Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-27T22:02:50.140Z Has data issue: false hasContentIssue false
  • English
  • Français

Home parenteral nutrition and the psyche: psychological challenges for patient and family*

Published online by Cambridge University Press:  07 March 2007

Julian Stern
Julian Stern*
Affiliation:
Psychological Medicine Unit, St Mark's Hospital, Watford Road, Harrow HA1 3UJ, UK
*
Corresponding author: Dr Julian Stern fax +44 208 235400, email [email protected]
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The paper discusses the case histories of three patients who have faced the emotional implications of being initiated onto long-term parenteral nutrition (PN). In each case the patient's personal and family history, relationship to their illness and the presence or relative absence of resentments and grievances have influenced their ability to tolerate the training and the transition to home PN (HPN). In addition, the emotional importance of food and feeding from a developmental and social perspective is explored, together with the numerous psychological and social ‘losses’ experienced by all patients on PN and the adaptations required within the family setting. The ‘meaning’ of PN to the individual and the need for both internal and external support are identified and, based on clinical experience, a number of features are described that may be indicative of the relative abilities of different patients to cope with HPN. Finally, the role of a dedicated Psychological Medicine Unit closely allied to a nutrition service is discussed.

Keywords

Home parenteral nutritionPsychological challengesMultidisciplinary approach
Type
BAPEN Symposium 1 on ‘Nutritional support in children and adolescents’
Information
Proceedings of the Nutrition Society , Volume 65 , Issue 3 , August 2006 , pp. 222 - 226
Copyright
Copyright © The Nutrition Society 2006

Footnotes

*

In accordance with recommendations from within the field of psychiatry and psychotherapy publication, case material pertaining to all three cases has been substantially disguised to safeguard the confidentiality of the described.

References

Emmanuel, AV, Stern, J, Forbes, A, Treasure, J & Kamm, MA (2004) Anorexia nervosa in gastrointestinal practice. European Journal of Gastroenterology and Hepatology 16 1135–1142.Google Scholar
Freud, S (1905) Three Essays on the Theory of Sexuality. The Penguin Freud Library, vol. 7 London: Penguin UK.Google Scholar
Freud, S (1914) Remembering, repeating and working through. Further Recommendations in the Technique of Psychoanalysis, standard ed., vol. 12, pp. 145–156. London: Hogarth Press.Google Scholar
Lishman, A (1987) Organic Psychiatry: The Psychological Consequences of Cerebral Disorder, 2nd ed. Oxford: Blackwell.Google Scholar
Senior, R, Barnes, J, Emberson, J & Golding, J (2005) Early experiences and their relationship to maternal eating disorder symptoms, both lifetime and during pregnancy. British Journal of Psychiatry 187 268–273.Google Scholar
Stein, A, Woolley, H, Murray, L, Cooper, P, Cooper, S, Noble, F, Affonso, N & Fairburn, CG (2001) Influence of psychiatric disorder on the controlling behaviour of mothers with one-year old infants. A study of women with maternal eating disorder, postnatal depression and a healthy comparison group. British Journal of Psychiatry 179 157–163.CrossRefGoogle Scholar
Steiner, J (1996) Revenge and resentment in the Oedipal situation. International Journal of Psychoanalysis 77 433–443.Google Scholar
Stern, JM (1999) Psychoanalytic psychotherapy in a medical setting. Psychoanalytic Psychotherapy 13 51–68.Google Scholar
Stern, JM (2003) Review article: Psychiatry, psychotherapy and gastroenterology–bringing it all together. Alimentary Pharmacology and Therapeutics 17 175–184.CrossRefGoogle ScholarPubMed