Adjustment disorder in cancer patients after treatment: prevalence and acceptance of psychological treatment.

PURPOSE: To investigate the prevalence of adjustment disorder (AD) among cancer patients and the acceptance of psychological treatment, in relation to sociodemographic, clinical, and psychological factors. METHODS: Breast, prostate, and head and neck cancer patients of all stages and treatment modalities (N = 200) participated in this observational study. Patients completed the Hospital Anxiety and Depression Scale, Checklist Individual Strength, Distress Thermometer and problem list. Patients with increased risk on AD based on these questionnaires were scheduled for a diagnostic interview. Patients diagnosed with AD were invited to participate in a randomized controlled trial on the cost-effectiveness of psychological treatment. Participation in this trial was used as a proxy of acceptance of psychological treatment. Logistic regression analyses were used to investigate associated factors. RESULTS: The overall prevalence of AD was estimated at 13.1%. Sensitivity analyses showed prevalence rates of AD of 11.5%, 15.0%, and 23.5%. Acceptance of psychological treatment was estimated at 65%. AD was associated both with being employed (OR = 3.3, CI = 1.3-8.4) and having a shorter time since diagnosis (OR = 0.3, CI = 0.1-0.8). CONCLUSION: Taking sensitivity analysis into account, the prevalence of AD among cancer patients is estimated at 13 to 15%, and is related to being employed and having a shorter time since diagnosis. The majority of cancer patients with AD accept psychological treatment.

Psychological complexities of visual restoration.

In this paper, we report the psychological and emotional experience of a patient who regained vision after over a decade of vision loss. The negative psychological implications of blindness are well recognised and there is a robust link between visual impairment and low mood and depressive symptoms. Although uncommon, low mood and depressive symptoms have been reported in patients whose sight has been restored, and lack of research gives rise to the possibility their prevalence may be grossly under-recognised in such patient groups. The effects can be so severe that patients may revert to living in darkness in mimicry of their previous lifestyle, effectively obviating the sight-restoring surgery. Healthcare professionals have a responsibility to address this traditionally neglected need by facilitating social, psychological and medical interventions that may ease the return to vision.

COVID-19 y su asociación con síntomas depresivos en población española / COVID-19 and its association with depressive mood symptoms in the Spanish Population

RESUMEN. Introducción: la emergencia sanitaria por el COVID-19 ha generado una conmoción mundial que conlleva una serie de problemáticas relacionadas con la salud, los factores psicosociales y la situación económica. Objetivo: evaluar el efecto del confinamiento en el ánimo depresivo en población residente en España mayor de 18 años durante el estado de alarma provocada por la pandemia de la COVID-19, analizando, además, la posible incidencia de las variables sexo, edad, tamaño de la vivienda e ingresos económicos. Material y Métodos: diseño transversal, descriptivo y correlacional con metodología de carácter cuantitativo. El acceso a la muestra fue no probabilístico a través de la técnica bola de nieve. Para evaluar la condición de ánimo depresivo se utilizó la escala CES-D. Para recopilar los datos relacionados con el sexo, la edad, el tamaño de vivienda y la situación económica, se crearon preguntas ad hoc en la propia encuesta. Resultados: las mujeres presentan valores de ánimo depresivo superiores a los hombres. Además, los valores de ánimo depresivo son mayores cuanto menor es la edad. Las personas que residen en viviendas con un tamaño menor, presentan valores de ánimo depresivo superiores respecto a las personas que viven en residencias con superficies mayores. A su vez, las personas con peores condiciones económicas perciben mayores niveles de ánimo depresivo. Conclusiones: los resultados indican que los síntomas de ánimo depresivo y las consecuencias psicosociales en la población española durante el confinamiento, se encuentran condicionadas por el sexo, la edad, el tamaño de la vivienda y la situación económica(AU)

ABSTRACT Introduction: Health emergency due to the COVID-19 pandemic has generated a global commotion, leading to a series of problems related to health, psychosocial factors and economic situation. Objective: To evaluate the effect of confinement on depressive mood in Spanish residents who are over 18 years old during the state of emergency which was declared due to the COVID-19 pandemic. Additionally, this paper aims to analyze the possible impact of some variables such as sex, age, size of dwelling and income. Materials and Methods: Cross-sectional, descriptive and correlational design with quantitative methodology. Access to the sample was based on a non-probabilistic sampling through snowball technique. CES-D scale was used to evaluate the state of depressive mood. In order to collect data related to sex, age, size of dwelling and economic situation, ad hoc questions were included in the survey. Results: Women presented higher values of depressive mood than men. Furthermore, depressive mood values are higher in younger individuals. People who live in smaller dwellings showed higher values of depressive mood compared to those who live in larger dwellings. Similarly, individuals with less favorable economic conditions perceive higher levels of depressive mood. Conclusions: The results show that depressive mood symptoms and their psychosocial consequences in the Spanish population during confinement are conditioned by sex, age, dwelling size and economic situation(AU)

Adjustment Disorder in Female Breast Cancer Patients: Prevalence and Its Accessory Symptoms.

Women diagnosed with breast cancer may have serious psychological problems and will suffer from adjustment disorder (AjD). We investigated the prevalence of AjD in female breast cancer patients who were diagnosed within 1 year and examined the severe life events they experienced, and the most common symptoms of AjD. 342 newly diagnosed (<1 year) female breast cancer patients were recruited from Tongji Hospital and Hubei Cancer Hospital in Hubei, China, from July 2018 to May 2019. The patients completed the self-report questionnaire including demographic characteristics and the scale ADNM-20 for the diagnosis of AjD. SPSS20.0 was used for data analysis. As a result, the prevalence of AjD in breast cancer patients was 38.6%. Patients from rural areas and lacking of exercise were more likely to suffer from AjD (P<0.05). The prevalence of AjD in patients who did not regard breast cancer as the most severe life event was higher than that in patients who took breast cancer as the most severe life event (44.4% vs. 33.9%, P<0.05; OR=1.728, 95% CI=1.072-2.787). The symptom that scored highest was preoccupation (3.15). We found that the prevalence of AjD in women with breast cancer in this study is very high and warrants more attention. Patients from rural areas, lacking of exercise and subject to multiple stressors are more likely to suffer from AjD. The commonest and severe symptom is preoccupation.

Prevalence of adjustment disorder among cancer patients, and the reach, effectiveness, cost-utility and budget impact of tailored psychological treatment: study protocol of a randomized controlled trial.

BACKGROUND: Information on the prevalence of adjustment disorders among cancer patients and the value of psychological interventions in this group of patients is limited. This study investigates the prevalence of adjustment disorders among cancer patients as well as the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. METHOD: This study consists of two parts. Part 1 is an observational study among a representative group of mixed cancer patients after cancer treatment on the prevalence of adjustment disorder as well as the uptake (i.e. reach) of psychological treatment. In Part 2, patients diagnosed with an adjustment disorder are invited to participate in a randomized controlled trial. Patients will be randomized to the intervention (access to the tailored psychological intervention) or control group (waitlist period of 6 months). The psychological intervention consists of three modules: one module containing psycho-education (3 sessions, all patients) and two additional modules (maximum of 6 sessions per module) provided as continuum, in case needed. Module 2 and 3 can consist of several evidence-based interventions (e.g. group interventions, mindfulness, eHealth) The primary outcome is psychological distress (HADS). Secondary outcomes are mental adjustment to cancer (MAC) and health-related quality of life (EORTC QLQ-C30). To assess the cost-utility and budget impact, quality of life (EQ-5D-5 L) and costs (iMCQ and iPCQ) will be measured. Measures will be completed at baseline and 3 and 6-months after randomization. DISCUSSION: This study will provide data of the prevalence of adjustment disorders and the reach, effectiveness, cost-utility and budget impact of a tailored psychological intervention. TRIAL REGISTRATION: Netherlands Trial Register identifier: NL7763. Registered on 3 June 2019.

Has "Iron" Felix Dzerzhinsky been affected by post-traumatic embitterment disorders?

Retrospective psycho-historical personality analysis of "Iron" Felix Dzerzhinsky presents an opportunity to evaluate development and progression of events and behaviors associated with the killing of hundreds of thousands during the "Red Terror". A biopsychosocial assessment provides evidence suggestive of the presence of post-traumatic embitterment disorder (PTED) as an underlying pathological catalyst for his actions. The introduction of PTED as a possible psychopathology leading to such violent and destructive events promotes the significance of understanding the diagnosis and how negative events may lead to maladaptive behaviors on a broad scale.

Transtorno de adaptação decorrente do parto: avaliação de sinais e sintomas em puérperas / Adjustment disorder resulting from childbirth: evaluation of signs and symptoms in postpartum women

Estudo transversal analítico, que objetivou avaliar a presença de sinais e sintomas de Transtorno de Adaptação em puérperas de uma maternidade pública do Recife, bem como, evidenciar fatores relacionados a este transtorno. Para a coleta de dados foram utilizados dois instrumentos: um sobre dados sociodemográficos e a Escala de Impacto de Eventos. Das 151 puérperas pesquisadas, 12 (7,94%) apresentaram escore compatível com a presença de sinais e sintomas de Transtorno de Adaptação decorrentes do parto, estando associados principalmente a: presença de sentimento de tristeza e desinteresse pela vida anteriores ao parto, via de parto final não desejada, ausência de acompanhante durante o parto, relato de nenhum ou pouco planejamento de gestação, cesárea ou parto vaginal com episiotomia como tipo de parto atual, e assistência prestada pelo profissional médico. Verificou-se que o uso da Escala de Impacto de Eventos pode contribuir na triagem, acompanhamento e suporte adequado das puérperas identificadas com indícios de Transtorno de Adaptação.

This is an analytical cross-sectional study aimed to evaluate the presence of signs and symptoms of Adjustment Disorder in postpartum women in a public maternity hospital in Recife, as well as to discuss factors related to this disorder. Data were collected using two instruments: one for sociodemographic information and the Impact of Events Scale. Of the 151 women in the postpartum surveyed in this study, 12 (7.94%) scored positive for signs and symptoms of Adjustment Disorder resulting from childbirth. These signs and symptoms were chiefly associated with feelings of sadness and disinterest in life prior to delivery, undesired route of delivery, absence of companion during delivery, unplanned or minimally planned pregnancy, cesarean section or vaginal delivery with episiotomy as the current form of childbirth and quality of care provided by the medical professional. It was found that the use of Impact of Events Scale can help screen, monitor and support postpartum women with signs of Adjustment Disorder.

The burden of psychosocial morbidity related to cancer: patient and family issues.

With cancer incidence increasing over time, attention to the burden of related psychiatric and psychosocial consequences of the disease and treatment is a major topic for both cancer patients and their caregivers. Among cancer patients, psychiatric (e.g. adjustment, anxiety, depressive disorders) and neuropsychiatric disorders (e.g. cognitive disorders secondary to treatment, delirium) have been shown to affect an average of 30-35% patients, with differences according to stage and type of cancer. Also other psychosocial syndromes (e.g. demoralization, health anxiety, irritable mood) not taken into account in usual nosological systems should be considered for their impact on the patient's quality-of-life. Also, it has been repeatedly reported that psychological distress reverberates substantially throughout the nuclear family, and that a family approach is necessary in cancer care, with the caregiver-patient dyad as a unit to be the focus and direction of assessment and intervention. In this review the most significant psychosocial disorders causing burden for cancer patients and their caregivers are examined, and the main methods of assessment for more proper referral and treatment are summarized.

Investigation of Mental Disorders in Lung Cancer Outpatients: A Retrospective Analysis.

Cancer patients often develop mental conditions, including anxiety and depressive disorder. And, patients with chemotherapy often exhibit mental changes including anxiety and depressive disorder. Furthermore, it is well known that the frequency of delirium is increased in cancer patients receiving terminal care. Thus, the psychiatric and cognitive functions of cancer survivors are significantly influenced by their quality of life. In this study, we performed a retrospective analysis to identify the risk factors for psychiatric disorders in lung cancer survivors. Most lung cancer survivors that were diagnosed with psychiatric disorders had stage 4 disease. In addition, it was found that an increase in disease stage and high doses of opioids are associated with an increased risk of psychiatric disorders in lung cancer survivors. These findings suggest that it is necessary to consider the mental changes experienced by lung cancer patients during disease progression.

[Reactive anxiety crisis and chronic adjustment disorder: a unique case of work injury and suspected occupational disease]. / Crisi d'ansia reattiva e disturbo dell'adattamento cronico: un caso particolare di infortunio sul lavoro e di sospetta malattia professionale.

The present study aims to describe a case of work injury and occupational disease which is unique for the type of disease diagnosed, conditions of onset and mode of management by INAIL (Italian National Institute of Insurance for Injuries at Work and Occupational Diseases). A worker, after a verbal animated dispute with some collegues and superiors, had an acute psychiatric agitation attack and went to the nearest emergency room, where he was subjected to clinical exams. No neuropsychiatric alteration was found, but the physicians diagnosed an anxiety crisis reactive to the work environment. Consequently, the medical certificate for work injury was edited and sent to INAIL. The worker has been off work for 110 days because of a anxious and depressive syndrome, due to the verbal conflict. In a later assessment, INAIL recognized only the first 30 days of the employee's time off as injury at work, while judging the following period off work as related to affectivity disturbance due to common disease, not related to work environment. The following year, "anxious-depressive syndrome" is worsened and attributed by the same worker to the recurrence of acts of persecution and discrimination against him at work. For this reason he applied for recognition of occupational disease diagnosed as "Chronic Adjustment Disorder with prolonged depressive reaction and somatic anxiety, which developed into a protracted conflict marked the employment situation". INAIL rejected that request, but in the same year the employee has submitted the complaint for "mobbing". Even this request was rejected. Literature shows many examples of traumatic events during working activities which cause psychiatric disturbances. These events include industrial disasters, explosions, transport and mining accidents, accidents in psychiatric units with high risks of assaults, armed conflicts, war, assault and sexual assault, natural disasters. Victims show symptoms of acute stress disorder (ASD) or post-traumatic stress disorder (PTSD). Cases of acute stress disorder resulting only from verbal conflict recognised as work injury aren't currently described. This case opens new perspective for the occupational physician in the assessment of ASD as work injury and of PTSD as professional disease, suggesting to put more attention to psychiatric health of workers.

[Prevalence of adjustment disorder, acute and posttraumatic stress disorders as well as somatoform disorders in cancer patients]. / Prävalenz von Anpassungsstörung, Akuter und Posttraumati-scher Belastungsstörung sowie somatoformen Störungen bei Krebspatienten.

We aimed to systematically summarize the empirical evidence on the 4-week-, 12-month-, and lifetime prevalence of adjustment disorders, acute and posttraumatic stress disorders as well as somatoform disorders in cancer patients. We evaluated 64 English or German language original papers and systematic reviews that assessed the prevalence of affective and anxiety disorders using structured clinical interviews published between 1995 and 2010. Adjusted prevalence rates were calculated using a random-intercept model. We found the following pooled adjusted 4-week prevalence rates: For adjustment disorder 12.5% (95% CI 9.9-15.7), for posttraumatic stress disorder 2.6% (95% CI 1.7-4.0), for acute stress disorder 4.8% (95% CI 2.2-10.0) and for somatoform disorders 3.1% (95% CI 1.6-5.8). Our findings show the need for further research on representative studies that take into account the range of psychosocial stressors and supportive care needs.

Anniversary reactions in medical patients.

The aim of this study was to explore the prevalence and characteristics of anniversary reactions (somatic symptoms occurring at the anniversary of specific events) in a large sample of 1498 medical patients from different medical settings who underwent the Structured Clinical Interview for DSM-IV (SCID) and the Structured Interview for Diagnostic Criteria for Psychosomatic Research (DCPR), which provide definition of anniversary reactions. In 54 (3.6%) of the 1498 patients for whom anniversary reaction was identified, 61.1% had a concurrent DSM-IV diagnosis. Other syndromes related to somatization, abnormal illness behavior, irritable mood, demoralization, and alexithymia were present in 9 of 10 cases. Symptoms of the conversion syndrome were found in 6 (0.4%) patients with the SCID and in 67 (4.5%) patients with the DCPR, 20% of whom also had anniversary reaction. The results should alert physicians to enquire about the timing of symptoms in relation to meaningful personal events.

Slow versus standard up-titration of paroxetine for the treatment of depression in cancer patients: a pilot study.

OBJECTIVES: This study aimed to compare the tolerability and efficacy of two different titrations of paroxetine (slow and standard) in a population of cancer patients with depression. METHODS: This randomized open trial included 30 cancer patients with depression (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and aimed to compare the safety of slow up-titration (arm A) versus standard up-titration (arm B) of paroxetine chlorhydrate. In both arms, the maximum final dose was 20 mg/day. Patients were evaluated at baseline and after 2, 4, and 8 weeks with rating scales for depression and anxiety (MADRS, HADS, HAM-A, CGI), quality of life (EORTC-QLQ-30), and side effects (DOTES, SIDE). RESULTS: Thirty consecutive cancer patients (F = 21; M = 9) meeting DSM-IV TR criteria for mood disorders (MD) were enrolled in the study and randomly assigned to slow or standard paroxetine titration. Both treatment groups showed a significant mood improvement (change in MADRS total score) from baseline to end point (arm A-F(2,18) = 33.68 p < 0.001; arm B-F(2,12) = 6.97 p < 0.005). A significantly higher rate of patients in arm A compared with arm B showed no side effects after 2 weeks (40% vs. 6.7%, respectively). A multinomial logistic regression confirmed such differences between arms (chi square = 20.89 p = 0.004). The self-evaluating scale (SIDE) confirmed this difference: 60% of subjects in arm B perceived side effects compared to only 11.1% of patients in arm A. CONCLUSIONS: The results of this study suggest that slow paroxetine up-titration is better tolerated and at least as effective as the standard paroxetine up-titration in cancer patients with depression.

Treatment response to psychiatric intervention and predictors of response among cancer patients with adjustment disorders.

CONTEXT: Although adjustment disorders (ADs) are common among patients with cancer and such patients are frequently referred to consultation-liaison psychiatrists, little is known about the clinical courses of these patients. OBJECTIVES: The present study investigated treatment response to psychiatric intervention and predictors of response in a relatively large sampling of cancer patients with ADs. METHODS: We created a database of all referral cases with ADs that included data on the patients' demographic and medical factors and physician-rated Clinical Global Impression (CGI) scale to assess treatment response and clinical course. A CGI-Improvement scale score of better than "much improved" was regarded as indicating a response to treatment; the number of patients who responded to treatment during a four-week follow-up period was assessed. Also, predictors of treatment response were explored by examining demographic and medical factors using a multivariate analysis. RESULTS: Among the 238 eligible patients, 136 (57.1%) responded to psychiatric treatment; most of these responders improved to a subthreshold level of illness. On the other hand, 56 patients (23.5%) did not respond to psychiatric treatment, seven patients (2.9%) developed major depressive disorders, and 39 patients (16.4%) discontinued treatment before achieving a response. Among the predictive factors that were explored, suffering from pain significantly predicted a good treatment response, whereas a worse performance status predicted a poor treatment response. CONCLUSION: Cancer patients with ADs can respond to psychiatric treatment, but a few cases develop major depressive disorders. Several predictors of treatment response were identified.

Involvement of a psychiatric consultation service in a palliative care team at the Japanese cancer center hospital.

OBJECTIVE: Close collaboration between the cancer care team service and the psychiatric consultation service is recommended to provide adequate comprehensive care to cancer patients. In Japan, specialized palliative care teams work in conjunction with consultation-liaison psychiatrists as an essential members. There are, however, few studies reporting on these services. METHODS: We obtained the characteristics, physical and psychiatric symptoms and outcomes of cancer patients by analyzing the database of patients referred to the palliative care team at the National Cancer Center Hospital East, Japan. RESULTS: Among consecutive 2000 referrals, most patients referred to the palliative care team present both physical and psychiatric symptoms. Psychiatric diagnoses were provided for ∼70% of these patients. Consultation-liaison psychiatrists provided medical care to 80% of all the referrals. The main symptoms for psychiatric consultation were delirium (28%), adjustment disorder (18%), major depression (7.6%) and dementia (6.6%). CONCLUSIONS: Psychiatric problems are common in cancer patients of the palliative care team. The palliative care team should assess the psychiatric problems in cancer patients, and the involvement of the consultation-liaison psychiatrists in the palliative care teams may be one of the strategies to establish the psychosocial support for cancer patients in the acute hospital settings.

Screening for emotional distress in cancer patients: a systematic review of assessment instruments.

Screening for emotional distress is becoming increasingly common in cancer care. This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress, with the goal of encouraging screening programs to use standardized tools that have strong psychometrics. Systematic searches of MEDLINE and PsycINFO databases for English-language studies in cancer patients were performed using a uniform set of key words (eg, depression, anxiety, screening, validation, and scale), and the retrieved studies were independently evaluated by two reviewers. Evaluation criteria included the number of validation studies, the number of participants, generalizability, reliability, the quality of the criterion measure, sensitivity, and specificity. The literature search yielded 106 validation studies that described a total of 33 screening measures. Many generic and cancer-specific scales satisfied a fairly high threshold of quality in terms of their psychometric properties and generalizability. Among the ultrashort measures (ie, those containing one to four items), the Combined Depression Questions performed best in patients receiving palliative care. Among the short measures (ie, those containing five to 20 items), the Center for Epidemiologic Studies-Depression Scale and the Hospital Anxiety and Depression Scale demonstrated adequate psychometric properties. Among the long measures (ie, those containing 21-50 items), the Beck Depression Inventory and the General Health Questionaire-28 met all evaluation criteria. The PsychoSocial Screen for Cancer, the Questionnaire on Stress in Cancer Patients-Revised, and the Rotterdam Symptom Checklist are long measures that can also be recommended for routine screening. In addition, other measures may be considered for specific indications or disease types. Some measures, particularly newly developed cancer-specific scales, require further validation against structured clinical interviews (the criterion standard for validation measures) before they can be recommended.

Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: superiority over imipramine.

GOALS OF THE WORK: This study aimed to compare the effectiveness of mirtazapine and imipramine on not only the distressing symptoms of cancer patients such as pain, nausea, vomiting, appetite loss, and sleep disturbances but also depressive and anxiety symptoms. MATERIALS AND METHODS: Fifty-three patients with cancer who were diagnosed with major depressive disorder, anxiety disorder, or adjustment disorder were included. Twenty patients on mirtazapine, 13 patients on imipramine, and 20 patients in the control group without medication were interviewed during three visits (baseline, third week, and sixth week). Pain, nausea, vomiting, appetite loss, and sleep disturbances were evaluated with self-assessment single-symptom scales during each visit. The patients were also asked to complete the Hospital Anxiety Depression Scale (HADS) during each visit. MAIN RESULTS: There were no significant differences among the three visits in the mirtazapine, imipramine, or control groups in terms of pain, nausea, vomiting, or appetite loss. For the initial, middle, and late insomnia, only the mirtazapine group showed improvements (p = 0.001, p = 0.001, p = 0.003). There were also significant differences in the mean total (p = 0.03), anxiety (p = 0.003), and depression (p = 0.025) scores of HADS among the three visits for patients taking mirtazapine. There were no significant differences for HADS scores from the baseline to the end point for patients taking imipramine or control group patients. CONCLUSION: Our findings suggest that mirtazapine is effective for resolving insomnia as well as anxiety and depressive symptoms in cancer patients. However, more systematic research, such as placebo-controlled studies, is needed.

Psychiatric disorders in bone marrow transplant patients.

OBJECTIVE: To identify the psychiatric illnesses in patients with hematological/oncological disorders encountered during blood and bone marrow transplantation. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Bismillah Taqee Institute of Health Sciences and Blood Diseases Centre, Karachi from December 2002 to December 2005. PATIENTS AND METHODS: All consecutive patients, aged 15 years and above, who fulfilled inclusion and exclusion criteria and underwent blood and bone marrow transplantation, were enrolled in this study. Psychiatric assessment comprised of a semi-structured interview based on Present Status Examination (PSE). The psychiatric diagnosis was made on the basis of International Classification of Diseases (ICD-10) system of classification devised by W.H.O. RESULTS: Eighty patients, who fulfilled the inclusion criteria, were inducted in this study. Thirty (37.5%) cases were found to have psychiatric disorders. Out of the total, 60 (75%) were males and 20 (25%) females. Adjustment disorder was the most frequent diagnosis (n=12), followed by major depression (n=7). Rest of the diagnoses made were generalized anxiety disorder, acute psychotic disorder, delirium and depressive psychosis. CONCLUSION: High psychiatric morbidity associated with blood and bone marrow transplantation was observed. It indicates the importance of psychiatric intervention during the isolation period of BMT as well as pre-transplant psychiatric assessment and counseling regarding procedure.