The prevalance of psychiatric symptoms and disorders, the quality of life, general cognitive and sexual functions before and one year after liver transplantation

Objective: The primary aim of this study is to compare the prevalence of psychiatric symptoms and disorders, the levels of quality of life, general cognitive functions and sexual functions in patients before and one year after liver transplantation. Other aims of the study is to determine the relationship of psychiatric symptoms and disorders with alexytimic properties and also to evaluate the cultural factors which may have impact on the course at the end of one year after transplantation.Method: The inpatients who had liver insufficiency and had been referred to liver transplantation (n: 68) and the outpatients who were evaluated for their routine controls at twelve months after liver transplantation (n:53) in the General Surgery and Gastroenterology Units of Dokuz Eylul University Hospital were included in the study which was carried out between 15.11.2008 and 31.07.2010. Patients were evaluated in two groups; the pretransplantation group and the outpatient group who were approximately twelve months posttransplant. Cross-sectional evaluations were conducted in these two patient groups; for one group before and for the other after transplantation (BTG, ATG). The patients in these two groups were given Receiver Sociodemographic Data Form, SCID-1 Clinical Interview, SF-36 Quality of Life Scale (SF-36), Standardized Mini-Mental Test (SMMT), Hospital Anxiety and Depression Scale (HADS), Toronto Alexitymia Scale-20 (TAS-20) and Arizona Sexual Experiences Scale (ASES). 16 patients were evaluated both before and after transplantation prospectively and they were also analysed.Results: There was no difference by means of the sociodemographic and clinical variables between the two groups. The patients before transplantation showed significantly lower levels in most of the SF-36 Quality of Life Scale scores bt there was no significant difference in the mental health subscale for the groups. There was no difference in the mean SMMT scores between the groups. In the BTG % 29,4 of the patients and in the ATG % 20,8 of the patients had one current psychiatric disorder. There was no significant difference in the prevalances of the psychiatric disorders of the groups. In the BTG the patients showed significantly higher depressive scores in HADS compared to the ATG. The number of patients who had sexual dysfuncton in the BTG was significantly higher compared to the ones in the ATG. The presence of alexythymia was significantly higher in patients who had psychiatric disorders in the BTG.Conclusion: Liver transplantation (LT) provides improvement in most of the domains of the quality of life of patients except the mental health domain. The prevalance of psychatric disorders one year after transplantation was high enough not to be underestimated compared to the higher prevalance before transplantation. These findings show that patients after LT continue to be under risk of psychiatric disorders even later in the follow-up. For these reasons regular psychiatric evaluations and follow-up for patients who undergo LT is very important, not only preop or post op in early stages but also at later stages. Pradoxical Psychiatric Syndrome which was described in Japan, was found to be very rare in Turkish patients. This suggests that it may be a culture-bound syndrome and needs to be validated.