43rd Italian Transplantation Society Congress
Kidney transplantation
Analysis of Psychopathologic Elements as a Compliance Limitation: Team Work as a Therapeutic Response

https://doi.org/10.1016/j.transproceed.2020.03.009Get rights and content

Highlights

  • Check for psychopathologic elements to prevent limited compliance.

  • Teamwork is a therapeutic response.

  • The relationship with the health team is important in ensuring a good perception of psychophysical health in recipients only after transplant.

  • Patients should be assisted by a multidisciplinary team and receive support from relatives during the post-transplant adaptation process.

Abstract

Introduction

The psychological evaluation of the patient, carried out through psychodiagnostic tests, clinical interviews, and a joint work with the medical-surgical team, provided useful information to assess the compliance of the kidney transplant recipient.

Methodology

Two hundred and forty-five visits were carried out between September 2018 and May 2019 in the General Surgery and Organ Transplant Department of the San Salvatore Hospital, L’Aquila. The visits consisted of clinical interviews, targeted psychodiagnostic evaluations, graphic-projective tests, and personality and cognitive structure evaluation tests. These assessments were key not only to defining the patient’s personality picture but also to offering suitable psychological support to patients on waiting lists for transplantation, during hospitalization, and during follow-up visits from transplantation phases.

Results

From the analysis of the tests and from the clinical and support interviews, some of the patients presented forms of psycho-emotional immaturity that impaired the predisposition to compliance and ultimately the establishment of the therapeutic alliance. During 8 months, 18 compliance limit cases were observed, 5 patients were sent to mental health centers, and 13 psychological support courses were activated within the Regional Transplant Center-Abruzzo Region Molise Region. No structured psychological support courses were deemed necessary for 9 of these 13 cases, whereas 4 were sent to the mental health centers.

Conclusions

By assessing the complexity of each patient from a medical and a psychological point of view and by considering the high number of transplant surgeries currently occurring, it can be noted that compliance to therapy is strongly linked to the reliability of the relationships between patients and caregivers.

Section snippets

Material and Methods

245 visits were carried out between September 2018 and May 2019. The visits consisted of clinical interviews, targeted psychodiagnostic evaluations, graphic-projective tests, and personality and cognitive structure evaluation tests (Tree test, Draw-a-Person [DAP] test, Draw-A-Person-in-the-Rain [DAP-R] test, MMPI-2, Wartegg test, Rorschach test, Wais-IV, MMSE) [[3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]]. These assessments were key not only to defining the patient’s personality

Results

From the analysis of the tests and from the clinical and support interviews, some of the patients presented forms of psycho-emotional immaturity that impaired the predisposition to compliance and ultimately the establishment of the therapeutic alliance: lack of clear thinking, insufficient criticism and judgment, and scarce coherence in the examination of reality. The patients presented low psychological and cognitive levels, with fragile egos, using primordial defense mechanisms [18,19].

During

Discussion

Depending on the recipient’s personality characteristics, we can find several expectations that will still lead to facing the transplant’s procedures and consequences, on which it is worth dwelling to get directions on the management and organization of post-transplant events in order to define the treatment’s possibility. It should be noted that the transplant patient comes from a disabling condition of chronicity and pathology [20], conditions that may have created an experience Winnicott [21

Conclusions

This debate allowed us to highlight the importance of identifying, at an early stage, those patients who showed pathologic personality traits during the pre-transplant evaluation phase, essential key point to provide an adequate psychological-psychiatric support and follow-up.

By assessing the complexity of each patient from a medical and a psychological point of view, and by considering the high number of transplant surgeries currently occurring, it can be noted that compliance to therapy is

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