Psychiatric factors in the management of long-term hyperalimentation patients

Most patients receiving chronic IVH therapy adjust well, not only to their treatment, but also to their underlying illness. Depression, organic mental syndromes, and encapsulated delusions occur with sufficient frequency to educate staff, patients, and families as to their possible occurrence. Discussing their possible development before they appear reduces anxiety and makes the patient feel less alien. Advance knowledge makes management easier and permits families to discuss problems before they become major sources of conflict. Multidisciplinary hyperalimentation teams of medical, surgical, and psychiatric physicians, psychiatric and specially trained TPN nurses, social workers, pharmacists and dietitians are useful in providing a comprehensive program for long-term hyperalimentation patients. The elements of a TPN program should include: 1) medical services available 24 hours a day; 2) a comprehensive educational program for staff, patients, and family members; 3) psychiatric support on both a routine and an as-needed basis; 4) patient participation in treatment planning; 5) easy access to needed supplies; and 6) and assistance with financial planning.