A Ventricular Assist Device Recipient and Suicidality: Multidisciplinary Collaboration With a Psychiatrically Distressed Patient

Balliet, Wendy E. PhD; Madan, Alok PhD, MPH; Craig, Michael L. MD; Serber, Eva R. PhD; Borckardt, Jeffery J. PhD; Pelic, Christine MD; Barth, Kelly DO; Hale, Anthony RN; van Bakel, Adrian B. MD, PhD; Peura, Jennifer L. MD

Journal of Cardiovascular Nursing: March/April 2017 - Volume 32 - Issue 2 - p 135–139
doi: 10.1097/JCN.0000000000000293
DEPARTMENTS: Clinical Report

Background: Ventricular assist device (VAD) recipients are at high risk of depression and anxiety, and poor psychosocial functioning is associated with worse medical outcomes.

Purpose: We present a case of a 31-year-old depressed patient who demonstrated passive suicidal behavior through multiple episodes of noncompliance, including temporarily discontinuing warfarin (Coumadin) several months after VAD implantation. The patient’s psychosocial and medical histories and outcomes are presented.

Conclusions: This case underscores the importance of pre-VAD as well and ongoing psychosocial evaluation and management for this unique patient population.

Clinical Implications: Medical teams who are treating patients with cardiovascular disease who are under consideration for VAD or heart transplantation need to be aware of the multitude of ways in which patients can express depressed and suicidal mood and work with a multidisciplinary team to treat such symptoms to optimize patients’ success with VAD/heart transplantation.

Wendy E. Balliet, PhD Assistant Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Alok Madan, PhD, MPH Assistant Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Michael L. Craig, MD Assistant Professor, Department of Medicine and Cardiothoracic Transplant Center, Medical University of South Carolina, Charleston.

Eva R. Serber, PhD Associate Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Jeffery J. Borckardt, PhD Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Christine Pelic, MD Assistant Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Kelly Barth, DO Associate Professor, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.

Anthony Hale, RN Nurse Coordinator, Cardiothoracic Transplant Center, Medical University of South Carolina, Charleston.

Adrian B. van Bakel, MD, PhD Professor, Department of Medicine and Cardiothoracic Transplant Center, Medical University of South Carolina, Charleston.

Jennifer L. Peura, MD Associate Professor, Department of Medicine and Cardiothoracic Transplant Center, Medical University of South Carolina, Charleston.

The authors have no funding or conflicts of interest to disclose.

Correspondence Wendy E. Balliet, PhD, Department of Psychiatry and Behavioral Sciences, Medical, University of South Carolina, 67 President St, IOP 1 S, Ste BA104, Charleston, SC 29425 (ballietw@musc.edu).

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