Anxiety, Depressive Symptoms and Heart Transplantation

  • S. Zipfel
  • A. Schneider
  • J. Jünger
  • W. Herzog


For patients suffering from terminal heart failure, orthotopic heart transplantation has become an established means of treatment. So far, over 50000 heart transplantations (HTx) have been performed in 271 transplantation centres around the world. It has been demonstrated that 1-year survival rates are over 80 percent; the mean survival time for HTx-patients has reached nearly 10 years, with a consecutive yearly mortality rate of 4 percent [1]. As a consequence, an increasing number of patients are reaching a long-time survival of more than 10 years [2], [3].


Depressive Symptom Heart Transplantation Heart Lung Transplant Orthotopic Heart Transplantation Psychological Risk Factor 
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  1. 1.
    Hosenpud JD, Bennett LE, Keck BM et al (2000) The registry of the international society for heart and lung transplantation: seventeenth official report-2000. J Heart Lung Transplant 19:909–931CrossRefPubMedGoogle Scholar
  2. 2.
    Hetzer R, Albert W, Hummel M et al (1997) Status of patients presently living 9 to 13 years after orthotopic heart transplantation. Ann Thorac Surg 64:1661–1668CrossRefPubMedGoogle Scholar
  3. 3.
    Pethig K, Besser K, Heublein B, Wahlers T et al (1999) Koronare Vaskulopathie nach Herztransplantation-Einfluss von zeitlichem Auftreten, Schweregrad und Progredienz auf die Prognose im Langzeitverlauf. Z Kardiol 88:498–506CrossRefPubMedGoogle Scholar
  4. 4.
    Grady KL, Jalowiec A, White WC et al (1996) Predictors of quality of life in patients with advanced heart failure awaiting transplantation. J Heart Lung Transplant 14:2–10Google Scholar
  5. 5.
    Frierson R, Tabler J, Spears R (1992) Heart transplantation. In: Craven J, Rodin G. Psychiatric aspects of organ transplantation. Oxford University Press 12:164–176Google Scholar
  6. 6.
    Castelnuovo-Tedesco P (1973) Organ transplant, body image, psychosis. Psychoanal Quart 42:349–363Google Scholar
  7. 7.
    Kuhn WF, Myers B, Brennan AF et al (1988) Psychopathology in heart transplant candidates. J Heart Transplant 7:223–226PubMedGoogle Scholar
  8. 8.
    Magni G, Bogherini G (1992) Psychosocial outcome after heart transplantation. In: Walter PJ (Ed) Quality of life after open heart surgery. Dordrecht: Kluwer Academic PressGoogle Scholar
  9. 9.
    Lang T, Klaghofer R, Buddeberg C (1997) [Psychiatric comorbidity and psychosocial markers in patients before heart, liver or lung transplantation]. Schweiz Med Wochenschr 127:1950–1960PubMedGoogle Scholar
  10. 10.
    Zipfel S, Bergmann G (1999) Psychosomatische Aspekte bei Herzschrittmacher und Herzoperation. In: Studt HH, Petzold ER (Eds) Psychotherapeutische Medizin. Berlin: de Gruyter 135–137Google Scholar
  11. 11.
    American Psychiatric Association (APA) (1994) Diagnostic and statistical manual of mental disorders (DSM-IV). Fourth edition. Washington, DCGoogle Scholar
  12. 12.
    Trumper A, Appleby L (2001) Psychiatric morbidity in patients undergoing heart, heart and lung, or lung transplantation. J Psychosom Res 50:103–105CrossRefPubMedGoogle Scholar
  13. 13.
    Triffaux JM, Wauthy J, Bertrand J et al (2001) Psychological evolution and assessment in patients undergoing orthotopic heart transplantation. Eur Psychiatry 16:180–185CrossRefPubMedGoogle Scholar
  14. 14.
    Bunzel B (1993) Herztransplantation: psychosoziale Grundlagen und Forschungsergebnisse zur Lebensqualität. Stuttgart, New York: ThiemeGoogle Scholar
  15. 15.
    Nolan MT, Cupples SA, Brown MM et al (1992) Perceived stress and coping strategies among families of cardiac transplant candidates during the organ waiting period. Heart Lung 21:540–547PubMedGoogle Scholar
  16. 16.
    Collins EG, White WC, Jalowiec A (1996) Impact of the heart transplant waiting process on spouses. J Heart Lung Transplant 15:623–630PubMedGoogle Scholar
  17. 17.
    Zerssen D (1975) Depressionkala (D-S). Beltz, WeinheimGoogle Scholar
  18. 18.
    Christopherson LK (1987) Cardiac transplantation: a psychological perspective. Circulation 75:57–62PubMedGoogle Scholar
  19. 19.
    Bunzel B, Laederach HK, Schubert MT (1999) Patients benefit-partners suffer? The impact of heart transplantation on the partner relationship. Transpl Int 12:33–41PubMedGoogle Scholar
  20. 20.
    Dew MA (1998) Quality-of-life studies: organ transplantation research as an exemplar of past progress and future directions. J Psychosom Res 44:189–195CrossRefPubMedGoogle Scholar
  21. 21.
    Dew MA, Roth LH, Schulberg HC et al (1996) Prevalence and predictors of depression and anxiety-related disorders during the year after heart transplantation. Gen Hosp Psychiatry 18(6 Suppl):48–61CrossRefGoogle Scholar
  22. 22.
    Spitzer RL, Williams JB, Gibbon M, First MB (1992) The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry 49:624–629PubMedGoogle Scholar
  23. 23.
    Stukas AAJ, Dew MA, Switzer GE et al (1999) PTSD in heart transplant recipients and their primary family caregivers. Psychosomatics 40:212–221PubMedGoogle Scholar
  24. 24.
    Bunzel B, Laederach HK (1999) Long-term effects of heart transplantation: the gap between physical performance and emotional well-being. Scand J Rehabil Med 31:214–222CrossRefPubMedGoogle Scholar
  25. 25.
    Fraser-Smith N, Lesperance F, Gravel G et al (2000) Social support, depression, and mortality during the first year after myocardial infarction. Circulation 101:1919–1924Google Scholar
  26. 26.
    Dew MA, Kormos RL, DiMartini AF et al (2001) Prevalence and risk of depression and anxiety-related disorders during the first three years after heart transplantation. Psychosomatics 42:300–313CrossRefPubMedGoogle Scholar
  27. 27.
    Zipfel S, Schneider A, Wild B et al (2002) Effect of depressive symptoms on survival after heart transplantation. Psychosom Med 64:740–747CrossRefPubMedGoogle Scholar
  28. 28.
    Trunzo JJ, Petrucci RJ, Carter A, Donofrio N (1999) Use of the MMPI and MMPI-2 in patients being evaluated for cardiac transplant. Psychol Rep 85:1105–1110CrossRefPubMedGoogle Scholar
  29. 29.
    Alla F, Briancon S, Juilliere Y et al (2000) Differential clinical prognostic classifications in dilated and ischemic advanced heart failure: the EPICAL study. Am Heart J 139:895–904CrossRefPubMedGoogle Scholar
  30. 30.
    Majani G, Pierobon A, Giardini A et al (1999) Relationship between psychological profile and cardiological variables in chronic heart failure. The role of patient subjectivity. Eur Heart J 20:1579–1586CrossRefPubMedGoogle Scholar
  31. 31.
    Millon T, Green C, Meager R (1982) Millon Behavioral Health Inventory Manual, 3rd ed. Minneapolis, MN: National Computer Systems Inc.Google Scholar
  32. 32.
    Coffman KL, Brandwin M (1999) The Millon Behavioral Health Inventory Life Threat Reactivity Scale as a predictor of mortality in patients awaiting heart transplantation. Psychosomatics 40:44–49PubMedGoogle Scholar
  33. 33.
    Chacko RC, Harper RG, Gotto J, Young J (1996) Psychiatric interview and psychometric predictors of cardiac transplant survival. Am J Psychiatry 153:1607–1612PubMedGoogle Scholar
  34. 34.
    Harper RG, Chacko RC, Kotik HD et al (1998) Self-report evaluation of health behavior, stress vulnerability, and medical outcome of heart transplant recipients. Psychosom Med 60:563–569PubMedGoogle Scholar
  35. 35.
    Deng MC, De Meester JM, Smits JM et al (2000) Effect of receiving a heart transplant: analysis of a national cohort entered on to a waiting list, stratified by heart failure severity. Comparative Outcome and Clinical Profiles in Transplantation (COCPIT) Study Group. BMJ 321:540–545CrossRefPubMedGoogle Scholar
  36. 36.
    Kirsch M, Baufreton C, Naftel DC et al (1998) Pretransplantation risk factors for death after heart transplantation: the Henri Mondor experience. J Heart Lung Transplant 7:268–277Google Scholar
  37. 37.
    Deng MC, Plenz G, Erren M et al (2000) Transplant vasculopathy: a model for coronary artery disease? Herz 25:95–99CrossRefPubMedGoogle Scholar
  38. 38.
    Aziz T, Burgess M, Rahmann AN et al (2001) Cardiac transplantation for cardiomyopathy and ischemic heart disease: differences in outcome up to 10 years. J Heart Lung Transplant 20:525–33CrossRefPubMedGoogle Scholar
  39. 39.
    Carney RM, Freedland KE, Stein PK (2000) Anxiety, depression, and heart rate variability. Psychosom Med 62:84–87PubMedGoogle Scholar
  40. 40.
    Gorman JM, Sloan RP (2000) Heart rate variability in depressive and anxiety disorders. Am Heart J 140:77–83CrossRefPubMedGoogle Scholar
  41. 41.
    Camacho A, Dimsdale JE (2000) Platelets and psychiatry: lessons learned from old and new studies. Psychosom Med 62:326–336PubMedGoogle Scholar
  42. 42.
    Appels A, Bär FW, Bruggeman C, Baets M (2000) Inflammation, depressive symptomatology, and coronary artery disease. Psychosom Med 62:601–605PubMedGoogle Scholar
  43. 43.
    Shapiro PA, Sloan RP, Bagiella E et al (1996) Heart rate reactivity and heart period variability throughout the first year after heart transplantation. Psychophysiology 33:54–62CrossRefPubMedGoogle Scholar
  44. 44.
    Salmon P, Stanford C, Mikahil G et al (2001) Hemodynamic and emotional responses to a psychological stressor after cardiac transplantation. Psychosom Med 63:289–99PubMedGoogle Scholar
  45. 45.
    Überfuhr P, Frey AW, Reichart B (2000) Vagal reinnervation in the long term after orthotopic heart transplantation. J Heart Lung Transplant 19:946–50CrossRefPubMedGoogle Scholar
  46. 46.
    Bunzel B, Laederach HK (2000) Noncompliance in organ transplantation: a review. Wien Klin Wochenschr 12:423–440Google Scholar
  47. 47.
    DiMatteo MR, Lepper HS, Croghan TW (2000) Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 160:2101–2107CrossRefPubMedGoogle Scholar
  48. 48.
    Ziegelstein RC, Fauerbach JA, Stevens SS et al (2000) Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med 160:1818–1823CrossRefPubMedGoogle Scholar
  49. 49.
    Padovan CS, Sostak P, Straube A (2000) Neurological complications after organ transplantation. Nervenarzt 71:249–258CrossRefPubMedGoogle Scholar
  50. 50.
    Adair JC, Call GK, O’Connell JB, Baringer JR (1992) Cerebrovascular syndromes following cardiac transplantation. Neurology 42: 819–823PubMedGoogle Scholar
  51. 51.
    Inoue K, Luth JU, Pottkamper D et al (1998) Incidence and risk factors of perioperative cerebral complications. Heart transplantation compared to coronary artery bypass grafting and valve surgery. J Cardiovasc Surg 39:201–208Google Scholar
  52. 52.
    Wolkowitz OM, Reus VI, Canick J et al (1997) Glucocorticoid medication, memory and steroid psychosis in medical illness. Ann NY Acad Sci 82:381–396Google Scholar
  53. 53.
    Grimm M, Yeganehfar W, Laufer G et al (1996) Cyclosporine may affect improvement of cognitive brain function after successful cardiac transplantation. Circulation 94:1339–1345PubMedGoogle Scholar
  54. 54.
    Riedel-Keil B, Strenge H (1994) Psychologische Betreuung Herztransplantierter: Interventionsmethoden. In: Strenge H, Strauß B, Stauch C (editors) Ein neues Herz. Göttingen: Hogrefe 120–125Google Scholar
  55. 55.
    Johann B, Richter-Görge H (1999) Familientherapeutische Interventionen in der Betreuung von Transplantationspatienten. In: Johann B, Lange R (Eds) Psychotherapeutische Interventionen in der Transplantationsmedizin. Lengerich: Pabst Science Publishers 119–125Google Scholar
  56. 56.
    Berron K (1986) Transplant patients’ perceptions about effective preoperative teaching. J Heart Transplant 5:162–165PubMedGoogle Scholar
  57. 57.
    Cupples SA, Streslow B (2001) Use of behavioral contingency contracting with heart transplant candidates. Prog Transplant 11:137–144PubMedGoogle Scholar
  58. 58.
    Schlehofer B, Zipfel S, Siwinska J et al (2001) A prospective follow-up study of the EUROPACT study group on psychosocial aspects in heart transplantation. Acta Chir Austriaca 33(Suppl):126Google Scholar
  59. 59.
    Hoevels R, Schlehofer B, Zipfel S et al (1999) Psychotherapeutische und psychosoziale Betreuung von Herztransplantationspatienten. In: Johann B, Lange R (editors) Psychotherapeutische Interventionen in der Transplantationsmedizin. Lengerich: Pabst Science Publishers 106–118Google Scholar
  60. 60.
    Kay J, Bienenfeld D, Slomowitz M et al (1991) Use of tricyclic antidepressants in recipients of heart transplants. Psychosomatics 32:165–170PubMedGoogle Scholar
  61. 61.
    Strouse TB, Fairbanks LA, Skotzko CE, Fawzy FI (1996) Fluoxetine and cyclosporine in organ transplantation: failure to detect significant drug interactions or adverse clinical events in depressed organ recipients. Psychosomatics 37:23–30PubMedGoogle Scholar
  62. 62.
    Wright DH, Lake KD, Bruhn PS, Emery RW (1999) Nefazodone and cyclosporine drug-drug interaction. J Heart Lung Transplant 18:913–915CrossRefPubMedGoogle Scholar
  63. 63.
    Armstrong SC, Cozza KL (2001) Consultation-liaison psychiatry drug-drug interactions update. Psychosomatics 42:157–159CrossRefPubMedGoogle Scholar
  64. 64.
    Turton-Weeks SM, Barone GW, Gurley BJ et al (2001) St John’s Wort: a hidden risk for transplant patients. Progress in Transplantation 11:116–120PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2006

Authors and Affiliations

  • S. Zipfel
    • 1
  • A. Schneider
    • 2
  • J. Jünger
    • 3
  • W. Herzog
    • 3
  1. 1.Department Internal Medicine VI Psychosomatic Medicine and PsychotherapyUniversity Medical HospitalTübingenGermany
  2. 2.Department of General Practice and Health Service ResearchUniversity Medical HospitalHeidelbergGermany
  3. 3.Department of General Internal and Psychosomatic MedicineUniversity Medical HospitalHeidelbergGermany

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