Khalifa Ahmed S, Bishry Zeinab, Tantawy Azza A G, Ghanem Mohammed H, Effat Safia M, El Shahawy Heba, Ebeid Fatma S E
Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Neuropsychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Hematol Oncol Stem Cell Ther. 2014 Jun;7(2):76-84. doi: 10.1016/j.hemonc.2014.01.002. Epub 2014 Mar 11.
To evaluate the psychological morbidity of acute lymphoblastic leukemia (ALL) on children and their parents at different stages of illness and to assess the crucial contribution of the psychologist in the pediatric oncology team.
We recruited 103 children with ALL and their 96 parents, and divided them into five groups according to disease phase: diagnosis, initial remission, active treatment, survival and relapsing. We compared these to 22 healthy controls and their parents. Patients and controls were subjected to clinical assessments, the symptoms checklist of the International Classification of Disease ICD (ICD-10), and the Wechsler Intelligence Scale for Children The parents of patients and controls underwent a general health questionnaire, the ICD-10 symptoms checklist, rating scales for anxiety and depression, post-traumatic stress disorder (PTSD) assessment scale, and the physical cognitive affective social economic ego problems (PCASEE) questionnaire for quality of life (QOL) rating.
Psychiatric morbidity was evident in nearly 60% of leukemic children and their parents and was significantly increased in comparison to controls. Children mostly suffered from adjustment and oppositional defiant disorders. The most common discriminators between patient groups were conduct and attention problems being lowest in newly diagnosed patients, and social aggression being lowest in patients in remission. The three parameters were highest in relapsed patients whose parents mostly had adjustment and depressive disorders. Risk factors for child psychopathology were older age, female gender, and parental psychopathology. Mothers and parents with lower education and professional level were found to be vulnerable. Performance and total intelligence quotient (IQ) were significantly lower in leukemic children, and these were most pronounced in the survivor group. Risk factors for cognitive dysfunction were younger age, longer chemotherapy duration, and lower parental education level.
Most patients and their caregivers suffered from significant psychiatric morbidity, highlighting the need for routine screening to improve psychological outcomes in such cases.
评估急性淋巴细胞白血病（ALL）在疾病不同阶段对儿童及其父母造成的心理疾病，并评估心理学家在儿科肿瘤团队中的关键作用。
我们招募了103名ALL患儿及其96名父母，根据疾病阶段将他们分为五组：诊断期、初始缓解期、积极治疗期、生存期和复发期。我们将这些人与22名健康对照者及其父母进行比较。患者和对照者接受了临床评估、国际疾病分类ICD（ICD - 10）症状清单以及韦氏儿童智力量表。患者和对照者的父母接受了一般健康问卷、ICD - 10症状清单、焦虑和抑郁评定量表、创伤后应激障碍（PTSD）评估量表以及用于生活质量（QOL）评定的身体认知情感社会经济自我问题（PCASEE）问卷。
近60%的白血病患儿及其父母存在明显的精神疾病，与对照组相比显著增加。儿童主要患有适应障碍和对立违抗障碍。患者组之间最常见的区别在于品行和注意力问题在新诊断患者中最低，社交攻击行为在缓解期患者中最低。这三个参数在复发患者中最高，其父母大多患有适应障碍和抑郁症。儿童心理病理学的危险因素包括年龄较大、女性以及父母心理病理学。发现受教育程度和职业水平较低的母亲和父母更容易受到影响。白血病患儿的表现和总智商（IQ）显著较低，在存活组中最为明显。认知功能障碍的危险因素包括年龄较小、化疗时间较长以及父母教育水平较低。
大多数患者及其照顾者患有明显的精神疾病，这突出了在此类情况下进行常规筛查以改善心理结果的必要性。
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