Anxiety as a possible predictor of acute GVHD.

In order to determine the influence of anxiety on the development of BMT complications and survival, we analysed data on 35 consecutive patients undergoing BMT in our Centre between June 1992 and December 1994. All patients received bone marrow from HLA-identical MLC non-responsive siblings. For GVHD prophylaxis, all patients received cyclosporin (CsA) and short methotrexate (MTX). The diagnosis and severity of acute GVHD were defined according to the Seattle Transplant Team criteria. The patients were tested with the Spielberger STAI test as a measure of anxiety as a state (STAI-S) and as a trait (STAI-T). The STAI-S/1 and STAI-T/1 were performed during the first week of isolation (day -5 to day -3 prior BMT) and STAI-S/2 and STAI-T/2 at the end of the discharge from laminar air flow units (day +35 to day +40 post-transplant). During isolation all patients had daily psychiatric support. Out of 35 patients, 31 (89%) fulfilled the STAI-S and STAI-T during the first week and at discharge from laminar air flow isolation. The level of anxiety at the beginning of isolation as measured by STAI-S/1 and STAI-T/1 tests had been significantly higher in patients who subsequently developed acute grade II-IV GVHD as compared to patients with GVHD grade 0-I (P < 0.001), irrespective of age, sex or stage of the disease prior to BMT. In those patients who died, the STAI-S/1, STAI-T/1 and STAI-T/2 tests had been almost identical to those of surviving patients, while STAI-S/2 had been significantly higher (P = 0.034). These data clearly indicate an association between the level of anxiety and the risk for BMT complications, but this should be confirmed in further controlled clinical trials.

[Transference and countertransference problems in patients treated with bone marrow transplantation]. / Transferni i kontratransferni problemi u radu s bolesnicima lijecenim transplantacijom kostane srzi.

Psychological problems that restrain the patient before, during and after the bone marrow transplantation (BMT) are multiple and are very complex and often have significant effect on the transplantation procedure itself. What patient is going through followed with his expectations and dependence on the transplantation team, together with development of an archaic transference develops a number of counter-transference reactions within the team members. If we assume that during the time spent in a sterile unit and isolation, because of the regressive position, patients use early defending mechanisms, which again, reflect in the reactions of the team members. The aim of this project is to analyse transference and counter-transference problems of the patients and the team members during the BMT. The method used was psychodynamic clinical observance and analysis of transference and counter-transference problems of patients and the team members during the process of transplantation. Thirty-five patients with acute myeloblastic and acute lymphoblastic leukemia, treated with allogenic BMT, were observed during their stay in a sterile unit over the 5-year period. Transplantation procedure, based on observation of psychological dwelling and transference reactions of the patients, is divided into five phases while, from the perspective of the team members, the counter-transference problems are revealed especially during the moments of helplessness. The most important mechanism that the team members are using to protect themselves from this feeling is "selective avoidance of psychological", in other words, avoidance of empathy.