Depression in Advanced Cancer Patients

Transcription

Depression in Advanced
Cancer Patients
Bunty Anderson, BSW
Clinician, Psychosocial Oncology,
CancerCare Manitoba, SBGH Site
CCPN Provincial Conference
September 30, 2011
GOALS
What
are the most salient points to
cover in the short time we have?
DEPRESSION

1) How prevalent is depression?

2) What increases a patent’s vulnerability?

3) Differentiating depression from vegetative
signs of illness….and…..
4) Differentiating depression from grief.
5) and if we have time = thoughts on
compliance.
DEPRESSION
The
material presented today is
taken from clinical experience and
EPEC-O Canada. (Education in
Palliative and End of Life Care for
Oncology Health Professionals)
QUICK REVIEW ON WHAT
DEPRESSION LOOKS LIKE
Depressed
Mood
Anhedonia
(loss of pleasure or
interest)
>
2 weeks duration
DEPRESSION

Irritability
Changes in appetite or weight
Sleep
Psychomotor

activity
Decreased Energy
Guilt/Worthlessness
Helplessness, Hopelessness
DEPRESSION
DIFFICULTY:

Thinking
Concentrating
Making decisions
Suicidal ideation or a wish to hasten death
How
prevalent is depression in
patients with advanced disease?
PREVALENCE
Up
to 58% of cancer patients
RISK FACTORS

What increases vulnerability?

Poorly controlled pain.

Progressive physical impairment.

Advanced disease.

Medications: (e.g.) Steroids, Chemotherapeutics.
RISK FACTORS

Particular diseases:

Pancreatic, Breast, Lung, CNS metastases

Younger age

Spiritual pain

Conflicts over issues of meaning, guilt and
fear
TREATMENT
SSRI’s:
Lower side effect profile.
Psycho
stimulants to hasten
response in palliative population.
Medication
results.
and counselling get best
DEPRESSION and VEGETATIVE
SIGN OF ILLNESS

SIMILARITIES:
Eating
changes
Sleeping changes
Libido changes
Fatigue
Difficulty concentrating
Trouble with decision making
Low mood/withdrawn
DEPRESSION vs ILLNESS
DIFFERENCES:
Persistent
weepiness
Increase Irritability
Social avoidance
Hopelessness: “Why Bother?”
Suicidality
Anhedonia
SIMPLE ASSESSMENT
QUESTIONS
1)
Do you feel depressed most of the
time?
2)
Are you able to take pleasure in
the thing’s you normally have
enjoyed?
ASSESSMENT
Involve
What
the family where possible
are they seeing?
DEPRESSION? or GRIEF?
With
grief, feelings of sadness and
low mood are episodic.
Pleasure
Warmth,
can still be experienced.
affection and emotional
presence comforts the bereaved.
WITH DEPRESSION
Low
mood is pervasive and
oppressive.
Pleasure
Others
is absent. (anhedonia)
do not bring comfort.
ASSESSMENT QUESTION
1)
Does your low mood come and
go?
2)
Can you still take pleasure in
things you’ve enjoyed in the past?
DISPELLING MYTHS
By
educating the patient, we can
increase compliance.
Time
for Questions / Discussion