Psychiatric aspects of bone marrow transplantation: Part I: Special issues during pre‐transplant assessment and hospitalization

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Abstract
Bone marrow transplantation (BMT) has become an important innovative treatment for hematological malignancies, solid tumors, immunodeficiency diseases and metabolic disorders. It has evolved over the last decade from a controversial research procedure to a standard therapeutic modality, which prolongs remission of some patients and cures others. Historically, the BMT procedure is divided into several stages, each of which have accompanying emotional problems. In providing psychological care for transplant recipients, donors and families, care‐givers must be familiar with the psychological stages of the procedure, the psychological themes such as body image, rebirth and the patient's mechanisms of coping with the extreme stress of such protocols. Its complex medications, high‐dose chemotherapy, total‐body irradiation (TBI), germ‐free environment, graft‐versus‐host disease (GvHD), Broviac or Hickman line catheterization and total parenteral nutrition (TPN), can precipitate significant psychological sequelae with immediate and long‐term consequences. In response to their illness, transplant patients may also develop emotional disturbances of anxiety, depression, agitation, non‐compliance and rare suicidal thoughts. These reactions, and the occasional presence of concurrent psychiatric illness, require recognition and development of guidelines for management.This paper is the first in a series of two and will inform the reader about: (1) the biology, epidemiology, history and economics of BMT; (2) informed consent issues and the psychological/social assessment of patients and families prior to BMT; (3) the psychological care of patients during BMT; and (4) address special issues concerning donation of marrow, donor registries, family issues, children as patients and prevention of staff burn‐out. Part II of this series will review the psychosocial adjustment and quality of life of BMT patients as they convalesce and re‐enter normal daily routines. A summary is given of research into which psychosocial factors predict better post‐BMT outcome.