Psychiatrische Evaluation von Patienten vor Lebertransplantation

 

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Zusammenfassung

Innerhalb eines 4-Jahres-Zeitraums gelangten 281 Patienten konsekutiv zur konsiliarpsychiatrischen Evaluation im Rahmen der Vorbereitung einer Lebertransplantation. Alle Patienten wurden mit einem halbstrukturierten psychiatrischen Interview unter Berücksichtigung der diagnostischen Kriterien nach DSM-III-R untersucht und mithilfe der Transplant Evaluation Rating Scale (TERS) hinsichtlich ihres psychosozialen Funktionsniveaus beurteilt. Es ergab sich eine Prävalenz psychischer Erkrankungen von 65,8 %. Die beiden am häufigsten gestellten Diagnosen waren Alkoholmissbrauch (27,8 %) und Alkoholabhängigkeit (11,7 %). Der mittlere TERS-Wert aller evaluierten Kandidaten lag bei 33,38 ± 7,31 Punkten. 68,4 % der Kandidaten wurden aus psychiatrischer Sicht keine Bedenken hinsichtlich der vorgesehenen Lebertransplantation formuliert. 18,1 % der Patienten wurden als Risikokandidaten identifiziert und bei 13,5 % der Kandidaten wurden erhebliche Bedenken geäußert. Die TERS-Werte zwischen den drei Beurteilungsgruppen unterschieden sich signifikant. Neben einer sorgfältigen diagnostischen Beurteilung einschließlich Abklärung von Substanzgebrauch sollte das psychiatrische Konsil bei Kandidaten vor Lebertransplantation immer auch psychosoziale Merkmale wie Copingstrategien, Compliance, soziale Unterstützung und Gesundheitsverhalten mitberücksichtigen. Die TERS kann hierbei routinemäßig eingesetzt werden.

Abstract

281 consecutive candidates for liver transplantation were referred to our consultation-liaison service for psychiatric evaluation over a 4-year period. For these candidates a semistructured psychiatric interview according to the codes listed in the DSM-III-R and the Transplant Evaluation Rating Scale (TERS) classifying patients` level of adjustment in psychosocial functioning were completed. Our study showed a prevalence rate of psychiatric disorders of 65.8 % among candidates. The categories of alcohol abuse (27.8 %) and alcohol dependence (11.7 %) were the most frequent psychiatric diagnoses. The mean TERS summary score of the whole sample was 33.38 ± 7,31. 68.4 % of the sample were considered good candidates, 18.1 % of the candidates were identified borderline, but acceptable under some conditions, and 13.5 % of the referrals were rated poor liver transplant candidates. The TERS summary scores discriminated well between the three rating categories of candidate quality. Apart from a careful assessment of psychiatric morbidity including substance abuse disorders, the C-L psychiatrist should always rate psychosocial functioning referring to coping, compliance, social support and lifestyle factors among liver transplant candidates. The TERS therefore may be used routinely.

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Dr. med. Hans-Bernd Rothenhäusler

Universitätsklinik für Psychiatrie der Karl-Franzens-Universität Graz

Auenbrugger Platz 31

8036 Graz/Österreich

Email: Hans-Bernd.Rothenhaeusler@klinikum-graz.at