Non-compliance or suicide attempt: a case study

Both noncompliance and suicide attempts are frequent in post-orthotopic heart transplantation (OHT) patients. However, distinguishing between noncompliance and suicide is difficult. A case of a young woman after OHT who withdrew immunosuppressive drugs several times was presented. The last withdrawal led to the patient's death. Psychiatric examination conducted during one of hospitalizations revealed the signs of social phobia with no features of depression. The patient did not show any suicidal thoughts. She even appeared to be frightened by possible consequences of immunosuppression cessation. In spite of this, a consecutive fatal treatment interruption took place. Due to the fact that the patient's place of residence was remote from the transplantation centre, it was impossible to provide her with continuous psychological support. Each case of immunosuppressant withdrawal requires thorough diagnosis with respect to mental disorders and possible suicidal actions. Patients at risk should be covered by continuous psychological care.