Psychiatric Comorbidity

A detailed review of patients' and their parents' current and past psychiatric illnesses and treatment, with particular attention to the recurrence risk of these illnesses during the transplant process, is essential. Research with pediatric renal transplant patients indicates an association between the presence of psychiatric illness and nonadherence (Shaw et al.

2003). In fact, a recent investigation of predictors of treatment nonadherence revealed that the presence of a comorbid psychiatric condition had one of the highest correlations to nonadherence among pediat-ric transplant patients (Kahana et al. 2008). The severity of preexisting psychiatric disorders was also cited as highly associated with lower adherence in cancer patients who were assessed using a transplant evaluation rating scale (Grube 2006).

Decreased pretransplantation emotional functioning is correlated with psychological functioning and increased number of hospitalizations following transplantation in the pediatric transplant population (DeMaso et al. 1995). Not surprisingly, rates of psychological distress are high prior to transplantation. For example, pediatric heart-lung transplant patients have been found to have significantly elevated scores on measures of behavioral and psychological distress (Wray and Radley-Smith 2007). Self-reported levels of depression also have been found to be higher in this pediatric population than in the general population (Wray and Radley-Smith

2004). While screening for psychiatric symptoms, the clinician should routinely evaluate for childhood exposure to traumas or abuse, which have been described as significant risk factors for poor outcome following transplant surgery (Shemesh et al. 2007).

Parental psychiatric history is particularly essential to assess among pediatric transplant candidates because parental psychopathology may adversely affect the parents' ability to support and supervise their children's treatment. For example, a study examining the mental health, stress, and quality of life of parents of pediatric liver transplant patients suggests that significant parental distress may negatively impact the patients during the perioperative period (Tarbell and Kosmach 1998).

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