Mental disturbances during isolation in bone marrow transplant patients with leukemia

Abstract

Summary:The mental status of 39 leukemia patients, who received bone marrow transplants (BMT), was studied during the period of isolation.

Acute health-related quality of life in children undergoing stem cell transplant: II. Medical and demographic determinants

“…This finding confirms widely held clinical impressions within pediatric BMT, but curiously, such differences had not been previously reported in studies of the acute response of adults undergoing BMT. [4][5][6] The shape of the response trajectory of the autologous group was similar, with a peak in distress (and nadir in activity) at week ϩ1 followed by a rapid recovery. However, the recovery is much faster and more pronounced among autologous patients, whose Somatic Distress declined to below admission levels by week ϩ4, in contrast to the allogeneic groups who did not reach this level until month ϩ3.…”

“…The only consistent finding has been that patients with higher levels of distress prior to transplant tend to experience higher levels of distress subsequently, and thus pre-BMT psychological state and performance status are generally the best predictors of post-transplant distress and functioning. 1,[4][5][6]11 Occasional reports of differences in outcome as a function of age or gender 9,13 are offset by a larger number of null findings on these variables. 3,4,6,11 Even type of transplant (allogeneic vs autologous) and diagnostic background have often not been significant predictors of response.…”

“…3,4,6,11 Even type of transplant (allogeneic vs autologous) and diagnostic background have often not been significant predictors of response. [4][5][6]11 Research regarding predictors of patient response to BMT has been characterized by the same limitations of BMT psychosocial research in general, ie retrospective data collection strategies subject to recall biases, or if prospective, small sample sizes. The sample size issue becomes more problematic when examining predictors of patient response since power is reduced when samples are broken into subgroups based on medical or demographic variables.…”

“…However, to date, studies of physical and psychological responses of patients during the acute phase of BMT, [3][4][5][6][7][8] as well as those depicting the trajectory to recovery of health-related quality of life in the year following BMT [9][10][11][12][13] have identified few significant predictors of transplant-related distress. The only consistent finding has been that patients with higher levels of distress prior to transplant tend to experience higher levels of distress subsequently, and thus pre-BMT psychological state and performance status are generally the best predictors of post-transplant distress and functioning.…”

Isolation in the allogeneic transplant environment: how protective is it?

“…Emotional disturbance is common, with one series reporting DSM-IV psychiatric diagnoses among 41% after transplantation. 55 Physical isolation can lead to emotional isolation after transplantation. 56 Major themes in the experience of transplant patients include maintaining control in a seemingly out of control situation, intellectualizing the need for isolation, and staying in contact with family and staff.…”