Psychiatric and psychological problems are common among post-transplant patients and are closely related to the health and quality of life of post-transplant patients, which directly affect the long-term outcome of organ transplantation. We must pay attention to these problems, through early detection, early diagnosis and early intervention, to improve patient compliance, improve patient mood and establish good internal defense mechanism, and ultimately improve the quality of life of post-transplant patients and improve the prognosis of organ transplantation. Postoperative delirium occurs in approximately 50% of transplant patients and can have many negative effects, including decreased organ function, increased mortality, and overuse of health resources. Delirium has many clinical manifestations, which makes early detection and diagnosis difficult. Immediate pharmacological control of delirium once diagnosed is generally associated with good outcomes. For post-transplant delirium, the main focus is to find and treat the underlying cause of delirium, of which sleep and control of agitation are crucial. Diazepam has the potential to exacerbate the patient’s clouded consciousness, whereas small doses of haloperidol, fenadine, or new atypical antipsychotics are effective in controlling agitation. However, they should be discontinued as soon as the patient’s psychiatric symptoms are under control. The room for post-transplant patients should be quiet, softly lit and simply furnished. It is best to have a loved one with the patient to reduce anxiety, agitation and disorientation. Good nursing care is an important part of treatment and should provide appropriate comfort, explanation, and reassurance to prevent accidents. Nursing staff should be trained to recognize the early signs of delirium after organ transplantation. Nighttime observation of the patient by medical staff is especially necessary. Of course, emphasis must also be placed on symptomatic and supportive treatment, such as fluid administration and maintenance of electrolyte-acid-base balance. Psychiatric problems related to anti-rejection drug therapy, cognitive function, etc. Psychiatric problems caused by anti-rejection drugs themselves
High doses of glucocorticoids and immunosuppressive drugs used after organ transplantation have been shown to cause drug-related psychiatric disorders. Graft failure is the strongest risk factor for post-transplant hospital-acquired psychiatric disorders, such as high-dose hormone shock therapy, and an increased risk of metabolic disorders, opportunistic infections, and autoimmune complications. In addition, graft failure itself is a strong stressor and can cause very severe post-transplant hospital-acquired psychiatric disorders. Cognitive dysfunction and neurological symptoms
Cognitive function assessments can detect problems including memory and concentration abilities, and these functional abnormalities often impair patient self-management and post-transplant medication compliance. More importantly, immune transplant agents themselves can affect cognitive function, such as cyclosporine and tacrolimus, which can cause damage to the central nervous system with symptoms such as tremor, paresthesia, headache, seizures, ataxia, speech impairment, blindness, and coma.
Problems of poor compliance
About 22.5% of post-transplant patients have poor compliance. In kidney and heart transplantation, poor compliance with immunosuppressive agents is an important risk factor for graft failure and delayed acute rejection. Adherence includes not only the use of medications but also the signing of informed consent forms, guided dietary control, physical activity, and smoking and alcohol cessation. Anxiety and depressive disorders Post-transplant patients commonly experience a number of common affective psychiatric symptoms, including depression and anxiety disorders. Patients may lose their confidence in life, lose patience with the medication they have been adhering to for a long time, lose compliance, refuse to take medication as prescribed, and refuse to go to the hospital for regular follow-ups, resulting in graft failure or increased incidence of rejection reactions, and even miss the best time for early detection, early diagnosis, and early treatment, resulting in a lower survival rate after transplantation. Although most patients’ depression decreases after transplantation, it is still significantly higher than that of the general population and may increase shortly after transplantation. This impairs the patient’s psychosocial functioning and leads to repeat hospitalizations. Psychiatric medication, behavioral therapy and psychological support can have a positive effect on depression and anxiety disorders. It has been suggested that a specific anxiety disorder exists in transplant patients, called ambivalence, in which the patient has both a desire and a rejection for transplantation, which can significantly increase the patient’s anxiety disorder and affect the compliance with postoperative treatment. Re-evaluation and denial mechanism The biggest problem faced by post-transplant patients is re-perception and re-evaluation of themselves. After transplantation, most patients believe that another person’s organ becomes their own and rehabilitates them. Those who realize this before transplantation usually have no problem with another person’s organ becoming their own, but have the idea that their image will change. The fact of losing one’s own organ and transplanting the organ of an unknown person can cause mental confusion and even feelings of guilt. However, this feeling is usually transient and the patient will immediately reevaluate himself. Denial is a self-protective and self-adaptive process that can smooth out the already volatile emotions. Denial can reduce the psychological and psychological effects of personal rejection of the transplanted organ. In a sense, organ transplantation not only promotes the patient’s physical health, but also improves the patient’s psychological state. In the immediate post-transplant period, anxiety and depressive disorders are significantly reduced, and some patients are completely free of them.