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Psychiatric management of patients

with head and neck cancers

Dr. Arun Kumar PandeyMBBS, MD[Psychiatry]

DAFE,PGDGC.

MBA[Hospital Mgt.]

2.15 PM ---- 25/03/2012

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Cancer

Diseases in which abnormal cells divide without control and are able to

invade other tissues, spreads through the blood and lymph systems.

One of the most feared of diseases ; 100+ Cancer types ;

Understood as unpleasant and slow way to die

Distress in patients, family , caregivers, professionals

Psychological and Social problems more common

Pain Nausea Fatigue

Finances Employment HousingChildcare Family Spiritual doubts

Patient may develop psychiatric illness

Can be minimised by well-planned care.

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Hazard

Psychosocial FactorsAttitudesBehaviourQuality of Life

Illness (well-being)

Biopsychosocial model of Illness

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Challenges to cancer patients

Keep active

Keep independence

Accept cancer ; Seek / understanding medical info and support

Coping with Illness and treatment related issues.

Regulate emotions and Manage stress ; Maintain positive outlook

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Psychological Consequences

Elizabeth Kubler RossIn Late 60s gave 5 stages in coping with loss.

Shock & a period of denial ---- anger--- bargaining--- despair ---acceptance.

Distress Delay seeking help Fear

Increased somatic complaints

Pain Fatigue Breathlessness

Adjustment Disorder commonest ; Depressed / Anxious;

Neuropsychiatric complications / Increased risk of suicide in early (other)

stages / Reduced QoL

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Distress

An unpleasant emotional experience of a psychological, social, or spiritual

nature.

May interfere with a patient's ability to cope with cancer and its treatment.

May be related to

-Fear of cancer

-Fear of treatment and outcome-Fear of treatment disfigurement

-Practical problems/ Family/ Emotional / Spiritual

Vulnerable Sadness Fear Depression Anxiety Panic Isolation Crisis

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Risk Factors for Psychiatric Disorder

Patient sources

View about Illness

Coping style

Available & perceived support

History of psychiatric disorder

View about Treatment & medical care

Cancer sources

Limitation of activity

Disfigurement

Poor prognosis

Treatment sources

Isolation

Disfigurement

Side effects and cost

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Akechi T et al. Psychiatric disorders in Cancer Patients : Descriptive analysis of 1721 psychiatric referrals at twoJapanese cancer centre Hospitals. J JC O. 2001;31(5):188-194.

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Care for Cancer Patients

Issues :

1. Patients can be distressed due to non-cancer related issues.2. Psychological care overlooked by medical focus on treatment.

3. Psych. care can be delivered even in Primary Care; Staff need skills

Good case managers needed Active screening esp. for Depression and Anxiety

Improve survival (time)

Benefits QoL

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Psychological Care for Cancer Patients

PRIMARY CARE

Multidisciplinary skills

Individually agreed collaborative care

Regular liaison with units / agencies

Local training

SPECIALIST UNITS

Sensitisation Training in psychological aspects for the primary treating staff.

Regular review of treatment plans

Understand at risk stages

Specialist nurses, psychiatrists and psychologists

Self-help methods and specialist agencies

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Specialist Treatment

Problem solving discussions ; Joint / Group / Family Therapy.

Persistent / severe distress -- Refer to Psychiatry / Psychology Deptt.

Cognitive Behavioural Therapy (CBT) of psych. Complications / to cope with

Illness/ treatment related issue

Antidepressant Drugs & supportive treatment

Others

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Disorder Treatment Success Rate (%)

Mental Health

Panic 80

Bipolar 80

Major depression 65-80

Schizophrenia 60

OCD 60

Success Rates for the Treatment of Common

Medical Disorders

Cardiovascular

Arthrectomy 52

Angioplasty 41

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THANK YOU