Psychological risk factors and early complications after bone marrow transplantation in adults.

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.

Psychiatric assessment of candidates for bone marrow transplantation: a psychodynamically-oriented approach.

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 semiquantitative 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 percent of those assigned the highest scores (F.I.T. = 7-9) remained alive. The strongest predictors were the "I" and "T" parameters. CONCLUSION: This approach to assessment of candidates for bone marrow transplantation may identify individuals who require added, supportive measures, both medical and psychological. Furthermore, the results suggest possible leads in the search for how psychological factors might influence the physiologic response to a toxic stress.

A double-blind randomized clinical trial of rapid tranquilization with I.M. clonazepam and I.M. haloperidol in agitated psychotic patients with manic symptoms.

This double-blind clinical trial studied 16 acutely agitated psychotic patients with manic or manic-like symptoms who needed rapid tranquilization and were therefore on maintenance treatment. They were randomized to receive intramuscular preparations of clonazepam (1 to 2 mg) or haloperidol (5 to 10 mg) at 0, 0.5, and 1.0 hours. Both medications produced significant reduction of manic symptoms within two hours of initial treatment; however, haloperidol produced beneficial results more rapidly than clonazepam. All patients completed the study, with the exception of one haloperidol-treated patient who developed severe parkinsonism. It was concluded that I.M. clonazepam is an effective, safe, but slower-acting alternative to I.M. haloperidol in the treatment of agitated psychiatric patients in need of rapid tranquilization.

Patient predictors of process and outcome in short-term individual psychotherapy.

Twenty-one psychiatric outpatients were treated with short-term, psychoanalytically oriented, individual psychotherapy. Outcome ratings were provided by the patient, the therapist, and an independent assessor. Process ratings were provided by the patient and the therapist at the end of therapy. From a series of multiple regression analyses two pretherapy predictor scores (defensive style of the patient, object choice of the patient) emerged as good predictors of several of the process and outcome ratings. The two predictor scores were statistically independent of one another and were not significantly related to initial severity of disturbance. Attention to these two concepts in future research and in clinical assessment of patients for short-term individual psychotherapy is recommended.