Academic journal article Indian Journal of Psychiatry

Prevalence of Psychiatric Morbidity among Cancer Patients – Hospital-Based, Cross-Sectional Survey

Academic journal article Indian Journal of Psychiatry

Prevalence of Psychiatric Morbidity among Cancer Patients – Hospital-Based, Cross-Sectional Survey

Article excerpt

Byline: Mohan. Gopalan, Vidhukumar. Karunakaran, Anil. Prabhakaran, Krishnannair. Jayakumar

Aim: To study the prevalence of Psychiatric disorders in cancer patients and to find out the factors associated with Psychiatric disorders in Cancer Patients. Settings and Design: Department of Radiotherapy, Medical College, Thiruvananthapuram, cross sectional survey design was used. Methods and Material: Adult patients (18 years of age and above), having a diagnosis of carcinoma were selected by consecutive sampling method.A questionnaire which included back ground data, socio economic variables, treatment variables like type of malignancy, exposure to radiation & chemotherapy prior to the evaluation and current treatment, co occurring medical illness & treatment and past & family history of psychiatric illness was used to collect data. Delirium rating scale and MINI International neuropsychiatric interview were used to assess Psychiatric disorders and delirium. Statistical Analysis Used: Chi square and logistics regression tests were used for analysis. Results: Of the 384 assessed, 160(41.7%) had psychiatric disorders. Adjustment disorders were seen in 22.6%. 10.9% of subjects had major depressive disorder. Thus a total of 33.5% of patients had a diagnosis of either anxiety or depressive disorder. Proportion of patients having delirium was 6.5%. Hypomania was seen in small (1.6%) of patients. Multivariate analysis for various parameters for psychiatric disorders showed that age, past history of chemotherapy, past history of radiotherapy, & surgical treatment of carcinomas are significant predictors of psychiatric disorders. Conclusions: Psychiatric disorders are seen in a significant proportion of Psychiatric patients.

Introduction

Cancer is a leading cause of death worldwide accounting for 7.6 million deaths (around 13% of all deaths) in 2008, and about 70% of all cancer deaths occurred in low- and middle-income countries. Deaths from cancer worldwide are projected to continue to rise to over 11 million by 2030.[sup][1] India is no exception to this, population-based cancer registries within the National Cancer Registry Programme and outside the network has provided a picture of the cancer pattern in India based on which it is estimated that there will be about 800,000 new cancer cases in India every year. At any given point, the prevalence is likely to be three times this load that is about 2,400,000 cases in a year.[sup][2]

The experience of having cancer has been associated with high levels of psychological stress. Galen noted a relationship between dysphoric affect and cancer long ago.[sup][3] Correlations between neoplasia and psychological disorders were noted by numerous 18[sup]th and 19[sup]th century physicians.[sup][4] An illness like cancer can have various psychiatric sequelae as a result of the disease itself or due to associated problems. The diagnosis of cancer itself when revealed to the patient can cause emotional reactions such as shock and disbelief, followed by anger, depression, loss, and grief.

Adjustment disorder is the most common psychiatric syndrome in cancer patients.[sup][5] Conceptually, these are disorders with emotional and behavioral symptoms which are responses to an identifiable stressor.[sup][6] A life-threatening illness like cancer will definitely have emotional consequences.

There have been many criticisms against the prevalence studies of psychiatric illness in cancer. Most researchers limited their focus to specific forms of a psychological disorder such as “depression,” and few included formal complete psychiatric evaluation in their designs, other investigators concentrated on the general psychological adjustment of the cancer patient, utilizing symptom, and mood measures to estimate levels of well-being rather than to measure the prevalence of disorder.

To plan interventions efficiently, it is important to gain insight into the prevalence, severity, course of the psychological sequelae, and the variables influencing them. …

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