An Adolescent with Suicidal Behavior After Liver Transplant

Abstract

The patient was a 14-year-old sixth-grade girl who had been born in Sweden and now lived with her mother. The patient was taken to the Psychiatric Emergency Department because she was aggressive toward her mother, who reported that the patient had frequent periods of uncontrollable rage, during which the patient would scream and spit at her mother. The patient had undergone cadaveric left lateral segment orthotopic liver transplantation (OLT) for extrahepatic biliary atresia at 10 months of age and had developed hepatitis B from the donor. She had been treated with tacrolimus anhydrous (current dose 1mg q12h) since the transplant. She fi rst manifested anxiety symptoms and violent tantrums at age 6 years, following surgery for a bile duct stricture. She developed nonsuicidal self-injurious behavior at age 12 years, including hitting herself with belts and an attempt to cut herself a few months before presentation to the PED. The patient had experienced wors