San Francisco -- Integrating psychiatric care with other medical treatments can go a long way toward helping patients deal with the physical, mental, and emotional stressors of illness--and can even improve prognosis and survival, Dr. David Spiegel said at the annual meeting of the American Psychiatric Association.
"The lives of medically ill patients are radically altered," said Dr. Spiegel, professor of psychiatry at Stanford (Calif.) University. "They're facing a series of stressors, such as their mortality, physical symptoms like pain, and pressures to make treatment decisions. So many patients respond to medical illness as a kind of physical assault with reactions not so different from responses to traumatic situations such as natural disasters, motor vehicle accidents, and criminal assault."
These stressors take an emotional toll, often rendering patients unable to express their reactions in words. The result is that they may not fully realize the amount of stress they are under. The inability to vocalize their feelings could also leave patients feeling helpless because "if you can't find words for these situations, you feel even more assaulted by them and less able to cope in an active manner with them," he said.
Stress also disrupts cognition, impairing the ability to think and make decisions. While patients may think they are functioning at maximal capacity and doing what they need to get through the day and their treatments, the reality is that their cognitive faculties are compromised.
Addressing the patient's level of social contact is also important. Having someone to confide in modulates the emotional impact of a stressful event. "Coping with these situations alone is far more difficult and painful than when one is with people," he said.
Neglecting to address the effects of stress often leads to depression, which can be described as a "maladaptive stress response," Dr. Spiegel said. Associated with both endocrine abnormalities and psychological responses that include feelings of hopelessness, helplessness, and worthlessness, depression is seen in 6% of medical out-patients and 12 percent of inpatients, compared with 3% in the general population. Among the terminally ill, 20% are depressed, and 60% of those requesting physician-assisted suicide are depressed.
Studies have shown that depression can increase the risk of cancer incidence or progression. In one study of 5,000 people, those who had major depression on three separate incidences over 4 years had a twofold elevated risk of getting cancer.
One reason may be the tightly regulated stress response system that stimulates cortisol secretion, increases in blood glucose and suppresses the immune system. …