Case series on defense mechanisms in patients for reconstructive hand transplantation: consideration on transplant defense concept.
BACKGROUND
The technical demands of reconstructive hand transplantation (RHT) and need for complex multidisciplinary care have led to intense research efforts to improve patient care and outcomes. However, RHT is an extraordinary life event which carries the potential for long-term consequences including psychological distress, which invokes coping and defense mechanisms.


METHODS
Little is known about the relationship between psychological defense mechanisms and health outcomes in RHT patients. In an effort to elucidate this relationship, we studied seven RHT patients who underwent standardized psychological assessment either pre- or post transplantation.


RESULTS
No single defense concept was identified as common to all patients, which we suspect was due in part to the varied mechanisms of hand loss. All seven patients demonstrated diverse psychological reactions to RHT. The self-reported defense styles were associated with psychological adjustment. The patients who reported defenses that distorted reality described less adaptive functioning and psychological well-being.


CONCLUSIONS
These preliminary findings reveal the varied psychological mechanisms invoked in RHT patients. An assessment of defense mechanisms should be part of multicenter evaluation protocols that address unique psychosocial aspects of RHT in large samples, in order to better guide psychological management.
Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria.
Martin
M
Kumnig
Department of Psychiatry, Mayo Graduate School of Medicine, Mayo Clinic, Rochester, USA.
Sheila G
SG
Jowsey
Department of Psychiatry, Ronald Reagan UCLA Medical Center, Los Angeles, USA.
Elisa
E
Moreno
Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Gerald
G
Brandacher
Department of Orthopaedic Surgery and Plastic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, USA.
Kodi
K
Azari
Department of Medical Psychology, Innsbruck Medical University, Innsbruck, Austria.
Gerhard
G
Rumpold
D000223:Adaptation, Psychological; D000328:Adult; D000342:Affective Symptoms / Q000523:psychology*; D003674:Defense Mechanisms; D005260:Female; D063987:Hand Transplantation / Q000523:psychology*; D006801:Humans; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D011581:Psychological Tests; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology; D057566:Self Report; D055815:Young Adult