Psychiatric Illness in Indian Bone Marrow Transplant Patients.

Introduction: Bone marrow transplantation is the main stay treatment for various disorders. Psychosocial morbidity associated with Bone Marrow Transplant are due to the diagnosis of a deadly disease, curative option with its associated risk of death. Several psychosocial factors influence the long-term outcome in patients.

Objective: To identify Psychiatric illnesses in Indian patients undergoing hematopoietic stem cell transplantation.

Materials and Methods: This cross-sectional study was conducted during the period of July 2015 to March 2017 at Institute of Haematology and Bone Marrow Transplantation, MIOT INTERNATIONAL, Chennai, India. All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE).

Results: Out of 72 enrolled patients, twenty-six (36.1%) patients met the psychiatric diagnostic criteria. Adjustment disorder (43%) was more frequently encountered among the affected individuals followed by depressive illnesses (24%).

Discussion:

We had 36% of patients with symptoms of psychiatric illnesses. Interestingly higher percentage (54% and 41%) of psychiatric morbidity was observed in studies carried out by Leigh et al. and Sasaki respectively. Regarding diagnostic breakup among transplant patients, adjustment disorders (with symptoms of anxiety and depression) was the most frequent diagnosis (43%) in our study, which is similar to research of Sasaki.

While on the other hand study done by Jenkin et al.observed higher prevalence (40%) of depression, which was the second highest psychiatric morbidity in our research. Majority of patients appeared to be mentally prepared and tolerant during transplantation and very few patients observed psychological problems. So, any sort of psychological issues encountered during transplantation has no relation with the diagnosis or the therapy per se but rather is more intricately related to the personality and personal history of the patients.

Post-transplantation period seems to be highly stressful mainly due to the isolation, high vigilance, expectations, apprehension of the future and reverse barrier nursing. Therefore, most of psychiatric symptoms were observed within first week after transplantation procedure in 69% (n=18) of patients in our study. Other studies by Illescas - Rico et al. and Sasaki also noted that psychiatric disorders mainly developed after transplantation in majority of cases (68.75%). 76%(n=20) required psychotropic medicines in addition to counselling and psychotherapy Psychiatric symptoms settled in 62% (n=16) of cases during their stay in BMT unit.

In this study, patients of the age group 24-45 years, were mostly affected comprising of 54% of all the individuals having psychological problems. Another study carried out by Prieto et al.on 220 patients who had recieved stem cell transplantation had however observed that younger age is one of the risk factor associated with psychiatric disorder in BMT. This clearly reflects the more stress observed in younger population secondary to transplantation. Regarding gender, it is believed that psychiatric disorders are significantly more common in females than males. However in this study, the number of males (58%) were more than the number females amongst the affected patients.

There are few limitations of our study like the relatively small sample size, single centre study and limited time period. A multi-centric study is mandated to establish the findings more strongly to bring about a comprehensive care for the patients.

Conclusion: Significant psychiatric morbidity (>1/3 - 36%) associated with bone marrow transplantation was observed. This study indicates the importance of psychiatric intervention during the transplant procedure as well as pre-transplant psychiatric assessment and counselling regarding transplant procedure.

Keywords: Psychiatric disorder, Adjustment disorder, Hematopoietic stem cell transplantation.

References

1. Andrykowski MA.Psychological factors in bone marrow transplantation: a review and recommendation. Bone Marrow Transplant 1994; 13: 357-375,

2. PrietoJM, BlanchJ, AtalaJ, CarrerasE, RoviraM, CireraE, et.al. Stem cell transplantation: risk factors for psychiatric morbidity. Eur J Cancer 2006; 42:514-20.

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