Colon cancer patients with a serious psychiatric disorder present with a more advanced cancer stage and receive less adjuvant chemotherapy - A Nationwide Danish Cohort Study.

BACKGROUND: Psychiatric patients with colorectal cancer may have delayed diagnosis and be oncologically undertreated. METHODS: The Danish Colorectal Cancer Group database comprised 25,194 colorectal cancer patients (CRC), (colon cancer (CC, n = 16,641), rectal cancer (RC, n = 8553)), having an operation in 2007-2013, were alive at least 30 days after operation, of which 422 have had at least one hospital contact for a serious psychiatric disorder; ICD-10: DF20-29: primary psychotic disorders, or DF30-39: affective disorders (exposed) in a period of 3650-120 days before the operation date. Pearson chi-squared test for cancer stage was calculated. Odds Ratio (OR) with 95% confidence interval (CI) for having had a palliative vs an intended curative aim of the operative treatment for CRC patients (cohort 1), and for having an oncological treatment for each cancer site CC or RC (cohort 2 and 3) in patients with and without a psychiatric history was estimated. We adjusted the OR for: age, gender, comorbidity index, cancer stage, socio-economic position group, and educational level. RESULTS: A higher cancer stage at the time of operation in patients with psychiatric disorders compared with patients without such a history was seen and may possibly point towards a delay in the diagnosis or in the treatment of CC in patients with psychiatric disorders. They also had decreased adjusted OR for having an oncological treatment, OR 0.55, 95% CI (0.40-0.76)), which was not explained by cancer stage. For patients with RC no difference was seen. CONCLUSIONS: Attention for CC patients with pre-existing serious psychiatric disorders is recommended.

[Opioid detoxication under general anesthesia]. / Opioidafgiftning under generel anaestesi.

Antagonist-precipitated opioid detoxification under general anaesthesia has been used extensively since its introduction in 1988. The use of antagonists was believed to shorten the detoxification period. Administration to opioid dependents is followed by a violent activation of the adrenergic system, which results in the development of an acute withdrawal syndrome in the patient. This is usually treated with clonidine. To reduce the subjective discomfort, the procedure is conducted under anaesthesia. From the existing literature, one may conclude that despite more than ten years of development there is currently no sufficient evidence of the effectiveness of antagonist-precipitated opioid detoxification under general anaesthesia conducted under modern anaesthesiological management. Randomised, clinical trials are necessary to document the advantages of this detoxification method as compared to conventional treatment.