Nothing Special   »   [go: up one dir, main page]

Skip to main content

Advertisement

Log in

Identifying patients at risk for, and treatment of major psychiatric complications of cancer

  • Review Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

A critically important aspect of supportive care in cancer is the prompt recognition and effective treatment of psychiatric complications. Psychiatric disorders such as depression, anxiety and delirium occur in a signifcant percentage of cancer patients, particularly as disease advances and as cancer treatments become more aggressive. This paper reviews factors that can be utilized to identify patients who are at increased risk for developing psychiatric complications, such as those with advanced disease, certain cancer treatments, uncontrolled physical symptoms, functional limitations, lack of social support, and past history of psychiatric disorder. Methods of diagnostic assessment and strategies for managing depression, anxiety, delirium and suicidal ideation are also reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Achte KA, Vanhkouen ML (1971) Cancer and the psyche. Omega 2:46–56

    Google Scholar 

  2. Adams F, Quesada JR, Gutterman JU (1984) Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. JAMA 252:938–941

    Google Scholar 

  3. Adams F, Fernandez F, Andersson BS (1986) Emergency pharmacotherapy of delirium in the critically ill cancer patient. Psychosomatics 27:33–37

    Google Scholar 

  4. American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn (revised). American Psychiatric Association, Washington, DC

    Google Scholar 

  5. Ayd F (1979) Amoxapine: a new tricyclic antidepressant. Int Drug Ther Newslett 14:33–40

    Google Scholar 

  6. Beaver WT, Feise G (1968) Comparison of the analgesic effects of morphine, hydroxyzine and their combination in patients with postoperative pain. In: Bonica JJ, Albe-Fessard (eds) Advances in pain research and therapy. Raven Press, New York, pp 553–557

    Google Scholar 

  7. Beaver WT, Wallenstein SL, Houde RW, et al (1966) A comparison of the analgesic effect of methotrimeprazine and morphine in patients with cancer. Clin Pharmacol Ther 7:436–446

    Google Scholar 

  8. Beck AT, Ward CH, Mendelson M, et al (1961) An inventory for measuring depression. Arch Gen Psychiatry 4:P561-P571

    Google Scholar 

  9. Beck AT, Kovacs M, Weissman A (1975) Hopelessness and suicidal behavior: an overview. JAMA 234:1146–1149

    Google Scholar 

  10. Bolund C (1985) Suicide and cancer. II. Medical and care factors in suicide by cancer patients in Sweden 1973–1976. J Psychosoc Oncol 3:17–30

    Google Scholar 

  11. Bottomley DM, Hanks GW (1990) Subcutaneous midazolam infusion in palliative care. J Pain Symptom Manage 5:259–261

    Google Scholar 

  12. Boyer WF, Feigner JP (1992) An overview of paroxetine. J Clin Psychiatry 53:3–12

    Google Scholar 

  13. Breitbart W (1986) Tardive dyskinesia associated with high dose intravenous metaclopramide. N Engl J Med 315:518

    Google Scholar 

  14. Breitbart W (1987) Sucide in cancer patients. Oncology 1:49–53

    Google Scholar 

  15. Breitbart W (1988) Psychiatric complications of cancer. In: Brain MC, Carbone PP (eds) Current therapy in hematology oncology. 3. Decker, Toronto Philadelphia, pp 268–274

    Google Scholar 

  16. Breibart W (1989) Endocrine-related psychiatric disorder. In: Holland J, Rowland J (eds) The handbook of psychooncology: the psychological care of the cancer patient. Oxford University Press, New York, pp 356–366

    Google Scholar 

  17. Breitbart W (1989) Psychiatric management of cancer pain. Cancer 63:2336–2342

    Google Scholar 

  18. Breitbart W (1990) Cancer pain and suicide. In: Foley K, et al (eds) Advances in pain research and therapy, vol 16. Raven Press, New York, pp 399–412

    Google Scholar 

  19. Breitbart W, Holland JC (1993) Psychiatric aspects of symptom management in cancer patients. American Psychiatric Press, Washington, DC

    Google Scholar 

  20. Breitbart W, Mermelstein H (1992) Premoline: an alternative psychostimulant for the management of depressive disorders in cancer patients. Psychosomatics 33:352–356

    Google Scholar 

  21. Breitbart W, Platt M, Marotta R, et al (1991) Low-dose neuroleptic treatment for AIDS delirium (abstract). 144th Annual Meeting, American Psychiatric Association, 11–16 May 1991

  22. Breitbart W, Stiefel F, Pannulo S, Kornblith A (1993) Neuropsychiatric cancer patients with epidural spinal cord compression receiving high. dose corticosteroids: a prospective comparison study. Psycho-oncology 2:233–245

    Google Scholar 

  23. Brennan SC, Redd WH, Jacobsen PB, et al (1988) Anxiety and panic during magnetic resonance scans. Lancet II:512

    Google Scholar 

  24. Brown JH, Henteleff P, Barakat S, Rowe JR (1986) Is it normal for terminally ill patients to desire death? Am J Psychiatry 143:208–211

    Google Scholar 

  25. Bruera E, Chadwick S, Brennels C, et al (1987) Methylphenidate associated with narcotics for the treatment of cancer pain. Cancer Treat Rep 71:67–70

    Google Scholar 

  26. Bruera E, MacMillan K, Kuchn N, et al (1989) The cognitive effects of the administration of narcotics. Pain 39:13–16

    Google Scholar 

  27. Bruera E, MacMillan K, Pither J, MacDonald RN (1990) Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 5:341–344

    Google Scholar 

  28. Bruera E, Miller L, McCalion S (1990) Cognitive failure in patients with terminal cancer: a prospective longitudinal study. Psychosoc Aspects Cancer 9:308–310

    Google Scholar 

  29. Bukberg J, Penman D, Holland J (1984) Depression in hospitalized cancer patients. Psychosom Med 43:199–212

    Google Scholar 

  30. Cella DF, Jacobsen PB, Ovar EJ, et al (1987) A brief POMS measure of distress for cancer patients. J Chronic Dis 40:939–942

    Google Scholar 

  31. Chiarillo RJ, Cole JO (1987) The use of psychostimulants in general psychiatry. A reconsideration. Arch Gen Psychiatry 44:286–295

    Google Scholar 

  32. Chouinard G, Young SN, Annable L (1983) Antimanic effect of clonazepam. Biol Psychiatry 18:451–466

    Google Scholar 

  33. Ciraulo DA, Shader RI (1990) Fluoxetine drug-drug interactions. I. Antidepressants and antipsychotics. J Clin Psychopharmacol 10:48–50

    Google Scholar 

  34. Cooper GL (1988) The safety of fluoxetine — an update. Br J Psychiatry 153:77–86

    Google Scholar 

  35. Costa D, Mogos I, Toma T (1985) Efficacy and safety of mianserin in the treatment of depression of women with cancer. Acta Psychiatr Scand 72:85–92

    Google Scholar 

  36. DeAngelis LM, Delattre J, Posner JB (1989) Radiation-induced dementia in patients cured of brain metastases. Neurology 39:789–796

    Google Scholar 

  37. De Sousa E, Jepson A (1988) Midazolam in terminal care. Lancet I:67–68

    Google Scholar 

  38. Denicoff KD, Rubinow DR, Papa MZ, et al (1987) The neuropsychiatric effects of treatment with interleukin-w and lymphokine-activated killer cells. Ann Intern Med 107:293–300

    Google Scholar 

  39. Derogatis LR, Melisaratos N (1976) The brief symptom inventory (BSI): an introductory report. Psychol Med 7:1–15

    Google Scholar 

  40. Derogatis LR, Spencer PM (1984) Psychometric issues in the psychological assessment of the cancer patient. Cancer 53:2228–2232

    Google Scholar 

  41. Derogatis LR, Marrow GR, Fetting J, et al (1983) The prevalence of psychiatric disorders among cancer patients. JAMA 249:751–757

    Google Scholar 

  42. Doogan DP, Caillard V (1988) Sertraline: a new antidepressant. J Clin Psychiatry 49 [Suppl]:46–51

    Google Scholar 

  43. Dubovsky SL (1978) Averting suicide in terminally ill patients. Psychosomatics 19:133–115

    Google Scholar 

  44. Eller KC, Sision AC, Breitbart W, Passik S (1992) Morphine-induced acute confusional states: a retrospective analysis (abstract). Academy of Psychosomatic Medicine 39th Annual Meeting, San Diego, Calif, 1992

  45. Endicott J (1983) Measurement of depression patients with cancer. Cancer 53:2243–2248

    Google Scholar 

  46. Fainsinger R, Bruera E (1992) Treatment of delirium in a terminally ill patient. J Pain Symptom Manage 7:54–56

    Google Scholar 

  47. Fainsinger R, MacEachern T, Hanson J, et al (1991) Symptom control during the last week of life in a palliative care unit. J Palliat Care 7:5–11

    Google Scholar 

  48. Farberow NL, Schneidman ES, Leonard CV (1963) Suicide among general medical and surgical hospital patients with malignant neoplasms. (Medical Bulletin 9) US Veterans Administration, Washington, DC

    Google Scholar 

  49. Farberow NL, Ganzler S, Cuter F, Reynolds D (1971) An eight year survey of hospital suicides. Suicide Life Threat Behav 1:27–31

    Google Scholar 

  50. Fernandez F, Adams F, Holmes VF, et al (1987) Methylphenidate for depressive disorders in cancer patients. Psychosomatics 28:455–461

    Google Scholar 

  51. Fernandez F, Adams F, Levy J, et al (1988) Cognitive impairment due to AIDS related complex and its response to psychostimulants. Psychosomatics 29:38–46

    Google Scholar 

  52. Fernandez F, Levy JK, Mansell PWA (1989) Management of delirium in terminally ill AIDS patients. Int J Psychiatry Med 19:165–172

    Google Scholar 

  53. Fisch R (1985–1986) Methylphenidate for medical inpatients. Int J Psychiatry Med 15:75–79

    Google Scholar 

  54. Fleishman SB, Lesko LM (1989) Delirium and dementia. In: Holland J, Rowland J (eds) Handbook of psychooncology: psychological care of the patient with cancer. Oxford University Press, New York, p 165

    Google Scholar 

  55. Foley KM (1985) The treatment of cancer pain. N Engl J Med 313:84–95

    Google Scholar 

  56. Folstein MF, Folstein SE, McHugh PR (1975) Mini-mental state. J Psychiatr Res 12:189–198

    Google Scholar 

  57. Fox BH, Stanek EJ, Boyd SC, Flannery JT (1982) Suicide rates among cancer patients in Connecticut. J Chronic Dis 35:85–100

    Google Scholar 

  58. Glassman AH (1984) The newer antidepressant drugs and their cardiovascular effects. Psychopharmacol Bull 20:272–279

    Google Scholar 

  59. Goldeberg JR, Cullen LO (1985) Factors important to psychosocial adjustment to cancer: a review of the evidence. Soc Sci Med 20:803–807

    Google Scholar 

  60. Guze S, Robins E (1970) Suicide and primary affective disorders. Br J Psychiatry 117:437–438

    Google Scholar 

  61. Holland JC (1982) Psychological aspects of cancer. In: Holland JF, Frei E (eds) Cancer medicine, 2nd edn. Lea & Febiger, Philadelphia, pp 252–267

    Google Scholar 

  62. Holland JC (1989) Anxiety and cancer: the patient and family. J Clin Pscychiatry 50:20–25

    Google Scholar 

  63. Holland JC, Fassanellos, Ohnuma T (1974) Psychiatric symptoms associated with l-asparaginase administration. J Psychiatr Res 10:165

    Google Scholar 

  64. Holland JC, Hughes Korzun A, Tross S, et al (1986) Comparative psychological disturbance in pancreatic and gastric cancer. Am J Psychiatry 143:982–986

    Google Scholar 

  65. Holland JC, Rowland JH (eds) (1989) Handbook of psychooncology. Psychological care of the patient with cancer. Oxford University Press, New York

    Google Scholar 

  66. Holland JC, Morrow G, Schmale A, et al (1991) A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms. J Clin Oncol 9:1004–1011

    Google Scholar 

  67. Itil T, Fink M (1966) Anticholinergic drug-induced delirium: experimental modification, quantitative EEG and behavioral correlations. J Nerv Ment Dis 143:492–507

    Google Scholar 

  68. Jellema JC (1987) Hallucinations during sustained-release opioid and methadone administration. Lancet II:392

    Google Scholar 

  69. Katon W, Raskind M (1980) Treatment of depression in the medically ill elderly with methylphenidate. Am J Psychiatry 137:963–965

    Google Scholar 

  70. Kaufmann MW, Muarray GB, Cassem NH (1982) Use of psychostimulants in medically ill depressed patients. Psychosomatics 23:817–819

    Google Scholar 

  71. Kovacs M, Beck AT, Weissman A (1975) Hopelessness: an indication of suicidal risk. Suicide 5:98–103

    Google Scholar 

  72. Levine PM, Silberfarb PM, Lipowski ZJ (1978) Mental disorders in cancer patients: a study of 100 psychiatric referrals. Cancer 42:1385–1390

    Google Scholar 

  73. Liebowtiz MR (1985) Imipramine in the treatment of panic disorder and its complications. Psychiatry Clin North Am 8:37–47

    Google Scholar 

  74. Liepzig RM, Goodman H, Gray P, et al (1987) Reversible narcotic-associated mental status impairment in patients with metastatic cancer. Pharmacology 53:47–57

    Google Scholar 

  75. Lipowski ZJ (1987) Delirium (acute confusional states). JAMA 285:1789–1792

    Google Scholar 

  76. Lloyd AH (1977) Practical consideration in the use of maprotiline (ludiomil) in general practice. J Int Med Res 5:122–125

    Google Scholar 

  77. Louhivuori KA, Hakama J (1979) Risk of suicide among cancer patients. Am J Epidemiol 109:59–65

    Google Scholar 

  78. Massie MJ (1989) Anxiety, panic and phobias. In: Holland JC, Rowland J (eds) Handbook of psychooncology. Psychological care of the patient with cancer. Oxford University Press, New York, pp 300–309

    Google Scholar 

  79. Massie MJ, Holland JC (1984) Diagnosis and treatment of depression in the cancer patient. J Clin Psychiatry 42:25–28

    Google Scholar 

  80. Massie MJ, Holland JC (1987) The cancer patient with pain: psychiatric complications and their management. Med Clin North Am 71:243–258

    Google Scholar 

  81. Massie MJ, Holland JC (1990) Depression and the cancer patient. J Clin Psychiatry 51:12–17

    Google Scholar 

  82. Massie MJ, Holland JC, Glass E (1983) Delirium in terminally ill cancer patients. Am J Psychiatry 140:1048–1050

    Google Scholar 

  83. Massie MJ, Holland JC, Straker N (1989) Psychotherapeutic interventions. In: Holland JC, Rowland JH (eds) Handbook of psychooncology. Psychological care of the patient with cancer. Oxford University Press, New York, pp 455–469

    Google Scholar 

  84. Mermelstein HT, Lesko L (1992) Depression in patients with cancer. Psychooncology 1:199–215

    Google Scholar 

  85. Murphy GE (1977) Suicide and attempted suicide. Hosp Pract 12:78–81

    Google Scholar 

  86. Murray GB (1987) Confusion, delirium, and dementia. In: Hackett TP, Cassem NH (eds) Massachusetts General Hospital handbook of general hospital psychiatry, 2nd edn. PSG, Littleton, Mass, pp 84–115

    Google Scholar 

  87. Nehra A, et al (1990) Pemoline associated hepatic injury. Gastroenterology 99:1517–1519

    Google Scholar 

  88. Noyes R, Kathol RG, Debelins-Enemark P, et al (1990) Distress associated with cancer as measured by the Illness Distress Scale. Psychosomatics 31:321–330

    Google Scholar 

  89. Oliver DJ (1985) The use of methotrimeprazine in terminal care. Br J Clin Pract 39:339–340

    Google Scholar 

  90. Patchell RA, Posner JB (1989) Cancer and the nervous system. In: Holland JC, Rowland J (eds) Handbook of psychooncology. Psychological care of the cancer patient. Oxford University Press, New York, pp 327–341

    Google Scholar 

  91. Pearson HJ (1990) Interaction of fluoxetine with carbamazepine. J Clin Psychiatry 51:126

    Google Scholar 

  92. Peck AW, Stern WC, Watkinson C (1983) Incidence of seizures during treatment with tricyclic antidepressant drugs and buproprion. J Clin Psychiatry 44:197–201

    Google Scholar 

  93. Plumb MM, Holland JC (1977) Comparative studies of psychological functionin patients with advanced cancer. Psychosom Med 39:264–276

    Google Scholar 

  94. Popkin MK, Callies AL, Mackenzie TB (1985) The outcome of antidepressant use in the medically ill. Arch Gen Psychiatry 42:1160–1163

    Google Scholar 

  95. Portenoy RK (1987) Continuous intravenous infusion of opioid drugs. Med Clin North Am 71:233–241

    Google Scholar 

  96. Portenoy RK, Moulin DE, Rogers A, Inturrisi Ce, Foley KM (1986) Intravenous infusions of opioids in cancer pain: clinical review and guidelines for use. Cancer Treat Rep 70:575–581

    Google Scholar 

  97. Posner JB (1988) Nonmetastatic effects of cancer on the nervous system. In: Wyngaarden JB, Smith LH (eds) Cecil's textbook of medicine. Saunders, Philadelphia, pp 1104–1107

    Google Scholar 

  98. Preskorn SH, Jerkovich GS (1990) Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and role of therapeutic drug monitoring. J Clin Psychopharmacol 10:88–95

    Google Scholar 

  99. Purohit DR, Naylakha PL, Modi RS, et al (1978) The role of antidepressants in hospitalized cancer patients. J Assoc Physicians India 26:245–248

    Google Scholar 

  100. Rifkin A, Reardon G, Siris S, et al (1985) Trimipramine in physical illness with depression. J Clin Psychiatry 46:4–8

    Google Scholar 

  101. Robins E, Murphy G, Wilkinson RH Jr, Gassner S, Kayes J (1950) Some clinical considerations in the prevention of suicide based on 134 successuful suicides. Am J Public Health 49:888–889

    Google Scholar 

  102. Robinson D, Napoliello MJ, Schenk J (1988) The safety and usefulness of buspirone as an anxiolytic drug in elederly versus young patients. Clin Ther 10:740–746

    Google Scholar 

  103. Satel SL, Nelson CJ (1989) Stimulants in the treatment of depression: a critical overview. J Clin Psychiatry 50:241–249

    Google Scholar 

  104. Sher M, Krieger JN, Juergen S (1983) Trazodone and priapism. Am J Psychiatry 140:1362–1364

    Google Scholar 

  105. Shopsin B (1983) Buproprion: a new clinical profile in the psychobiology of depression. J Clin Psychiatry 44:140–142

    Google Scholar 

  106. Silberfarb PM, Maurer LH, Cronthamel CS (1980) Psychosocial aspects of breast cancer patients during different treatment regimens. Am J Psychiatry 137:450–455

    Google Scholar 

  107. Sindrup SH, Gram LF, Brosen K, et al (1990) The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain 42:135–144

    Google Scholar 

  108. Spiegel D, Bloom JR (1983) Group therapy and hypnosis reduce metastatic breast carcinoma pain. Psychosom Med 4:333–339

    Google Scholar 

  109. Spiegel D, Bloom JR, Yalom ID (1981) Group support for patients with metastatic cancer: a randomized prospective outcome study. Arch Gen Psychiatry 38:527–533

    Google Scholar 

  110. Stein RS, Flexner JH, Graber SE (1980) Lithium and granulocytopenia during induction therapy of acute myelogenous leukemia: update of an ongoing trial. Adv Exp Med Biol 127:187–198

    Google Scholar 

  111. Stiefel FC, Breitbart W, Holland JC (1989) Corticosteroids in cancer: Neuropsychiatric complications. Cancer Invest 7:479–491

    Google Scholar 

  112. Stoudemire A, Fogel BS (1987) Psychopharmacology in the medically ill. In: Stoudemire A, Fogel BS (eds) Principles of medical psychiatry. Grune & Stratton, Orlando, Fla, pp 79–112

    Google Scholar 

  113. Trzepacz PT, Baker RW, Green-house J (1988) A symptom rating scale for delirium. Psychiatry Res 23:89–97

    Google Scholar 

  114. Twycross RG, Lack SA (1983) Symptom control in far advanced cancer: pain relief. Pitman, London

    Google Scholar 

  115. Twycross RG, Lack SA (1984) Therapeutics in terminal disease. Pitman, London, pp 99–103

    Google Scholar 

  116. Ventafridda V, Ripamonti C, De-Conno F, et al (1990) Symptom prevalence and control during cancer patients' last days of life. J Palliat Care 6:7–11

    Google Scholar 

  117. Walsh TD (1990) Adjuvant analgesic therapy in cancer pain. In: Foley KM, Bonica JJ, Ventafridda V (eds) Advances in pain research and therapy, vol 16: Second International Congress on Cancer Pain. Raven Press, New York, pp 155–166

    Google Scholar 

  118. Weddington WW (1982) Delirium and depression associated with amphotericin B. Psychosomatics 23:1076–1078

    Google Scholar 

  119. Wellisch DK, Gritzer ER, Schain W, Wang H, Schain W, Wang HJ, Sian J (1991) Psychological functioning of daughters of breast cancer patients. Psychosomatics 32:324–336

    Google Scholar 

  120. Woods SW, Tesar GE, Murray GB, Cessem NH (1986) Psychostimulant treatment of depressive disorders secondary to medical illness. J Clin Psychiatry 47:12–15

    Google Scholar 

  121. Young DF (1982) Neurological complications of cancer chemotherapy. In: Silverstein A (ed) Neurological complications of therapy: selected topics. Futura, New York, pp 57–113

    Google Scholar 

  122. Zabora JR, Smith-Wilson R, Fetting JH, Enterline JP (1990) An efficient method for psychosocial screening of cancer patients. Psychosomatics 31:192–196

    Google Scholar 

  123. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Breitbart, W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer 3, 45–60 (1995). https://doi.org/10.1007/BF00343921

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00343921

Key words

Navigation