Mechanical circulatory support systems: an extreme psychological strain?

With increasing use of assist devices in patients with terminal heart disease as a bridge to heart transplantation, attention has to be paid to the way patients react psychologically to this invasive treatment. The aim of this study was to determine specific patterns of psychological and psychiatric syndromes and the dynamics of their remission over time, furthermore adaptation and coping processes were assessed. Study group and methods Our sample included 46 patients with a mean age of 42 years (range 15 to 66 years), 9 women and 37 men. 31 patients were treated with the biventricular Berlin Heart and 15 with left-ventricular assist systems: nine Novacor, six TCI. Mean implantation time was 96 days (range 11 to 388 days). The diagnoses were cardiomyopathy in 36 patients, coronary heart disease 8 patients, and other diseases in 2 patients. Psychiatric evaluation was performed twice weekly documented with psychiatric rating-scale (AMDP) and diagnoses were calcuated according to the guidelines of DSM IV during the first 2 weeks. The course of specific psychiatric syndromes, neuropsychological deficits and psychological reactions were assessed weekly up to 13 weeks after MCS implantation. Results During the first 2 weeks 41,3% of patients suffered from delirium or brief psychotic disorders, 28.4% from organically induced affective disorders and 19.6% from adjustment disorders. Beyond the first 2 weeks we assessed the course of different mental syndromes over time on MCS and there was predominantly a rapid remission of the “syndrome of disturbances of consciousness and disorientation” and the “syndrome of delusions and hallucinations”. “Neurocognitive disorders” remitted more slowly and remained stable on about one fifth of the initial level after 10 weeks. The “anxious-depressive syndrome” was also characterized by a 40% remission during the first 2 weeks but there was no continuing remission. On the other hand the incidence of “aggressive-dysphoric syndrome” behavior increased continuously over time and this was also the case with the “regressive withdrawal syndrome” and with “eating disorders/anorectic reactions”. A “vegetative psychomotoric inhibition and tension” increased initially and remained furthermore on a high level. The pattern of coping strategies was characterized predominantly by “depressive withdrawal”, “denial and wishful thinking” and “active adjustment to problems”. To illustrate the impact of an MCS treatment on the emotions and intrapsychological processes, finally a number of works from a particular patient‘s art therapy is presented.