Neuropsychiatric assessment of liver transplantation candidates: delirium and other psychiatric disorders.

Abstract

Forty consecutive liver transplantation candidates underwent a standard psychiatric evaluation as part of a multidisciplinary preoperative examination. Psychiatric diagnoses were determined using DSM-III criteria and correlations between the psychiatric diagnoses and the results of bedside cognitive examinations, biochemical measures of hepatic function, and EEG's were made. Half of the patients could not be given a specific psychiatric diagnosis despite the fact of their being in terminal stages of a severe medical illness and being stressed by the uncertainty of whether they would be accepted for possible liver transplantation. Of the twenty patients given a psychiatric diagnosis, 60 percent were found to be delirious and 35 percent had an adjustment disorder. Delirium was associated with a serum albumin less than 3.0 g/dl, grades 1 through 3 EEG dysrhythmias, a Mini Mental State score less than 24 or impairment on Trailmaking Tests. In addition, discriminant analyses were performed to determine which batteries of tests best differentiated the delirious patients. A unique pattern of psychosocial stressors was noted in these patients where the severity of overall stress and of occupational dysfunction was high in most, yet family and social relationships were reported as less affected.