Living kidney transplantation: preoperative assessment in the donor and recipient
Galletta D., Lauria I., Confuorto M., Mastrola A.M., Suarato V., Micanti F.
Background: The study aimed to demonstrate the importance ofthe assessment of psychological profile for the evaluation of the beingready to take on the operation.
Methods: It’s evaluated another pair of brothers, using the following tests: SCL-90R, IRI, graphics test, Raven’s ProgressiveMatrices and Rorschach test.
Results: In the donor there’s a search of security in the past, tendency to coarctation and defensive attitude. He has a strong self but difficulties to act in the future, showing anxiety, stress and difficult to manage. The receiving’s an immature self, exposing traits of obsessive-compulsive behaviour, negative mood and traits of anxiety. He tends to excessive adherence to reality, blockage in affections, defensive attitude seeking security in the past. Compared to donor, he seems to have the capacity to manage the difficulty.
Conclusions: Living donor kidney transplantation didn’t affect the lives of donors and improved many aspects of the lives of recipients. However, psychological and social aspects may be impaired by living donation. Therefore, it’s important an appropriate multidisciplinary approach, knowing the psychological status of both patients.
Keywords: kidney transplantation; multi-disciplinary approach;psychological assessment; the degree of awareness, psycho-diagnosis
EPA 2018 – 26th European Congress of Psychiatry, Nice, France 3-6 March 2018. Galletta D., Lauria I., & Cotena A. Living kidney transplantation: preoperative assessment in the donor and recipient.
Introduction. The kidney transplantation isn’t only medical process but it also influences the patient’s body image, with difficult to accept a new part of itself (Karaminia et al.). It’s complex both for the receiving and the donor, because it’s psychological, emotional, relational and social implications, as shown in literature (Galletta et al.). It’s just analysed with multidisciplinary approach with a couple of brothers, inserting other tools in the assessment (Galletta et al).
Objective. To demonstrate the importance of the assessment of psychological profile for the evaluation of the being ready to take on the operation.
Methods. It’s evaluated another pair of brothers, using the following tests: SCL-90-R, IRI, graphics test, Raven’s Progressive Matrices and Rorschach test.
Results. In the donor there’s a search of security in the past, tendency to coarctation and defensive attitude. He has a strong self but difficulties to act in the future, showing anxiety, stress and difficult to manage. He has ambivalent personality, tending to insourcing, intellectualize and tending to continuous comparison with himself, sometimes extensive and tending to lift out (FM 4; kF 1; Fc 1; cF 1; C’F 1 + 2add; CF 3 + 1add). The subject is aware of the situation in question, that’s operation and its complexity, showing a certain discomfort, as said before.
The receiving’s an immature self (M/FM=2/8) and fragile (4F including 3F minus), reticent and coarse, denying affectionate and dependence needs (absence of Fc) exposing traits of obsessive-compulsive behaviour, negative mood and traits of anxiety. He tends to excessive adherence to reality, blockage in affections, defensive attitude seeking security in the past. Compared to donor, he seems to have the capacity to manage the difficulty. There are conflicts and problems in parental relationships. However, he presents the awareness and acceptance about the condition and the treatment, no showing discomfort, compared to donor.
Discussions and Conclusions. Living donor kidney transplantation didn’t affect the lives of donors and improved many aspects of the lives of recipients (Pascazio et al.). However, psychological and social aspects may be impaired by living donation (Haz et al.). Therefore, it’s important an appropriate multidisciplinary approach, knowing the psychological status of both patients.
1.Galletta D., Lauria I., Longobardi T., et al. The Complexity of Life Donor Renal Transplantation: The Role and Effectiveness of Multidisciplinary Approach in the Medical Route and Psychological Operation (2016). Journal of Clinical Research & Bioethics: 7, 1-5.
2.Galletta D., Mastrola A. M., Suarato V. (2015). Living renal transplant donors: psychiatric and psychological evaluation in pre-transplant assessment. UNESCO Chair in Bioethics 11th World Conference Bioethics, Medical Ethics and Health Law – “Living renal transplant donors: psychiatric and psychological evaluation in pretransplant assessment”. Naples, Italy.
3.Haz I., Naqvi A., Hasan Rizvi A., et al. Psychosocial aspects of dialysis and renal transplantation. 1-5.
4.Karaminia R., Tavallaii S. A., Lorgard-Dezfuli-Nejad M., et al. Anxiety and Depression: A Comparison Between Renal Transplant recipient and Hemodialysis Patients (2007). Transplantation Proceeding: 33, 1082-84.
5.Pascazio L. Nardone I. B., Clarici A., et al. Anxity, Depression and Emotional Profile in Renal Transplant Recipient and Healty Subjects: A Comparative Study (2010). Transplantation Proceeding: 42, 3586-90.
- The Complexity of Life Donor Renal Transplantation: The Role and
Effectiveness of Multidisciplinary Approach in the Medical Route and Psychological Operation
An analysis of the scientific literature, it was found that renal transplantation has profound psychological, existential, emotional, relational and social implications, both for the receiving patient for the donor. Consequently, it is necessary to study and to assessment the mental aspects of both patients, based on a thorough analysis of the psychic and personological profile, adopting a multidisciplinary approach in order to avoid issues not properly evaluated and analyzed, they can affect the success of the transplant, and/or they can lead to psychological distress and mental suffering for the patient. At the same time, it assumes a role of fundamental importance the evaluation of the quantity and quality of the family and social support system, in which the patient is inserted. This allows to investigate both how the family environment plays a supporting role in material terms and emotional for the candidate, both to observe the patterns of communication between the various family members. This paper documents the importance of providing and program, for a better post-transplant rehabilitation and for the obvious risks of psychopathology, the development of interdisciplinary interventions, one of the social and health and basic psychotherapeutic tasks, without which the next adaptation after transplantation may be difficult and which significantly impacted the quality of life for all involved.
Association between Epilepsy and Psychogenic Non-Epileptic Seizures: A Case Report
Diana Galletta, Monica Confuorto, Ilaria Lauria, Valentina Suarato, Annamaria Califano, Anna Maria Mastrola, Fausta Micanti
Epilepsy is a very complex disorder of the central nervous system. It is characterized by a sudden, disordered and excessive neuronal shock that causes different clinical evidences with specific related electroencephalogram (EEG). Psychogenic Non-Epileptic Seizures (PNES) can seriously complicate the diagnosis of epilepsy. The separoxysmal events have the same clinical evidences of epilepsy, such as an impairment of the self-control and a range of sensory, motor and mental manifestations, without the typical related electroencephalogram (EEG) because of the absence of an organic cause. The overwhelming majority of Psychogenic Non-Epileptic Seizures are related to psychological factors like dissociation. This is a defense mechanism used to cope stressful events or emotional conflicts. Psychological or psychiatric disorders, like Post Traumatic Stress Disorder (PTSD), are frequently associated to Psychogenic Non-Epileptic Seizures. In this article, we present a case report of epilepsy combined with Psychogenic Non-Epileptic Seizures. A joint intervention is of great significance in this occurrence. The subject received a psychological assessment including psychometric and projective tools. He stood MMPI-2, Wais-R, SCL-90, Rorschach test and graphic tests. A psychological disorder related to defense mechanisms was identified. The subject presents a tendency to convert his fears and emotive pains in rational and more socially acceptable problems, using his body to express his discomfort. Patient with epileptic seizures should receive a psychological assessment to exclude Psychogenic Non-Epileptic Seizures. Further studies should propose guidelines to integrate neurological, psychiatric and psychological intervention.
La condizione delle strutture sanitarie per la salute mentale nelle province di Caserta e Napoli
Il presente lavoro è centrato sullo studio della condizione e dell’organizzazione dei Centri di Salute Mentale (CSM) nella provincia di Caserta e di Napoli. I centri che sono stati presi in esame sono: il CSM di Caserta, quello di Maddaloni e quello di Santa Maria Capua Vetere, la struttura psichiatrica riabilitativa di Casoria, il CSM di Ascalesi e di Ponticelli.
Obiettivi – Lo studio è volto a coglierne i miglioramenti, in seguito alle diverse normative varate, con il fine di superare il modello manicomiale e realizzare strutture adeguate per le persone con alienazione mentale, andando incontro ai loro bisogni ed esigenze. Oltre a individuare tali progressi, nello stesso tempo si è condotta un’analisi finalizzata a riconoscere i punti di forza, quindi i vantaggi, i punti di debolezza, ossia le problematiche presenti all’interno delle strutture prese in esame e le eventuali nuove esigenze. Inoltre, si sono individuate anche le eventuali esigenze. Nello stesso tempo, oltre ad analizzare lo status quo delle stesse, si è valutata anche la presenza o meno delle possibili differenze che caratterizzano le strutture di Caserta e di Napoli.
Metodologia – E’ stato messo a punto un questionario basato sull’esame della Cultura Locale dei CSM, dato che quest’ultima permette di fornire una visione ben chiara dell’organizzazione del Centro e delle problematiche presenti al suo interno. A tal proposito è stata posta l’attenzione sulle opinioni degli operatori delle strutture all’interno delle quali lavorano. Nello stesso tempo, sono stati intervistati i dirigenti di ogni Centro, con l’obiettivo di avere a disposizione maggiori fonti d’informazione riguardo gli aspetti positivi e negativi che lo caratterizzano e lo distinguono dagli altri presi in esame. Le risposte fornite dagli operatori sono state, poi, elaborate attraverso il programma statistico IBM – SPSS (Statistical Package for Social Science) e l’uso delle funzioni di Excel. È stata condotta sia un’analisi statistico-descrittiva, finalizzato al calcolo delle frequenze, un’analisi quantitativa, per misurare il grado di correlazione tra le variabili, e sia un’analisi qualitativa, al fine di valutare il livello di regressione lineare sulla base delle problematiche emerse, per comprendere l’eventuale presenza di un rapporto di causa-effetto tra le variabili.