Psychiatric effects of cancer

Question 1

Which mental health condition is associated with smoking and lung cancer?

Answer 1

Schizophrenia

Question 2

Who are susceptible to steroid psychosis?

Answer 2

Bipolar patients

Question 3

Bloods for depression and anxiety?

Answer 3

FBC
LFT
TFT
U+E
Creatinine
Calcium
Vitamin B12

Question 4

Contraindication of epiltopgenic antidepressant medications?

Answer 4

Brain tumour

Question 5

Avoid SSRIs if…

Answer 5

If there is a current physical symptom burden e.g. nausea, diarrhoea, insomnia

Question 6

Contraindication of antidepressant venlafaxine?

Answer 6

Hypertension

Question 7

Fluoxetine should be avoided as an anti-depressant therapy for cancer for what reason?

Answer 7

Drug-drug interactions

Citalopram and sertraline are better options

Question 8

Risks of anti-depressants in cancer care?

Answer 8

SIADH/hyponatraemia
GI bleeding with SSRIs (esp. with NSAIDs)
Serotonin syndrome (esp. with tramadol)

Question 9

Which cancer has an 80% depression rate with psychotic features?

Answer 9

Pancreatic

Question 10

Inflammatory explanation for depression in pancreatic cancer?

Answer 10

High IL-6 causes resistance to glucocorticoid receptor
This causes hypercortisolaemia
Induction of IDO leads to serotonin depletion and high levels of Kynurenine and its metabolites
Depressive symptoms proportional to IL-6 level

Question 11

Frontal lobe tumour:

Organic psychiatry

Answer 11

Apathy
Coarsened social skills
Expressive dysphasia
Disinhibition
Perseveration
Change in personality

Question 12

Temporal lobe tumour:

Organic psychiatry

Answer 12

Memory loss
Deja vu
Auditory hallucinations
Complex partial seizures

Question 13

Pituitary tumour:

Organic psychiatry

Answer 13

Various endocrine effects on mental health

Question 14

Brain metastases are particularly likely with which cancers?

Answer 14

Small-cell lung
Advanced melanoma
Breast

Question 15

Endocrine paraneoplastic syndrome in small-cell lung cancer?

Answer 15

Ectopic ADH secretion
Hyponatraemia
Lassitude, nausea, low mood
Delirium and fits

Question 16

Endocrine paraneoplastic syndrome in non-small-cell lung cancer?

Answer 16

Ectopic PTHrP secretion
Hypercalcaemia
Low mood
Thirst
Delirium
Constipation

Question 17

Give an example of a Neuropsychiatric paraneoplastic syndrome:

Answer 17

Limbic encephalitis

Question 18

What can cause limbic encephalitis?

Answer 18

Anti-Hu antibody in small-cell lung cancer

Anti-NMDAR antibody in teratoma

Question 19

Psych symptom of paraneoplastic anti-Hu secretion in small-cell lung cancer?

Answer 19

Dementia as the anti-Hu binds to neurones exclusively

Question 20

Psych symptoms of paraneoplastic anti-NMDAR secretion in teratoma?

Answer 20

Psychosis and schizophrenia due to glutaminergic hypofunction - treat by immunotherapy/removing teratoma in the ovary

Question 21

Non-psych symptoms of paraneoplastic anti-NMDAR secretion in teratoma?

Answer 21

Opsoclonus
Nystagmus
Abnormal muscle tone/posture
Fits
Central hypoventilation

Question 22

‘Chemobrain’ side effects of antifolates:

Answer 22

Low mood and subtle cognitive impairment

Reason: demyelination, impaired hippocampal neurogenesis, reduced monoamine NT synth and build up of homocysteine

Question 23

Treatment for steroid psychosis?

Answer 23

Steroid reduction and olanzapine

Question 24

95% rate of what in whole brain radiotherapy?

Answer 24

Growth hormone deficiency (4 years later)

And 3-10 point IQ loss

Question 25

40% rate of what after head and neck radiotherapy?

Answer 25

Hypothyroidism (1 year later)

Question 26

Psych effect of PI3K/AKT inhibitors?

Answer 26

Sever depression - 30%

Question 27

Psych effect of proteosome inhibitors (myeloma treatment)?

Answer 27

Depression

Question 28

Psych effect of bevacuzumab (inhibits VEGF used in renal, colorectal and cervical cancers)?

Answer 28

Disrupts the BBB causing posterior reversible encephalopathy syndrome (PRES: pulsating headaches and confusion)

Question 29

Why is Rituximab given in PML?

Answer 29

Reactivation of childhood JC virus in severely immunocompromised state

Question 30

Psych effect of Rituximab in PML?

Answer 30

Clumsiness, visual field defects, cognitive impairment (30%), aphasia, personality changes and hemiparesis Reason: Asymmetrical demyelination in white matter of parietal and occipital lobes Treatment: steroids and plasmapheresis

Question 31

What is blinatumomab

Answer 31

Bi-specific antibody that acts as a T-cell engager It targets CD19 on tumour cell and CD3 on T-cells to bring them together Used in refractory B-cell ALL

Question 32

Psych effect of blinatumomab?

Answer 32

Confusion, dysphasia, somnolence, tremor, seizures, coma Reason: T-cells cross BBB, bind to B-cells and incite cytokine storm Prevention/management: infusion of high dose steroids