tailieunhanh - Chapter 077. Approach to the Patient with Cancer (Part 7)

The recognition and treatment of depression are important components of management. The incidence of depression in cancer patients is ~25% overall and may be greater in patients with greater debility. This diagnosis is likely in a patient with a depressed mood (dysphoria) and/or a loss of interest in pleasure (anhedonia) for at least 2 weeks. In addition, three or more of the following symptoms are usually present: appetite change, sleep problems, psychomotor retardation or agitation, fatigue, feelings of guilt or worthlessness, inability to concentrate, and suicidal ideation. Patients with these symptoms should receive therapy. . | Chapter 077. Approach to the Patient with Cancer Part 7 The recognition and treatment of depression are important components of management. The incidence of depression in cancer patients is 25 overall and may be greater in patients with greater debility. This diagnosis is likely in a patient with a depressed mood dysphoria and or a loss of interest in pleasure anhedonia for at least 2 weeks. In addition three or more of the following symptoms are usually present appetite change sleep problems psychomotor retardation or agitation fatigue feelings of guilt or worthlessness inability to concentrate and suicidal ideation. Patients with these symptoms should receive therapy. Medical therapy with a serotonin reuptake inhibitor such as fluoxetine 10-20 mg d sertraline 50-150 mg d or paroxetine 10-20 mg d or a tricyclic antidepressant such as amitriptyline 50-100 mg d or desipramine 75-150 mg d should be tried allowing 4-6 weeks for response. Effective therapy should be continued at least 6 months after resolution of symptoms. If therapy is unsuccessful other classes of antidepressants may be used. In addition to medication psychosocial interventions such as support groups psychotherapy and guided imagery may be of benefit. Many patients opt for unproven or unsound approaches to treatment when it appears that conventional medicine is unlikely to be curative. Those seeking such alternatives are often well educated and may be early in the course of their disease. Unsound approaches are usually hawked on the basis of unsubstantiated anecdotes and not only cannot help the patient but may be harmful. Physicians should strive to keep communications open and nonjudgmental so that patients are more likely to discuss with the physician what they are actually doing. The appearance of unexpected toxicity may be an indication that a supplemental therapy is being information about unsound methods may be obtained from the National Council Against Health Fraud Box 1276 Loma Linda