Podcast Summary
Intersection of Psychiatry and Oncology: Psycho-oncology: Psycho-oncology is a specialized field that focuses on the emotional and psychological well-being of cancer patients and their families, emphasizing whole person care and the importance of addressing the emotional and psychological aspects of cancer care.
Psycho-oncology is a specialized field where psychiatry and oncology intersect, focusing on the emotional and psychological well-being of cancer patients and their families. Psycho-oncologists work in multidisciplinary teams and provide consultations in both inpatient and outpatient settings. They prioritize whole person care and consider the impact of cancer on the broader family unit. Mona Moch Tahedzadeh, a psycho-oncologist at City of Hope, shared her experience and the importance of this holistic approach in her work. By pursuing a career in psycho-oncology, Mona has found a way to make a significant impact on patients' lives beyond just treating their disease. The collaboration between oncology and psychiatry in this field highlights the importance of addressing the emotional and psychological aspects of cancer care.
Mental health support during cancer care: During cancer treatment, mental health teams collaborate to provide comprehensive care, considering various mental health conditions and approaches, including psychotherapy and medication, while offering empathy and understanding.
Effective mental health support is an essential component of cancer care. During and after stem cell transplants, specialized teams including psychiatrists, psychologists, social workers, and pain specialists collaborate to ensure patients receive comprehensive care. When diagnosing mental health conditions in cancer patients, it's crucial to consider various approaches and differentiate between depression, normal grief, hypoactive delirium, and cancer symptoms. Depression may present with symptoms like anorexia, insomnia, and fatigue, which could be due to medical conditions or psychological causes. Adjustment disorder, a common response to a cancer diagnosis, may be treated with psychotherapy as a first line, while medications may have limited evidence for use. Always consider potential drug interactions when prescribing antidepressants. Remember, it's normal for patients to struggle with the diagnosis and adjustment process, and providing empathy and understanding is an essential part of their care.
Identifying Depression in Cancer Patients: Distinguishing between depression, adjustment disorder, and normal grief in cancer patients requires careful consideration of symptoms and context. Misdiagnosis or underdiagnosis can occur, so seeking psychiatric consultation is important. Effective communication and collaboration between healthcare teams are crucial for optimal care.
Distinguishing between major depression, adjustment disorder, and normal grief in cancer patients can be challenging for healthcare professionals. The presence of anhedonia, hopelessness, and other symptoms common in depression can help identify potential cases. However, it's essential to consider the context and individual circumstances before making a diagnosis. Misdiagnosis or underdiagnosis can occur, and seeking psychiatric consultation is crucial for proper assessment and treatment. Additionally, the use of certain medications for cancer patients can interact with psychiatric medications, complicating the situation further. Therefore, effective communication and collaboration between healthcare teams are essential for providing optimal care to cancer patients dealing with emotional distress.
Recognizing Hypoactive Delirium in Older Patients: Healthcare professionals should be aware of hypoactive delirium in older patients, characterized by cognitive impairment, poor concentration, and sedation, which can be mistaken for depression. It's associated with higher mortality risk and doesn't respond to therapy or SSRIs. Quick tests and medication awareness can aid in accurate diagnoses and treatments.
Therapists and primary care physicians should be more aware of hypoactive delirium, a condition often seen in older patients in palliative care settings. This condition is characterized by cognitive impairment, poor concentration, and sedation, which can be confused with depression. Hypoactive delirium is associated with a higher risk of mortality and does not respond to therapy or SSRIs. Quick tests like asking the patient to draw a clock or count backwards can help differentiate hypoactive delirium from depression. Additionally, certain medications, like amitriptyline, which is commonly used for pain and is highly anticholinergic, can interact with 2D6 blockers and increase the risk of hypoactive delirium. It's essential for healthcare professionals to be knowledgeable about this condition to provide accurate diagnoses and effective treatments.
Medications and treatments linked to delirium in cancer patients: Some medications and treatments, like Paxil, Wellbutrin, steroids, Benadryl, and high-dose methotrexate, can increase cancer patients' risk of delirium. Hospitals and ICUs also contribute to this risk. As a psychiatrist, minimizing anticholinergics and avoiding Benzodiazepines can help reduce delirium risk.
Certain medications and medical treatments, such as Paxil, Wellbutrin, steroids, Benadryl, and high-dose methotrexate, can increase the risk of delirium in cancer patients. Delirium is a state of confusion and disorientation, and it can manifest as hypoactive (less reactive and lethargic) or hyperactive (agitated and hallucinating). Hospitals and ICUs also increase the risk of delirium due to the stressful environment and potential infections. As a psychiatrist, minimizing anticholinergic medications and avoiding Benzodiazepines can help reduce the risk of delirium in cancer patients. The use of these medications and treatments comes with a risk-benefit analysis, as they are often necessary for treating cancer but can have negative effects on cognitive function and sensorium.
Approaching Hypoxic Delirium and Suicidality in Cancer Patients: Approach each situation individually, minimize use of deliriogenic meds, distinguish between fleeting thoughts and chronic ideation, and consider unique circumstances for elderly patients expressing suicidality.
When dealing with patients suffering from hypoxic delirium or suicidality in the context of cancer, it's crucial to approach each situation individually and with sensitivity. Deliriogenic medications, such as Benzodiazepines and anticholinergics, can exacerbate delirium, making it essential to minimize their use and educate patients and healthcare providers about their potential side effects. Cancer patients have a two-fold increased risk of suicide, but not all suicidal thoughts should be treated equally. Direct questions to the patient and consideration of their circumstances can help distinguish between fleeting thoughts and chronic suicidal ideation. In the case of elderly patients expressing suicidality due to loss of independence, the situation requires careful consideration, as every case is unique. It's important to remember that each patient's circumstances, experiences, and wishes should be taken into account when making decisions regarding their care.
Addressing anxiety in cancer patients: Involving mental health professionals early on can significantly improve cancer patients' quality of life and overall survival by managing anxiety symptoms and addressing the root cause.
Addressing mental health, specifically anxiety, is crucial for cancer patients from the very beginning of their diagnosis and throughout their treatment process. Early involvement of mental health professionals, such as psychiatrists and palliative care, can significantly improve patient quality of life and overall survival. Anxiety is a common issue among cancer patients, with underlying anxiety often being exacerbated by the disease and its treatment. Breathing practices and medications can help manage anxiety symptoms, but addressing the root cause is essential. Benzodiazepines can be tricky to prescribe in this population due to their potential for dependency and side effects. By involving mental health professionals, patients receive the support they need to cope with the challenges of treatment and adjust to life after transplantation.
Effective short-term anxiety relief vs long-term management: SSRIs and SNRIs are recommended for long-term anxiety management in cancer patients. Psychotherapy and complementary approaches can also be beneficial. Anxiety is common in cancer patients and their families, and medications can worsen symptoms. Consider physical and psychological factors when treating anxiety.
While benzodiazepines can be effective for short-term anxiety relief, they are not ideal for long-term treatment. Instead, SSRIs (Selective Serotonin Reuptake Inhibitors) and SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors) are recommended for long-term anxiety management. However, psychotherapy, including supportive therapy, educational therapy, and complementary approaches like acupuncture, massage therapy, and creative art therapy, can also be highly beneficial. Anxiety is common in cancer patients, often peaking during diagnosis, treatment, and recurrence, as well as in anticipation of these events. Anxiety can also impact family members, increasing the likelihood of anxiety in the partner. Medications, such as steroids and dopamine blockers, can worsen anxiety, and it's essential to consider the timing of medication use in relation to anxiety symptoms. Pain and anxiety are interconnected, with anxiety amplifying pain and untreated anxiety worsening pain. It's crucial to consider both physical and psychological factors when treating anxiety in cancer patients.
Managing anxiety in cancer patients: Exercise can reduce cancer-related fatigue and improve overall well-being, while understanding medication history and considering all factors is crucial for effective treatment.
Effective management of anxiety in cancer patients requires a holistic approach. While addressing physical pain with opiates can help alleviate attachment pain and anxiety in the short term, long-term use can lead to decreased functionality and potential worsening of depression and anxiety. Substance withdrawals, especially from sedative medications, can also contribute to anxiety. Exercise, with a recommended 150 minutes of moderate intensity per week, has been found to have a moderate to large effect size on reducing cancer-related fatigue and improving overall well-being. Understanding the nuances of medication history and considering all potential contributing factors to anxiety is crucial for effective treatment.
Adapting to Challenges: Patients Find Creative Solutions: Patients can overcome physical and emotional challenges through creative solutions like indoor biking with virtual reality or reframing their perspective on their diagnosis. Exercise and psychotherapy are effective alternatives to medications for managing cancer-related fatigue.
Even in the face of significant challenges like obesity or cancer-related fatigue, patients can find creative solutions to improve their quality of life. The patient discussed in this conversation found a way to continue biking indoors with the help of virtual reality technology, while another patient discovered the importance of reframing their perspective on their cancer diagnosis. Research also suggests that exercise and psychotherapy are more effective than medications for managing cancer-related fatigue. It's inspiring to see how individuals can adapt and find new opportunities, despite the challenges they face. Additionally, it's important to consider the role of psychotherapy in supporting cancer patients, particularly for advanced cases, as it can have a significant impact on both physical and psychological issues.
Exploring the Impact of Therapies on Distress, Anxiety, Depression, and Quality of Life: ACT, Dignity conserving, Meaning centered, Life narrative, and Existential therapies can significantly improve distress, anxiety, depression, and overall quality of life for individuals. Effect sizes range from 0.89 to 1.69.
Therapy, particularly Acceptance and Commitment Therapy (ACT), can have significant positive effects on individuals dealing with distress, anxiety, depression, and overall quality of life. Effect sizes for ACT were impressive, with 0.89 for distress, 1.25 for anxiety, 1.69 for depression, and 1.35 for overall quality of life. Dignity conserving psychotherapy, meaning centered psychotherapy, life narrative psychotherapy, and existential therapy can also be beneficial, especially for advanced cancer patients dealing with demoralization and finding meaning and purpose in their lives. These therapies can help patients preserve their sense of worth and leave a meaningful legacy for their loved ones. However, it's important to note that effect sizes for pharmacotherapy will be smaller due to comparison against placebos, which have their own therapeutic effects.
Understanding the complexities of mental health treatments: Effects of mental health treatments may be smaller than expected due to comparison to placebo, but it's crucial to consider medication interactions, particularly those related to the cytochrome P450 system, to ensure effective treatment and avoid potential complications.
While the effect sizes of various treatments for mental health conditions, such as pharmacological interventions and psychosocial interventions, may be smaller than we might expect, it's important to remember that these effects are often compared to placebo. Placebos can have significant effects, making the comparison more nuanced than it may initially seem. For example, when considering medication options, it's crucial to be aware of how different medications interact with each other, particularly in relation to the cytochrome P450 system, which plays a role in how medications are metabolized. One specific example given was tamoxifen, an estrogen receptor blocker used in breast cancer treatment. The active form of tamoxifen, endoxifen, has a much higher affinity for the estrogen receptor than the parent compound. However, if a patient is taking a medication that blocks the metabolism of tamoxifen, such as fluoxetine or paroxetine, they may not be able to effectively metabolize tamoxifen and get the active form, potentially requiring a change in medication. Overall, it's important to be aware of these interactions and consider the long-term implications of different treatment choices.
Considering psychiatric comorbidities in cancer patients requires individualized treatment plans: When treating psychiatric conditions in cancer patients, consider their prior response to treatment, medical comorbidities, and drug interactions. Personalized plans that take into account individual patient needs are crucial.
When treating psychiatric comorbidities in cancer patients, it's crucial to consider the patients' prior response to treatment, medical comorbidities, and drug interactions. Certain medications, like SSRIs such as Paxil and Prozac, have strong 2D6 CYP inhibition and are often the first choice. Other medications, like Effexor and mirtazapine, have lower 2D6 CYP inhibition and can be used when other options are not viable. Hot flashes, a common side effect of tamoxifen, can indicate a better prognosis and can be managed with SNRIs like Effexor or its active form, desvenlafaxine. When oral or sublingual medications are not an option, IV medications and psychostimulants with rapid onset can be considered for increased energy and an active lifestyle. Overall, personalized treatment plans that take into account individual patient needs and circumstances are essential when dealing with this complex population.