Psychosocial aspects of hematopoietic stem cell transplantation

Hematopoietic stem cell transplantation (HSCT) has become a conventional and potentially curative treatment for various hematological diseases. As more sophisticated procedures have been developed and mortality rates have decreased, attention has shifted to the psychosocial challenges associated with transplantation. The psychosocial difficulties accompanying transplantation are addressed in the context of both quality of life (QOL) and psychopathological research. Among the psychiatric comorbidities of HSCT, anxiety, depression, sleep and sexual disorders, delirium and post-traumatic stress disorder are the most studied conditions. Recently, more attention has been focused on the psychosocial burden of caregivers. Devising recommendations for the management of psychiatric symptoms and psychosocial interventions in HSCT sufferers and close relatives is a major concern to consultation–liaison psychiatrists and transplant teams. This review synthesizes and critically evaluates the current literature on the psychosocial aspects of HSCT and appraises the clinical significance of these outcomes. Issues of QOL assessment; psychosocial functioning and QOL in the course of HSCT; impact of graft-versus-host disease and other predictors of QOL and psychosocial functioning; comorbid psychiatric disorders; and interventions to maintain or improve QOL and reduce psychopathology and psychosocial burden on family members are presented

Változások és újítások a Minnesota Multiphasic Personality Inventory-2 (MMPI-2) pszichodiagnosztikai tesztben

Bevezetés: A Minnesota Multiphasic Inventory (MMPI) Magyarországon az 1970-es évek óta használatos pszichodiagnosztikai mérőeszköz, melynek második kiadása (MMPI-2) 1989-ben jelent meg a nemzetközi használatban, Magyarországon pedig 2009-ben készült el az adaptációja. Célkitűzés: Jelen tanulmány célja, hogy bemutassa az MMPI-2-ben megjelent változásokat, újításokat és a teszt előnyeit a korábbi változatához képest. Következtetések: A téma-összefoglaló tanulmány rávilágít, hogy az MMPI-2 kifejlesztése nemcsak új normatív mintát, de nyelvi-stilisztikai megújulást is hozott. Ezenfelül a korábbi Validitási és Klinikai skálák mellett olyan új skálák is megjelentek, mint az Újrastrukturált klinikai skálák, a Tartalmi skálák és a személyiségpszichopatológia mérésére alkalmas PSY-5 skálák. Megtörtént továbbá a Kiegészítő skálák revíziója, illetve új Kiegészítő skálák bevezetése és új Validitási skálák kifejlesztése is. Konklúzió: A változtatások részletes számbavétele rámutat arra, hogy az MMPI újrasztenderdizálása során kialakított MMPI-2 jóval átfogóbb, egyben differenciáltabb értelmezést kínál a különböző mentális zavarok és pszichopatológiai jelenségek megértése szempontjából, mint az eredeti változat. Kitekintésként pedig ismertetésre kerül a nemzetközi gyakorlatba már bevezetett két új MMPI-fejlesztés, az MMPI-2-Resturctured Form (MMPI-2-RF) és az MMPI-3 is

Impact of the type of hematopoietic stem-cell transplant on quality of life and psychopathology

Background and purpose – Despite the decrease in transplant-related mortality, patients who receive hematopoietic stemcell transplants often suffer from short-and long-term morbidities, poorer quality of life, and psychosocial functioning deficits. Several studies have compared the quality of life and affective symptoms of patients after undergoing autologous and allogeneic hematopoietic stem-cell transplants. Some studies have reported similar or greater quality of life impairments in allogeneic hematopoietic stemcell recipients, but the findings have been inconsistent. Our purpose was to examine the influence of the type of hematopoietic stem-cell transplantation on the quality of life and affective symptoms of patients. Methods – The study sample comprised 121 patients with various hematological diseases who underwent hematopoietic stem-cell transplantation at St. István and St. László Hospitals, Budapest. The study had a cross-sectional design. Quality of life was evaluated using the Hungarian version of the Functional Assessment of Cancer Therapy– Bone Marrow Transplant scale (FACT-BMT). Anxiety and depressive symptoms were assessed using Spielberger’s State and Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI), respectively. Basic sociodemographic and clinical variables were also recorded. Comparisons between autologous and allogeneic recipients were analyzed using a t-test when the variables were normally distributed and a Mann–Whitney U test otherwise. A stepwise multiple linear regression analysis was performed to identify the risk factors that contributed to the quality of life and the affective symptoms in each group. Results – Quality of life (p=0.83) and affective symptoms (pBDI=0.24; pSSTAI=0.63) were similar between the autologous and allogeneic transplant groups. The BDI scores of allogeneic transplant patients indicated mild depression, but their STAI scores were similar to those of the general population. Allogeneic transplant patients with symptoms of graft-versus-host disease (GVHD) experienced more severe clinical conditions (p=0.01), poorer functional status (p\u3c0.01) and received more immunosuppressive treatment (p\u3c0.01) than those without graft versus host disease. Patients suffering from graft versus host disease experienced more severe depression (p=0.01), and constant anxiety (p=0.03) than those without graft versus host disease. Quality of life was affected by depressive and anxiety symptoms and psychiatric comorbidity in both the allogeneic and autologous groups. Conclusion – Graft versus host disease-related severe somatic complaints seemed to influence the allogeneic transplant patients’ quality of life by inducing depressive and anxiety symptoms