abstract: Psychiatric morbidity in gynecological outpatients

Psychiatric morbidity in gynecological outpatients - Judd - 2012 - Journal of Obstetrics and Gynaecology Research

Abstract

Aim:  To assess the prevalence of depression and anxiety in women presenting with gynecological symptoms, to determine how many women with these disorders were receiving treatment for them, and to investigate risk factors for these disorders.

Method:  Two hundred and sixty-four women seeking medical care from gynecology clinics at a specialist women's hospital completed a self-report questionnaire asking about sociodemographics, physical and mental health, personality (neuroticism) and psychosocial stressors.

Results:  A total of 91 women met the diagnostic criteria for one or more Patient Health Questionnaire (PHQ) diagnosis. Forty-six (17.4%) met criteria for major depressive disorder (MDD), 15 (5.7%) for panic disorder (PD) and 73 (27.7%) for generalized anxiety disorder (GAD). Thirty-nine (42.9%) of the 91 women met criteria for two or more disorders. An additional 23 (8.7%) met DSM-IV-TR criteria for minor (sub-threshold) depression. Fifty percent with MDD, 4% with minor depression, 53% with PD and 22% with GAD reported they were receiving treatment. Psychosocial stressors and the neuroticism score were risk factors for both anxiety and depression.

Conclusions:  Anxiety and depression are common amongst women attending a gynecology clinic. Clinicians should be alert to the possibility of these disorders and make specific enquiries about their emotional wellbeing.

abstract: Oncologist Burnout: Causes, Consequences, and Responses

Oncologist Burnout: Causes, Consequences, and Responses

 Abstract

"Although the practice of oncology can be extremely rewarding, it is also one of the most demanding and stressful areas of medicine. Oncologists are faced with life and death decisions on a daily basis, administer incredibly toxic therapies with narrow therapeutic windows, must keep up with the rapid pace of scientific and treatment advances, and continually walk a fine line between providing palliation and administering treatments that lead to excess toxicity. Personal distress precipitated by such work-related stress may manifest in a variety of ways including depression, anxiety, fatigue, and low mental quality of life. Burnout also seems to be one of the most common manifestations of distress among physicians, with studies suggesting a prevalence of 35% among medical oncologists, 38% among radiation oncologists, and 28% to 36% among surgical oncologists. Substantial evidence suggests that burnout can impact quality of care in a variety of ways and has potentially profound personal implications for physicians including suicidal ideation. In this review, we examine the causes, consequences, and personal ramifications of oncologist burnout and explore the steps oncologists can take to promote personal well-being and professional satisfaction."

Medscape: The Case for Retaining Bereavement Exclusion

"....
"The evidence suggests that the excluded episodes are best considered a normal variation in bereavement and not a mental disorder," he added.
Reflection Advisable
In an accompanying editorial, Mario Maj, MD, PhD, of the Department of Psychiatry, University of Naples, Italy, and chairperson of the World Health Organization Working Group on the Classification of Mood and Anxiety Disorders, concludes that the removal of the BE from the diagnosis of major depressive episode can only be justified by "strong and unequivocal new research evidence. Wakefield and First's review...suggests that such a solid and consistent new evidence is not available."
"Further reflection," Dr. Maj writes, "seems therefore warranted before proceeding with the deletion of the bereavement exclusion.".....

Depression’s Criteria May Be Changed to Include Grieving - When does a broken heart become a diagnosis? NYTimes.com

"In a bitter skirmish over the definition of depression, a new report contends that a proposed change to the diagnosis would characterize grieving as a disorder and greatly increase the number of people treated for it.

The criteria for depression are being reviewed by the American Psychiatric Association, which is finishing work on the fifth edition of its Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., the first since 1994. The manual is the standard reference for the field, shaping treatment and insurance decisions, and its revisions will affect the lives of millions of people for years to come......"

Expanding the Definition of Depression - Does grieving over a loved one constitute full-blown depression? NYTimes.com

abstract : The effect of sleep disturbance on quality of life in women with ovarian cancer

"PSQI was not correlated with age, time since diagnosis, number of previous chemotherapy regimens. PSQI score did not differ by current disease or chemotherapy status."

Highlights

► Ovarian cancer patients have a high prevalence of sleep disturbances and poor sleep quality.
► Sleep disturbances are associated with decreased quality of life and increased depression.

Treating Depression with Anti-Inflammatory Agents > CMELLC - Life Long Learning > Treating the Whole Patient

Note: interesting discussion regarding aspirin (anti-inflammatory) and depression

Depression and anxiety in people with physical illness - Special Collection - The Cochrane Library (includes references to the Cochrane Gyn Group/research papers)

eMedicine: Selective Serotonin Reuptake Inhibitors and CYP2D6: eMedicine Genomic Medicine (anxiety/depression)

Host Factors and Cancer Progression: Biobehavioral Signaling Pathways and Interventions — JCO

Abstract

Whereas evidence for the role of psychosocial factors in cancer initiation has been equivocal, support continues to grow for links between psychological factors such as stress, depression, and social isolation and progression of cancer. In vitro, in vivo, and clinical studies show that stress- related processes can impact pathways implicated in cancer progression, including immuno-regulation, angiogenesis, and invasion. Contributions of systemic factors, such as stress hormones to the crosstalk between tumor and stromal cells, appear to be critical in modulating downstream signaling pathways with important implications for disease progression. Inflammatory pathways may also be implicated in fatigue and other factors related to quality of life. Although substantial evidence supports a positive effect of psychosocial interventions on quality of life in cancer, the clinical evidence for efficacy of stress-modulating psychosocial interventions in slowing cancer progression remains inconclusive, and the biobehavioral mechanisms that might explain such effects are still being established. This article reviews research findings to date and outlines future avenues of research in this area.

JAMA -- Abstract: Effect of Telecare Management on Pain and Depression in Patients With Cancer: A Randomized Trial, July 14, 2010

Conclusion
Centralized telecare management coupled with automated symptom monitoring resulted in improved pain and depression outcomes in cancer patients receiving care in geographically dispersed urban and rural oncology practices.

A Longitudinal Investigation of Psychological Disorders in Patients Prior and Subsequent to a Diagnosis of Ovarian Cancer

Cancer Symptom Clusters: Old Concept But New Data

Abstract:
Individuals with cancer have multiple symptoms, which frequently co-occur. A nonrandom distribution of symptoms suggests a common mechanism. Symptom clusters (SCs) were considered part of various syndromes in the early years of medicine. The SC concept in clinical medicine is old. Symptom clusters were commonly described in the psychology/psychiatry and neurology literature. Symptom cluster may be defined either clinically or statistically. Statistically derived clusters can differ from clinically defined clusters. The clinical importance of statistically derived clusters is unclear. Pain-insomnia-fatigue and pain-depression-fatigue are commonly recognized clinical clusters. Nausea-vomiting and anxiety-depression are also statistically observed clusters.

Difficulty Accepting a Terminal Prognosis Linked with Depression, Anxiety, and Suffering -- A Cancer Journal for Clinicians

Note: VERY SENSITIVE TOPIC Dissenting Opinion
Not all clinicians agree with the foregoing interpretations of these findings. "I've certainly seen people who denied dying up to their last breath and somehow never accepted it," Dr. Holland tells CA. "Were they more upset? I'm not sure."
She cautioned against allowing the findings by Dr. Thompson and colleagues to set a tone in which nonaccepting patients are viewed as dysfunctional. Death is as individualized as is life, she argues, invoking Sir William Osler, who said "Basically, people die as they have lived."

Difficulty Accepting a Terminal Prognosis Linked with Depression, Anxiety, and Suffering - A Cancer Journal for Clinicians

Dissenting Opinion:

"Not all clinicians agree with the foregoing interpretations of these findings. "I've certainly seen people who denied dying up to their last breath and somehow never accepted it," Dr. Holland tells CA. "Were they more upset? I'm not sure."
She cautioned against allowing the findings by Dr. Thompson and colleagues to set a tone in which nonaccepting patients are viewed as dysfunctional."