Psychiatric referral in the patient candidate for liver transplant: The psychodynamic perspective

Author/s Maria Moscara
Publishing Year 2022 Issue 2022/2 Language Italian
Pages 15 P. 79-93 File size 172 KB
DOI is like a bar code for intellectual property: to have more infomation click here

Below, you can see the article first page

If you want to buy this article in PDF format, you can do it, following the instructions to buy download credits

Article preview

FrancoAngeli is member of Publishers International Linking Association, Inc (PILA), a not-for-profit association which run the CrossRef service enabling links to and from online scholarly content.

According to current regulations and guidelines, patients who are candidates for liver transplantation undergo, together with other specialist assessments, a psychiatric evaluation, which aims to provide a judgment of suitability for inclusion on the transplant list. The guidelines identify some contraindications to performing a liver transplant, including active addiction to drugs or alcohol and psychiatric disorders, in particular schizophrenia, major psychosis and severe personality disorders; clinical observation and literature indicate that the presence of psychiatric disorders and / or dysfunctional personality traits at the index evaluation negatively affect the prognosis of the transplant. The psychiatric consultation activity carried out in the context of the General Hospital requires the acquisition and development of adequate basic clinical skills, as well as specific relational and psychotherapeutic skills, in order to be adequately carried out. Even more specific skills are required to carry out the pre-insertion assessments in the liver transplantation list; this clinical area is characterized by the high medical-surgical comorbidity, the complexity of the ethical issues of a life-saving treatment path, the peculiarities in the doctor-patient relationship that involves multiple clinicians interacting with each other and with the patient, the jumble of the emotional reactions that such a serious health condition arouses in the patient, in his family network and, last but not least, in the network of caregivers both in the hospital and in the Community Services represents a challenge for the healthcare system. In this work we will trace the lines of the experience of the Psychiatric and Psychosomatic Counseling Service (SCPP) that the Mental Health Department of the AUSL of Modena carries out at the University Hospital, mentioning the psychodynamic perspective used in carrying out psychiatric counseling and how some psychoanalytic tools can be used to facilitate the patient's self-observation, to facilitate the understanding of the dynamics of his family group and of the dynamics between patient and treating group and, last but not least, of the relationships between the different members of the treating staff. The psychoanalytic tools allow you to give a reading of the moments of relational blocks with the patient and in the treating group to facilitate understanding of the mechanisms that support them and facilitate their overcoming.

Keywords: Consultation psychiatry, liver transplantation, psychoanalytic tools, psychodynamic approach

  1. Mattei G. Fashion industry as a source of inspiration for the ‘Mental Health Department 4.0’: an overview. Journal of Psychopathology 2019; 25: 183-9.
  2. Fiandri D, Moscara M. Competenze cliniche in psicoterapia breve. Attitudini e formazione Riv Sper Fren 2014; CXXXVIII: 135-55.
  3. Associazione Italiana per lo Studio del FAssociazione Italiana per lo Studio del Fegato (A.I.S.F.), Commissione “Trapianto di fegato”. Il trapianto di fegato. Raccomandazioni dell’Associazione Italiana per lo Studio del Fegato; 2008. -- http://www.
  4. Lang T, Klaghofer R, Buddeberg C. Psychiatric comorbidity and psychosocial markers in patients before heart, liver or lung transplantation. Schweiz Med Wochenschr 1997; 27(47): 1950-60.
  5. Zahn A, Seubert L, Jünger J, et al. Factors influencing long-term quality of life and depression in German liver transplant recipients: a single- centre cross-sectional study. Ann Transplant 2013; 26: 327-35.
  6. Miller LR, Paulson D, Eshelman A, et al. Mental health affects quality of life and recovery after liver transplantation. Liver Transpl 2013; 19: 1272-8.
  7. Telles-Correia D, Barbosa A, Barroso E, et al. Psychiatric approach of liver transplant. Acta Med Port 2006; 19: 165-79.
  8. Rozenberg D, Santa Mina D, Nourouzpour S, Camacho Perez E, Stewart BL, Wickerson L, et al. Feasibility of a Home-Based Exercise Program for Managing Posttransplant Metabolic Syndrome in Lung and Liver Transplant Recipients: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2022; 11(3): e35700.
  9. Reggianini C, Guicciardi A, Cuoghi G, Carra E, Moscara M, Iemmolo R, De Ruvo N: “The relapse of alcohol abuse in liver transplant patients: the impact of the multidisciplinary team of the Policlinico of Modena” Reserch and Advances in Psychiatry, Supplement on the 4° National Congress of Young Psychiatrists Vol. 3-n. 1, January-March 2016
  10. Gruppo multidisciplinare sui Farmaci per l’epatite cronica C. Trattamento della epatite cronica C nell’adulto con particolare riferimento alle indicazioni di Boceprevir e Telaprevir. Regione Emilia- Romagna, Linee guida terapeutiche 6, maggio 2013.
  11. S. Cavana, M. Galletti, G. Rioli, G. Mattei, D. Perrone, M. Moscara,
  12. S. Ferrari. Are patients with pre-orthotopic liver transplant psychiatric consultation different in bio-psycho-social complexity from other consultation inpatients? A study from a Consultation – Liaison Psychiatric Service. Poster presentato al Congresso annual della European Psychiatric Association, Nizza 3-6-marzo 2018.
  13. G. Mattei, A. Laghi, M. Moscara, C. Piemonte, C. Reggianini, L. Pingani, S. Ferrari, G. M. Galeazzi. Predictors of complexity of liaison psychiatry involvement in liver-transplant candidates. International Congress of the Royal College of Psychiatrists 2016. London, UK, 27- 30 June 2016.
  14. Mattei G, Laghi A, Balduzzi S, et al. Indicators of Complex Care During the Consultation-Liaison Psychiatry Activity at the Transplant Center of the Policlinico Hospital, Modena. Transplant Proc 2017; 49: 2105-2109.
  15. Bottesi, G., Granziol, U., Forza, G., Volpe, B., Feltrin, A., Battermann, F., Cavalli, C., Cillo, U., Gerosa, G., Fraiese, A., Rea, F., Loy, M., Maiorano, D., Rizzi, I., Leandro, G., Ferraro, C., Biasi, C., Donato, D., Vidotto, G., & Maldonado, J. R. (2020). The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). Psychosomatics, 61(2), 127-134. 10.1016/j. psym.2019.11.008.
  16. Rigatelli M, Ferrari S. The Modena consultation-liaison psychiatry service. Italy, Br J Psychiatry 2004; 184: 268-9.
  17. M. Moscara, M. Bolondi, M. Cameli, A. Guicciardi, L. Martire, V. Moretti, E. Carra, S. Ferrari. CLP in general hospital:a review of the activities in Modena over 14 year period. Poster presentato alla terza conferenza della European Association of Psychosomatic Medicine, Norimberga, 1-4 luglio 2015, pubblicato su Psychologische Medizin 2015, 1: 26, Supp/2015, p. 61.
  18. Marchi M., Magarini F.M., Mattei G., Pingani L., Moscara M., Galeazzi G.M., Ferrari S. Diagnostic Agreement between Physicians and a Consultation–Liaison Psychiatry Team at a General Hospital: An Exploratory Study across 20 Years of Referrals. Int. J. Environ. Res. Public Health 2021, 18, 749.
  19. Bergonzini E, Moscara M. TFP-oriented consultant in a General Hospital Psychosomatic Consultation Service: a clinical contribution. 3rd International Conference of Transference Focused Psycotherapy, Parma (Italy), 14-15 ottobre 2014.
  20. Moscara M., Bergonzini E. Integrating the principles of transference- focusedpsychotherapywithpsychiatricconsultationforpatientsadmitted to a general hospital: A clinical application of a psychotherapeutic tool” Int J Appl Psychoanal Studies. 2020; 1-12.
  21. Moscara M., Mattei G., Ferrari S., Galeazzi G.M. Why candidates for liver transplantation should considered as frail patients. Minerva gastroenterological and dietologica, 2020 Mar; 66(1): 84-85. DOI: 10.23736/S1121-421X.19.02627-8
  22. Ferruta A. Teaching, training and continual education: Methods and models, In: Psychoanalysis and Psychiatry-Partners and Competitors on the Mental Health Field. Eds.: Claudio Eizirik and Giovanni Foresti. Routledge London-New York Association, 2019.
  23. Bolognini S. Reflections on psychoanalytic supervision changes in psychiatry In: Psychoanalysis and Psychiatry-Parteners and Competitors on the Mental Health Field. Eds.: Claudio Eizirik and Giovanni Foresti. Routledge London-New York, 2009.
  24. Fonagy P., Lemma A. Does psychoanalysis have a valuable place in modern mental health services? Yes. BMJ 2012; 344: e1211.
  25. S. Guerzoni, M. Moscara, M. Vandelli. Approccio psico-tossicologico nel percorso trapiantologico. Presentazione tenuta al Convegno: Il trapianto di fegato nel paziente alcolista: le ragioni di una scelta. Bologna 7 marzo 2018.

Maria Moscara, La consulenza psichiatrica nel paziente candidato a trapianto di fegato: l’ottica psicodinamica in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2022, pp 79-93, DOI: