Psychopharmacology and neuropsychiatric syndromes in organ transplantation

Trzepacz, Paula T.; Levenson, James L.; Tringali, Ronald A.

doi:10.1016/0163-8343(91)90124-f

Cited by 48 publications

(26 citation statements)

References 53 publications

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“…Risk factors and etiologies of delirium in cancer patients are quite numerous; however, the cancer patient is especially susceptible to delirium because of disease-and treatment-related complications, including severe pain [14,30]. Immunosuppression resulting from the cancer itself or from chemotherapy increases the risk for infection and delirium [7,30,33,48,52].…”

Section: Introductionmentioning

confidence: 99%

A retrospective study of the psychiatric management and outcome of delirium in the cancer patient

Olofsson

Weitzner

Valentine

et al. 1996

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This report describes the evaluation and treatment of delirium in the cancer patient in a major comprehensive cancer center. Ninety consecutive cases of delirium seen by the inpatient psychiatry consultation/liaison service were analyzed in a retrospective fashion to evaluate demographic information, alcohol use, central nervous system disease, coexisting medical disease, and past psychiatric history. Delirium cases were divided into hyperalert, hypoalert, and mixed subtypes. For these three subtypes, medication profiles including dose of medication, duration of delirium, outcome, and the venue where the delirium began were also evaluated. The hyperalert subtype of delirium was the commonest type observed (71%) and had the shortest duration (P < 0.0001) and best outcome (P < 0.001). The patients with a hyperalert delirium subtype were treated with the least amount of haloperidol (P < 0.0001). Patients were delirious for longer when the delirium began in the intensive-care units (P < 0.04). In general, patients who received no haloperidol experienced delirium of longer duration (P < 0.02) than those receiving haloperidol. Since the data represent patients who were referred for psychiatric treatment, this may explain the increased number of hyperalert deliriums and, therefore, the generalizability of the results is limited. Delirium in the cancer patient is particularly problematic given the coexisting medical problems these patients experience. Because the outcome of delirium is better when the duration is shorter, it is important for clinicians to be sensitive to early symptoms so that treatment can be implemented faster, leading to less morbidity and mortality.

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Section: Introductionmentioning

confidence: 99%

A retrospective study of the psychiatric management and outcome of delirium in the cancer patient

Olofsson

Weitzner

Valentine

et al. 1996

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“…24 However, the denervated transplanted heart, with no autonomic innervation, is less sensitive to these effects than may be first assumed. 25 Shapiro 26 reported that nortriptyline at therapeutic doses in HTx recipients increases heart rate and QRS interval, but does not affect PR, QT and QTc intervals. Similarly, Kay et al reported unchanged electrocardiographic (ECG) measures in a group of depressed transplant patients receiving desipramine.…”

Section: Old-generation Anti-depressants (Tricyclic Antidepressants Amentioning

confidence: 99%

“…Finally, the effect of the TCAs to lower seizure threshold is a major concern in heart transplant recipients with their additional risk factors for seizures including encephalopathy and calcineurin inhibitormediated neurotoxicity. 25,34 The physiologic and clinical effects of TCAs on the denervated human heart remain largely unknown. For the reasons just discussed, the use of TCAs should be reserved for HTx recipients with severe depression that has not responded to other agents.…”

Section: Old-generation Anti-depressants (Tricyclic Antidepressants Amentioning

confidence: 99%

“…32 Because TCAs are hepatically metabolized, lower doses should be used in transplant recipients with hepatic impairment. 25 The secondary amines (i.e., nortriptyline), which require less hepatic metabolism, are preferable, 25 while nortriptyline's unique therapeutic window 33 allows toxicity monitoring. Finally, the effect of the TCAs to lower seizure threshold is a major concern in heart transplant recipients with their additional risk factors for seizures including encephalopathy and calcineurin inhibitormediated neurotoxicity.…”

Section: Old-generation Anti-depressants (Tricyclic Antidepressants Amentioning

confidence: 99%

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Anti-depressive Therapies After Heart Transplantation

Fusar‐Poli¹,

Picchioni²,

Martinelli³

et al. 2006

The Journal of Heart and Lung Transplantation

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“…■ Psychische bzw. psychiatrische Nebenwirkungen der medikamentösen Behandlung bei CED Azathioprin besitzt keine neurotoxischen Effekte [57]. Kortikosteroide können zu organischen affektiven Veränderungen, speziell Manie oder Delirium, führen [26], jedoch auch zu Depressionen [57].…”

Section: ■ Behandlungunclassified