possibility of different problems in these patients than older cardiac transplant patients. The most common disorders you will encounter in all transplants are delirium, depression, anxiety, adjustment disorders, organic mood and personality disorders, substance abuse and lifelong personality disorders. What often makes diagnosis challenging is the great overlap of psychiatric conditions, personality, culture, and physical symptoms of disease which masquerade as psychological symptoms, medication side effects, staff anxiety and presence of cognitive disorders. Often only good detective work or time clarifies some of these issues. The detective work includes getting good pre-morbid histories and systematically ruling out medical causes and medication side effects. Often no definitive etiology can be ascertained and the cause is unknown or multi-factorial. Even when it is clear what is causing the psychiatric symptoms, some symptoms such as delirium can only be controlled after the medical cause abates: steroid-related mood changes or insomnia secondary to high dose steroid administration.

Mood Disorders

The most common affective symptom that we encounter in the transplant population is depression. Depression is a subjective symptom that can range from mild, transient sadness secondary to a known stressor such as illness, to more serious clinical syndromes such as major depression or bipolar disorder. The most obvious serious medical emergency in depression is suicide. Depression as a symptom

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