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We conducted formal psychiatric evaluations and extensive chart reviews in a series of 34 patients surviving an average of 5 1/4 years after hepatic transplantation. Seven of 14 children and 19 of 20 adults exhibited obvious psychiatric disturbances before the operation. (There was not time to evaluate another 5 children and a sixth was an infant; one adult arrived in hepatic coma.) All patients experienced psychiatric problems postoperatively. Organic brain syndromes and apprehensiveness were the most common preoperative problems in pediatric patients, and problems in relationships with family members, anxiety, regression, and helplessness were most common after surgery. In adults, organic brain syndromes, anxiety, and depression were the most common preoperative and postoperative problems. While psychosocial disturbances in liver transplant recipients were similar in many respects to those of the more well-studied kidney homograft patients, a number of important differences emerged: organic brain syndromes, fear of death, severe regression (psychological functioning appropriate to a younger age), worries that a suitable donor would not be found in time, and insomnia were more common, and concerns about the origin of the homograft and about changes in body image were relatively rare postoperatively. These differences seem to be related to the severity of liver disease requiring transplantation, the effects of the illness on the brain, the lack of an alternative means of life support resulting in greater prominence of concerns about survival, the exclusive use of cadaver rather than living donors, and the greater effect of the illness than of its treatment on physical appearance.
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PMID:Psychiatric aspects of hepatic transplantation. 634 38

Paranoia may be a significant concern during adolescence, but there has been little research on excessive mistrust in young people. In this longitudinal study we set out to test the predictive ability of a number of cognitive, affective, and social factors in the early development of paranoia in a clinical adolescent population. Thirty four help-seeking adolescents, aged 11-16 years, reporting paranoid thoughts and attending mental health services were recruited. Self-report and interview assessments of paranoia were conducted at baseline. Measures relating to a cognitive model of persecutory delusions were completed. Paranoia was reassessed after three months with thirty three participants. Significant predictors of paranoia persistence were anxiety, depression, worry, negative self-beliefs, perceptual anomalies, insomnia, affective reactivity, bullying, and cyber victimization. No effect was found for reasoning bias or negative perceptions of academic ability, social competence, and physical appearance. In conclusion, many of the maintenance factors implicated in adult paranoia are likely to prove important in the early development of paranoia in young people. Further experimental and treatment studies are now needed to examine the causal role of these factors in the occurrence of paranoia in adolescents.
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PMID:Cognitive, affective, and social factors maintaining paranoia in adolescents with mental health problems: A longitudinal study. 2871 66