Table of Contents - Academy of Psychosomatic Medicine

35. Decision-Making Process Involved
in Living Kidney Donation in Japan: A
Qualitative Research Study
Presenting Author: Katsuji Nishimura, MD, PhD
Co-Authors: Sayaka Kobayashi, MA, Sachi Okabe, Hideki
Ishida, MD, PhD, Kazunari Tanabe, MD, PhD, Satoshi Teraoka,
MD, PhD, Yoshie Okada, DNSc, Jun Ishigooka, MD, PhD
Purpose: To elucidate the factors influencing the decisionmaking
process involved in organ donation for living kidney
transplantation in Japan.
Methods: A 50-minute semistructured psychological interview
was conducted for 152 candidate donors for living kidney
transplantation to confirm that the donors were voluntarily
donating their kidneys. The interview was performed
in the period between April 1, 2007, and March 31, 2008.
Of the 152 candidate donors, 20 were randomly sampled;
these 20 donors volunteered as organ donors on the basis
of their relationships with the recipients. In addition, 6 candidates
who had problems with their initiative involved in
organ donation were also sampled. Data were collected from
interview records among the medical records. Sections of
the records that were considered to be factors related to the
decision-making process involved in organ donation were
selected. Then, the contents were clustered into categories.
The interviews were conducted by psychiatrists and clinical
psychologists who were appointed by the university’s ethics
committee.
Results: The selected factors influencing the decisionmaking
process involved in organ donation were as follows:
mental and physical burden experienced by the recipient
struggling with a disease, understanding and cooperation of
family members, donor selection, donor health, donor’s work
and financial status, information related to transplantation,
etc. These factors can also in part hamper the decision-making
process.
Conclusions: The factors influencing the decision-making
process involved in organ donation for living kidney transplantation
are complicated. Careful assessment and support
during the decision-making process are required.
36. Psychological Factors Affecting an
Identified Medical Condition: Health Anxiety
Related to Acute Intermittent Porphyria in the
Internet Era
Presenting Author: Lois Krahn, MD, FAPM
Co-Author: Erika Boroff, MD
Introduction: Patients can access a plethora of medical information
via the internet. Patients with rare medical conditions
are likely to search the internet for additional information.
These searches include misinformed or outdated data;
and finding lists of non-specific symptoms.
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Methods/Results: Case report of a 62 year old woman
with laboratory confirmed AIP (acute intermittent porphyria).
The diagnosis was made 38 years previously, when the patient
presented with episodic abdominal pain, brown urine,
muscle weakness, mental status changes, and eventually,
coma. Porphyrin testing was positive for 5 attacks. She was
advised to avoid most prescription medications to prevent
further episodes. Eventually she developed co-morbid conditions
including hypertension, end stage renal disease,
generalized anxiety disorder and irritable bowel syndrome.
There have been no recent documented phorphyria attacks.
She remains very wary of all pharmacologic treatments (especially
psychotropic agents) . Interestingly. she continues
to smoke cigarettes despite an association between tobacco
and attacks. She utilizes web-based resources to research
whether the vague symptoms she experiences may be an
atypical form of an attack, a practice which often leads to
her to discontinue a medical treatment. Lab testing done during
a suspected “attack” has been in the normal range. This
information was not reassuring to the patient who remains
fearful of AIP attacks and meets criteria for a somatoform
disorder.
Discussion: The authors have followed this patient closely
for three years and discuss the treatment options. In essence
the treatment team must be familiar with the presenting
symptoms and triggers of the rare disease, AIP in this
case. This patient requires ongoing patient education about
her disease, warnings about accessing material on the web
plus cognitive restructuring and supportive psychotherapy
37. Developing a Web 2.0-Based Interface for
Training Residents and Fellows in Transplant
Psychiatry
Presenting Author: Sheila Jowsey, MD, FAPM
Co-Authors: Albin Scott, DO, Angela Leise, MD, Terry Schneekloth,
MD, Christina Wichman, DO, James Rundell, MD,
FAPM
Introduction: Web technology allows the creation of an accessible
portal for resident training in Transplant Psychiatry.
It also provides an avenue to key documents and presentations,
web links, customized contact information, specialized
search capabilities and web feed formats of weblog entries
and table of contents.
Objective: To develop a Web 2.0 training interface for Transplant
Psychiatry rotations.
Methods: Software was chosen that could provide the
following:
1. A document library
2. A task list
3. A search engine
4. Presentations archive
5. Links to commonly visited transplant and psychiatry websites
and journal links
6. Surveys to allow rapid adaptation of best practices
7. Discussion weblogs on new or complex management areas
in the field
(Examples provided in presentation)