The diagnosis is cancer and then Depression

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Slide 1 : Caroline Nothdurfter Caroline.Nothdurfter@med.uni-muenchen.de The diagnosis is cancer – and then depression?
Slide 2 : Frequency of psychiatric disorders in cancer patients Difficulty of differentiation between symptoms caused by psychiatric disorders and symptoms caused by cancer (e.g. loss of appetite and weight, sleep disturbances) Delirium: more than 80% of all prefinal cancer patients Depression: 1/3 of all cancer patients The frequency of depression in cancer patients seems to depend on the kind of cancer: especially common in patients who suffer from breast cancer, pancreas and oropharyngeal carcinoma
Slide 3 : The diagnosis of depression The ICD-10 Classification of Mental and Behavioural Disorders, WHO
Slide 4 : Can Psychiatric disorders be a risk factor for the development of cancer? „unhealthy lifestyle“: Smoking: widespread among patients with psychiatric disorders Alcohol abuse: depression as a consequence of alcohol abuse is much more common than drinking alcohol because of depression. Especially high risk of suicide!!! Obesity: often due to reduced motor activity Immune system: Reduced activity of natural killer cells and low proliferation rate of lymphocytes Hyperactivity of proinflammatory cytokines (e.g. Il-1, TNF-a und IFN-?) HPA-axis Dysregulation may be involved in the development of this imbalance of the immune system Impact of this imbalance so far not known „Cancer prone personality“: Personality features such as reduced perception of own needs and hyper control of negative emotions ARE NO risk factors for the development of cancer „fighting spirit“: CANNOT improve survival rates of cancer patients
Slide 5 : Suicidalty in cancer patients I Suicidal ideas of cancer patients often seem comprehensible Be careful not to under diagnose depression!!! 80% of all depressive patients have suicidal ideas 10% die of suicide
Slide 6 : Suicidalty in cancer patients II Cancer patients seem to commit suicide in a rather considerate than in an impulsive way Highest risk of committing suicide within the first two years after the diagnosis of cancer Attitude towards euthanasia: no more socio-cultural differences when patients know they have to die because of cancer Interestingly, cancer patients mainly wish to die because of fear and depressive mood, not because of cancer pain Risk of suicide in cancer patients is clearly associated to depression!!!
Slide 7 : Therapy of depressive disorder in cancer patients Most important: good doctor-patient-relationship!!! Antidepressive medication: There are no special guidelines for cancer patients who suffer from depressive disorder Be careful with interaction of medication: venlafaxine, citalopram, sertraline und mirtazapine have a comparatively low interaction profile Methylphenidat might be helpful in patients with cancer-related-fatigue-syndrome Electroconvulsive therapy (ECT): improvement of symptoms of pyschopharmacologically therapy-resistant depressive patients is 50-60% in general cancer is not a general contraindication for ECT Psychotherapy: Psycho education, stress relaxation (e.g. Jacobson), family intervention
Slide 8 : Stages of dying – E. Kübler-Ross
Slide 9 : Literature I 1. Akechi T., Okuyama T., Sugawara Y., Nakano Y., Uchitomi Y.: Suicidalty in terminally ill Japanese patients with cancer. Cancer (2003), 100(1):183-91. 2. Angst J.: Epidemiology of depression. In: Honig A., Van Praag H. M. (Hrsg.): Depression. Neurobiological, psychopathological and therapeutic advances. Wiley, Chichester (1997), S.17-30. 3. Bruera E., Driver L., Barnes E. A., Willey J., Shen L., Palmer J. L., Escalante C. Patient-controlled methylphenidate for the management of fatigue in patients with advanced cancer: a preliminary report. J Clin Oncol (2003), 21(23):4439-43. 4. Centeno C., Sanz A., Bruera E.: Delirium in advanced cancer patients. Palliat Med (2004), 18(3):184-94. 5. Chochinov H. M., Wilson K. G., Enns M., Mowchun N., Lander S., Levitt M., Clinch J. J.: Desire for death in the terminally ill. Am J Psychiatry (1995), 152(8):1185-91. 6. Covey L. S., Glassman A. H., Stetner F.: Cigarette smoking and major depression. J Addict Dis (1998), 17(1):35-46. 7. De Boer M. F., Ryckman R. M., Pruyn J. F., Van den Borne H. W. Psychosocial correlates of cancer relapse and survival: a literature review. Patient Educ Couns (1999), 37(3):215-30. 8. Evans D. L., Charney D. S., Lewis L., Golden R. N., Gorman J. M., Krishnan K. R. R., Nemeroff C. B., Bremner J. D., Carney R. M., Coyne J. C., Delong M. R., Frasure-Smith N., Glassman A. H., Gold P. W., Grant I., Gwyther L., Ironson G., Johnson R. L., Kanner A. M., Katon W. J., Kaufmann P. G., Keefe F. J., Ketter T., Laughren T. P., Leserman J., Lyketsos C. G., McDonald W. M., McEwan B. S., Miller A. H., Musselman D., O’Connor C., Petitto J. M., Pollock B. G., Robinson R. G., Roose S. P., Rowland J., Sheline Y., Sheps D. S., Simon G., Spiegel D., Stunkard A., Sunderland T., Tibbits P. Jr., Valvo W. J.: Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry (2005), 58:175-189. 9. Faller H., Lang H., Schilling S.: Causal „cancer personality“ attribution—an expression of maladaptive coping with illness? Z Klin Psychol Psychiatr Psychother (1996), 44(1):104-16. 10. Grinshpoon A., Barchana M., Ponizovsky A., Lipshitz I., Nahon D., Tal O., Weizman A., Levav I. Cancer in schizophrenia: is the risk higher or lower? Schizophr Res (2005), 73(2-3):333-41. 11. Herbert T. B., Cohen S.: Depression and Immunity: a meta-analytic review. Psycho Bull (1993), 113(3):472-86. 12. Kübler-Ross E.: Interviews mit Sterbenden. Droemer-Knaur-Verlag, 2001. 13. Mackenthun G. Krebs und Psyche – Die sogenannte Krebspersönlichkeit. Einführund in die Psychosomatik und Somatopsychologie. Vorlesung an der medizinischen Fakultät der Humboldt-Universität zu Berlin WS 1999/2000. 14. McElroy S. L., Kotwal R., Malhotra S., Nelson E. B., Keck P. E., Nemeroff C. B.: Are mood disorders and obesity related? A review for the mental health
Slide 10 : Literature II 15. Pasquini M., Biondi M.: Depression in cancer patients: a critical review. Clin Pract Epidemiol Mental Health (2007), 3:2. 16. Patkar A. A., Hill K. P., Weinstein S. P., Schwarzt S. L. ECT in the presence of brain tumor and increased intracranial pressure: evaluation and reduction of risk. J ECT (2000), 16(2):189-97. 17. Penninx B. W., Guralnik J. M., Pahor M., Ferrucci L., Cerhan J. R., Wallace R. B., Havlik R. J. Chronically depressed mood and cancer risk in older persons. J Natl Cancer Inst (1998), 90(24):1888-93. 18. Pukkila K., Hakko H., Väisänen E., Särkioja T., Räsänen P.: Does alcohol drinking have an influence on suicides in cancer sufferers? A population-based study of 1515 suicide victims. Jpn J Clin Oncol (2000), 30(12):568-70. 19. Reiche E. M., Nunes S. O., Morimoto H. K. Stress, depression, the immune system, and cancer. Lancet Oncol (2004), 5(10):617-25. 20. Rodin G., Lloyd N., Katz M., Green E., Mackay J. A., Wong R. K., Supportive Care Guidelines Group of Cancer Care Ontario Program in Evidence-Based Care. The treatment of depression in cancer: a systematic review. Support Care Cancer (2007), 15(2):123-36. 21. Ronson A. Psychiatric disorders in oncology: recent therapeutic advances and new conceptual frameworks. Curr Opin Oncol (2004), 16(4):318-23. 22. Sackeim H. A., Prudic J., Devanand D. P., Nobler M. S., Lisanby S. H., Peyser S., Fitzsimons S., Moody B. J., Clark J.: A prospective, randomized, double-blind comparison of bilateral and right unilateral electroconvulsive therapy at different stimulus intensities. Arch Gen Psychiatry (2000), 57(5):425-34. 23. Schiepers O. J., Wichers M. C., Maes M. Cytokines and major depression. Prog Neuropsychopharmacol Biol Psychiatry (2005), 29(2):201-17. 24. Sellschop A., Fegg M., Frick E., Gruber U., Pouget-Schors D., Theml H., Vodermaier A., Vollmer T. Manual Psychoonkologie, Tumorzentrum München (2005), 2. Auflage. 25. Sher L. Risk and protective factors for suicide in patients with alcoholism. ScientificWorldJournal (2006), 6:1405-11. 26. Soyka M., Hollweg M., Naber D.: Alcohol dependence and depression. Classification, comorbidity, genetic and neurobiological aspects. Nervenarzt (1996), 67(11):896-904. 27. Temoshok L.: Personality, coping style, emotion and cancer: towards an integrative model. Cancer Surv (1987), 6(3):545-67. 28. Thornicroft G., Sartorius N.: The course and outcome of depression in different cultures: 10-year follow-up of the WHO collaborative study on the assessment of depressive disorders. Psychol Med (1993), 23(4):1023-1032.

 


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