The role of the psychiatrist in myelodysplasia.
Management of the myelodysplasia patient and his family is best performed in the multidisciplinary setting of a comprehensive care clinic. Careful initial evaluation by each subspecialist on the team followed by family counseling provides the basis for selection of patients for treatment. Subsequently each subspecialist contributes up-to-date assessment and on-going medical care. Prevention of progressive orthopedic deformity through the use of plaster casts may minimize the need for surgical treatment. Severe deformities may require muscle balancing procedures. Aggressive surgical intervention is indicated in cases of progressive scoliosis and lordoscoliosis. Minimal urologic evaluation and surveillance guidelines have been developed, and prevention of irreversible renal damage is possible. Chemotherapy, adequate bladder drainage, and sophisticated techniques including sphincter and bladder electromyography and the use of artificial urinary sphincters and bladder pacemakers contribute to improved urologic management. The emotional needs of the patient and his family are complex, and support by the psychiatrist and the social worker as well as all other team members is necessary for adequate development of a well adjusted child in the face of physical handicaps.