Mental disturbances during isolation in bone marrow transplant patients with … (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.
Depressed Mood and Other Variables Related to Bone Marrow Transplantation Survival in Acute Leukemia
Psychosomatics, 1991
Routine psychiatric evaluations of 100 adult patients undergoing allogeneic bone marrow transplantation for acute leukemia were reviewed to examine the possible relationship ofpsychiatric and psychosocialfactors to duration ofsurvivalfollowing the procedure. Three variables were found to independently affect outcome: illness status (first remission vs. other status), presence ofdepressed mood, and the extent ofperceived social support. Patients transpl(Jnted while in their first remission had significantly improved survival; patients with depressed mood, regardless ofspecific psychiatric diagnosis, had poorer outcomes; and patients with a high level ofperceived social support had improved survival. The possible mechanisms by which these variables affect outcome are discussed. B one marrow transplantation has emerged as a treatment alternative and. in some instances. the treatment of choice for a variety of hematologic disorders. 1.2 A recent report from the International Bone Marrow Transplant Registry described a 20-fold increase in the use of this procedure from 1977 to 1987. 3 Of the 10.887 transplants included in the report. 75% were for the treatment of leukemia. The transplantation procedure initially requires eradication of the
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 factors and survival after bone marrow transplantation in patients with leukemia
Psychiatry and Clinical Neurosciences, 2003
Psychological factors may be associated with the outcome of cancer treatment, including bone marrow transplantation (BMT). However, studies on the issue have provided controversial results. In the present study, effects of mood status on the outcome was studied through a follow-up period of 1-3 years as well as in shorter periods (3 and 8 months) post-BMT in 72 Japanese patients with leukemia. Psychological status was evaluated 2 weeks before BMT using Profile of Mood States (POMS). The most major factor abstracted from the POMS subscales (Factor 1, mainly comprising anxiety, depression, anger, fatigue and confusion) was associated with disease-free survival rate at 3 months post-BMT. However, the factor most significantly associated with the outcome was gender. Females had better outcome than males through the period of 1-3 years as well as at 8 months post-BMT. When analyzed by gender, Factor 1 was associated with poor prognosis at 3 and 8 months in males. In females, however, Factor 1 was not significantly associated with the prognosis. The present results suggest an association between mood status pre-BMT and prognosis post-BMT in a gender-specific manner.
The International Journal of Psychiatry in Medicine, 1999
Objective: To seek possible relationships between psychological factors and survival after an intensive medical therapy, using bone marrow transplantation as a model. Method: Candidates for bone marrow transplantation underwent two to three psychodynamically-oriented psychiatric interviews that explored family functioning (“ F”), individual psychological maturity (“ I”), and the capacity to form and communicate a mature psychological construct of the transplant (“ T”) process. The results were recorded in a semi-quantitative manner, assigning a possible score of 1 to 3 for each parameter, for a possible total of 3 to 9 (the “ F.I.T.” assessment). Survival after the transplant was analyzed retrospectively in relation to the F.I.T. assessment. Results: In a series of 112 candidates interviewed prior to transplant, those with the lowest F.I.T. assessment tended not to survive as long. By one year, 95 percent of individuals assigned the lowest score (F.I.T. = 3) had died, whereas 96 per...
Objective: Bone Marrow Transplantation is considered one of the main procedures used in the treatment of both malignant and non-malignant diseases. Psychological factors after Bone Marrow Transplantation have an important role in the survival of the patients undergoing this procedure. Method: In the present study, some parameters including depression, anxiety and cognition were assessed during both pre and post-transplantation in patients undergoing Bone Marrow Transplantation. The evaluations were performed by utilizing several questionnaires including Hospital Anxiety and Depression Scale and Wechsler Memory Scale within 72 hours after hospitalization (pre-transplantation) and one month after transplantation (post-transplantation). All patients received intensive chemotherapy during the first 72 hours after hospitalization. Paired t test was used to compare pre and post values. SPSS (version 18) was used to analysis the data. The significance level was defined as p < 0.05. Resu...
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.
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.
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