Exploring the Developmental Impact of Cystic Fibrosis on Lung Transplant Candidacy: Considerations for Adulthood.

The average life expectancy for cystic fibrosis (CF) has increased over the past four decades resulting in a higher rate of adult CF patients. Adults seeking lung transplant to address CF-related advanced lung disease (ALD) represent a small, yet growing, subset of lung transplant recipients. Psychosocial factors such as adherence to medical recommendations, self-management of medical care, and caregiver support have been identified as positive prognostic factors in lung transplant outcomes. These factors are also implicated in the pediatric chronic illness literature and are crucial as patients begin to transition to a more autonomous and independent role in their own health management. Adults with CF facing ALD must navigate through another transitional phase as lung transplant requires additional supports and new expectations. A case series is used to highlight specific psychosocial considerations in this population and to explore the seemingly dichotomous relationship between independent self-management and caregiver support.

Psychiatric Disorders and Their Treatment: Impact of Outcomes in Patients With Chronic Liver Disease.

Content available: Audio Recording.

The Need for Psychological Rehabilitation in Lung Transplant Recipients.

Transplant recipients have significant psychosocial stressors due to unique posttransplant sequela that results in an increased incidence of psychopathology. Posttransplant psychological interventions, especially in lung transplant recipients, are understudied, as the focus of prior research has emphasized pretransplant interventions. However, posttransplant psychological stability affects medical outcomes. The importance of posttransplant psychological intervention is highlighted. Recommendations exist which call for attention to specific psychological domains in the posttransplant recovery period and highlight the impact of psychological rehabilitation on overall wellness and success in recovery. A novel psychological rehabilitation intervention is outlined as a response to posttransplant intervention recommendations to demonstrate implementation.

Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient.

There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns.