Psychiatric Evaluation of Children and Adolescents With Left Ventricular Assist Devices BURCU OZBARAN, MD, SEZEN KOSE, MD, TAHIR Y AGDI, MD, CAGATAY ENGIN, MD, SERPIL ERERMIS, MD, TACISER UYSAL, MD, F ATIH A YIK, MD, SULTAN KARAKULA,ZULAL ULGER, MD, YUKSEL ATAY , MD, AND MUSTAFA OZBARAN, MD Objectives: To evaluate the psychiatric symptoms of children equipped with a ventricular assist device (VAD) and follow them up for 6 months. With the shortage of donor hearts available for the treatment of end-stage heart failure, VADs have been used to provide temporary treatment until a heart becomes available. VADs provide external sources of power for mechanical circulatory support and are capable of sustaining life over weeks and months. This study provides preliminary details about the psychiatric symptoms and disorders of the first eight children equipped with a VAD in Turkey. Methods: Eight pediatric patients who recently underwent VAD implantation, aged 1 to 16 years, were evaluated using the Kiddie Schedule for Affective Disorders and Schizophrenia, Child Behavior Checklist, Children’s Depression Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory for Children and followed up for 6 months. Results: In the first evaluation, five participants had a psychiatric disorder diagnosis. Two patients had adjustment disorder with depressive and anxiety symptoms; one had anxiety disorder, not otherwise specified; and two had major depressive disorder. The anxiety and depressive symptom levels in questionnaires were consistent with psychiatric diagnoses. Two patients had heart transplantation during the follow-up period. Conclusions: To determine and treat psychiatric symptoms and disorders at an earlier stage, it is important for children and adolescents with a VAD and those who have undergone heart transplantation to be evaluated by a multidisciplinary consultation liaison team including psychiatrists, psychologists, consultant nurses, and counselors. Key words: anxiety, children, adolescents, depression, heart transplantation, ventricular assist device. VAD = ventricular assist device; K-SADS = Kiddie Schedule for Affective Disorders and Schizophrenia; CBCL = Child Behavior Checklist; BDI = Beck Depression Inventory; CDI = Children’s Depression Inventory; STAI-C = State-Trait Anxiety Inventory for Children; MDD = major depressive disorder; AD = adjustment disorder; PE.I = initial psychiatric evaluation; PE.II = second psychiatric evaluation. INTRODUCTION H eart transplantation is a treatment method for end-stage heart failure (1). Because of the shortage of available donor hearts, there is a need for treatment techniques to bridge the gap between the time when a donor heart is first needed and when it becomes available (2,3). Ventricular assist devices (VADs) provide an external source of power for mechanical circulatory support and are capable of sustaining life over a period until a suitable heart becomes available (4). The use of implantable devices is limited in pediatric population (5). VAD applications in pediatric population have progressed in the past decade (6). At Ege University in Turkey, the VAD program for the pediatric population started in 2009 (2). Because of insufficient medi- astinal space, external devices are mostly used, and prolonged hospitalizations are more prominent and disturbing in pediatric population (5,6). Although there are many studies on pediatric heart trans- plant patients, the literature on psychiatric and psychosocial effects of VADs is limited (7Y9). This may be related to the limited number of pediatric patients with a VAD, differences in devices used, and the rapid progress of VAD practices (5). The responsibility for the device may affect the psychological status of the patients (6). Individuals using VADs may be under pres- sure from prolonged hospitalization and the complex technical regimen of the devices. Feelings of being overwhelmed may result from the responsibilities of recognizing and responding to warning signals, securing all parts of the device (power leads, battery clips, and percutaneous tubes), and taking measures to avoid infection (6). Living with the noise and vibration of a device and the thought of having a mechanical ‘‘thing’’ keeping the person alive may lead the patients to feeling restricted (5). Baba et al. (10) found in their study that adjustment disorder (AD) and depression were the most common diagnoses in adults with VADs. It has been suggested that psychiatric symptoms should be rapidly identified and treated because they predict nonadherence to treatment and physical deterioration (6). Studies on adults after heart transplantation report depres- sive symptoms and emotional difficulties, but studies on children have generally reported healthy adjustment capacities (7,11). In the pretransplantation period, internalizing symptoms and behavioral problems have been identified in children, and they benefit from transplantation physically and psychologically (12Y16). The most frequent psychiatric disorders in children who are heart transplant candidates are depression, AD, generalized anxiety disorder, and anxiety and depressive symptoms. It has also been reported that some psychosocial functioning impairments and psychiatric complaints may still remain after transplantation (17,18). In this study, we aimed to evaluate the psychiatric symptoms of the first series of pediatric heart transplant candidates equipped with a VAD in Turkey and to report results from their first 6 months of psychiatric follow-up. MATERIALS AND METHODS This study includes eight pediatric patients with dilated cardiomyopathy who were equipped with Berlin Heart EXCOR VAD (Berlin, Germany) for their end-stage cardiac failure at Cardiovascular Surgery Clinic of Ege Uni- versity Hospital, Turkey. 554 Psychosomatic Medicine 74:554Y558 (2012) 0033-3174/12/7405Y0554 Copyright * 2012 by the American Psychosomatic Society From the Departments of Child and Adolescent Psychiatry (B.O., S.Ko., S.E., T.U.), Cardiovascular Surgery (T.Y., C.E., F.A., S.Ku., Y.A., M.O.), and Pediatric Cardiology (Z.U.), Faculty of Medicine, Ege University, Izmir, Turkey. Address correspondence and reprint requests to Burcu Ozbaran, MD, Depart- ment of Child and Adolescent Psychiatry, Faculty of Medicine, Ege University, Bornova Izmir, Turkey. E-mail: drbbeker@yahoo.com; burcu.ozbaran@ege.edu.tr Received for publication June15, 2011; revision received November 14, 2011. DOI: 10.1097/PSY.0b013e318258853a