Psycho-oncology Flashcards
What treatment is recommended for mild-moderate psychiatric problems?
Cognitive behavioural therapy (CBT).
What treatment is used for moderate to severe psychiatric problems?
Pharmacological treatment. Psychiatric specialist.
What treatment is used for severe psychiatric problems?
Psychiatric emergency - specialist within hours.
If cancer patient depressed, which drug should you not give them?
Fluoxetine - drug to drug interaction.
If you can’t give fluoxetine to a depressed cancer patient, state a drug you can give?
Citalopram. Sertraline.
State 2 consequences of anti-depressants for a cancer patient.
SIADH/hyponatraemia - with antidepressants. GI bleeding - with SSRIs. Serotonin syndrome (fever, confusion, tachycardia, tremor, hyperreflexia) - with tramadol.
How does the inflammatory effect of pancreatic cancer lead to depression?
Cytokine provokes depressive syndrome (glucocorticoid receptor resistance). Alters serotonin metabolism - serotonin depletion - become depressed.
State a treatment for the depressive effects of pancreatic cancer.
Tocilizumab - anti-cytokine (antidepressant action).
State 3 causes of psychiatric problems associated with cancer.
Brain tumours. Chemobrain - with conventional agents. Steroid psychosis. Brain/head neck radiation. Psychiatric side effects of MTAs.
State a psychiatric syndrome associated with cancer.
Endocrine paraneoplastic syndromes. Neuropsychiatric paraneoplastic syndromes.
State 2 effects of a brain metastasis.
Frontal - apathy, dysphagia, coarsened social voice, change in personality. Temporal - memory loss, auditory hallucinations, complex partial seizures. Pituitary - endocrine effects, all with psychiatric symptoms.
State an endocrine hormone secreted in small cell lung cancer.
Ectopic ADH. Ectopic PTHrP.
State 2 symptoms experienced in Endocrine Paraneoplastic syndrome.
Ectopic ADH - hyponatraemia - nausea, low mood then delirium. Ectopic PTHrP - hypercalcaemia - low mood, thirst, constipation, delirium.
State a neuropsychiatric paraneoplastic syndrome.
Limbic encephalitis - inflammation of the liver. Cancer produces antibodies which target neurones (psychiatric problem).
State a drug which results in ‘chemobrain.’
Antifolates - low mood and subtle cognitive impairment.
What is the effect of dexamethasone on a cancer patient?
Dexamethasone increases risk of a severe psychiatric disorder (steroid psychosis). Treated with steroid reduct
How is steroid psychosis reduced?
Treated with steroid reduction. Olanzepine (antipsychotic used to treat schizophrenia and bipolar disorder. .
What can damage the anterior pituitary and thyroid gland to result in psychiatric problems?
Infra red radiation.
Give 3 molecular targeted agents (MTA).
Bevacizumab - posterior reversible encephalopathy syndrome (PRES). Rituximab - progressive multifocal leukoencephalopathy (PML). Blinatumomab + CAR-T -(cytokine release syndrome (delirium) as T cells/cytokines flood CNS.
State 2 symptoms of posterior reversible encephalopathy syndrome (PRES).
Pulsatile headache. Hypertension. Confusion. Impaired vision.
What causes posterior reversible encephalopathy syndrome (PRES)?
Bevacizumab - inhibits angiogenesis and disrupts blood brain barrier - fluid build up in back of the brain.
What causes progressive multifocal leukoencephalopathy (PML)?
Rituximab - monoclonal antibody targets CD20 on surface of leukaemia and lymphoma which can be picked out and destroyed. This weakens the immune system - demyelination in white matter of parietal/occipital lobe.
How does blinatumomab cause a cytokine storm?
It acts as a T-cell engager (tumour cell links to T cell), resulting in confusion, dysphagia, tremor, seizures and possible coma.
