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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 julianstern@hotmail.com
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Abstract

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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.

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