Stem cell transplantation: risk factors for psychiatric morbidity.

The aim of this study was to determine the risk factors for psychiatric disorder in haematological cancer patients during hospitalization for stem cell transplantation. In this 3-year prospective study, 220 patients received stem cell transplantation at a single institution. Structured psychiatric interviews applying standardized diagnostic criteria were performed at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 interviews. Psychiatric disorder (any depressive, anxiety, or adjustment disorder) prevalence at the time of hospital admission was 21% and psychiatric disorder incidence during post-admission follow-up was 22%. After adjusting for multiple confounders in multivariate logistic regression analyses, we found that younger age, women, a past psychiatric history, lower functional status, pain, smoking cessation, and higher regimen-related toxicity were significantly associated with psychiatric disorder risk. Our study findings may help to improve identification of the patients most at risk for psychiatric disturbances during hospitalization for stem cell transplantation.

Clinical factors associated with fatigue in haematologic cancer patients receiving stem-cell transplantation.

We have evaluated risk factors associated with fatigue in 220 cancer patients during hospitalization for stem-cell transplantation (SCT). Fatigue was assessed using a validated one-item energy scale and a comprehensive set of fatigue predictors, at hospital admission (baseline), day of SCT, and 7 days and 14 days after SCT. In cross-sectional multivariate analysis, depression was the variable most consistently and strongly associated with fatigue; other factors significantly associated with fatigue at some time during the study included older age, higher education, smoking, lower Karnofsky performance status, loss of appetite, nausea/vomiting, pain, higher regimen-related toxicity, low hemoglobin level, requirement for red blood-cell transfusions, and third year of the study period. In prospective multivariate analysis, baseline depression showed significance or a trend towards significance in its ability to predict subsequent measures of fatigue during hospitalization. Our findings may help to shed light on the mechanisms underlying fatigue and may also guide future interventions.

Role of depression as a predictor of mortality among cancer patients after stem-cell transplantation.

PURPOSE: To determine the association between depression and survival among cancer patients at 1, 3, and 5 years after stem-cell transplantation (SCT). PATIENTS AND METHODS: This was a prospective cohort study of 199 hematologic cancer patients who survived longer than 90 days after SCT and who were recruited in a University-based hospital between July 1994 and August 1997. Patients received a psychiatric assessment at four consecutive time points during hospitalization for SCT, yielding a total of 781 interviews. Depression diagnoses were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. RESULTS: Eighteen (9.0%) and 17 patients (8.5%) met criteria for major and minor depression, respectively. Multivariate Cox regression models found major depression to be predictive of higher 1-year (hazard ratio [HR], 2.59; 95% CI, 1.21 to 5.53; P = .014) and 3-year mortality (HR, 2.04; 95% CI, 1.03 to 4.02; P = .041) but not 5-year mortality (HR, 1.48; 95% CI, 0.76 to 2.87; P = .249). Minor depression had no effect on any mortality outcome. Other multivariate significant predictors of higher mortality were higher regimen toxicity in the 1-, 3-, and 5-year models; older age and acute lymphoblastic leukemia in the 3- and 5-year models; chronic myelogenous leukemia in the 3-year model; and lower functional status and intermediate/higher risk status in the 5-year model. Use of peripheral-blood stem cells predicted lower mortality in the 5-year model. CONCLUSION: After adjusting for multiple factors, major depression predicted higher 1- and 3-year mortality among cancer patients after SCT, underscoring the importance of adequate diagnosis and treatment of major depression.

Psychometric study of quality of life instruments used during hospitalization for stem cell transplantation.

OBJECTIVE: To test the psychometric properties of four patient-rated quality of life (QoL) instruments devised by the authors: three single-item instruments measuring (1) overall physical status, (2) overall emotional status, and (3) energy level, and one eight-item instrument measuring systemic symptoms. METHOD: In a prospective inpatient study conducted from July 1994 to August 1997, 220 patients aged 16-65 years received hematopoietic stem cell transplantation (SCT) for hematologic cancer at a single institution. Patients were assessed at hospital admission and then on a weekly basis during hospitalization until discharge or death. RESULTS: Internal consistency reliability and test-retest reliability of the tested scales were adequate. Convergent, divergent, criterion, and predictive validities as well as responsiveness to change of our scales were demonstrated by significant associations with their tested constructs. CONCLUSION: Our data indicate that the four QoL instruments are reliable and valid for use during hospitalization for SCT.

Psicosis paranoide recurrente: primera manifestación de feocromocitoma / Relapsing paranoid psychosis as the first manifestation of phaeochromocytoma

Aunque de vez en cuando se ven manifestaciones psiquiátricas en los pacientes con feocromocitoma, éstas se limitan normalmente a estados de ansiedad. Otras manifestaciones menos frecuentes son la depresión y los síntomas psicóticos. En este artículo describimos a un paciente que presentó una psicosis paranoide como única manifestación de un feocromocitoma mucho antes de que éste fuera diagnosticado de dicha enfermedad. El trastorno delirante, que se trató con fármacos antipsicóticos durante dos años, desapareció tras la resección del tumor. Se podría especular que las catecolaminas podrían tener relación con el estado psicótico de este paciente y nos planteamos hasta que punto el feocromocitoma podría ser un "ejemplo natural" para explicar la fisiopatología catecolaminérgica involucrada en algunos trastornos psicóticos (AU)

Psychiatric morbidity and impact on hospital length of stay among hematologic cancer patients receiving stem-cell transplantation.

PURPOSE: To determine the prevalence of psychiatric disorders during hospitalization for hematopoietic stem-cell transplantation (SCT) and to estimate their impact on hospital length of stay (LOS). PATIENTS AND METHODS: In a prospective inpatient study conducted from July 1994 to August 1997, 220 patients aged 16 to 65 years received SCT for hematologic cancer at a single institution. Patients received a psychiatric assessment at hospital admission and weekly during hospitalization until discharge or death, yielding a total of 1,062 psychiatric interviews performed. Psychiatric disorders were determined on the basis of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Univariate and multivariate linear regression analyses were used to identify variables associated with LOS. RESULTS: Overall psychiatric disorder prevalence was 44.1%; an adjustment disorder was diagnosed in 22.7% of patients, a mood disorder in 14.1%, an anxiety disorder in 8.2%, and delirium in 7.3%. After adjusting for admission and in-hospital risk factors, diagnosis of any mood, anxiety, or adjustment disorder (P =.022), chronic myelogenous leukemia (P =.003), Karnofsky performance score less than 90 at hospital admission (P =.025), and higher regimen-related toxicity (P <.001) were associated with a longer LOS. Acute lymphoblastic leukemia (P =.009), non-Hodgkin's lymphoma (P =.04), use of peripheral-blood stem cells (P <.001), second year of study (P <.001), and third year of study (P <.001) were associated with a shorter LOS. CONCLUSION: Our data indicate high psychiatric morbidity and an association with longer LOS, underscoring the need for early recognition and effective treatment.

Assessment of the efficacy of a cognitive-behavioural group psychotherapy programme for HIV-infected patients referred to a consultation-liaison psychiatry department.

BACKGROUND: Most HIV-infected patients attending a consultation-liaison psychiatry service show symptoms of anxiety and depression. The present study sought to evaluate the immediate and long-term efficacy of a structured cognitive-behavioural group therapy reducing anxiety and depression in HIV-infected patients referred to a consultation-liaison psychiatry department, and to identify baseline variables predictive of greater improvement. METHODS: Repeated-measures ANOVA was used to analyse changes in the Beck Depression Inventory (BDI) and the state subscale of the State/Trait Anxiety Inventory (STAI) administered to 39 participants at 4 time points: T1 (1 month before beginning the therapy), T2 (during the first session), T3 (during the last session) and T4 (3 months after the last session). The therapy consisted of 16 weekly 2-hour sessions following a structured time-limited cognitive-behavioural group psychotherapy programme. RESULTS: During the intervention time (between T2 and T3) an improvement was observed in depression and anxiety, which persisted after the 3-month follow-up period (between T3 and T4). No changes were observed during baseline (between T1 and T2). Patients with higher levels of anxiety at baseline showed greater improvement in STAI state subscale scores. Transmission of HIV infection through intravenous drug use was associated with less improvement on the BDI. CONCLUSIONS: This is the first report of an ongoing study which suggests long-lasting efficacy of a structured cognitive-behavioural group psychotherapy programme in a heterogeneous sample of HIV-1-infected patients referred to a consultation-liaison psychiatry unit.