Aspetti clinici e psicologici del trapianto epatico: studio degli effetti psicologici durante la pandemia di COVID-19 in un campione di pazienti trapiantati di fegato

Il trapianto di fegato rappresenta una procedura salvavita che ha come obiettivo quello di ripristinare la funzionalità dell’organo, migliorare la salute e la qualità di vita del soggetto ricevente. La fase post-operatoria appare caratterizzata da una importante transizione fisica ed emotiva: nonostante essa sia meno stressante rispetto al periodo pre-operatorio, i soggetti trapiantati devono adattarsi a un nuovo stile di vita che consiste nell’assumere quotidianamente una terapia, recarsi regolamentante alle visite di controllo, seguire una dieta sana, astenersi dal consumo di alcol e altre sostanze e praticare esercizio fisico (Dew, Fox & DiMartini 2013). A causa dei numerosi stressor a cui i soggetti trapiantati sono sottoposti, essi sono a rischio di sviluppare problematiche psicopatologiche, che a loro volta costituiscono un fattore di rischio per l’outcome dell’intervento. La recente diffusione della patologia COVID-19 rappresenta, oltre che un importantissimo problema di salute pubblica, un fattore di rischio per problemi di salute mentale (Moreno et al., 2020). Sebbene le misure restrittive abbiano frenato in parte l’avanzare del contagio, esse hanno avuto un considerevole impatto sulla salute psicologica degli individui ed è quindi ragionevole aspettarsi che questa situazione possa provocare nelle persone ansia, depressione e risposte di stress; per tale motivo risulta fondamentale indagarne lo stato psicologico durante questo delicato periodo (Wang et al., 2020). Il presente lavoro di tesi ha come obiettivo quello di osservare gli effetti psicologici della pandemia di COVID-19 in un campione di soggetti trapiantati di fegato (n=314) per mezzo di questionari qualitativi e test psicometrici atti a valutare la presenza di risposte traumatiche, stress percepito, distress psicologico, capacità di resilienza e di mindfulness. Liver transplantation represents a life-saving procedure aimed to re-establish liver function, improve health and quality of life of the recipient. The post-operative phase is characterized by an important physical and emotional transition. Although it appears to be less stressful than the pre-operational phase, liver recipients have to adjust to a new life-style characterized by daily medication assumptions, follow-up visits, healthy diet, alcohol and other substances abstention and physical exercise (Dew, For & DiMartini, 2013). Due to all these stressors, people receiving liver transplant are at risk to develop psychological problems, which are dangerous for the transplantation outcome.The recent spread of COVID-19 represents, beyond a very consistent public health issue, a risk factor for mental health (Moreno et al., 2020). Despite social restrictions have delayed the progress of the infection, they had a significant impact on individuals psychological well-being and have caused anxiety, depression and stress responses. For these reasons, it is very important to investigate the psychological conditions of the general population, particularly the ones that are more vulnerable. The current work aims to investigate the psychological effects of COVID-19 pandemic in a sample of liver transplantation recipients (n=314) by qualitative questionnaires and psychometric tests to evaluate the responses to trauma, stress perception, psychological distress, resilience and mindfulness

Is adult hippocampal neurogenesis really relevant for the treatment of psychiatric disorders?

Adult neurogenesis consists in the generation of newborn neurons from neural stem cells taking place in the adult brain. In mammals, this process is limited to very few areas of the brain, and one of these neurogenic niches is the subgranular layer of the dentate gyrus (DG) of the hippocampus. Adult newborn neurons are generated from quiescent neural progenitors (QNPs), which differentiate through different steps into mature granule cells (GCs), to be finally integrated into the existing hippocampal circuitry. In animal models, adult hippocampal neurogenesis (AHN) is relevant for pattern discrimination, cognitive flexibility, emotional processing and resilience to stressful situations. Imaging techniques allow to visualize newborn neurons within the hippocampus through all their stages of development and differentiation. In humans, the evidence of AHN is more challenging, and, based on recent findings, it persists through the adulthood, even if it declines with age. Whether this process has an important role in human brain function and how it integrates into the existing hippocampal circuitry is still a matter of exciting debate. Importantly, AHN deficiency has been proposed to be relevant in many psychiatric disorders, including mood disorders, anxiety, post-traumatic stress disorder and schizophrenia. This review aims to investigate how AHN is altered in different psychiatric conditions and how pharmacological treatments can rescue this process. In fact, many psychoactive drugs, such as antidepressants, mood stabilizers and atypical antipsychotics (AAPs), can boost AHN with different results. In addition, some non-pharmacological approaches are discussed as well