Medline ® Abstracts for References 1,2
of 'Diagnosis of psychiatric disorders in patients with cancer'
The prevalence of psychiatric disorders among cancer patients.
Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL Jr
Two hundred fifteen randomly accessed cancer patients who were new admissions to three collaborating cancer centers were examined for the presence of formal psychiatric disorder. Each patient was assessed in a common protocol via a psychiatric interview and standardized psychological tests. The American Psychiatric Association's DSM-III diagnostic system was used in making the diagnoses. Results indicated that 47% of the patients received a DSM-III diagnosis, with 44% being diagnosed as manifesting a clinical syndrome and 3% with personality disorders. Approximately 68% of the psychiatric diagnoses consisted of adjustment disorders, with 13% representing major affective disorders (depression). The remaining diagnoses were split among organic mental disorders (8%), personality disorders (7%), and anxiety disorders (4%). Approximately 85% of those patients with a positive psychiatric condition were experiencing a disorder with depression or anxiety as the central symptom. The large majority of conditions were judged to represent highly treatable disorders.
Depression and anxiety in women with early breast cancer: five year observational cohort study.
Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A
BMJ. 2005;330(7493):702. Epub 2005 Feb 4.
OBJECTIVE: To examine the prevalence of, and risk factors for, depression and anxiety in women with early breast cancer in the five years after diagnosis.
DESIGN: Observational cohort study.
SETTING: NHS breast clinic, London.
PARTICIPANTS: 222 women with early breast cancer: 170 (77%) provided complete interview data up to either five years after diagnosis or recurrence.
MAIN OUTCOME MEASURES: Prevalence of clinically important depression and anxiety (structured psychiatric interview with standardised diagnostic criteria) and clinical and patient risk factors, including stressful life experiences (Bedford College life events and difficulties schedule).
RESULTS: Nearly 50% of the women with early breast cancer had depression, anxiety, or both in the year after diagnosis, 25% in the second, third, and fourth years, and 15% in the fifth year. Point prevalence was 33% at diagnosis, falling to 15% after one year. 45% of those with recurrence experienced depression, anxiety, or both within three months of the diagnosis. Previous psychological treatment predicted depression, anxiety, or both in the period around diagnosis (one month before diagnosis to four months after diagnosis). Longer term depression and anxiety, were associated with previous psychological treatment, lack of an intimate confiding relationship, younger age, and severely stressful non-cancer life experiences. Clinical factors were not associated with depression and anxiety, at any time. Lack of intimate confiding support also predicted more protracted episodes of depression and anxiety.
CONCLUSION: Increased levels of depression, anxiety, or both in the first year after a diagnosis of early breast cancer highlight the need for dedicated service provision during this time. Psychological interventions for women with breast cancer who remain disease free should take account of the broader social context in which the cancer occurs, with a focus on improving social support.
Cancer Research UK London Psychosocial Group, Institute of Psychiatry, King's College London, St Thomas's Hospital, London SE1 7EH. email@example.com