Delayed Adjustment Disorder in Adolescent Recipients After Living Related Renal Transplantation

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  • 生体腎移植後の思春期レシピエントにおける遅延性適応障害

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説明

母をドナーとして生体腎移植を受けた後, 1～6年後に境界性人格障害状態を呈した4人の思春期レシピエントについての後方視的評価を報告する.精神医学的操作的診断基準を用いた場合,彼らは境界性人格障害と診断されるが,長期的経過と治療戦略から,遅延性適応障害との位置づけが適当であると考えた.精神症状の特徴は身体症状の優勢化,対人関係障害,衝動制御不全,情動不安定性,行動化,そして長期にわたる退行的入院である.転帰はおしなべて不良であった.1例は大量服薬の後肺炎で死亡し,他の2例は不安定な状態にある.透析に戻った1例のみが情緒的に安定した.精神症状の発現の基盤には,ドナー(母親)・レシピエント(子ども)間の共生関係と移植を受けた病院への依存,知的能力を含めた発達水準の問題などが指摘された.移植術前後にわたる,レシピエントのみならず,ドナーに対する長期的,定期的心理サポートシステムが必要とされる.この場合,移植病棟への長期入院は退行を引き起こすため回避されるべきである.

Here we report a retrospective assessment of four adolescent recipients who developed borderline personality states between 1-6 years after receiving kidney transplants donated by their mothers. Even though such patients can be diagnosed as having borderline personality disorder using psychiatric operational diagnostic criteria, it is better to consider them as having adjustment disorders considering their long-term course and therapeutic strategy. The symptom characteristics included predominance of somatic symptoms, disturbance of inter-personal relationships, insufficient impulse control, emotional instability, acting-out and long-term regressive hospitalization. The outcome was invariably poor. One of the patients died of pneumonia after a massive self-inflicted drug overdose, and another two curently remain in an unstable condition. Only one patient is emotionally stable, although she has returned to dialysis. The basis of the psychiatric manifestation can be considered to be a symbiotic relationship between donor (mother) and recipient (child) and dependence on the hospital where the transplantation was carried out. The patients' developmental levels including intelligence are also discussed. Systems for regular long-term psychological support are needed not only for recipients but also for donors before and after transplantation. In such patients, long-term hospitalization in the transplantation ward must be avoided because it can cause regression of their mental state.

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