The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive psychosocial assessment proven useful for predicting the outcomes of organ transplantation that is ...expected to be useful in Japan. However, the characteristics of organ-specific SIPAT scores for organ transplant recipient candidates in Japan are unclear and, to date, the SIPAT has not been properly utilized in clinical practice. The purpose of this study was to present basic data that can be used to establish the relation between SIPAT scores and post-transplantation psychosocial outcomes as well as organ-specific outcomes.
This study included 167 transplant recipient candidates (25 heart, 71 liver, and 71 kidney) who completed a semi-structured interview based on the Japanese version of SIPAT (SIPAT-J) prior to transplantation. The differences between organs in terms of SIPAT scores and differences in SIPAT scores based on demographic data were comparatively analyzed.
The total SIPAT scores were higher for liver recipient candidates than for heart recipient candidates (P = .019). Regarding the subscales, SIPAT B (social support system) scores were higher for liver and kidney recipient candidates than for heart recipient candidates (P = .021), whereas SIPAT C (psychological stability and psychopathology) scores were higher for liver recipient candidates than for kidney recipient candidates (P = .002). Recipient candidates with a history of psychiatric treatment and those who were unemployed had higher SIPAT scores, regardless of the transplant organ, than recipient candidates without a history of psychiatric treatment and those who were employed (P < .001, P = .016, respectively).
There were notable differences in the total SIPAT-J and subscale scores among the liver, heart, and kidney recipient candidates. Each organ was associated with specific psychosocial issues that should be addressed before transplantation. Interventions such as information provision and patient education based on SIPAT assessment results for each organ may improve recipient post-transplant outcomes.
This study aimed to clarify predictors of depressive symptoms and anxiety symptoms after cancer diagnosis among Japanese cancer survivors (CSs).
As part of a Japanese cancer survivorship research ...project commissioned by the Ministry of Health, Labour and Welfare (MHLW) of Japan, we conducted a web-based nationwide survey of CSs in 2018. We analyzed the risk factors for depressive and anxiety symptoms, as measured by the Hospital Anxiety and Depression Scale Japanese version (HADS).
Of 1,234 Japanese CSs, mean score of HADS-depression and HADS-anxiety were 4.08 and 4.78, respectively. At the time of the study, the number of CSs with symptoms of depression and anxiety were 111 (9.0%) and 269 (21.8%), respectively. After multivariable analysis, CSs ≥ 60 years old (reference: ≤ 39 years old, odds ratios (OR): 0.39, 95%CI: 0.17-0.90) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.55, 95%CI: 0.32-0.96) had lower odds for depressive symptoms. And CSs ≥ 60 years old (reference: ≤ 39 years old, OR: 0.27, 95%CI: 0.15-0.49) and those ≥ 10 years from cancer diagnosis (reference: 0-4 years, OR: 0.62, 95%CI: 0.42-0.90) also had lower odds for anxiety symptoms. CSs who received chemotherapy (OR: 1.56, 95%CI: 1.10-2.20) had higher odds for anxiety symptoms.
Based on manifestation of symptoms, CSs who were younger, closer to the time of cancer diagnosis, had advanced-staged cancer, or received chemotherapy may be at higher risk for depressive or anxiety symptoms. Those CSs who have higher risk for depression and anxiety symptoms, should be followed-up more carefully for better cancer survivorship, by medical professionals, companies, and society.
Coronavirus disease 2019 (COVID-19) has grown to pandemic levels, making a significant impact on people's physical, mental, and social lives. Along with the direct central nervous system damage ...caused by the infection, those infected have experienced psychological effects as well, including the stress they experience during treatment, the guilt of infecting others, and the accompanying stigma. For the uninfected public, there are effects on lifestyle changes because of the spread of the infection, along with the anxiety caused by isolation (due to restricted mobility for preventing the spread of the infection). Healthcare workers and other support staff may experience anxiety, depression, and insomnia, which may interfere with their social lives, such as a difficulty in concentrating at work and the development of post-traumatic stress disorder.The mental health responses in a pandemic are diverse. Responses to infected individuals include dealing with the infection's effects on the central nervous system and the psychological burden of the treatment. Care for non-infected people includes providing accurate information and dealing with the stress of limited mobility; moreover, care for supporters includes organizational support and individual psychological education. Another form of mental health support that should be provided first in the event of a major disaster, regardless of the target population, is psychological first aid. This involves engaging with the affected population, gathering information, providing safety and adequate information, and linking them to available services.In addition to the Psychiatric Liaison Team, Tokyo Women's Medical University Hospital formed the COVID-19 Mental Health Care Team, which consists of doctors, nurses, and psychologists. This team not only provides a support system for infected patients but also for their families and the healthcare workers at the hospital.In this paper, we will discuss the impact of COVID-19 on mental health and introduce the mental health support (the Psychiatric Liaison Team & COVID-19 Mental Health Care Team) during the pandemic.This is a secondary publication of "Mental Health Care on COVID-19 Pandemic: The Role of Psychiatric Team on Pandemic" published in the Journal of Tokyo Women's Medical University (in Japanese) 91 (1): 72-80, 2021.
Patients with heart failure (HF) accompanied by delirium are at risk of rehospitalization and death, thus early detection and appropriate treatment is imperative. Palliative care for patients with HF ...is an important issue, particularly for patients who also have delirium. This retrospective study examined the accuracy of delirium assessment by cardiologists treating patients with HF, identified factors related to the detection of delirium, and recorded the initial treatment.
This was a retrospective chart survey of 165 patients with HF referred to a consultation liaison (C-L) service during treatment in the cardiology wards of a general hospital over a 6-year period. Diagnosis of delirium by the C-L psychiatrists was based on DSM-IV-TR.Cases in which cardiologists had stated "delirium" in the medical records were classified as an accurate assessment of delirium (Agreement group). Cases in which cardiologists did not state "delirium" were classified as Disagreement.
Among 81 patients with delirium (51 62.9% male; 74.7 ± 13.3 years old), the ratio of accurate assessment of delirium by cardiologists was 50.6% (
= 41; Agreement group). Age, sex, and HF severity did not differ significantly between the two groups. Although disquietedness was identified most frequently (
= 59, 73%), only 33 of these 59 patients (55.9%) were recognized as having delirium by cardiologists.Inappropriate initial treatments were only noted in the Disagreement group. In both groups, most cases were referred to a C-L service without new medication for psychiatric symptoms.
An accurate assessment of the delirium of inpatients with HF by cardiologists was found in only around half of all cases. Accurate detection is important to avoid harmful drug administration and to provide appropriate palliative care.
No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published.
Donor satisfaction levels were measured using the ...Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors' sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients' clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors' perceptions of the donation results and transplant procedure were assessed using measures that we developed.
The mean (standard deviation SD) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio OR = 0.17; 95% confidence interval CI = 0.079-0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045-1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250-1.011; p = 0.054) independently increased the odds of having less satisfaction with donation.
Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.
The prevalence of circadian rhythm sleep-wake disorder (CRSWD) among patients with schizophrenia is not clear. The effect of comorbid CRSWD on such patients has also not been fully evaluated yet. ...Outpatients with schizophrenia in the maintenance phase who visited Tokyo Women's Medical University Hospital between April 2018 and March 2019 participated in this study. The Brief Psychiatric Rating Scale (BPRS), the Clinical Global Impressions-Severity Illness Scale (CGI-S), Global Assessment of Functioning (GAF), World Health Organization Disability Assessment Schedule II, Insomnia Severity Index (ISI), and Morningness-Eveningness Questionnaire (MEQ) were administered, and the patient responses with and without CRSWD were compared. Of the 105 patients with schizophrenia, 19 (18.1%) had CRSWD. There were trends toward higher BPRS and lower GAF scores in the CRSWD group than in the non-CRSWD group, although these did not reach statistical significance following a false discovery rate correction. Among the BPRS subitems, the anxiety scores were significantly higher in the CRSWD group than in the non-CRSWD group (
< 0.01). CRSWD was highly prevalent among patients with schizophrenia in the maintenance phase. Comorbidities of CRSWD may affect psychopathological characteristics and psychosocial functioning.
The relationship between polysomnography-based objective sleep and delirium in the intensive care unit (ICU) is inconsistent across studies, suggesting limitations in manually determining the sleep ...stage of critically ill patients. We objectively measured 24-h sleep using a single-channel electroencephalogram (SleepScope SS) and an under-mattress sleep monitor (Nemuri SCAN NSCAN), both of which have independent algorithms that automatically determine sleep and wakefulness. Eighteen patients (median age, 68 years) admitted to the ICU after valvular surgery or coronary artery bypass grafting were included, and their sleep time was measured one day after extubation. The median total sleep times (TSTs) measured by SS (TST-SS) and NSCAN were 548 (48−1050) and 1024 (462−1257) min, respectively. Two patients with delirium during the 24-h sleep measurement had very short TST-SS of 48 and 125 min, and the percentage of daytime sleep accounted for >80% in both SS and NSCAN. This preliminary case series showed marked sleep deprivation and increased rates of daytime sleeping in ICU patients with delirium. Although data accuracy from under-mattress sleep monitors is contentious, automated algorithmic sleep/wakefulness determination using a single-channel electroencephalogram may be useful in detecting delirium in ICU patients and could even be superior to polysomnography.
Information regarding new-onset posttransplant psychotic disorders and their effect on nonadherence and posttransplant outcome is quite limited. We report a case of new-onset posttransplant ...schizophrenia that led to death. The patient, a woman with Wilson disease but no history of psychiatric problems or a substance use disorder had undergone liver transplantation at age 21. She married subsequently and bore children, being well able to handle her housework, child care, and full-time employment. She continued her medications as prescribed, and good graft function was maintained. At age 41, she experienced an episode of schizophrenia, then graft loss associated with nonadherence to immunosuppressive agents. Death ensued, occurring 6 months after the onset of schizophrenia. This case highlights the possibility that schizophrenia manifesting long after liver transplantation can result in graft loss and death due to medication nonadherence. Thus, awareness of the possibility of this rare clinical scenario is critical.
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