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].
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