Psychiatric Care in Hematopoietic Stem Cell Transplantation

Abstract

Background: Patients with cancer frequently experience neuropsychiatric symptoms due to their medical illness or its treatment. In recent decades, psychiatrists have become increasingly involved in the care of patients with cancer. However, psychiatrists may be less familiar with hematopoietic stem cell transplantation (HSCT), a distinct cancer treatment modality associated with multiple neuropsychiatric sequelae.Objective: To provide an overview of HSCT, and describe the prevalence, impact, risk factors, and suggested management of psychiatric consequences of HSCT. Methods:We performed literature searches in PubMed and PsychInfo to identify articles describing neuropsychiatric symptoms, including depression, anxiety, distress, post-traumatic stress disorder, delirium and cognitive impairment, resulting from HSCT in adults. Those articles most relevant to this manuscript were included.Results: Psychiatrists may be involved in the treatment of patients before, during, or after inpatient hospitalization for HSCT. Each phase of treatment introduces unique stressors that may lead to or exacerbate psychiatric disorders. Appropriate management requires evaluation of HSCTrelated medications, an understanding of the impact of complications from HSCT, and

Psychosocial aspects of hematopoietic stem cell transplantation

“…Other risk factors include poor psychosocial functioning, while protective factors include good social support and coping skills. Consequently, pre-transplant screening for at-risk recipients should include an assessment of comorbidities, the functional status, psychosocial difficulties and social support[ 2 ].…”

“…Research on psychosocial issues has explored the adverse impact of psychological symptoms on treatment outcomes. Studies have primarily concentrated on anxiety and depression during the course of treatment and yielded contradictory results regarding the trajectory of these symptoms[ 2 , 36 - 39 ]. The findings indicate a fluctuating, but generally decreasing, tendency in anxiety levels over the course of treatment compared with persistent pre-transplant anxiety, while depressive symptoms show a gradual posttransplant increase over time, regardless of their pretransplant level[ 8 , 35 , 36 , 40 ].…”

“…Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various malignant and non-malignant hematological diseases. The number of survivors of malignant hematological conditions is rapidly increasing worldwide[ 1 , 2 ]. Despite recent advances in this field, transplant-related severe medical complications, including graft-versus-host disease (GVHD) and mortality, remain a major and well-documented concern[ 3 - 6 ].…”

“…Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder (PTSD) are the most studied conditions[ 2 , 13 ]. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is also a major concern to consultation–liaison psychiatrists and transplant teams.…”

Standardized Semi-structured Psychosocial Evaluation before Hematopoietic Stem Cell Transplantation Predicts Patient Adherence to Post-Transplant Regimen

“…Psychiatric care is an important aspect of hematopoietic stem cell transplantation (SCT) because of high rates of acute and chronic anxiety, depression, delirium, cognitive impairment [1], decreased quality of life, body image disturbances, and post-traumatic stress [2,3]. The use of psychosocial rating scales is potentially useful to integrate psychiatric evaluation findings into medical risk stratification models in transplantation but has not been studied in SCT.…”