title: A psychosomatic approach to severe nausea and vomiting in liver transplant recipients with familial amyloid polyneuropathy: clinical outcome in 10 cases.
abstract: After transplant, patients with familial amyloid polyneuropathy may manifest several medical and psychiatric symptoms that can be difficult to diagnose and treat. We describe 10 liver transplant candidates with familial amyloid polyneuropathy who had severe somatic signs and symptoms (nausea and vomiting) after transplant. Their physical examinations were performed by physicians from different specialties. Before transplant, the patients' evaluations did not reveal relevant medical or psychiatric symptoms. After transplant, they had severe nausea and vomiting and high scores on the Hospital Anxiety and Depression Scale. A psychopharmacological trial with a selective serotonin reuptake inhibitor plus an antiemetic drug was unsuccessful. Remission was obtained with tricyclic antidepressants and low-dose atypical antipsychotic agents. Previous researchers had concluded that the mental quality of life in patients with familial amyloid polyneuropathy was worse after receiving a liver transplant, unlike other transplant recipients. The 10 cases described in this study are a good example of comorbid physical and mental symptoms occurring after transplant in patients with familial amyloid polyneuropathy. The conclusions of this study have implications for clinical practice, showing how a careful holistic approach in the posttransplant period is relevant in these cases.
authors.affiliation: Curry Cabral Hospital, Lisbon, Portugal Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Diogo
authors.initials: D
authors.lastname: Telles-Correia
authors.affiliation: Hospital de Santa Maria, Lisbon, Portugal University of Lisbon, Lisbon, Portugal.
authors.forename: Ana-Lúcia Rodrigues
authors.initials: AL
authors.lastname: Moreira
mesh_terms: D000328:Adult; D028227:Amyloid Neuropathies, Familial / Q000523:psychology* / Q000601:surgery*; D000929:Antidepressive Agents, Tricyclic / Q000627:therapeutic use; D000932:Antiemetics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy / Q000523:psychology; D003863:Depression / Q000188:drug therapy / Q000523:psychology; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D008297:Male; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D016896:Treatment Outcome
chemical_list: D000929:Antidepressive Agents, Tricyclic; D000932:Antiemetics; D014150:Antipsychotic Agents