Kirsh Kenneth L, McGrew John H, Dugan Michael, Passik Steven D
Symptom Management and Palliative Care Program, Markey Cancer Center, University of Kentucky, Lexington, Kentucky 40536-0093, USA.
Palliat Support Care. 2004 Mar;2(1):23-31. doi: 10.1017/s1478951504040040.
Although success rates for bone marrow transplantation (BMT) continue to improve, there is still a high level of morbidity and physical and emotional distress associated with BMT. To date, limited research has focused on the assessment of and screening for specific psychiatric disorders of patients facing BMT. This is especially true with regard to identifying adjustment disorder (AD), despite the fact that AD is the most prevalent psychiatric diagnosis in cancer patients.
A sample of 95 BMT patients were interviewed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th edition (SCID) and completed several commonly used self-report instruments to determine if these tools could be used to identify patients with adjustment disorder in need of further assessment and intervention.
Of these patients, 34.7% were diagnosed with adjustment disorder, 11.6% with major depression, and 5.3% with generalized anxiety disorder. The instruments were not found to be predictive of AD. However, the results of a regression analysis showed that the Social Subscale of the Functional Assessment of Cancer Therapy-General (R2 delta = 0.04, F = 4.30, p < 0.05) was a significant predictor of adjustment disorder.
We conclude that there is little efficacy in using existing scales for detecting adjustment disorders in cancer patients undergoing bone marrow transplantation, and that other tools for identifying patients with adjustment disorder who might benefit from counseling are needed.
尽管骨髓移植（BMT）的成功率持续提高，但BMT仍伴随着较高的发病率以及身体和情绪困扰。迄今为止，针对面临BMT的患者特定精神障碍的评估和筛查的研究有限。尤其是在识别适应障碍（AD）方面更是如此，尽管AD是癌症患者中最常见的精神诊断。
使用《精神障碍诊断与统计手册》第四版（SCID）的结构化临床访谈对95名BMT患者进行了访谈，并完成了几份常用的自我报告工具，以确定这些工具是否可用于识别需要进一步评估和干预的适应障碍患者。
在这些患者中，34.7%被诊断为适应障碍，11.6%为重度抑郁症，5.3%为广泛性焦虑症。未发现这些工具可预测AD。然而，回归分析结果显示，癌症治疗功能评估通用版的社会子量表（R2增量 = 0.04，F = 4.30，p < 0.05）是适应障碍的显著预测指标。
我们得出结论，使用现有量表检测接受骨髓移植的癌症患者的适应障碍几乎没有效果，需要其他工具来识别可能从咨询中受益的适应障碍患者。
