Psychological aspects of long-term home hyperalimentation

Ten patients (24--66 yr), maintained on ambulatory home intravenous hyperalimentation (HIVH) for 1/2--3 1/4 years, have undergone psychological evaluation. Acceptance of oral deprivation and the inconveniences, restraints, and risks of long-term or life-long HIVH, and the mechanisms for coping with these stresses, varied among this group. At times, the fear related to the HIVH apparatus and its function assumed almost delusional proportions; at other times, the patients acted indifferently or even irresponsibly toward the management of their life-sustaining system. These patients had to cope with public inquisitiveness as well as their own self-consciousness in public. Stress seemed to be related to the patient's prognosis, not only regarding recovery from the primary pathologic process, but also his/her prospects for return of normal gastrointestinal function. Stress reactions also varied among the spouses and families of the patients, and the quality of their psychological support appeared to affect the patient's mental, physical, and social wellbeing significantly. An entirely new spectrum of psychologic and social problems have emerged to challenge the IVH team who successfully manage patients unable to sustain themselves nutritionally. It is imperative that we recognize, prevent, ameliorate, and treat these problems with the same degree of enthusiasm and competence with which we nourish the patients.