Psychiatric effects of cancer Flashcards
Which mental health condition is associated with smoking and lung cancer?
Schizophrenia
Who are susceptible to steroid psychosis?
Bipolar patients
Bloods for depression and anxiety?
FBC LFT TFT U+E Creatinine Calcium Vitamin B12
Contraindication of epiltopgenic antidepressant medications?
Brain tumour
Avoid SSRIs if…
If there is a current physical symptom burden e.g. nausea, diarrhoea, insomnia
Contraindication of antidepressant venlafaxine?
Hypertension
Fluoxetine should be avoided as an anti-depressant therapy for cancer for what reason?
Drug-drug interactions
Citalopram and sertraline are better options
Risks of anti-depressants in cancer care?
SIADH/hyponatraemia
GI bleeding with SSRIs (esp. with NSAIDs)
Serotonin syndrome (esp. with tramadol)
Which cancer has an 80% depression rate with psychotic features?
Pancreatic
Inflammatory explanation for depression in pancreatic cancer?
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
Frontal lobe tumour:
Organic psychiatry
Apathy Coarsened social skills Expressive dysphasia Disinhibition Perseveration Change in personality
Temporal lobe tumour:
Organic psychiatry
Memory loss
Deja vu
Auditory hallucinations
Complex partial seizures
Pituitary tumour:
Organic psychiatry
Various endocrine effects on mental health
Brain metastases are particularly likely with which cancers?
Small-cell lung
Advanced melanoma
Breast
Endocrine paraneoplastic syndrome in small-cell lung cancer?
Ectopic ADH secretion
Hyponatraemia
Lassitude, nausea, low mood
Delirium and fits
Endocrine paraneoplastic syndrome in non-small-cell lung cancer?
Ectopic PTHrP secretion Hypercalcaemia Low mood Thirst Delirium Constipation
Give an example of a Neuropsychiatric paraneoplastic syndrome:
Limbic encephalitis
What can cause limbic encephalitis?
Anti-Hu antibody in small-cell lung cancer
Anti-NMDAR antibody in teratoma
Psych symptom of paraneoplastic anti-Hu secretion in small-cell lung cancer?
Dementia as the anti-Hu binds to neurones exclusively
Psych symptoms of paraneoplastic anti-NMDAR secretion in teratoma?
Psychosis and schizophrenia due to glutaminergic hypofunction - treat by immunotherapy/removing teratoma in the ovary
Non-psych symptoms of paraneoplastic anti-NMDAR secretion in teratoma?
Opsoclonus Nystagmus Abnormal muscle tone/posture Fits Central hypoventilation
‘Chemobrain’ side effects of antifolates:
Low mood and subtle cognitive impairment
Reason: demyelination, impaired hippocampal neurogenesis, reduced monoamine NT synth and build up of homocysteine
Treatment for steroid psychosis?
Steroid reduction and olanzapine
95% rate of what in whole brain radiotherapy?
Growth hormone deficiency (4 years later)
And 3-10 point IQ loss
40% rate of what after head and neck radiotherapy?
Hypothyroidism (1 year later)
Psych effect of PI3K/AKT inhibitors?
Sever depression - 30%
Psych effect of proteosome inhibitors (myeloma treatment)?
Depression
Psych effect of bevacuzumab (inhibits VEGF used in renal, colorectal and cervical cancers)?
Disrupts the BBB causing posterior reversible encephalopathy syndrome (PRES: pulsating headaches and confusion)
Why is Rituximab given in PML?
Reactivation of childhood JC virus in severely immunocompromised state
Psych effect of Rituximab in PML?
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
What is blinatumomab
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
Psych effect of blinatumomab?
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
