Diogo Telles-Correia

When Does Quality of Life Improve After Liver Transplantation? A Longitudinal Prospective Study

OBJECTIVES We sought to investigate the improvement in quality of life (mental and physical components) at 1 and 6 months after liver transplantation. METHODS A sample of liver transplant candidates (n = 60), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit (25% of the patients had familial amyloid polyneuropathy [FAP] and the remaining patents had chronic liver diseases), was assessed by means of the Short Form (SF)-36, Portuguese-validated version, a self-rating questionnaire developed by the Medical Outcome Trust, to investigate certain primary aspects of quality of life, at 3 times: before, and at 1 and 6 months after transplantation. RESULTS We observed a significant improvement in quality of life (both mental and physical components) by 1 month after transplantation. Between the first month and the sixth month after transplantation, there also was an improvement in the quality of life (both mental and physical components), although only the physical components of quality of life was significantly improved. CONCLUSIONS Our findings suggested that quality of life improved early after liver transplantation (1 month). Between the first and the sixth months, there only was a significant improvement in the physical quality of life.

Psychiatric and psychosocial predictors of medical outcome after liver transplantation: a prospective, single-center study.

OBJECTIVE Recognizing the potential impact of psychiatric and psychosocial factors on liver transplant patient outcomes is essential to apply special follow-up for more vulnerable patients. The aim of this article was to investigate the psychiatric and psychosocial factors predicted medical outcomes of liver transplanted patients. METHODS We studied 150 consecutive transplant candidates, attending our outpatient transplantation clinic, including 84 who had been grafted 11 of whom died and 3 retransplanted. RESULTS We observed that active coping was an important predictor of length of stay after liver transplantation. Neuroticism and social support were important predictors of mortality after liver transplantation. CONCLUSION It may be useful to identify patients with low scores for active coping and for social support and high scores for neuroticism to design special modes of follow-up to improve their medical outcomes.

Adherence correlates in liver transplant candidates.

The study sought to investigate the psychiatric and psychosocial correlates of multidimensional adherence among liver transplant candidates. A liver transplant candidate sample (N = 100), comprising consecutive patients attending outpatient clinics of a liver transplantation central unit, was assessed by means of the Multidimensional Adherence Questionnaire (MAQ; Telles-Correia 2007), the Diagnostic and Statistical Manual of Mental Disorders, Revised 4th Edition (DSM-IV-TR) criteria, the Toronto Alexithymia Scale (TAS), the NEO Five-Factor Inventory (NEO-FFI) personality inventory, the Hospital Anxiety and Depression Scale (HADS), the Brief COPE, and the Psychological Assessment of Candidates for Transplantation (PACT). We found that multidimensional adherence positively correlated with personality traits (agreeableness), good social support, and coping strategies (planning).

Psychosocial Determinants of Quality of Life 6 Months After Transplantation: Longitudinal Prospective Study

OBJECTIVES We sought to investigate the psychosocial determinants of quality of life at 6 months after transplantation. METHODS A sample of liver transplant candidates (n = 60), composed of consecutive patients (25% with familial amyloid polyneuropathy [FAP]) attending outpatient clinics was assessed in the pretransplant period using the Neo Five Factor Inventory, Hospital Anxiety and depression Scale (HADS), Brief COPE, and SF-36, a quality-of-life, self-rating questionnaire. Six months after transplantation, these patients were assessed by means of the SF-36. RESULTS Psychosocial predictors where found by means of multiple regression analysis. The physical component of quality of life at 6 months after transplantation was determined based upon coping strategies and physical quality of life in the pretransplant period (this model explained 32% of variance). The mental component at 6 months after transplantation was determined by depression in the pretransplant period and by clinical diagnoses of patients. Because FAP patients show a lower mental component of quality of life, this diagnosis explained 25% of the variance. CONCLUSIONS Our findings suggested that coping strategies and depression measured in the pretransplant period are important determinants of quality of life at 6 months after liver transplantation.

Psychosocial predictors of adherence after liver transplant in a single transplant center in Portugal.

Context— Nonadherence has important implications for morbidity and mortality, reduced quality of life, and increased medical costs after transplant. Objective— To investigate which psychiatric and psychosocial factors determine adherence after liver transplant. Design— A group of 150 consecutive transplant candidates attending the outpatient clinics of the transplant unit of Hospital de Curry Cabral were studied between January 1, 2006, and December 1, 2007. Among these, 84 received a transplant and of those 84, 11 recipients died, 3 received another transplant, and 8 refused to finish the study (62 patients remained). Measures— Before transplant, prospective recipients were assessed via the Hospital Anxiety and Depression Scale, the NEO Five-Factor Inventory, and the revised Illness Perception Questionnaire. Both before and after transplant, patients were assessed with the Multidimensional Adherence Questionnaire. Results and Conclusions— Adherence to medication improved significantly from before to after transplant. This kind of adherence after transplant was associated with adherence to medication before transplant and high scores on the personal control dimension of the Illness Perception Questionnaire before transplant. Therefore it might be useful to focus on patients with poor adherence to medication and low scores on the personal control dimension of the Illness Perception Questionnaire before transplant in order to design interventions for them.

Mental Health and Quality of Life in Alcoholic Liver Disease Patients After Liver Transplantation: A Prospective Controlled Study

OBJECTIVE Alcoholic liver disease (ALD) is one of the most important indications for liver transplantation. Discordant conclusions have been found concerning quality of life and mental health after transplantation in this particular group. The aim of this work was to investigate improvements in mental health and quality of life among transplanted patients for ALD. METHODS We studied 45 consecutive transplant candidates with ALD, attending the outpatient clinics. Among these patients we transplanted 24 with the control candidates remaining in wait for transplantation. RESULTS There was a significant improvement in all mental health and quality of life dimensions among the transplanted ALD group. We also observed a favorable evolution of coping mechanisms (CM) in this group. CONCLUSION There is a favorable adjustment of ALD patients after transplantation as shown in CM evolution, which might explain the improved mental health and quality-of-life dimensions.

Candidates for liver transplantation with alcoholic liver disease: Psychosocial aspects

In Europe, 30% to 50% of liver transplantations are currently due to alcoholic liver disease (ALD). In the United States, this percentage is 17.2%. Post-transplant survival and other predictors of clinical course do not differ significantly from those in other types of transplanted patients, as long as there is no relapse of drinking. However, 20%-25% of these patients lapse or relapse to heavy drinking post-operatively, which has been associated with an increased risk of liver damage and mortality. It is therefore crucial to design specific selection and follow-up strategies aimed at this particular type of patient. Several good and poor prognosis factors that could help to predict a relapse have been suggested, among them the duration of abstinence, social support, a family history of alcoholism, abuse diagnosis versus alcohol dependence, non-acceptance of diagnosis related to alcohol use, presence of severe mental illness, non-adherence in a broad sense, number of years of alcoholism, and daily quantity of alcohol consumption. In this article, we discuss these and other, more controversial factors in selecting ALD patients for liver transplantation. Abstinence should be the main goal after transplantation in an ALD patient. In this article, we review the several definitions of post-transplant relapse, its monitoring and the psychopharmacological and psychotherapeutic treatment.

The Proximity between Hallucination and Delusion Dimensions: An Observational, Analytic, Cross-Sectional, Multicentre Study

In psychiatric classifications, hallucinations (mainly auditory hallucinations) are one of the fundamental criteria for establishing a schizophrenia diagnosis or any of the related psychotic disorders diagnoses. The conceptual proximity between delusions and hallucinations was maintained until the end of the XIX century, with several supporters during the XX century. Their limits were not yet definitely defined in terms of Descriptive Psychopathology, and much less so in terms of biochemical and anatomical models. In this article we aimed to analyse the dimensions of both hallucinations and delusions in a sample of patients with schizophrenia and schizoaffective disorder. We also intend to find the determinants of the main dimensions of hallucinations. One hundred patients with schizophrenia (80) or schizoaffective disorder (20), 64% males, mean age 39.75, from the outpatient and inpatient units of the Psychiatry Department of Hospital de Santa Maria and the Centro Hospitalar Psiquiátrico de Lisboa were assessed by means of the Psychotic Symptom Rating Scales (PSYRATS) and a structured interview. In this study we designed an empirical based model by means of bivariate Spearmans rank correlation coefficient, and multivariate statistics (linear regression and multiple multivariate linear regression), where the main dimensions of hallucinations are determined by the central dimensions of delusions.

Hallucinations and related concepts—their conceptual background

Prior to the seventeenth century, the experiences we now name hallucinations were valued within a cultural context, they could bring meaning to the subject or the world. From mid-seventeenth to eighteenth centuries, they acquire a medical quality in mental and organic illnesses. However, the term was only fully integrated in psychiatry by Esquirol in the eighteenth–nineteenth centuries. By then, a controversy begins on whether hallucinations have a perceptual or intellectual origin. Esquirol favors the intellectual origin, describing them as an involuntary exercise of memory and imagination. By the twentieth century, some authors maintain that hallucinations are a form of delusion (Ey), while others describe them as a change in perception (Jaspers, Fish). More integrated perspectives like those proposed by Alonso Fernandez and Luque, highlights the heterogeneity of hallucinations and the multiplicity of their types and causes. The terms pseudohallucination, illusion, and hallucinosis are grafted into the concept of hallucination. Since its introduction the term pseudohallucination has been used with different meanings. The major characteristics that we found associated with pseudohallucinations were “lack of objectivity” and “presence of insight” (differing from hallucinations). Illusions are unanimously taken as distortions of real objects. Hallucinosis, first described in the context of alcohol consumption, is generally considered egodystonic, in which insight is preserved. These and other controversial aspects regarding the evolution of the term hallucination and all its derivative concepts are discussed in this paper.

Editorial: Historical Roots of Psychopathology

Mental illness and mental symptoms depend on a construction that results from the decisions of certain social agents, which, in a specific social and historical context, according to an epistemological framework (how symptoms and disorders are constructed and detected) and an ontological framework (how they are defined, what they consist of), identify the behaviors which make up a symptom or a disorder (Berrios, 2011). Only after these theoretical hypotheses of mental symptom and disorder have been outlined are the data which empirically validate them searched and found. Therefore, the objects of psychiatry (mental symptom and disorder) being the result of a social conjecture and a philosophical perspective rooted in a specific time, they should also be studied with elements from social and human sciences (history, sociology, philosophy) (Telles-Correia, 2015). Besides these elements, clinical experience is essential to find out new forms of presentation, as well as to name new clinical behaviors and manifestations. After all, this was the fundamental method of the great psychopathologists and nosologists of the late Nineteenth century and early Twentieth century, such as Falret, Kalbaum, Kraeplin, etc. (Jaspers, 1963; Goas, 1966). These theoretical hypotheses, born out of clinical experience together with the historical, sociological and philosophical analysis of previously established theories are connected to reality through empirical validation. The latter aims to show that the said symptoms/diagnoses do really exist (Zachar, 2012). According to Zachar (2012), there are two major paradigms of empirical validation. The first paradigm is the medical model. According to this model, validation includes the study of the natural history of disorders (which show to be consistent in terms of natural history with the proposed diagnosis), studies of family aggregation (which show a greater influence of heredity in the proposed diagnosis) and the search for neurobiological causality. This model was the basis for the development of classification systems such as the DSM. At the same time a psychological model was developed. In this psychological/psychometric model current validation processes follow a different paradigm. According to this model, psychological/psychiatric variables are latent variables (which cannot be measured/observed directly but need instead to be assessed through other component variables). The validation of the instruments which measure this latent variable includes complex statistical methods (in the search for construct validity and criterion validity). These two kinds of validation are not exclusive and nowadays there is a tendency for them to coexist and combine. In recent years, the search for empirical validation has reached proportions never seen before, generally in line with the structures of diagnosis universally accepted. The so called content validation was thus devaluated. In this approach, the theoretical hypotheses are reassessed based on an important revision of the history and evolution of the established concepts (which comprises the sociological movements and the ontological and epistemological philosophical frameworks of the different authors) and also on the new data from updated clinical practice. With the devaluation of content validation, the current guidelines are considered to be beyond criticism and irrefutable. Most of the times the technicians involved in the validation of psychometric instruments aimed at evaluating a specific concept which has been established decades ago (sometimes more than a 100 years ago) do not know the origin of these concepts nor the history of their development thoroughly (nor if they are socially, historically and philosophically appropriate nowadays). The same applies to the researchers who try to find the anatomical/chemical correlates of psychiatric manifestations but often do not grasp the conceptual basis of the object studied nor the validity of the methods used to detect the said object, nor have they in their team a member able to explain this to them (Telles-Correia, 2015). New advances of the neuroscience supported by a refined, reliable and valid phenotyping (e.g., at the level of symptoms and not at the level of disorders), are bringing some promising results. The mapping of clinical phenomenology on specific brain dysfunction is now becoming plausible and the resulting functional psychopathology may in the future significantly replace the present nosology (Jablensky, 2010). Nevertheless, as Andreasen (2007) points out: “Applying technology without companionship of wise clinicians with specific expertise in psychopathology will be a lonely, sterile and perhaps fruitless enterprise.” Some of the chapters of this Ebook deal with aspects which are essential to the historical understanding of mental symptoms and disorders. The first text of this topic will briefly review the fascinating history of Asperger syndrome: why it was born, its tumultuous existence, and its downfall. The second text presents an historical overview of the understanding of Obsessive Compulsive Disorder, highlighting the advances in neuroscience and how they influenced current perspectives on the nosology of this disorder. The third text reviews many historical sources about the understanding and treatment of mental disorders in the early modern England and connects these with current trends in mental health care. The fourth text will show a critical review about psychopathology classification systems on Sexual orientation and gender identity and argues for the broader respect and value of the diversity of human sexuality and of gender expressions. The fifth text will review the history of histrionic personality disorder, one of the most ambiguous diagnostic categories in psychiatry reflecting attitudes about health, religion and gender across time. The sixth text aims to review the evolution of the term “hallucination” up to present time, highlighting the difficulty in both defining and limiting this concept ever since its first appearance. The seventh text presents some elements of the Freudian thinking on psychosis. Can the psychotic individual be invaded by a pulsating unconscious which demands a symbolic mediation? The eighth text reflects recent changes in the Brazilian public policies for mental health since Diagnostic and Statistic Manual of Mental Disorders was introduced which might disregard the subject and its personal history. The ninth text aims at reviewing the contributions by the different authors to the construction of the term “melancholia,” throughout history, where it has been associated not only to affective disorders but also to abnormal beliefs.