Ms Maggie Carson
Western General Hospital, Edinburgh

Mrs June Williamson

The impact of a pituitary disorder affects the whole family. There is a change of focus at the time of diagnosis; family communication styles can alter, and if the stress of caring becomes chronic, the initial adaptive behaviour of the family members can break down. The carer experiences more stress, and the family can be rejected by other people.

It is recognised that psychiatric symptoms, such as depression, anxiety and behavioural changes, may occur in patients with pituitary disorders. There is a significant interrelationship between the Endocrine system and mental health. Through its connections with other limbic structures, the hypothalamic-pituitary axis may affect behavioural control in some patients, causing mood swings and personality changes. Some patients develop apathy syndrome; diagnosis depends on the detection of simultaneous reductions in goal-related action, goal-related thought activity and emotional responses. These changes are misunderstood by other people. Families can't cope and become dysfunctional; they feel rejected and unsupported. This inhibits the patient's progress.

A problem-centred approach to family therapy has been developed in America. The McMaster model has been used as an assessment and intervention tool in families of patients with chronic health problems such as pituitary disorders. It is said to be more valuable to carers than support groups and counselling. Families are assessed by a trained person who works with them and the patient, making them aware of the causes of the patient's behavioural changes, and helping them to adapt their own behaviour accordingly. The McMaster model identifies six primary areas of family functioning which may need attention.

Roles

Day-to-day changes in the way a pituitary patient feels and behaves mean that they cannot fulfil the usual daily workplace/domestic tasks. The carer is under pressure because of financial worries and the extra workload. The family are encouraged to reallocate roles. This relieves the carer's stress. The patient should be fully involved in the organisation of the change, to avoid greater isolation.

Behavioural control

Families often misinterpret the patient's lack of interest or ability to take part in family activities, sometimes reacting by punishing the patient. When the family understand the effects of changed behaviour, they can control their own behaviour better, and cope with changes in the patient.

Communication

Sometimes pituitary patients only speak when spoken to, and may seem less than responsive. Their speech may be bland. Families interpret this communication problem as boredom or disinterest. This can cause the patient to become estranged from the family. When families understand the patient's inability to communicate, they can react to problems in a positive manner.

Affective responsiveness

This defines the whole range of emotions generated by a family. Most families have learned to read each other's feelings and to cope with positive and negative emotions. Some pituitary patients can no longer do this, leading to family estrangement. When families learn why patients have changed in this way, they may be better placed to cope with the patient's difficulty.

Affective involvement

This is a measure of a family's emotional investment in one another. Normally families have the ability to read each other's emotions. When pituitary patients can't do this, the family feel tempted to withdraw from the seemingly uncaring patient. When the family know how to recognise the patient's disability then the problem can be handled.

Problem solving

Pituitary patients can find it difficult to contribute to the family's efforts at problem solving. The family find this frustrating, but, with help, difficulties can be overcome.

So, where behavioural changes are experienced and diagnosed, the McMaster model supports families whilst they learn to adapt their own patterns of behaviour. This allows the patient's needs to be met, and the family can function in a more positive manner.