Psychiatric Assessment of Candidates for Bone Marrow Transplantation: A Psychodynamically-Oriented Approach (original) (raw)
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Psychological risk factors and early complications after bone marrow transplantation in adults
Bone Marrow Transplantation, 1999
Complications of bone marrow transplantation can compromise its effectiveness, and often it is not possible to predict who is at greatest risk. In a previous study we reported that certain psychological factors correlated with a high incidence of post-transplant mortality, and here we analyze the associated complications and causes of death. Prior to receiving high-dose chemotherapy and bone marrow transplantation, 112 patients underwent a psychodynamically oriented psychiatric assessment (the 'FIT' assessment). Mortality and associated complications were ascertained by a retrospective chart review. The results of the 'FIT' assessment correlated with the incidence of complications and death, whether or not the transplant was performed for hematologic or solid organ cancers, or was from an allogeneic or autologous source. Most individuals with a high risk profile died of progressive major organ dysfunction or recurrent/refractory neoplastic disease in the first year after transplant. We propose that such a psychiatric assessment might identify a subgroup of individuals in whom pre-emptive therapeutic interventions could be most effective. Keywords: bone marrow transplantation; multiorgan failure; personality assessment; risk assessment; leukemia/lymphoma; cancer of breast and ovary Bone marrow transplantation can reverse the myelotoxicity of high-dose radiation and chemotherapy used in many current strategies to treat cancer. However, sepsis and hemorrhage before engraftment, acute and chronic graftversus-host disease, graft rejection, and late organ dysfunction still limit its effectiveness. 1 Thus, an understanding of predisposing factors that place an individual at risk for such difficulties might enable better control and prevention, and ultimately improve survival.
Psychological Distress Among Adult Patients Being Evaluated for Bone Marrow Transplantation
Psychosomatics, 1997
A sample of 437 patients being evaluated for bone marrow transplantation (BMT) complered interviews and questionnaires to assess their psychosocial adjustment. Nearly a third of the patients (3/%) showed some degree ofdepression on the Center for Epidemiologic Studies Depression Scale. Scores on the Profile of Mood States Scale also indicated that these BMT candidates were experiencing a high level ofpsychological distress. This distress was found to be predicted by low scores on the Self-Rated Kama/sky Performance Scale and on scales measuring mastery and dispositional opti• mism. The value ofassessing the levels ofpsychological distress and psychosocial resources ofpatients being evaluated for BMT and/or providing necessary psychiatric interventions are discussed.
Psychological Aspects of Bone Marrow Transplantation
Psychotherapeutic approach to the illness includes that there is a continuous connection between somatic and psychic processes, which leads to the conclusion that the human organism should be treated as a single undividable unit. Psychotherapist point out that the human organism with its worries, fears, hopes and ambitions is a integrated unit, and not just an carrier of organs, because of this it is subduable to medical research. According to the hypothesis ‚of complete unity and mutual connection between the physical and mental (psychological) processes allows the phenomena with which doctors are constantly faced to be researched and understood. Anxiety is a constant side effect of stressful situations. Bone marrow transplantation treatment because of its uncertain outcome and high level of pain caused by radiation and cytostatic therapy favours the development of anxiety. This research will measure the level of anxiety as well as other manifesting symptoms such as depression and denial which is the most used defence mechanism by patients which undergo this procedure. Depression begins its manifestation later when the patients are in the sterile environment separated from other people, where as anxiety and denial manifest them self through out the whole course of the treatment but more predominantly at the very beginning. We will observe the differences between genders and the success of the treatment between 31 par
Psychological adaptation and symptom distress in bone marrow transplant recipients
Psycho-Oncology, 1996
This prospective study was designed to measure changes in the psychological status, self-esteem, dependence on other people, physical symptom distress and coping during isolation for bone marrow transplantation (BMT). A sample of 26 BMT patients was assessed at four different points in time. Results indicated that high psychological morbidity was present the day before the transplant, which remained elevated throughout hospitalisation and even a month after discharge. Main distressing symptoms included changes in bowel patterns. fatigue, insomnia, poor appetite and poor concentration. Tension-anxiety and depression showed a non-significant decrease throughout hospitalisation, but anger-hostility and fatigue were increased, especially in the last assessment about a month after discharge from hospital. Activity levels declined over time. Dependence on others and self-esteem have shown no significant changes over time, although pre-transplant assessment showed low self-esteem and a high degree of dependence on others. Main coping mechanisms during isolation identified in the study were hope, directing attention, maintaining control over the situation and acceptance. Psychological disturbance during isolation had a 'carry-over' effect even a month after discharge from hospital. Higher symptom distress was associated with higher mood disturbance. Different types of isolation during BMT were not associated with differential amounts of psychomorbidity. Finally, patients who received professional psychological support during BMT demonstrated significantly lower mood disturbance compared with patients who did not receive psychological support.
Psychological functioning and quality of life following bone marrow transplantation
Journal of Psychosomatic Research, 2000
To assess changes in quality of life and psychological distress following bone marrow transplantation (BMT) and variables related to this change. One hundred twenty-five consecutive patients who underwent bone marrow transplantation (BMT) at the Leiden University Medical Centre between 1987 and 1992 filled in questionnaires measuring quality of life, functional limitations, psychological distress, anxiety, depression, self-esteem, and health locus of control. Measurements were taken before the BMT; 1 month after discharge; and 6 months, 1 year, and 3 years after the BMT. Three years after BMT, a quarter of the patients continued to experience serious functional limitations. Thirteen percent of the patients scored >4 on the General Health Questionnaire (GHQ-12), a percentage comparable to general population prevalence. Quality of life was reported to be good to excellent by almost 90% of the patients at three years. Changes in quality of life could be explained entirely by changes in functional limitations and somatic symptoms. Changes in psychological distress were also related to these measures, and furthermore to baseline psychological functioning. Although patients were doing well three years after BMT, there was a group of patients needing help. In interventions special attention should be given to patients with ongoing psychological problems. Emphasis should be on coping with physical limitations.
Transplantation, 2008
Objectives. Quality of life and psychosocial well-being usually improve after an organ transplant and remain stable for a minimum of several years. These findings, however, mainly apply to the "average" trend for transplant patients. This study aims to investigate whether transplant patients fall into different groups in good or poor psychosocial outcome after organ transplantation. Methods. One hundred thirty-one patients were assessed before and 6, 12, and 24 months after a heart, lung, liver, kidney, or bone-marrow transplant. Cluster analysis was applied to identify typical outcome profiles of the patients' mental health (SF-36); differences between the clusters were investigated with regard to further psychosocial parameters (sense of coherence, optimism, psychosocial functioning, anxiety, depression, life/health satisfaction, medication experience). Results. The analysis revealed two clusters of transplant patients. Cluster A (nϭ78, 59.5%) showed a fairly good psychosocial outcome, improving over the posttransplant period of 2 years. Cluster B (nϭ53, 40.5%) included patients who reported a limited or poor outcome, deteriorating after the transplant. Furthermore, there are significant differences between clusters A and B in psychosocial parameters and physical functioning. Conclusions. These findings indicate that the experience of the transplant process may vary greatly from patient to patient, and that a considerable number of transplant recipients require psychosocial support, despite the majority of patients showing an unquestionable posttransplant improvement in psychosocial well-being.
Psychoanalytic aspects of bone marrow transplantation
International Congress Series, 2006
Bone marrow transplantation is an extremely demanding intervention for the curative treatment of oncological conditions. Some patients that after having survived the high risk intervention and from a somatic point of view could be regarded as cured from an otherwise fatal disease–cancer of the blood system–did not show adequate psychosocial rehabilitation. This paper presents clinical issues and reviews findings on the role of defensive processes in the process of psychosocial rehabilitation.
Bone Marrow Transplantation, 1998
The purpose of this study was to measure the trajectory of psychosocial recovery over the first year after bone marrow transplantation (BMT). BMT patients were assessed at baseline (n = 86), hospital discharge (n = 74), 100 days (n = 64) and at 1 year (n = 45). Participants completed the Functional Assessment of Cancer Therapy-Bone Marrow Transplant Scale (FACT-BMT), the Profile of Mood States Total Mood Disturbance Scale (POMS-TMDS), the Medical Outcomes Social Support Survey (MOS-SSS), the Center for Epidemiologic Studies-Depression (CES-D) scale screener, a performance Status Rating Scale (PSR), and an interview questionnaire. The recovery trajectory in this patient population showed three distinct trends. The trajectory for distress was linear and improved over time with approximately 20% of patients continuing to have psychological distress at 1 year. Secondly, the trend for overall quality of life was parabolic, worsening at discharge, then improving at 100 days and at 1 year. However, there were individual areas of deficit at follow-up, eg fatigue, even while overall quality of life mean scores improved. Thirdly, the trend for patient concerns over time was linear and worsening. These recovery trajectories suggest psychosocial interventions before and after BMT that may prepare patients for increasing and worsening concerns even as physical well-being improves.
European journal of cancer care, 2014
This study was performed to evaluate psychiatric symptoms and resilience levels of the hematopoietic stem cell transplant patients and their relatives. The study enrolled 51 patients and 45 relatives undergoing bone marrow transplantation. Data were collected using Personal Information Form, Brief Symptom Inventory and Resilience Scale for Adults. Psychiatric symptoms of both patients and their relatives were negatively associated with resilience levels. Patients and their relatives with a higher degree of resilience showed a lower degree of psychiatric symptoms. The study results demonstrate that haematopoietic stem cell transplantation is a process that affects patients as well as their families. We suggest that patients and their family members be evaluated for psychiatric symptoms by nurses during this process and resilience level of patients be increased by helping them improve their coping and problem-solving skills for adaptation throughout the process.
Psychiatric assessment in transplantation Avaliação psiquiátrica no transplante
The implementation of the presumptive donor law in Brazil is expected to increase the availability of organs for transplantation. As medical management of end-stage organ dysfunction continues to improve, increasing numbers of potential transplant recipients will be available to meet this supply. There is mounting evidence that supports the involvement of skilled psychiatric practitioners in the selection of transplant candidates. Data supporting the influence of psychosocial factors on compliance and therefore medical outcomes continues to grow. The literature review allows delineating the components and rationale for comprehensive psychosocial evaluations as a component of preoperative transplantation evaluation. Resumo A implementação da figura do doador presumido e as recentes mudanças na regulamentação do transplante no Brasil irão aumentar a disponibilidade de órgãos no País. O avanço no cuidado de doentes portadores de insuficiência grave de órgãos, por sua vez, irá aumentar ...