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Management of psychiatric disorders in patients with cancer

Peter P Roy-Byrne, MD
Section Editor
Jonathan M Silver, MD
Deputy Editor
David Solomon, MD


Patients with cancer have a high rate of psychiatric comorbidity; approximately one-half exhibit emotional difficulties. The psychological complications generally take the form of adjustment disorder, depressed mood, anxiety, impoverished life satisfaction, or loss of self-esteem. The 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.

In addition to these psychiatric conditions, non-specific distress and anxiety are very common in cancer patients, in addition to formal psychiatric diagnoses. 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.

Specific issues regarding the management of psychiatric illness in patients with cancer are reviewed here. The diagnosis of these disorders is discussed separately. (See "Diagnosis of psychiatric disorders in patients with cancer".)


The identification and diagnosis of adjustment disorder is not straightforward, but is important since many of these patients will benefit from counseling. Physicians attempting to identify individuals who could benefit from counseling should focus upon a lack of patient flexibility [1,2]. Those who develop adjustment disorder may be more rigid in their thinking and determined to address their cancer-related problems in the same manner as they have for prior stressors. If the old coping and problem-solving strategies fail, the person may begin to exhibit depressed mood and anxiety associated with adjustment disorder. In contrast, patients who successfully adapt typically have a flexible style [3].

People with adjustment disorder have positive outcomes when they are treated with brief psychotherapy [4]. Early treatment using counselors, nurses, and other staff is helpful before the problem expands to the point of requiring more intensive care.


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Literature review current through: Sep 2016. | This topic last updated: Sep 29, 2016.
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