Psycho-oncology

Question 1

What treatment is recommended for mild-moderate psychiatric problems?

Answer 1

Cognitive behavioural therapy (CBT).

Question 2

What treatment is used for moderate to severe psychiatric problems?

Answer 2

Pharmacological treatment. Psychiatric specialist.

Question 3

What treatment is used for severe psychiatric problems?

Answer 3

Psychiatric emergency - specialist within hours.

Question 4

If cancer patient depressed, which drug should you not give them?

Answer 4

Fluoxetine - drug to drug interaction.

Question 5

If you can’t give fluoxetine to a depressed cancer patient, state a drug you can give?

Answer 5

Citalopram. Sertraline.

Question 6

State 2 consequences of anti-depressants for a cancer patient.

Answer 6

SIADH/hyponatraemia - with antidepressants. GI bleeding - with SSRIs. Serotonin syndrome (fever, confusion, tachycardia, tremor, hyperreflexia) - with tramadol.

Question 7

How does the inflammatory effect of pancreatic cancer lead to depression?

Answer 7

Cytokine provokes depressive syndrome (glucocorticoid receptor resistance). Alters serotonin metabolism - serotonin depletion - become depressed.

Question 8

State a treatment for the depressive effects of pancreatic cancer.

Answer 8

Tocilizumab - anti-cytokine (antidepressant action).

Question 9

State 3 causes of psychiatric problems associated with cancer.

Answer 9

Brain tumours. Chemobrain - with conventional agents. Steroid psychosis. Brain/head neck radiation. Psychiatric side effects of MTAs.

Question 10

State a psychiatric syndrome associated with cancer.

Answer 10

Endocrine paraneoplastic syndromes. Neuropsychiatric paraneoplastic syndromes.

Question 11

State 2 effects of a brain metastasis.

Answer 11

Frontal - apathy, dysphagia, coarsened social voice, change in personality. Temporal - memory loss, auditory hallucinations, complex partial seizures. Pituitary - endocrine effects, all with psychiatric symptoms.

Question 12

State an endocrine hormone secreted in small cell lung cancer.

Answer 12

Ectopic ADH. Ectopic PTHrP.

Question 13

State 2 symptoms experienced in Endocrine Paraneoplastic syndrome.

Answer 13

Ectopic ADH - hyponatraemia - nausea, low mood then delirium. Ectopic PTHrP - hypercalcaemia - low mood, thirst, constipation, delirium.

Question 14

State a neuropsychiatric paraneoplastic syndrome.

Answer 14

Limbic encephalitis - inflammation of the liver. Cancer produces antibodies which target neurones (psychiatric problem).

Question 15

State a drug which results in ‘chemobrain.’

Answer 15

Antifolates - low mood and subtle cognitive impairment.

Question 16

What is the effect of dexamethasone on a cancer patient?

Answer 16

Dexamethasone increases risk of a severe psychiatric disorder (steroid psychosis). Treated with steroid reduct

Question 17

How is steroid psychosis reduced?

Answer 17

Treated with steroid reduction. Olanzepine (antipsychotic used to treat schizophrenia and bipolar disorder. .

Question 18

What can damage the anterior pituitary and thyroid gland to result in psychiatric problems?

Answer 18

Infra red radiation.

Question 19

Give 3 molecular targeted agents (MTA).

Answer 19

Bevacizumab - posterior reversible encephalopathy syndrome (PRES). Rituximab - progressive multifocal leukoencephalopathy (PML). Blinatumomab + CAR-T -(cytokine release syndrome (delirium) as T cells/cytokines flood CNS.

Question 20

State 2 symptoms of posterior reversible encephalopathy syndrome (PRES).

Answer 20

Pulsatile headache. Hypertension. Confusion. Impaired vision.

Question 21

What causes posterior reversible encephalopathy syndrome (PRES)?

Answer 21

Bevacizumab - inhibits angiogenesis and disrupts blood brain barrier - fluid build up in back of the brain.

Question 22

What causes progressive multifocal leukoencephalopathy (PML)?

Answer 22

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.

Question 23

How does blinatumomab cause a cytokine storm?

Answer 23

It acts as a T-cell engager (tumour cell links to T cell), resulting in confusion, dysphagia, tremor, seizures and possible coma.