Psychiatry Service
Introduction
The Psychiatry Division was
established in July 1996. The division was designed not only to manage and
alleviate the emotional distress due to cancer among patients, their families,
and staff, but also to study the influence of psychosocial issues on patients・quality
of life or survival.
Routine Activities
The Psychiatry Division consists
of three part-time psychiatrists and one clinical resident. The main clinical
practice involves psychiatric consultation to assess and deal appropriately
with the emotional distress and other psychological problems of cancer patients
who are referred by attending physicians. The consultation data are shown
in the Table. We base psychiatric diagnoses on the Diagnostic and Statistical
Manual of Mental Disorders, 4th edition (DSM-IV) criteria. In 1999, physicians
referred 318 cancer patients to the Psychiatry Division. Of these patients,
76.1% were inpatients. The most common psychiatric diagnosis was adjustment
disorders (30.2%); the next most common were major depression (23.3%) and
delirium (20.1%). These three mental disorders accounted for approximately
three-quarters of the psychological problems in referred cancer patients.
The most common cancer site was the lung, followed by the head and neck. Approximately
70% of referred patients had recurrent or metastatic cancer. The most common
reason for psychiatric consultation was psychiatric evaluation (60.4%), followed
by depression (26.1%). Of all the referred patients, 71.9% had pain. These
trends are similar to those of last year.
The liaison rounds for the
newly referred inpatients are performed every Wednesday afternoon with staff
from the Psycho-Oncology Division of the National Cancer Center Research Institute
East. Difficult cases to assess or deal with are discussed carefully before
rounds are made.
A conference on research activities
is held every Tuesday evening. At the conference, planning protocols are discussed
and important journals are reviewed by all the members of our division staff
and all members of both the Psycho-Oncology Division of the National Cancer
Center Research Institute East and the Psychiatry Division of the National
Cancer Center Hospital.
Research Activities & New Developments
(1) Screening for nicotine dependence among smoking-related
cancer patients
The purpose of this study was
to develop a simple battery of tests to measure the severity of nicotine dependence
in Japanese patients with lung and head-and-neck cancer. We interviewed and
tested 151 patients using the Fagerstrom test for nicotine dependence (FTND).
The results suggested that the Japanese version of FTND was a reliable and
valid measure of nicotine dependence in patients with smoking-related cancers.
(2) Successful antidepressant treatment for five
terminally ill cancer patients with major depression, suicidal ideation, and
a desire for death
The purpose of this study was
to evaluate the effect of antidepressant treatment in terminally ill cancer
patients. Six cancer patients with suicidal ideas thought to be due to major
depression were treated with tricyclic antidepressants. One week after the
start of treatment with antidepressants, five of the six patients showed a
marked improvement in their mood and showed no further suicidal thoughts.
These results suggest that antidepressant treatment can be effective in alleviating
the desire for death due to major depression, even in terminally ill cancer
patients.
(3) Algorithm for the treatment of major depression
in patients with advanced cancer
We developed an algorithm to
guide the treatment of major depression in patients with advanced cancer based
on psychopharmacological literature. In this algorithm, we selected medication
according to the severity of depression and drug delivery route.
(4) Ongoing protocol study
Studies on therapeutic intervention
against fatigue among cancer patients made in collaboration with the Palliative
Care Service, and on the relationship between hippocampal volumes, memory
functions, and posttraumatic stress disorder (PTSD) symptoms among breast
cancer survivors are ongoing.
|
Psychiatric
Consultation Data (N=318, january - december, 1999) |
|
|
No.
(%) |
|
|
Age
(Mean + SD, yr.) |
58+11
(median; 59, range; 21-85 yr.) |
|
Gender
(male/female) |
168
(52.8) / 150 (47.2) |
|
Inpatient/Outpatient
|
242
(76.1) / 76 (23.9) |
|
Cancer
site |
|
|
Lung
|
63
(20.1) |
|
Head
and neck |
51
(16.3) |
|
Breast
|
48
(15.6) |
|
Colo-rectal
|
28
(8.9) |
|
Esophagus
|
13
(5.8) |
|
Stage Recurrent or metastatic |
207
(68.1) |
|
PS
(0/1,2/3,4) |
75
(23.6) / 144 (45.3) / 99 (31.1) |
|
Pain
(Presence) |
223
(70.1) |
|
Disclosure
of cancer diagnosis |
|
|
(disclosed)
|
305
(95.9) |
|
Reason
for the consultation (multiple choice) |
|
|
Psychiatric
evaluation |
192
(60.4) |
|
Depression
|
83
(26.1) |
|
Anxiety/fear
|
60
(18.9) |
|
Sleep
problems |
47
(14.8) |
|
Organic
brain syndrome |
24
(7.5) |
|
Psychiatric
diagnosis |
|
|
Adjustment
disorders |
96
(30.2) |
|
anxious mood |
34
(10.7) |
|
depressive mood |
10
(3.1) |
|
mixed emotion |
44
(13.8) |
|
Major
depression |
74
(23.3) |
|
Delirium
|
64
(20.1) |
|
Others
|
57
(17.9) |
|
No
diagnosis |
27
(8.5) |
(Y. UCHITOMI)
