Past History Of Psychiatric Disorder Research Articles

Psychiatric disorders in older adults with cancer referred to psycho-oncology service in a tertiary care cancer centre: a 7-year real world experience from India

BackgroundCancer affects mental health in older adults with cancer (OAC), affecting almost 50% of the patients. There are only a few studies on psychiatric disorders in OAC, especially in low resource settings. We report on our real-world experience of prevalence of and factors associated with psychiatric disorders in OAC referred to a psycho-oncology service in an Indian tertiary care cancer institute.MethodsWe retrospectively analysed medical and psycho-oncology records of patients aged 60 + on cancer-directed treatment or follow-up for < 2 years after treatment completion, referred to psycho-oncology services in a tertiary care cancer centre in Mumbai, India, from Jan 2011-Dec 2017. We recorded sociodemographic, clinical, and treatment-related variables, as well as past psychiatric disorders. The ICD-10 was used to record current psychiatric disorder type and presence. IBM SPSS version 24 (Armonk, NY, USA) was used for descriptive measures, tests of association, and logistic regression analysis. The study protocol was approved by Institutional Ethics Committee and registered with the Clinical Trials Registry-India (CTRI/2020/06/026095).ResultsOf 763 patients included in the study, 475 (62.3%) were males and 436 (57.1%) were inpatients, with a median age of 65 years. 93% of the patients had a solid tumour and 207 (27.1%) had a history of psychiatric disorder. A current psychiatric diagnosis was noted in 556 patients (72.9%) on initial presentation, of which adjustment disorders, delirium and depression and anxiety disorders were most frequently seen in 25.2%, 21% and 11.1%, respectively. On univariate analysis, a past history of psychiatric disorders (χ2 = 34.6, p < 0.001), lower performance status (χ2 = 9.9, p = 0.002) and haematolymphoid malignancy (χ2 = 4.08, p = 0.04) significantly increased the risk of current psychiatric diagnosis. Logistic regression confirmed these variables as significant.ConclusionOlder adults with cancer referred to psycho-oncology services have high rates of psychiatric disorders at their initial presentation, mainly adjustment disorders, delirium and depression and anxiety. A past history of psychiatric disorders, lower performance status and haematolymphoid cancers significantly increased the risk of psychiatric disorders. Multidisciplinary psycho-oncology teams including a psychiatrist should be integrated in comprehensive care of this group of patients. Further research outcomes and effect of psycho-oncological interventions is required in older adults with cancer in LMIC settings.

Neuroticism is associated with entorhinal cortex volume in cognitively unimpaired older adults

AbstractBackgroundNeuroticism, the tendency toward negative mood states, is associated with Alzheimer’s Disease (AD) and tau pathology within entorhinal cortex (EC) in mild cognitive impairment and healthy older adults. However, studies of the link between neuroticism and structural neurodegeneration of EC have been negative. This may result from failure to account for subsyndromal affective symptoms or previous psychiatric history, as neuroticism is closely related to mood conditions that in turn, affect similar brain regions vulnerable to AD. We examined the association between neuroticism and EC volume while accounting for cognition, affective symptoms, and other personality traits in cognitively unimpaired (CU) older adults without history of major psychiatric conditions.Method42 CU adults (age = 71.1 years, 27 females) with normal neuropsychological test performance and no known neurological conditions and current or past psychiatric disorders completed Geriatric Depression Scale, State‐Trait Anxiety Inventory, NEO Five‐Factor Inventory‐3 which assesses neuroticism, openness, conscientiousness, extraversion, and agreeableness, Montreal Cognitive Assessment (MoCA), and structural magnetic resonance imaging of whole brain at 3T. Regression analyses examined the unconditional ability of neuroticism to predict bilateral EC volume, and while considering the potential contribution of cognition (MoCA, California Verbal Learning Test Delayed Recall), affective state, other personality traits, and age, gender, and education. P&lt;.10 was set as the significance threshold for β estimates.ResultIn univariable modelling, neuroticism was predictive of left EC volume (β = ‐17.4, p = .025), explaining 9.8% of its variability [F(1, 40) = 5.45, p = .025]. Neuroticism remained a significant predictor of left EC volume (β = ‐1.9, p = .045) after factoring in demographic, cognitive and affective/personality variables. Additional left EC predictors were extraversion and state anxiety (β = ‐2.61, p = .01; β = 1.71, p = .045 respectively). Neuroticism was not predictive of right EC in univariable or multivariable modelling, but agreeableness emerged as a significant predictor (β = ‐1.68, p = .091).ConclusionNeuroticism was predictive of left EC volume in CU adults without current or past history of psychiatric disorders, independent of cognition, affect, and other personality traits. These findings, which have not been previously reported, extend previous epidemiological evidence of increased AD risk due to neuroticism and suggest the importance of considering the impact of mood symptoms and psychiatric history in this context.

Risk of suicide during pregnacy and postpartum period

IntroductionPregnancy and the postpartum are generally characterized by positive feelings and expectations but they may also disguise maternal stress and difficulties. These are typical periods for the onset or relapse of psychiatric symptoms and disorders. Even though suicide during pregnancy and postpartum is rare, it is among the leading causes of maternal perinatal mortality.ObjectivesTo provide an overview on the risk of suicide during pregnancy and postpartum.MethodsPubMed database was searched using combinations of the terms “suicide”, combined with “pregnancy” and “depression”.ResultsThe major risk factors for suicidal ideation are previous suicide attempts, self-harm, current or past history of psychiatric disorder, young maternal age, being unmarried, an unplanned pregnancy, substance use disorders, lack effective psychosocial support and discontinuation of psychotropic drugs. Pregnant women with suicidality behavior have also an increased risk for various adverse obstetric outcomes, including miscarriage, preterm delivery, maternal hemorrhage, and stillbirth. Furthermore, the postpartum period is often associated with the onset of mood and psychotic disorders with an increased risk of both suicide and infanticide. Women who have suffered from serious psychiatric conditions either after childbirth or in other phases of life should be informed about the possibility of relapse after subsequent pregnancies, thus presenting a higher risk of suicide.ConclusionsDuring pregnancy and postpartum, it is fundamental to investigate suicide risk, including suicidal ideation, thoughts, and intent, especially (but not only) in women affected by mental pathology. Moreover, maternal suicide behaviour affects the child’s neuropsychological development and can also increase the infant´s suicide risk.DisclosureNo significant relationships.

Efavirenz Is Not Associated with an Increased Risk of Depressive Disorders in Patients Living with HIV: An 11-Year Population-Based Study in Taiwan.

(1) Background: This study aimed to determine the association between the use of efavirenz and depressive disorders among human immunodeficiency virus (HIV)-infected patients. (2) Methods: A retrospective cohort study was conducted using Taiwan’s National Health Insurance Database. We identified patients receiving anti-retroviral therapy (ART) between 2000 and 2009; these patients were followed until 2010 for diagnoses of depressive disorders using the Cox proportional hazard model to estimate hazard ratios. (3) Results: After up to 11 years of follow-up, the incidence of depressive disorders for the efavirenz-treated group was estimated at 12.2/1000 person-years (PYs), and the control group was at 12.5/1000 PY (p = 0.822). The independent risk factors for depressive disorders included an insurance premium of less than NTD 17,820 (New Taiwan Dollars—NTD) (adjusted hazard ratio (aHR) 2.59, 95% confidence interval (CI), 1.79–3.76, p < 0.001), and between NTD 17,821 and NTD 26,400 (aHR 1.55, 95% CI, 1.04–2.31, p = 0.030), living in Southern Taiwan (aHR 1.49, 95% CI, 1.21–1.84, p = 0.002), and with a psychiatric history (excluding depressive disorders) (aHR 4.59, 95% CI, 3.51–6.01, p = 0.030). (4) Conclusions: This study concluded that ART-treated patients with a past history of psychiatric disorders, lower insurance premium, and living in Southern Taiwan have an increased risk of depressive disorders, which are not associated with the use of efavirenz.

Psychological impact and coping strategies of medical students during university closure due to COVID-19 in a state university in Sri Lanka – an online survey

IntroductionLoss of routine, disengagement from peers and adapting to distant learning during the pandemic may lead to psychological distress in medical students. Psychological impact of the pandemic on medical students has not been assessed in Sri LankaObjectivesTo identify the psychological impact and coping strategies of medical students during the pandemic.MethodsAn online survey was done among 527 medical students in a state Medical Faculty in Sri Lanka. Depression Anxiety Stress Scale (DASS-21) was used to measure psychological impact.ResultsThe main worries among the students was upcoming exams (74.4%, n=389) and taking a longer time than expected to complete their undergraduate medical education (68.1%, n=356). 68.7% (n=362) of the respondents experienced difficulty in working up the initiative to do things and 62.6% (n=330) had tendency to overreact to situations. Depressive symptoms were present in 40.8%, anxiety in 34% and high levels of stress were seen in 24.7%. In 10.8% depression was severe and anxiety was severe in 10.3%. Depression (p&lt;0.01), anxiety (p&lt;0.05) and stress (p&lt;0.01) were significantly higher in students with a past history of psychiatric disorders. Depression, anxiety or stress was not associated with the gender, ethnicity, family income or living circumstances. The main coping strategy of the participants was engaging more with family (73.4%).ConclusionsGiven the high levels of psychological distress, supportive strategies should be designed to minimize the psychological impact in this vulnerable group.DisclosureNo significant relationships.

Depression among diabetic patients: a cross sectional study

Anxiety disorder is the most prevalent mental disorder in Bangladesh according to the estimation of The risk of depression is doubled by diabetes which is often overlooked. The aim of the cross[1]sectional study was to find out the proportion of depression and its connection with socio[1]demographic differences among diabetic patients attending in the outpatient and inpatient departments of Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) hospital and the endocrine outpatient department as well as medicine inpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU) from November 2006 to September 2007. Through consecutive sampling, 390 patients suffering from diabetes for at least one year, above 18 years of age, were included in the study. A semi[1]structured questionnaire to collect socio-demographic and other relevant information, the Global Health Questionnaire 12 items (GHQ 12) for screening of psychiatric manifestation, and diagnostic and statistical manual for mental disorder (DSM) IV TR diagnostic criteria to diagnose psychiatric disorders were used. The results showed that, out of 390 respondents, 106 patients (27.2%) had depression. An association with co-occurring depression was observed in female, low level of education, low socioeconomic condition, farmers, students, housewives, unmarried, divorced and patients having family or past history of psychiatric disorders. The findings of this study will help to draw adequate attention from physicians in this issue while treating diabetic patients. Bang J Psychiatry 2020; 34(1):9-13

Psychiatric Morbidity, Cultural Factors, and Health-Seeking Behaviour in Perinatal Women: A Cross-Sectional Study from a Tertiary Care Centre of North India.

Background:Poor mental health of the mother affects her physical health and the neonate's health and development. Studies from Southern India place different estimates of perinatal mental ill-health. Cultural variables affect health-seeking behaviour and are thus important to study in perinatal women with psychiatric morbidity.Methods:A total of 281 perinatal women were screened on Edinburgh Postnatal Depression Scale (EPDS), Perinatal Anxiety Screening Scale (PASS) and Mini International Neuropsychiatric Interview version 6.0 (MINI), assisted with a clinical interview to identify psychiatric illnesses. The cultural formulation interview (CFI) of DSM-5 was applied on perinatal women having psychiatric illnesses and their caregivers.Results:A psychiatric diagnosis was present in 10.3% of perinatal women. Depression and anxiety disorders were seen in 7.12% and 1.41%, respectively. Marital discord (P < 0.0001), psychosocial stressors (P < 0.0001), and past history of psychiatric disorder (P < 0.001) were significantly higher in perinatal women with a current psychiatric diagnosis. On CFI work-related stress, the gender of the infant, low education and conflict across generations were identified as the negative aspects of the culture associated with psychiatric illness during and after pregnancy. Religion and social support were the major coping strategies, while stigma and financial problems were the major barriers to help-seeking.Conclusion:The high prevalence of psychiatric disorders and the strikingly low help-seeking are noteworthy. These findings can help in planning treatment and prevention programs for timely detection and intervention for perinatal psychiatric disorders.

Importance of a psychological autopsy to identify the manner of death; a case of fall from height

It may not be possible to determine the manner of death, in circumstances such as death following fall from height. When a dead body is found in front of a tall building, the ascertainment of the manner of death is difficult and in this case, the importance of a psychological autopsy in such circumstance is discussed. Middle-aged female with bronchial asthma, arterial hypertension, chronic venous insufficiency, Forestier disease, hyperlordosis of lumbar spine and vitamin D deficiency developed bilateral leg swelling and rash following 14 hours of air travel. Duplex scan excluded lower limb venous thrombosis. She did not have past history of psychiatric disorder but suddenly developed aggressive abnormal behaviour, confusion and bizarre activities. She removed her clothes and finally jumped off from 6th floor of her residency. She was succumbed to death due to multiple injuries following fall from height. No suicidal letter was recovered from the scene. The manner of death was ascertained as suicide based on eyewitness evidence. Her sudden onset of abnormal and violent behaviour may be an act of automatism without volitional control due to undiagnosed inorganic or organic disease of the brain. The witnessed suicidal behaviour was reverted to accident as a manner of death. The importance of psychological autopsy and teamwork between Forensic Pathologist and Forensic Psychiatrist in suspicious circumstances to ascertain the manner of death is highlighted. Labelling as suicide will end up in negative social stigma and loss of insurance claims.

Psychiatric Comorbidity, Sexual Dysfunction, and Quality of Life in Patients Undergoing Hemodialysis: A Case-Control Study.

Due to disabilities caused by the disease and the requirement of dialysis, end-stage renal disease (ESRD) is frequently comorbid with psychiatric disorders, adversely affects quality of life, and causes significant sexual dysfunction (SD). We aimed to investigate the psychiatric comorbidity, quality of life, depression and anxiety levels, and SD in ESRD patients undergoing hemodialysis. Forty-nine patients undergoing hemodialysis treatment in a dialysis center and 44 non-ESRD control subjects selected with snowball sampling were enrolled in the study. All subjects were assessed using Structured Clinical Interview for Axis-I Disorders (SCID-I). Sociodemographic data form, Hospital Anxiety and Depression Scale (HADS), Arizona Sexual Experience Scale (ASEX), and World Health Organization Quality of Life Short Form Turkish Version Scale (WHOQOL-BREF-TR) were applied to both groups. There was no difference between the groups in terms of sex, age, education period, marital status, presence of additional physical illness, and past history of psychiatric disorders. Compared with the control group, HADS depression subscale and ASEX scores were significantly high (p<0.01) in the patient group, and WHOQOL-BREF-TR psychological and physical domain scores were low (p<0.05 and p<0.01, respectively). There was a significant negative relationship between HADS scores and WHOQOL-BREF-TR psychological, environmental, and national environmental scores in the patient group (p<0.05). When the differences between the groups were re-analyzed after controlling HADS depression scores with covariance analysis, the significant difference in ASEX and WHOQOL-BREF-TR physical domain scores between the groups remained, but the significant difference in WHOQOL-BREF-TR psychological domain scores disappeared. The quality of life of ESRD patients was lower, especially in the psychological and physical domains, and psychiatric comorbidities and SD rates were higher than in non-ESRD control subjects. Quality of life is affected by SD. Recognizing and treating depressive symptoms will help improve the quality of life, especially in the psychological domain.

Deliberate Self harm in Alcohol Dependent Outpatients in Tertiary Care Centre

Deliberate self harm (DSH) is a behavioral problem with significant clinical and public health importance. It is reported across several psychiatric illnesses like personality disorders, alcohol dependence syndrome (ADS) and affective disorders. A hospital based cross-sectional study was carried out to find the incidence of DSH in outpatients with alcohol dependence syndrome, to learn about the methods used for DSH and to describe the association of DSH with psychiatric co-morbidity in the study population. Data was collected from 100 consecutive outpatients with ADS using structured socio-demographic Performa and semistructured pre-validated DSH questionnaire. ADS and psychiatric co-morbidities were diagnosed by International Classification of Diseases Diagnostic criteria for research- Tenth Revision. (ICD-10 DCR) Incidence of DSH in them in 1 year was 25%. The commonest method of deliberate self-harm was consuming poison (76%). 84% had done DSH under intoxication.92% of them had stressful situation immediately before DSH. 48% had attempted DSH impulsively. 40% had past history of psychiatric disorder. 56% had past history of DSH. 56% had psychiatric co morbidities, of which Depressive disorders (39%) were the most common. 39% of patients with psychiatric co morbidity had past history of DSH. 16% with co morbid depressive disorder had attempted DSH in past 1 year. All patients presenting after deliberate self-harm need to be carefully screened for alcohol disorders and for co morbid psychiatric diagnoses. Abstaining from alcohol may be considered as a key to the resolution of deliberate self harm.

Suicidal ideation in patients undergoing brain tumor surgery: prevalence and risk factors.

Suicidal ideation (SI) is an important complication in cancer patients that should be promptly recognized and adequately managed. We investigated the prevalence rate and correlates of pre-operative SI in brain tumor (BT) patients admitted for elective BT surgery. Two hundred and eleven consecutive patients (70% women; mean age 55.9±15.4years) scheduled for BT surgery were evaluated for SI ("suicidal thought" item from the Beck Depression Inventory-II), depressive/anxiety symptom severity (Hospital Anxiety and Depression scale (HADS)), health-related quality of life (SF-36 scale), functional status (Barthel Index), and psychiatric histories and treatments. The majority of patients were diagnosed with meningioma (39%) and high-grade glioma (17%). SI was self-reported by 12 (6%) patients. Patients expressing SI were most commonly diagnosed with meningioma (50%). Patients with SI were more likely to have a past history of psychiatric disorders, scored higher on the HADS anxiety subscale, and reported worse health-related quality of life across physical and mental health domains. In multivariate regression analyses, worse perceived mental health was associated with increased risk for SI independently from clinical, sociodemographic, and other patient-oriented variables considered in the study. SI was self-reported by 6% of BT patients before surgical intervention and was associated with a past history of psychiatric disorders and worse perceived health status. Poor mental health was an independent correlate of SI. The perception of health status by a patient should be considered as an important determinant of poor mental health in BT patients.

Norepinephrine-enhancing antidepressant exposure associated with reduced antiviral effect of interferon alpha on hepatitis C.

Major depressive disorder is a common consequence of exposure to the pro-inflammatory cytokine interferon alpha, which is treated effectively with antidepressant medication. Antidepressant mode of action may conflict with interferon alpha's mechanism in treating hepatitis C however. The purpose of this study is to prospectively explore, in a large naturalistic cohort, whether antidepressant exposure influenced end of treatment response of hepatitis C to interferon alpha. Two hundred thirty-nine patients infected with chronic hepatitis C and due to receive treatment were recruited. All participants initiated peg-interferon-2-alpha 180μg weekly sub-cutaneously plus oral ribavirin 800-1200mg daily. Participants were assessed for DSM-IV major depression at baseline and four weekly during treatment. 32.6% of the cohort was exposed to an antidepressant (serotonin-reuptake inhibitor: other categorised antidepressants 49:29). At baseline, 3.8% had major depression and 55.2% developed major depression during interferon alpha treatment. Exposure to an antidepressant not classified as a serotonin-reuptake inhibitor, of which all were norepinephrine-enhancing (OR 0.15, 95% CI 0.04-0.60) and having a past history of psychiatric disorder (OR 4.41, 95% CI 1.39-13.96) independently reduced the likelihood of end of treatment response. Serotonin-reuptake inhibitor exposure did not influence end of treatment response (OR 1.21, 95% CI 0.35-4.19), neither did major depression at baseline (OR 2.31, 95% CI 0.55-9.60) or during treatment (OR 0.69, 95% CI 0.36-1.33). Our findings support a lack of conflict of therapeutic mechanism of serotonin-reuptake inhibitor antidepressants with interferon alpha in treating hepatitis C, which may include inflammatory influence. This appears not to be true for norepinephrine-enhancing antidepressant types and warrants investigation using more direct methods.

AB0390 Suicidal ideation in patients with systemic lupus erythematosus: prevalence and risk factors

ObjectivesTo study the prevalence of suicidal ideation in patients with SLE and its associated risk factorsMethodsConsecutive patients who fulfilled 34 ACR criteria for SLE were recruited for a questionnaire study...

2216 – Depression in chronic hepatitis- c egyptian patients: rate and correlates

Egypt has the highest prevalence of hepatitis C in the world (10–13%) yet understudied in terms of mental health services. To shed light on depression among chronic hepatitis C patients in Egypt. To assess the prevalence of depression and it's correlates in a group of Egyptian patients with chronic hepatitis C infection. 150 chronic HCV infection non cirrhotic Egyptian patients enrolled in the study. Patients are without past history of psychiatric disorder, having neither alcohol nor substance dependence disorders, did not receive interferon therapy. Psychiatric caseness, and depressive symptoms were assessed using General health questionnaire, and BDI-II questionnaire respectively. The study included 82 Males patients (54.67%) and 68 female patients (45.33%). Seventy three Patients (48.67%) were found to have current psychiatric morbidity with higher affection rates in younger (p < 0.001) and educated (p = 0.019) patients. Among those, 64 patients (42.67%) suffered from symptoms of depression (55 patients (36.67%) of them had mild depression, 6 patients (4%) had moderate depression and 3 patients (2%) had severe depression) with higher affection rates in younger (p < 0.001) and educated (p = 0.019) patients. Gender showed statistically non-significant difference. There is strong evidence of an association between chronic hepatitis C and psychiatric morbidity in the form of depression in relation rates recorded in general population. Depression is strongly positively correlated with age and level of education. It warrants the attention for providing specialized mental health services in such neglected population.

Suicidal mothers

:Background:Epidemiological research has demonstrated that suicidal ideation is a relatively frequent complication of pregnancy in both developed and developing countries. Hence, the aims of this study are: to assess whether or not pregnancy may be considered a period highly susceptible to suicidal acts; to recognize potential contributing factors to suicidal behaviors; to describe the repercussions of suicide attempts on maternal, fetal, and neonatal outcome; to identify a typical profile of women at high risk of suicide during pregnancy.Methods:Medical literature information published in any language since 1950 was identified using MEDLINE/PubMed, Scopus, and Google Scholar databases. Search terms were: "pregnancy", (antenatal) "depression", "suicide". Searches were last updated on 28 September 2010. Forty-six articles assessing the suicidal risk during pregnancy and obstetrical outcome of pregnancies complicated by suicide attempts were analyzed, without methodological limitations.Results:Worldwide, frequency of suicidal attempts and the rate of death by suicidal acts are low. Although this clinical event is rare, the consequences of a suicidal attempt are medically and psychologically devastating for the mother-infant pair. We also found that common behaviors exist in women at high risk for suicide during pregnancy. Review data indeed suggest that a characteristic profile can prenatally identify those at highest risk for gestational suicide attempts.Conclusions:Social and health organizations should make all possible efforts to identify women at high suicidal risk, in order to establish specific programs to prevent this tragic event. The available data informs health policy makers with a typical profile to screen women at high risk of suicide during pregnancy. Those women who have a current or past history of psychiatric disorders, are young, unmarried, unemployed, have incurred an unplanned pregnancy (eventually terminated with an induced abortion), are addicted to illicit drugs and/or alcohol, lack effective psychosocial support, have suffered from episodes of sexual or physical violence are particularly vulnerable.

P02-211 - THE -1021C/T polymorphism of the dopamine-B-hydroxylase (DBH) gene promoter affects personality traits in healthy subjects

IntroductionDopamine and norepinephrine are implicated in the characterization of personality traits. Dopamine-β-hydroxylase (DBH) is the enzyme responsible for conversion of dopamine to norepinephrine. Previous studies have shown that the -1021C/T polymorphism of the DBH gene promoter influences plasma DBH activity. Few studies investigated the association between this polymorphism and personality traits.AimTo examine the association between the -1021C/T DBH polymorphism and personality traits in healthy volunteers.MethodsThe participants were 627 Japanese unrelated volunteers. The subjects with present psychiatric disorders or past history of psychiatric disorders according to the DSM-IV were excluded. The DBH genotypes were identified by a PCR-RFLP method, and personality traits were assessed by the Temperament and Character Inventory (TCI). The study protocol was approved by the Ethics Committee of Yamagata University School of Medicine, and all subjects provided written informed consent to participate.ResultsIn the two-factor analysis of covariance with the DBH genotype and sex as factors and with age as a covariate, there was no main effect of the DBH genotype on any TCI score, while the interaction between the factors was significant in harm avoidance. In the post-hoc analysis, the group with the T allele predictive of lower DBH activity had higher scores of harm avoidance than that without the T allele in females (p=0.006), but not in males.ConclusionThe present study suggests that the -1021C/T DBH polymorphism affects the personality trait of harm avoidance in healthy females.

Akathisia Causing Secondary Severe Depression in a Cancer Patient

To the Editor: Akathisia is a common side effect of neuroleptics or dopamine D2 receptor antagonists in the treatment of schizophrenia. Dopamine D2 receptor antagonists are also used as antiemetic agents in cancer patients and can induce akathisia. However, akathisia in palliative care is often unrecognized by general physicians or oncologists.1,2 Akathisia may cause patients severe distress, but a major depressive–like episode secondarily induced by antiemetics in a cancer patient has not been reported. We report a case of a breast cancer patient who suffered from a severe major depressive–like episode induced by akathisia. Case report. In September 2009, Ms A, a 37-year-old woman, was referred to us by a surgeon for investigation of anxiety. She had undergone surgery for left breast cancer at 32 years of age. Since 2007, she has received radiation and chemotherapy for the treatment of metastases to the lungs and parasternal lymph nodes. To relieve pain, oxycodone tablets (5 mg/d) had been prescribed with prochlorperazine (5 mg/d) as an antiemetic agent for 6 months, and 5 weeks previously the dose of oxycodone had been increased to 10 mg/d due to increased breast pain in conjunction with the increased dose of prochlorperazine (10 mg/d). Despite her pain, her activities of daily living were maintained well and she was able to enjoy her life, in activities such as travel with her family. Two weeks before her presentation, she suddenly experienced restlessness of her limbs and anxiety, and she began to walk all day long. Insomnia and loss of appetite appeared. Her restlessness was quite burdensome, and she became severely depressed with suicidal ideation. She was unable to do anything other than walking and moving her limbs. She had no past history of psychiatric disorders, including depression and mania. On our psychiatric examination, all 9 symptoms listed as diagnostic criteria for a major depressive episode in DSM-IV-TR3 were present. Her score on the 17-item Hamilton Depression Rating Scale (HDRS)4 was 36. However, typical symptoms of akathisia such as restlessness, fidgety movement of the legs, and inability to sit or stand still were also observed. Neurologic examination revealed slight Parkinson's syndrome, with disturbance of the gait including lack of arm swing and brachybasia, but without tremor or muscle rigidity. On the basis of the symptoms and their time course, we strongly suspected prochlorperazine-induced akathisia and substance-induced mood disorder (severe depression). We recommended that she discontinue prochlorperazine and gave her supportive psychotherapy without prescribing antidepressants since her severe depression was strongly suspected to have been triggered by neuroleptic-induced akathisia. Following discontinuation of prochlorperazine, her akathisia improved dramatically. One week later, her akathisia was only episodic and of short duration, rather than continuous. Her depression disappeared with recovery from akathisia (HDRS score = 5). Akathisia usually develops as an acute extrapyramidal sign within a few weeks of starting or raising the dose of a neuroleptic medication (DSM-IV-TR).3 Although she had taken prochlorperazine for 6 months, an increase in the dose of prochlorperazine triggered akathisia. Akathisia is commonly observed in the treatment of schizophrenia with neuroleptics, but it is not well known that it can develop during palliative care of patients with antiemetic agents, such as prochlorperazine and metoclopramide, which block central D2 receptors. Prochlorperazine has a very high affinity for D2 receptors comparable to that of haloperidol5 and is likely to induce akathisia and other extrapyramidal side effects. Akathisia induced by D2-blocking antiemetic agents is frequently unrecognized in cancer patients.1,2 Half of 24 cancer patients receiving metoclopramide and prochlorperazine developed akathisia.1 Twenty of 483 patients referred to a department of psychiatry developed akathisia from an antiemetic drug (80% of such patients took prochlorperazine).2 Major depression is also highly prevalent in cancer patients.6 However, most oncologists and general physicians may be unaware that antiemetic-induced akathisia can cause severe depression with suicidality resembling major depressive disorder. Although prochlorperazine is one of the first-line drugs for the treatment of emesis induced by chemotherapy and opioids and is useful in caring for cancer patients, physicians should recognize that it, as well as D2-blocking antiemetic agents other than domperidone, may have pronounced side effects. Long-term use of prochlorperazine should be avoided, or domperidone, a peripherally acting D2 antagonist, should be substituted for it if possible.

Postpartum depression in Recife - Brazil: prevalence and association with bio-socio-demographic factors

OBJECTIVE:To use a semi-structured interview to detect depression in postpartum women according to the criteria proposed by the DSM in child health care clinics in the city of Recife, together with the proper association of this disorder to bio-socio-demographic data. METHODS: The study used a cross-section method and contained a convenience sample of 400 women that were between 2 and 26 weeks of postpartum in child health care clinics. A bio-socio-demographic questionnaire and the Portuguese version of the Structured Clinical Interview for DSM-IV Axis I Disorders were used. RESULTS: Twenty nine of the mothers (7.2%) were diagnosed as suffering from postpartum depression. Women with a past history of psychiatric disorders, a family history of psychiatric disorder and some sort of clinical complication presented a higher prevalence of depression. The same happened to those with a past history of spontaneous abortion, those who had a transpelvic birth and those over 8 weeks of puerperium. CONCLUSION: The rate of postpartum depression in this sample, 7.2%, was lower than that reported by other Brazilian studies. It probably occurred because the other researchers used screening scales to assess this estimate instead of a clinical interview.

Prevalence of Psychiatric Disorders at the Time of Breast Cancer Diagnosis.

Abstract Introduction: Studies thus far have documented the prevalence of depression and adjustment disorders after treatment of breast cancer. There is dearth of data on the prevalence of psychiatric disorders among newly diagnosed breast cancer patients. This study aimed at determining the prevalence of psychiatric disorders amongst patients at the time of breast cancer diagnosis.Methods: A retrospective study was done at a university based interdisciplinary breast cancer program. Every newly diagnosed breast cancer patient is evaluated by a surgical, medical and radiation oncologist as well as a licensed psychologist. All patients evaluated in 2005 were included. The psychologist performs an abbreviated evaluation that includes past and current psychiatric history, medications, stressors and the ability of the patient to cope with the diagnosis. Recommendations are made when the patient is in need of psychological assistance. Psychiatric diagnoses were made according to DSM-IV criteria. Socio-demographic and clinical data included age, tumor histology, menopausal, marital and occupational status, use of alcohol, tobacco, and recreational drugs, family history of breast cancer and psychiatric disorders, past history of psychiatric disorders and treatment, and race.Results: The study population included 189 females and 1 male. The median (25th-75 percentile) age was 58 (48-68) years. 68.4% had invasive ductal cancer, 68.9% were postmenopausal, 62.1% were married and 16.8% were smokers. 40% of the patients that denied current smoking had a past history of smoking. 58.4% were alcohol consumers and 51.5% were employed at the time of diagnosis. 54.7% of patients had no family history of breast cancer and 91.7% had no family history of psychiatric disorders. 54.7% of the patients were immigrants. 109 (57.3%) of the patients reported a history of psychotherapy and or psychiatric disorders in the past. Past history of psychiatric diagnoses included: major depression, post partum depression, dysthymia, post traumatic stress disorder, anxiety, panic attacks, bipolar disorder, adjustment disorder, anorexia and substance abuse (alcohol and heroin) .One patient had a history of suicidal attempt. At the time of breast cancer diagnosis, 53(27.8%) of the patients were taking psychiatric medications; the majority of these medications were antidepressants and anxiolytics. 15(7.8%) of the patients that denied current use of psychiatric medications had taken medications in the past. Most of the patients were taking a single medication 36(18%), while 4(1.5%) patients were taking up to 4 medications. At the time of evaluation, 31(16.3%) patients were diagnosed with a psychiatric disorder. 18(9.5%) were diagnosed with a depressive disorder; 8(4.2%) with an anxiety disorder, 3(1%) with an adjustment disorder and 2(1%) with bipolar disorder.Conclusion: This study reports a high incidence of psychiatric disorders amongst newly diagnosed breast cancer patients. This may have significant effect on the quality of life during survivorship after breast cancer. Consideration should be given to include a psychologist in the multidisciplinary evaluation of the breast cancer patient. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1068.

Rates of psychiatric illness in patients with cancer: An analysis of a psycho-oncology service

e20731 Background: The diagnosis of cancer represents a major physical and psychological challenge for patients and their families. Psycho-oncology services are limited throughout the country. We assess the service profile of patients assessed between 1/2003 and 6/2008 to determine how the needs of patients have changed. Methods: Case notes from all patients referred by medical oncologists, clinical nurse specialists and/or social workers to the psycho-oncology service were reviewed for the period 7/07 to 6/08. Demographic details, cancer diagnosis and stage, time since diagnosis, psychiatric diagnosis (past/current), and need for psychiatric intervention were collected. This data was compared to a similar review performed from 1/03 to 12/03. Results: 106 patients were psychiatrically assessed during the period 07/08 compared with 63 from 2003, representing a 68% increase in activity. All major cancers were represented. There was a 30% increase in patients assessed with lung cancer (14% in 07/08 vs. 11% in 2003). More patients were referred with localised disease in 07/08 than in 2003 (37.5% vs .19%, p=0.012).Patients with a past history of psychiatric disorder were more likely to be referred in 07/08 compared to 2003 (54% vs. 32% p=0.005). There was a significant decrease in the numbers diagnosed with depression in 07/08 (29% vs. 51%, p= 0.004) with a corresponding increase in the diagnosis of adjustment disorder (26% vs. 6%). Conclusions: Psycho-oncology services remain an important component of care for patients with cancer. The increased rate of referrals may reflect an increased awareness amongst oncology staff of psychological distress in this vulnerable population. No significant financial relationships to disclose.