ABSTRACT
Because only 2% of the 47% of cancer patients with psychiatric disorders receive psychiatric consultations, the authors investigated the impact of a psychiatric liaison program on improving consultation rates on a gynecologic oncology unit. Consultation rates for gynecologic cancer patients before and after introduction of the program were compared to rates from other cancer patients in the same hospital during the same 7-year period. Rates for the gynecologic patients were higher after the program (9%) than before (4%), as were rates for follow-up consultations, and the detection of minor DSM-III disorders improved. The authors conclude that liaison improves access to psychiatric treatments that often enhance the quality of life for seriously ill patients.
Subject(s)
Genital Neoplasms, Female/psychology , Mental Disorders/diagnosis , Patient Care Team , Psychiatry , Referral and Consultation , Female , Humans , Interprofessional Relations , Medical Oncology , Middle Aged , Neoplasms/psychologyABSTRACT
To determine the prevalence of major depression in cancer patients and assess the usefulness of the dexamethasone suppression test (DST) and the thyrotropin-releasing hormone (TRH) stimulation test for diagnosing major depression in these patients, the authors studied 83 women hospitalized for gynecological cancer. Nineteen (23%) had major depression according to DSM-III criteria. The sensitivity and specificity of the DST were 40% and 88%, respectively. No relationship between DST and TRH test results was found. These findings indicate a high prevalence of depression in cancer patients, but further research on these tests in cancer patients is needed; their routine use with cancer patients is premature at this time.
Subject(s)
Depressive Disorder/diagnosis , Genital Neoplasms, Female/complications , Adult , Aged , Depression/blood , Depression/diagnosis , Depression/epidemiology , Depressive Disorder/blood , Depressive Disorder/epidemiology , Dexamethasone , Female , Genital Neoplasms, Female/psychology , Hospitalization , Humans , Hydrocortisone/blood , Middle Aged , Psychiatric Status Rating Scales , Thyrotropin/blood , Thyrotropin-Releasing HormoneABSTRACT
Psychiatric oncology is a relatively new area, and few comprehensive reviews of related subject matter are available. Thus, the psychiatrists at North Carolina Memorial Hospital who provide liaison to oncology saw the need for a collection of pertinent psychiatric oncology materials that could be studied by faculty, residents, and staff. Such materials would be valuable for patient consultation, lecture preparation, and research background. Their bibliography and library system are discussed here, with a description of the methods of its compilation. The unique features are referenced materials are filed in a centrally available location (departmental library), so that readers have immediate access to them, and bibliographic entries are stored in a small computer in the library, and can be retrieved by topic, title, author. The file currently holds over 340 articles, and is continuously updated. It has been extensively utilized by professionals in this tertiary care teaching hospital as well as in programs across the state.
Subject(s)
Bibliographies as Topic , Neoplasms/psychology , Psychiatry , Referral and Consultation , Humans , United StatesABSTRACT
Benefits of cancer treatment must assess quality as well as quantity of survival. Recently, researchers have attempted to define and measure quality of life (QL). Reliable QL measures are useful for rating the QL costs of cancer itself, for rating existing cancer treatments and therapies under clinical investigation, and for evaluating the effectiveness of interventions to improve or prevent deterioration in QL status. Collaborative decision making by patients with their oncologists about anticipated therapy is enhanced by consideration of QL risks. Measures have broadened from assessing only performance status to include the domains of physical status (activity level, cognition, sexuality, fertility, and symptoms of pain, nausea, vomiting), psychological status (sense of well-being, depression, anxiety), social interaction (with sexual partner, family, friends, and co-workers), and economic status. Studies applying these concepts to patients who are survivors, in curative treatment, in palliative treatment, and terminally ill will be discussed.
Subject(s)
Genital Neoplasms, Female/psychology , Quality of Life , Female , Genital Neoplasms, Female/therapy , Hospices , Humans , Palliative Care , ResuscitationABSTRACT
The findings of a study of the frequency and type of psychotropic drugs that nonpsychiatric residents prescribed for nonpsychiatric patients in a teaching hospital in 1982 were compared with the findings of a similar study in the same hospital nine years earlier. The overall percentage of patients receiving psychotropic drugs remained almost the same, at less than 10 percent. However, in 1982 residents prescribed antidepressants almost four times as often as in 1973, and the use of antianxiety agents decreased. Deficiencies in chart documentation of psychotropic prescribing and the tendency to use conservative dosages remained unchanged from the earlier study.
Subject(s)
Drug Utilization , Internship and Residency , Mental Disorders/drug therapy , Psychotropic Drugs/therapeutic use , Anti-Anxiety Agents/therapeutic use , Antidepressive Agents/therapeutic use , Antipsychotic Agents/therapeutic use , Hospital Bed Capacity, 300 to 499 , Hospitals, General , Humans , North CarolinaABSTRACT
We examined the utility of patient self-report forms in identifying those gynecologic oncology patients who would be diagnosed by an experienced consultation-liaison psychiatrist as suffering from major depression. Sixty-five women with gynecologic tumors were evaluated by a consultation-liaison psychiatrist, using standardized (DSM-III) criteria. Each patient also completed a Carroll Rating Scale for Depression (CRS). The CRS demonstrated sensitivity and specificity of 87 percent and 58 percent, respectively. Used as a screening instrument to rule out depression, the CRS yielded a negative predictive value of 94 percent. We identified a priori forty items from the CRS which should not be influenced by the non-psychiatric biologic effects of gynecologic tumors, and compared the performance of this non-cancer related symptoms subscale (NCSG) to that of the CRS. The NCSG did not significantly outperform the CRS; its sensitivity and specificity were 87 percent and 62 percent, respectively. Because our study population was relatively homogeneous (i.e., non-ovarian gynecologic oncology patients without severe debilitation who were not receiving chemotherapy, radiation therapy, or other invasive procedures), the findings should not be generalized to other oncologic populations at this time. Our results suggest that patient self-report forms can be effective screening devices for identifying those non-ovarian, gynecologic oncology patients who should then be carefully evaluated for coexisting clinical depression.
Subject(s)
Depressive Disorder/diagnosis , Personality Inventory/statistics & numerical data , Sick Role , Uterine Cervical Neoplasms/psychology , Uterine Neoplasms/psychology , Vaginal Neoplasms/psychology , Adult , Depressive Disorder/psychology , Female , Humans , Psychometrics , Reproducibility of ResultsABSTRACT
Major depression occurs in a significant number of cancer patients, and there is evidence that cancer patients with depression do not receive adequate antidepressant treatment. In an uncontrolled pilot study, the authors assess the degree of depression and the quality of life after the initiation of antidepressant medication treatment in 12 depressed cancer patients who received adequate antidepressant drugs and in 10 depressed cancer patients who received inadequate antidepressant treatment. These preliminary findings suggest that cancer patients with major depression benefit from antidepressant medication treatment and may experience an improved psychosocial adjustment to cancer. Controlled clinical trials will be necessary to verify these preliminary findings.