Relation of psychological vulnerability factors to posttraumatic stress disorder symptomatology in bone marrow transplant recipients.

OBJECTIVE: Prior research suggests that the diagnosis and treatment of cancer can result in the development of symptoms of posttraumatic stress disorder (PTSD). Based on Lazarus and Folkman's model of stress, the current study examined whether trauma appraisals, coping, social support, and social constraint were associated with the severity of PTSD symptoms in cancer patients who had undergone bone marrow transplantation (BMT). METHODS: Participants were 23 males and 79 females treated with BMT an average of 20 months previously (range = 3-62 months). Past and current psychiatric diagnoses were assessed through a structured clinical interview. PTSD symptomatology and other psychological variables were assessed using standardized self-report measures. RESULTS: Results indicated that 5% of participants met diagnostic criteria for current PTSD. Participants reported an average of three to four symptoms of PTSD (range = 0-16). Univariate analyses confirmed predictions that increased PTSD symptomatology would be associated with more negative appraisals of the BMT experience, greater use of avoidance-based coping strategies, lower levels of social support, and greater social constraint (p < .05). Regression analyses indicated that each of these variables accounted for significant (p < .05) variability in PTSD symptomatology above and beyond relevant demographic and medical variables. CONCLUSIONS: Results of the present study confirm and extend prior research regarding the prevalence of PTSD and PTSD symptoms among patients treated for cancer. In addition, the study identified a set of theoretically derived psychological characteristics that seem to place patients at risk for greater PTSD symptomatology after BMT.

Posttraumatic stress disorder symptoms after bone marrow transplantation for breast cancer.

OBJECTIVE: On the basis of revisions of DSM criteria, questions have been raised concerning the occurrence of posttraumatic stress disorder (PTSD) symptoms among adults who have been diagnosed and treated for life-threatening illnesses. The present study examined the prevalence and correlates of PTSD symptoms among women who had undergone autologous bone marrow transplantation (ABMT) for breast cancer. METHODS: Participants were 43 women who had undergone ABMT for breast cancer an average of 19 months previously (range = 2 to 62 months) and had no clinical evidence of disease at their most recent follow-up visit. PTSD symptoms and quality of life were assessed using standardized self-report instruments. RESULTS: Between 12% and 19% of participants were likely to meet DSM-IV criteria for the current diagnosis of PTSD. Women who were less well educated, had more advanced disease at the time of the transplantation and had longer hospital stays for the transplantation reported more symptoms of PTSD. Greater PTSD symptomatology was associated with reports of poorer physical health, mental health, and sleep quality. CONCLUSION: Comparisons with previous research suggest that rates of PTSD are higher among women who undergo ABMT as opposed to less intensive forms of breast cancer treatment. These findings are consistent with the view that development of PTSD symptoms is associated with the degree of life threat. The clinical significance of PTSD in this patient population is underscored by findings indicating that greater PTSD symptoms are associated with poorer health-related quality of life.

Synergistic effects of testosterone metabolites on the development of motoneuron morphology in a sexually dimorphic rat spinal nucleus.

The rat lumbar spinal cord contains the testosterone-dependent spinal nucleus of the bulbocavernosus (SNB), whose motoneurons innervate perineal muscles involved in copulatory reflexes. In normal males, SNB dendrites grow exuberantly through the first 4 weeks postnatally. This growth is steroid-dependent: dendrites fail to grow in males castrated at P7, but grow normally in castrates treated with testosterone (T). Treatment with either of the T metabolites, dihydrotestosterone or estrogen, supports dendritic growth in castrates, but not to the lengths characteristic of intact males or T-treated castrates. The present study tested the hypothesis that dihydrotestosterone and estrogen act together to support development of SNB dendrites. Male rat pups were castrated on P7 and treated daily with dihydrotestosterone propionate (DHT) (2 mg), estradiol benzoate (E) (100 microg), DHT (2 mg) combined with estradiol benzoate in either 5 microg (E5) or 100 microg (E100) doses, or vehicle alone. On P28, when SNB dendritic length is normally maximal, motoneurons were retrogradely labeled with cholera toxin-HRP (BHRP). Soma size and dendritic lengths of labeled motoneurons were assessed and compared to those of age-matched, intact male rats. Soma areas of DHT + E5-treated and DHT + E100-treated castrates did not differ from those of castrates treated with DHT alone, although somata of all three groups were significantly larger than those of normal males and E- or oil-treated castrates. Dendritic lengths in DHT + E5-treated castrates were significantly shorter than those of normal males, and did not differ from those of castrates receiving DHT or E alone, although all hormone-treated groups had dendritic lengths that were significantly longer than untreated castrates. However, treatment of castrates with DHT + E100 fully supported dendritic growth to levels characteristic of normal males. These results suggest that somal and dendritic growth may occur through separate developmental mechanisms, and that E and DHT act synergistically to support normal masculine SNB dendritic development.