Diagnosis of psychiatric disorders in patients with cancer
- Peter P Roy-Byrne, MD
Peter P Roy-Byrne, MD
- Editor-in-Chief — Psychiatry
- Section Editor — Depressive Disorders
- Professor of Psychiatry and Behavioral Sciences
- University of Washington School of Medicine
Patients with cancer have a high rate of psychiatric comorbidity; approximately one-half exhibit emotional difficulties [1,2]. The psychological complications generally take the form of adjustment disorder, depressed mood, anxiety, impoverished life satisfaction, or loss of self-esteem [3-5]. Patients most at risk for depression and other psychiatric illness have advanced disease, a prior psychiatric history, poorly controlled pain, and other life stressors or losses [6,7].
In addition to these psychiatric conditions, non-specific distress is very common in cancer patients, with a reported incidence varying from 15 to 42 percent . Distress is the summation of multiple psychological, social, and spiritual factors. If severe enough, distress can interfere with the patient's ability to deal effectively with the illness, its symptoms, and the complications of treatment. The National Comprehensive Cancer Network has recommended routine screening of all cancer patients for psychological distress and simple instruments are available to measure distress in cancer patients [9-11].
Making psychiatric diagnoses and rapidly identifying patients who need help are difficult for many reasons. One problem is that psychiatric symptomatology may be mimicked by treatment side effects or symptoms of the cancer. Time factors and patient reluctance to discuss psychosocial problems can also act as barriers to the recognition of psychosocial problems .
Specific issues regarding the diagnosis of psychiatric disorders in patients with cancer are reviewed here. The management of cancer patients with these problems is discussed separately. (See "Management of psychiatric disorders in patients with cancer".) Further information on specific psychiatric disorders is available in separate topic reviews.
Adjustment disorder is the most prevalent psychiatric problem associated with cancer. It is evident in 20 to 30 percent of all such patients [1,13,14].To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Derogatis LR, Morrow GR, Fetting J, et al. The prevalence of psychiatric disorders among cancer patients. JAMA 1983; 249:751.
- Burgess C, Cornelius V, Love S, et al. Depression and anxiety in women with early breast cancer: five year observational cohort study. BMJ 2005; 330:702.
- Sarafino, E. Health psychology: Biopsychosocial interactions, 2nd ed, John Wiley and Sons, New York 1994.
- Friedenbergs, I, Kaplan, E. Cancer. In: Medical aspects of disability: A handbook for the rehabilitation professional, Eisenberg, M, Glueckauf, R, Zaretsky, H (Eds), Springer Publishing Company, New York 1993. p.105.
- Molassiotis A, Boughton BJ, Burgoyne T, van den Akker OB. Comparison of the overall quality of life in 50 long-term survivors of autologous and allogeneic bone marrow transplantation. J Adv Nurs 1995; 22:509.
- Kathol RG, Mutgi A, Williams J, et al. Diagnosis of major depression in cancer patients according to four sets of criteria. Am J Psychiatry 1990; 147:1021.
- Chochinov HM. Depression in cancer patients. Lancet Oncol 2001; 2:499.
- Strong V, Waters R, Hibberd C, et al. Emotional distress in cancer patients: the Edinburgh Cancer Centre symptom study. Br J Cancer 2007; 96:868.
- National Comprehensive Cancer Network. Distress management. Clinical practice guidelines. J Natl Compr Canc Netw 2003; 1:344.
- Jacobsen PB, Donovan KA, Trask PC, et al. Screening for psychologic distress in ambulatory cancer patients. Cancer 2005; 103:1494.
- Loscalzo MJ, Clark KL. Problem-related distress in cancer patients drives requests for help: a prospective study. Oncology (Williston Park) 2007; 21:1133.
- Vachon ML. Psychosocial needs of patients and families. J Palliat Care 1998; 14:49.
- Dugan W, McDonald MV, Passik SD, et al. Use of the Zung Self-Rating Depression Scale in cancer patients: feasibility as a screening tool. Psychooncology 1998; 7:483.
- Akechi T, Okuyama T, Sugawara Y, et al. Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol 2004; 22:1957.
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington, VA 2013.
- Strain, J. Adjustment disorders. In: Psycho-oncology, Holland, J (Ed), Oxford University Press, New York 1998. p.509.
- Zilberg NJ, Weiss DS, Horowitz MJ. Impact of Event Scale: a cross-validation study and some empirical evidence supporting a conceptual model of stress response syndromes. J Consult Clin Psychol 1982; 50:407.
- Fabrega H Jr, Mezzich J. Adjustment disorder and psychiatric practice: cultural and historical aspects. Psychiatry 1987; 50:31.
- Walker J, Hansen CH, Martin P, et al. Prevalence, associations, and adequacy of treatment of major depression in patients with cancer: a cross-sectional analysis of routinely collected clinical data. Lancet Psychiatry 2014.
- Andersen BL, DeRubeis RJ, Berman BS, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American Society of Clinical Oncology guideline adaptation. J Clin Oncol 2014; 32:1605.
- Steel JL, Geller DA, Gamblin TC, et al. Depression, immunity, and survival in patients with hepatobiliary carcinoma. J Clin Oncol 2007; 25:2397.
- Penninx BW, Guralnik JM, Pahor M, et al. Chronically depressed mood and cancer risk in older persons. J Natl Cancer Inst 1998; 90:1888.
- Irwin MR. Depression and risk of cancer progression: an elusive link. J Clin Oncol 2007; 25:2343.
- Massie MJ. Prevalence of depression in patients with cancer. J Natl Cancer Inst Monogr 2004; :57.
- Ell K, Sanchez K, Vourlekis B, et al. Depression, correlates of depression, and receipt of depression care among low-income women with breast or gynecologic cancer. J Clin Oncol 2005; 23:3052.
- Ayuso-Mateos JL, Nuevo R, Verdes E, et al. From depressive symptoms to depressive disorders: the relevance of thresholds. Br J Psychiatry 2010; 196:365.
- Moffic HS, Paykel ES. Depression in medical in-patients. Br J Psychiatry 1975; 126:346.
- Katon W, Sullivan MD. Depression and chronic medical illness. J Clin Psychiatry 1990; 51 Suppl:3.
- McDonald MV, Passik SD, Dugan W, et al. Nurses' recognition of depression in their patients with cancer. Oncol Nurs Forum 1999; 26:593.
- Passik, SD, McDonald, MV, Dugan, W, et al. Depression in cancer patients: Recognition and treatment. Medscape 1997.
- Massie, M, Holland, J, Lesko, L. Management of common psychiatric syndromes in elderly patients with cancer. In: Cancer and aging: Progress in research and treatment, Zenser, T, Coe, R (Eds), Springer Publishing Company, New York 1998.
- Byock, L. Dying well: The prospect for growth at the end of life. Riverhead Books, New York 1997.
- Miccinesi G, Crocetti E, Benvenuti A, Paci E. Suicide mortality is decreasing among cancer patients in Central Italy. Eur J Cancer 2004; 40:1053.
- Tanaka H, Tsukuma H, Masaoka T, et al. Suicide risk among cancer patients: experience at one medical center in Japan, 1978-1994. Jpn J Cancer Res 1999; 90:812.
- Allebeck P, Bolund C, Ringbäck G. Increased suicide rate in cancer patients. A cohort study based on the Swedish Cancer-Environment Register. J Clin Epidemiol 1989; 42:611.
- Fox BH, Stanek EJ 3rd, Boyd SC, Flannery JT. Suicide rates among cancer patients in Connecticut. J Chronic Dis 1982; 35:89.
- Lu D, Fall K, Sparén P, et al. Suicide and suicide attempt after a cancer diagnosis among young individuals. Ann Oncol 2013; 24:3112.
- Fang F, Fall K, Mittleman MA, et al. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med 2012; 366:1310.
- Yousaf U, Christensen ML, Engholm G, Storm HH. Suicides among Danish cancer patients 1971-1999. Br J Cancer 2005; 92:995.
- Holland JC. Anxiety and cancer: the patient and the family. J Clin Psychiatry 1989; 50 Suppl:20.
- Massie, MJ. Anxiety, panic and phobias. In: Handbook of Psychooncology: Psychological care of the patient with cancer, Holland, JC, Rowland, J (Eds), New York, Oxford University Press 1989. p.300.
- Foley KM. The treatment of cancer pain. N Engl J Med 1985; 313:84.
- Whitcup SM, Miller F. Unrecognized drug dependence in psychiatrically hospitalized elderly patients. J Am Geriatr Soc 1987; 35:297.
- Bruera E, Bush SH, Willey J, et al. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer 2009; 115:2004.
- Fleishman, SB, Lesko, LM. Delirium and dementia. In: Handbook of Psychooncology: Psychological care of the patient with cancer. Holland, J, Rowland, J (Eds), Oxford University Press, New York.
- Levine PM, Silberfarb PM, Lipowski ZJ. Mental disorders in cancer patients: a study of 100 psychiatric referrals. Cancer 1978; 42:1385.
- Fann JR, Alfano CM, Burington BE, et al. Clinical presentation of delirium in patients undergoing hematopoietic stem cell transplantation. Cancer 2005; 103:810.
- Massie MJ, Holland J, Glass E. Delirium in terminally ill cancer patients. Am J Psychiatry 1983; 140:1048.
- Tuma R, DeAngelis LM. Altered mental status in patients with cancer. Arch Neurol 2000; 57:1727.
- Bruera E, Macmillan K, Pither J, MacDonald RN. Effects of morphine on the dyspnea of terminal cancer patients. J Pain Symptom Manage 1990; 5:341.
- Stiefel FC, Breitbart WS, Holland JC. Corticosteroids in cancer: neuropsychiatric complications. Cancer Invest 1989; 7:479.
- Gaudreau JD, Gagnon P, Harel F, et al. Psychoactive medications and risk of delirium in hospitalized cancer patients. J Clin Oncol 2005; 23:6712.
- Gaudreau JD, Gagnon P, Roy MA, et al. Opioid medications and longitudinal risk of delirium in hospitalized cancer patients. Cancer 2007; 109:2365.
- Young, DF. Neurological complications of cancer chemotherapy. In: Neurological Complications of Therapy: Selected topics, Silverstein, A (Ed), Futura Publishing, New York 1982. p.57.
- Holland J, Fasanello S, Onuma T. Psychiatric symptoms associated with L-asparaginase administration. J Psychiatr Res 1974; 10:105.
- Adams F, Quesada JR, Gutterman JU. Neuropsychiatric manifestations of human leukocyte interferon therapy in patients with cancer. JAMA 1984; 252:938.
- Denicoff KD, Rubinow DR, Papa MZ, et al. The neuropsychiatric effects of treatment with interleukin-2 and lymphokine-activated killer cells. Ann Intern Med 1987; 107:293.
- Weddington WW Jr. Delirium and depression associated with amphotericin B. Psychosomatics 1982; 23:1076.
- Lipowski ZJ. Delirium (acute confusional states). JAMA 1987; 258:1789.
- Gaudreau JD, Gagnon P, Harel F, et al. Fast, systematic, and continuous delirium assessment in hospitalized patients: the nursing delirium screening scale. J Pain Symptom Manage 2005; 29:368.
- Breitbart, W, Passik, SD. Psychiatric aspects of palliative care. In: Oxford Textbook of Palliative Care, Oxford Press 1990.