De novo schizophrenia after liver transplantation: A case report

Abstract

BACKGROUND

This report describes the development of schizophrenia in a 63-year-old female patient approximately six months after undergoing liver transplantation. The patient exhibited no previous indications of psychiatric conditions and did not have any familial background of schizophrenia.

CASE SUMMARY

This particular case serves as an illustration of the intricate interaction of various elements, such as the liver transplantation process, surgical trauma, intraoperative narcosis, and immunosuppression, which may potentially contribute to the onset of schizophrenia. This report examines the clinical trajectory, diagnostic assessment, and therapeutic strategies employed in this case.

CONCLUSION

This report emphasizes the significance of identifying and managing psychiatric issues during the post-transplant phase, highlighting potential underlying mechanisms that may link transplantation-related factors to the onset of schizophrenia.

Keywords: De novo schizophrenia; Post-transplant psychosis; Calcineurin inhibitor neurotoxicity; Tacrolimus; Late-onset schizophrenia; Liver transplantation; Case report

Core Tip: We present the inaugural instance of new-onset schizophrenia occurring within one year post-liver transplantation in a 63-year-old female patient. The diagnosis was determined using structured interviews, sequential Positive and Negative Syndrome Scale scores, and thorough exclusion of metabolic, viral, and toxic variables. Following the commencement of antipsychotic treatment alongside low-dose tacrolimus and mycofenolate mofetil immunosuppression, the patient showed rapid improvement of symptoms, indicating calcineurin-inhibitor neurotoxicity as a direct catalyst; and surgical stress and anesthesia likely exacerbated individual vulnerability. This instance highlights the necessity for proactive neuropsychiatric monitoring and tailored immunosuppression in liver transplant recipients.