Psychiatric effects of cancer Flashcards

1
Q

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

A

Schizophrenia

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2
Q

Who are susceptible to steroid psychosis?

A

Bipolar patients

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3
Q

Bloods for depression and anxiety?

A
FBC
LFT
TFT
U+E
Creatinine
Calcium
Vitamin B12
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4
Q

Contraindication of epiltopgenic antidepressant medications?

A

Brain tumour

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5
Q

Avoid SSRIs if…

A

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

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6
Q

Contraindication of antidepressant venlafaxine?

A

Hypertension

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7
Q

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

A

Drug-drug interactions

Citalopram and sertraline are better options

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8
Q

Risks of anti-depressants in cancer care?

A

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

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9
Q

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

A

Pancreatic

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10
Q

Inflammatory explanation for depression in pancreatic cancer?

A

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

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11
Q

Frontal lobe tumour:

Organic psychiatry

A
Apathy
Coarsened social skills
Expressive dysphasia
Disinhibition
Perseveration
Change in personality
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12
Q

Temporal lobe tumour:

Organic psychiatry

A

Memory loss
Deja vu
Auditory hallucinations
Complex partial seizures

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13
Q

Pituitary tumour:

Organic psychiatry

A

Various endocrine effects on mental health

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14
Q

Brain metastases are particularly likely with which cancers?

A

Small-cell lung
Advanced melanoma
Breast

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15
Q

Endocrine paraneoplastic syndrome in small-cell lung cancer?

A

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

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16
Q

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

A
Ectopic PTHrP secretion
Hypercalcaemia
Low mood
Thirst
Delirium
Constipation
17
Q

Give an example of a Neuropsychiatric paraneoplastic syndrome:

A

Limbic encephalitis

18
Q

What can cause limbic encephalitis?

A

Anti-Hu antibody in small-cell lung cancer

Anti-NMDAR antibody in teratoma

19
Q

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

A

Dementia as the anti-Hu binds to neurones exclusively

20
Q

Psych symptoms of paraneoplastic anti-NMDAR secretion in teratoma?

A

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

21
Q

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

A
Opsoclonus
Nystagmus
Abnormal muscle tone/posture
Fits
Central hypoventilation
22
Q

‘Chemobrain’ side effects of antifolates:

A

Low mood and subtle cognitive impairment

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

23
Q

Treatment for steroid psychosis?

A

Steroid reduction and olanzapine

24
Q

95% rate of what in whole brain radiotherapy?

A

Growth hormone deficiency (4 years later)

And 3-10 point IQ loss

25
40% rate of what after head and neck radiotherapy?
Hypothyroidism (1 year later)
26
Psych effect of PI3K/AKT inhibitors?
Sever depression - 30%
27
Psych effect of proteosome inhibitors (myeloma treatment)?
Depression
28
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)
29
Why is Rituximab given in PML?
Reactivation of childhood JC virus in severely immunocompromised state
30
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
31
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
32
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