Browsing by Author "Teh, Lisa"

Now showing 1 - 6 of 6
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    Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes
    (Springer Nature, 2023-06-12) Hinton-Froese, Kendra E.; Teh, Lisa; Henderson, Danielle R.; Hage, Chadi A.; Chernyak, Yelena; Psychiatry, School of Medicine
    The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.
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    Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates
    (Springer, 2022-03) Chernyak, Yelena; Henderson, Danielle R.; Teh, Lisa; Powell, Anna-Leigh; Hinton, Kendra E.; Hage, Chadi A.; Psychiatry, School of Medicine
    The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U = 7.69, p < .05). The Total (β = − .05, SE = .018, p < .01), Social Support Subscale (β = − .133, SE = .058, p < .05), and Psychosocial Stability and Psychopathology Subscale (β = − .103, SE = .040, p < .05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.
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    Exploring the Developmental Impact of Cystic Fibrosis on Lung Transplant Candidacy: Considerations for Adulthood
    (Springer, 2021-01-29) Powell, Anna-Leigh; Teh, Lisa; Patel, Anahli; Chernak, Yelena
    The average life expectancy for cystic fibrosis (CF) has increased over the past four decades resulting in a higher rate of adult CF patients. Adults seeking lung transplant to address CF-related advanced lung disease (ALD) represent a small, yet growing, subset of lung transplant recipients. Psychosocial factors such as adherence to medical recommendations, self-management of medical care, and caregiver support have been identified as positive prognostic factors in lung transplant outcomes. These factors are also implicated in the pediatric chronic illness literature and are crucial as patients begin to transition to a more autonomous and independent role in their own health management. Adults with CF facing ALD must navigate through another transitional phase as lung transplant requires additional supports and new expectations. A case series is used to highlight specific psychosocial considerations in this population and to explore the seemingly dichotomous relationship between independent self-management and caregiver support.
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    Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates
    (Elsevier, 2023-09) Teh, Lisa; Henderson, Danielle; Hage, Chadi; Chernyak, Yelena; Psychiatry, School of Medicine
    Background Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. Objective To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. Methods Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. Results The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. Conclusions While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.
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    Medically Induced Exacerbation of PTSD Following Lung Transplantation: A Case Series
    (Springer, 2019-12-20) Chernyak, Yelena; Teh, Lisa
    Posttraumatic stress disorder (PTSD) occurs at double the rate in individuals undergoing lung transplantation, compared to the normal population. The psychological sequela of PTSD makes recovery more challenging and may result in poor medical and psychological outcomes. A series of three cases illustrate this presentation. In all cases, PTSD history and symptomatology was undisclosed prior to lung transplantation, despite robust psychological evaluation. All patients experienced traumatic delirium during the acute recovery phase from transplantation. Re-emergence and exacerbation of PTSD symptoms related to remote trauma lasting up to 2 years after transplant. Noncompliance with post-transplant recovery occurred in the sample of cases presented. Major surgeries, such as lung transplant may exacerbate premorbid PTSD possibly via psychological sequela such as delirium, regardless of type or remoteness of trauma experiences. Existing psychological evaluation practices may not be adequate to capture PTSD as many patients may fail to disclose relevant history. Novel evaluation and treatment methods need to be developed.
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    Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient
    (Sage, 2020-03) Chernyak, Yelena; Teh, Lisa; Henderson, Danielle R.; Patel, Anahli; Psychiatry, School of Medicine
    There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns.