Michelle Riba

Psychiatric Side Effects of Interferon Therapy: Prevalence, Proposed Mechanisms, and Future Directions

The increasing use of interferon (IFN) in treating a variety of disorders including, malignant melanoma and hepatitis C, has resulted in the identification and increasing concern about the psychiatric side effects that can result from treatment. These effects can occur either shortly after beginning IFN therapy or later as a result of continued treatment. Studies have reported the incidence of later side effects, which include symptoms of depression, anxiety, and occasional suicidal ideation, to be from 0% to 70%. Case studies have demonstrated that pharmacologic interventions are beneficial in reducing iatrogenic psychiatric symptoms while allowing patients to maintain IFN therapy. The present article provides an overview of the psychiatric effects of IFN therapy, the proposed mechanisms of these side effects, and case studies that provide mechanistic support. In addition, limitations of the current literature are provided with suggestions for treating physicians and a discussion of possible future research directions.

Psychosocial Characteristics of Individuals With Non–Stage IV Melanoma

PURPOSE Melanoma is the fastest growing solid tumor among men and women and accounts for 79% of skin cancer-related deaths. Research has identified that distress is frequently associated with a diagnosis of cancer and may slow treatment-seeking and recovery, increasing morbidity and even mortality through faster disease course. Given that the 5-year survival rates for individuals with melanoma are determined primarily by the depth and extent of spread, distress that interferes with seeking treatment has the potential to be life-threatening. PATIENTS AND METHODS The current study was designed to identify levels of distress present in individuals seeking treatment at a large, Midwestern, multidisciplinary melanoma clinic. It also focused on determining the quality of life, level of anxiety, and coping strategies used by individuals with melanoma before treatment. Given that the course of treatment and outcome for patients with stage IV disease is vastly different from that of patients with stages I to III disease, they were excluded from the study. RESULTS Results indicated that most individuals who are presenting to a melanoma clinic do not report a clinically significant level of distress. However, there is some variability in this, with 29% of patients reporting moderate to high levels of distress. Moreover, analyses suggest that distressed individuals are more likely to use maladaptive coping strategies, such as escape-avoidance coping, and to have poorer quality of life. CONCLUSION Although most individuals do not present with significant levels of distress, a significant minority are distressed and rely more heavily on coping strategies that do not benefit them. Such individuals would likely benefit most from psychological intervention.

Internet interventions for improving psychological well‐being in psycho‐oncology: review and recommendations

Too few cancer patients and survivors receive evidence‐based interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients.

Drug Interactions and Pharmacogenomics in the Treatment of Breast Cancer and Depression

Mrs. B is a 45 year old premenopausal female who was diagnosed with major depressive disorder 10 years ago and then successfully treated for 12 months with fluoxetine 20 mg daily without significant side effects from therapy. She remained free of depressive symptoms for the next 8-9 years. One year ago, she was diagnosed with estrogen receptor (ER) positive invasive breast cancer and underwent treatment with surgery, followed by chemotherapy, and then radiation therapy. Mrs. B. has been treated with the selective estrogen receptor modulator (SERM) tamoxifen for the past 6 months to reduce her likelihood of breast cancer recurrence. She has tolerated tamoxifen relatively well, except for moderately bothersome hot flashes for which she has received no pharmacologic therapy. Recently, however, she developed recurrent depressive symptoms and sought treatment from her psychiatrist. What pharmacologic agents are effective against both depression and hot flashes in women with breast cancer? Would any of these agents compromise the efficacy of tamoxifen or increase its toxicity through a drug-drug interaction?

Efficacy and safety of pharmacotherapy in cancer-related psychiatric disorders across the trajectory of cancer care: A review

Abstract At least 25–30% of patients with cancer and an even higher percentage of patients in an advanced phase of illness meet the criteria for a psychiatric diagnosis, including depression, anxiety, stress-related syndromes, adjustment disorders, sleep disorders and delirium. A number of studies have accumulated over the last 35 years on the use of psychotropic drugs as a pillar in the treatment of psychiatric disorders. Major advances in psycho-oncology research have also shown the efficacy of psychotropic drugs as adjuvant treatment of cancer-related symptoms, such as pain, hot flushes, pruritus, nausea and vomiting, fatigue, and cognitive impairment. The knowledge about pharmacokinetics and pharmacodynamics, clinical use, safety, side effects and efficacy of psychotropic drugs in cancer care is essential for an integrated and multidimensional approach to patients treated in different settings, including community-based centres, oncology, and palliative care. A search of the major databases (MEDLINE, Embase, PsycLIT, PsycINFO, the Cochrane Library) was conducted in order to summarize relevant data concerning the efficacy and safety of pharmacotherapy for cancer-related psychiatric disorders in cancer patients across the trajectory of the disease.

International medical graduates and the diagnosis and treatment of late-life depression

Purpose International medical graduates (IMGs) constitute a significant number of physicians in the United States. Because of cultural differences in the manifestations and acceptance of mental disorders, depression may be less recognized in countries where IMGs train than in the United States. Differences in medical training may affect IMGs’ recognition of depression. The authors hypothesized that the diagnosis and treatment of late-life depression would differ between United States medical graduates (USMGs) and IMGs. Method Physicians, both USMGs and IMGs, at two different professional physician association meetings in 2002 were asked to view a multimedia computer program including a vignette of an elderly patient-actor with late-life depression. They completed a computerized survey, including their diagnosis and recommendations for management. Statistical analyses were performed to compare the two groups for physician characteristics and patient treatment recommendations. Results Study subjects were 178 primary care physicians and 321 psychiatrists. Three hundred fifty-three (71%) respondents were USMGs and 146 (29%) were IMGs. IMGs were significantly less likely than USMGs to make the correct diagnosis of depression (p < .004) or recommend treatment with a first-line antidepressant (p < .001). When specialty, other physician characteristics, and patient race and gender were controlled for, IMGs still differed significantly in their diagnoses (p = .006) and treatment (p = .006) of depression. Conclusion The authors found significant differences between USMGs and IMGs for the diagnosis and treatment of late-life depression. This could be due to IMGs’ lesser familiarity with depressive symptoms or different cultural conceptions of depression. These findings may point to the need for additional depression training initiatives for IMGs.

Report of the WPA Task Force on Brain Drain

The brain drain of health professionals is an issue of continuing interest and debate. The WPA set up a Task Force to examine the phenomenon as it relates specifically to mental health professionals. This report provides a description of the work of the Task Force and its recommendations in regard to how the WPA might act to help address the issue.

Psychopharmacology in Psycho-oncology

Psychopharmacological intervention is a major clinical and research area in oncology and palliative care. Over the last 35 years, psychotropic drugs have been shown to have a number of important indications for the treatment of the most common psychiatric disorders, such as depression, anxiety, stress-related syndromes, severe adjustment disorders, sleep disorders and delirium, which combined affect at least 30-40% of patients with cancer and even a higher percentage of patients in an advanced phase of illness. The availability of new drugs, with less side-effects and safer pharmacological profiles, has been a major advance in clinical psycho-oncology. Interestingly, several drugs have also been found to be helpful for the adjuvant treatment of cancer-related symptoms, such as pain, hot flashes, pruritus, nausea and vomiting, fatigue, and cognitive impairment, making psychopharmacology an important tool for the improvement of cancer patients’ quality of life. The aim of this paper is to summarize recent relevant data concerning the use of psychotropic drugs, namely antidepressants, anxiolytics, antipsychotics, anticonvulsants and psychostimulants in patients with cancer.

Clinical Psycho-Oncology: An International Perspective

List of Contributors, vii Foreword, xi Acknowledgements, xiii Part 1 Clinical Issues 1 Introducing Multicultural Psycho-oncology, 3 Luigi Grassi and Michelle Riba 2 Communication in Cancer Care: A Cultural Perspective, 11 Phyllis Butow and Walter F. Baile 3 Psychosocial Assessment and Screening in Psycho-oncology, 21 Paul B. Jacobsen and Kristine A. Donovan 4 Sexuality and Gender: Psychosocial Implications in Cancer Patients: A Multicultural Perspective, 39 Anna Costantini, Chiara M. Navarra, Kimlin Tam Ashing-Giwa and Sophia Yeung 5 Psychosocial and Psychiatric Disorders, 55 Santosh K. Chaturvedi and Yosuke Uchitomi 6 Neurocognitive Effects of Anticancer Treatments, 71 Tim Ahles, Sanne Schagen and Janette Vardy 7 Screening for Distress, the 6th Vital Sign, as the Connective Tissue of Health Care Systems: A Roadmap to Integrated Interdisciplinary Person-centred Care, 83 Barry D. Bultz, Matthew J. Loscalzo and Karen L. Clark 8 Psychological Intervention, 97 Maggie Watson 9 Psychopharmacological Interventions, 109 Seema M. Thekdi, Marya Elisa Irarrazaval and Laura B. Dunn 10 Rehabilitation, 127 Anja Mehnert and Uwe Koch Part 2 Special Populations 11 Pediatric Psycho-oncology, 139 Margaret L. Stuber and Elizabeth M. Strom 12 A Life-stage Approach to Psycho-oncology, 155 Peter Fitzgerald, Rinat Nissim and Gary Rodin 13 Psycho-oncology in Underserved and Minority Populations, 165 Richard Fielding and Wendy W.T. Lam Part 3 Other Topics 14 Exploration of Family Care: A Multicultural Approach, 187 Lea Baider and Gil Goldzweig 15 Bioethical Challenges: Understanding Cultural Differences and Reducing Health Disparities, 199 Antonella Surbone 16 Post-traumatic Growth in Cancer Patients Across Cultures, 211 Michael Diaz, Matthew Cordova and David Spiegel 17 The Need for Psychosocial Support in Genetic Counselling and Genetic Testing, 223 Mary Jane Esplen, Jonathan Hunter and Kathryn M. Kash 18 Psychosocial and Physical Health in Post-treatment and Extended Cancer Survivorship, 237 Patricia A. Ganz and Annette L. Stanton 19 End-of-life Care, 249 William Breitbart, Harvey Max Chochinov and Yesne Alici 20 Grief and Bereavement, 271 Sue Morris and Susan Block 21 Spiritual and Religious Coping with Cancer, 281 David W. Kissane, Carrie E. Lethborg and Brian Kelly 22 Psycho-oncology and Advocacy in Cancer Care: An International Perspective, 297 Luzia Travado, Jan Geissler, Kim Thiboldeaux, Jeff Dunn, Ranjit Kaur and Anne Merriman Index, 311

Depressive spectrum disorders in cancer: prevalence, risk factors and screening for depression: a critical review

Abstract Background: Although depression and mood-related disorders are common in persons with cancer, these conditions remain frequently overlooked in clinical practice. Negative consequences of depressive disorder spectrum have been reported (e.g. suicidal ideation, increase physical complications and somatic symptoms, negative influence on prognosis), indicating the need for routine screening, assessment and management. Methods: A search of the major databases (Medline, Embase, PsycLIT, PsycINFO, and the Cochrane Library) was conducted on the reviews and meta-analyses available in order to summarize relevant data concerning depressive disorders spectrum in terms of prevalence, risk factors, and screening and assessment among patients with cancer across the trajectory of the disease. Results: The data show a prevalence of depression and depressive disorders between 5% and 60% according to the different diagnostic criteria, the tools used in the studies (e.g. semi-structured psychiatric interview and psychometric questionnaires), as well as the stage and type of cancer. Furthermore, despite the significant health care resources devoted to cancer care and the importance of addressing depressive symptoms, assessment and management of depressive spectrum disorders in cancer patients remains suboptimal. Conclusions: Routine screening and adequate assessment of depressive spectrum disorders is necessary in patients with cancer in order to effectively manage the multifaceted and complex consequences on cancer care.