Characteristics of changes of personal odor after experimental bone marrow transplantation]

In an operant conditioning paradigm 4 Balb/c inbred strain mice were conditioned to discriminate between urine samples of two other inbred strains. The purpose was to examine whether or not the known stimulus configuration during training had any effect upon the rate of recognition of other stimuli. On the basis of this procedure, we subsequently investigated the extent to which an allogeneic bone marrow transplantation interferes with the olfactory identity of an individual. For the transplants a strain was inbred which had no contact to the animals tested, a procedure used for the first time here. Furthermore, also for the first time, it was possible to demonstrate in a direct comparison, the role played by donor versus recipient characteristics on the olfactory composition of the recipients odor.     

Pain language of bone marrow transplantation patients.

Previous studies have shown that hypnosis may be effective in reducing intensity of pain among bone marrow transplantation patients whereas cognitive behavioral intervention without imagery was not effective for this group of patients. Since hypnosis alters patients' perception of pain and cognitive behavioral intervention changes patients' beliefs and improves their coping with pain, we hypothesized that sensory pain is more important than affective pain in understanding the pain experience of patients undergoing bone marrow transplantation. To test this hypothesis we administered the McGill Pain Questionnaire longitudinally to 50 consecutive eligible recipients of bone marrow transplantation during hospitalization to assess the different dimensions of pain they experienced. Consistent with our hypothesis, sensory pain fluctuated with treatment stages, and the pattern was consistent with previous findings. Patients reported significantly higher sensory pain than affective pain at all assessment points. In contrast, affective pain remained low and stable throughout the treatment. Our results contribute to the understanding of the nature of pain in bone marrow transplantation and suggest pain management strategies that focus on sensory pain as in hypnosis are more useful for such patients.     

Student volunteer social support and infant intervention: A case study

The emphases in infant mental health have been in the three areas of supporting the mother-infant dyad through education, psychotherapy to help parents resolve emotional conflicts that interfere with the parent-infant interaction, and support during the acute crisis that follows an abnormal birth. The case described herein involves a child with a genetic defect born to competent parents, a chronic stressful situation that does not fit these categories. It became apparent in the first few months after the birth that both the child and parents were in need of some help in coping with the situation. An intervention was designed to help provide both the necessary stimulation for the baby and the needed emotional support for the family, while it acknowledged their skill and competencies as parents. This was done through the help of college student volunteers, who assisted the mother in the home. Developmental data recorded at birth, 7 months, 12 months, and 39 months indicate that the child is severely multiply handicapped. Interview data with the parents at those times document their personal and family difficulties, the eventual resolution as a family in dealing with this problem, and the importance of the volunteer help during that process.     

The physician's influence on informed consent for bone marrow transplantation

The influence of physician judgment on the disclosure, competency, understanding, voluntariness, and decision aspects of informed consent for bone marrow transplantation are described. Ethical conflicts which arise from the amount and complexity of the information to be disclosed and from the barriers of limited time, patient anxiety and lack of prior relationship between patient and physician are discussed. The role of the referring physician in the decision-making is considered. Special ethical issues which arise with use of healthy related bone marrow donors are discussed, as is the physician's discretion in raising questions of competency. It is concluded that in this setting, regardless of the theoretical goals of the physician, patients appear to utilize informed consent discussions to assess their capacity to trust the physician rather than as a time to weigh the large amount of relevant data. The conscientious physician best serves the patient with recommendation of the best medical alternative rather than with attempts to remain neutral.     

The use of multitreatment modalities in early intervention: A quantitative case study

A quantitative single case study is presented to illustrate how an early intervention program used two therapeutic modalities to treat a depressed mother and her 2-month-old son. Drawing upon an ecological, transactional model of development, the case study utilized a multimethod, longitudinal approach to assess the infant's developmental competence and attachment status, the mother's history and current psychosocial functioning, patterns of mother-infant interaction, and components of the family's social ecology. Measures were administered during a baseline period to assess pre-intervention functioning and were systematically repeated throughout the 2-year period of intervention. The treatment modalities included psychodynamically oriented individual therapy and Parent-Infant Relationship Treatment (PIRT) in which the dyad was also seen by a second therapist to foster more adaptive mother-infant transactional patterns. The findings indicated increased infant developmental competence and a shift from an insecure to a secure attachment classification, improved maternal psychosocial functioning, and a decline in the dyadic interactional pattern of maternal intrusiveness and infant withdrawal. The advantages of using two treatment modalities and a single case approach to evaluation are discussed.     

Predictors of posttraumatic growth following bone marrow transplantation for cancer.

There is growing recognition that the experience of cancer can have a positive as well as a negative psychological impact. This longitudinal study sought to identify predictors of posttraumatic growth among cancer patients (N=72) undergoing bone marrow transplantation. Greater posttraumatic growth in the posttransplant period was related to younger age; less education; greater use of positive reinterpretation, problem solving, and seeking alternative rewards as coping strategies in the pretransplant period; more stressful appraisal of aspects of the transplant experience; and more negatively biased recall of pretransplant levels of psychological distress. Findings partially support J. A. Schaefer and R. H. Moos's (1992) model of life crises and personal growth and also suggest that temporal self-comparisons contribute to the experience of posttraumatic growth.     

Aphemia after a penetrating brain wound: A case study

The speech of a patient with aphemia (pure anarthria) resulting from a penetrating brain wound was studied using linguistic and acoustic observations as well as electromyographic recordings from four labial muscles. The results are discussed in relation to phonetic disintegration's syndrome and apraxia of speech which, respectively, enhance linguistic disorders and motor programming disturbance.     

A psychotherapeutic technique for mother-child intervention: A case study of a japanese down syndrome child

The purpose of this paper is to demonstrate our approach to the activation of mother-child interaction, by presenting a case study. We describe a Japanese mother's adaptation process (consisting of five stages) to her child's handicap through 6 years of continuous therapeutic support for both the mother and her child. In this particular case, the mother suffers from a mild form of cerebral palsy; therefore, the problem involves two generations, because both the mother and her child are handicapped. By analyzing the processes of this case, we also describe our method of intervention for problems in the development of multidimensional relationships. We discuss the mother's psychological maturation and the role of the therapist within the Japanese social and cultural context, under the following headings: (1) Sharing in the Mother's Ambivalence; (2) Natural Melting of the Mother's Frozen Emotional Availability; (3) Sharing in the Mother's Illusion and Disillusion; (4) Transformation of Relationships Between Family Members and Their Relationship to Society.     

Treatment of urethral catheter dependence: A case study of intervention in the interdisciplinary geriatric setting

This case report describes the assessment and treatment of a 69-year-old male medical patient with urethral catheter dependence. Assessment revealed an anxiety/phobic component to the dependence and hypothesized detrusor muscle deconditioning. Retraining of the bladder and desensitization to the anxiety-provoking situation were achieved by exposure to decatheterization in the context of a supportive adult day health care setting. Interdisciplinary collaboration between nursing and psychology were associated with successful functional, social, and psychological outcomes.A psychology intern at the Portland VA Medical Center at the time the study was conducted.     

Pain perception in patients undergoing bone marrow puncture--a pilot study

The objective of this study was to establish the relationship between the perception of pain, anxiety, and depressive tendency in performance of bone marrow puncture. 93 consecutive patients (62% men, 38% women) from a hematological oncology outpatient department ages 20 to 85 years (M age = 53.7, SD = 15.1) were questioned. On average, the patients had undergone 2.5 (+/- 2.6) punctures. The underlying disease was leukemia in 49%, malignant lymphoma in 41%, another malignant disease in 2%, and there was a benign condition in 8%. Depression and general anxiety were measured using the Hospital Depression and Anxiety Scale (HADS-D). Fear of puncture and perception of pain were registered with visual analog scales. Patients with increased scores of anxiety or depressive tendency on the HADS-D suffered significantly more severely from fear of puncture and pain than patients with normal scores. However, the puncture-related fear in the group as a whole correlated markedly more closely with the intensity and tolerability of pain than did general fear and depressive tendency. This finding must be considered when planning psychological interventions in this group of patients.     

Quality of life and social support of patients being evaluated for bone marrow transplantation

A sample of 437 patients completed self-report measures of quality of life and social support while they were being evaluated for bone marrow transplantation (BMT) at The Johns Hopkins Oncology Center. Generally, the candidates showed reasonably high levels of quality of life (QOL) on the Satisfaction with Life Domains Scale (SLDS), their present ranking on the Cantril Self-Anchoring Ladder of Life, and their scores on the Bradburn Positive Affect Scale. The level of QOL of these candidates for transplant was significantly related to their level of social support. Both availability and adequacy of social support for these transplant candidates were found to be significantly related to QOL as measured by the SLDS. Availability of social support as measured by patient membership in religious and other organizations was significantly related to Positive Affect but not Negative Affect. The Family APGAR and Relational Support Scales measures of social support were significantly correlated with both Positive and Negative Affect.     

Visual imagery: A case study

This paper describes the performance of a subject who, when presented with a word or a sentence, is abnormally proficient at spelling this material in reverse order. She reports that she does this by visualizing this material and reading off from this visual image. Her tachistoscopic performance is also abnormally good. It is suggested that her superiority in these two tasks is achieved principally because her internal visual representations are extremely resistant to disruption by other mental activities.     

Attachment, assessment, and psychological intervention: a case study of anorexia

Attachment patterns and personality dimensions have always been considered important to the development and adaptation of the individual. The first aim of this article was to address some basic questions about the place of attachment in a multimethod assessment when compiling a complete picture of the patient's personality functioning. The second aim was to present the Adult Attachment Projective Picture System (AAP; George & West, 2001) as a valid and productive assessment measure. Based on a single case study of an anorexic young woman, the article demonstrates how the AAP is integrated with the Rorschach Comprehensive System (Exner, 1991, 1993) and other assessment tools in both the assessment and in developing a treatment plan.     

Using strategic psychotherapy: A case study of chronic PTSD after a terrorist attack

This article describes a case of chronic post traumatic stress disorder (PTSD). The patient came to psychotherapy three years after he was injured in a terrorist attack. He was in a state of dysfunction. The article elaborates on theoretical issues, the choice of strategic model of psychotherapy, the various phases of the therapeutic process and the specific difficulties that such a case presents.