Depression at oncological patients
Depression at oncological patients – the symptomatic depressive frustration caused by the experience of a serious illness, neurohumoral changes caused by growth of a tumor or negative impact of an onkoterapiya. Main symptoms: tearfulness, sleeplessness, loss of appetite, fatigue, irritability, uneasiness, social isolation, feeling of helplessness, uselessness, hopelessness. The diagnosis is established on the basis of data of observation, a clinical conversation and psychological testing. For treatment medicamentous means, psychotherapy are used.
Depression at oncological patients
The depression problem at oncology is actively investigated for the last decades. The return correlation between weight of this frustration and survival of patients is established. Prevalence of a depression is defined by localization of a tumor: a pancreas, adrenal glands, a brain – to 50%, mammary glands – 13-23%, female genitals – 23%, a large intestine – 13-25%, a stomach – 11%, a rotoglotka – 22-40%. In group of the increased risk – the young people, patients who are on palliative treatment and the patients having affective frustration in the anamnesis. Complex medico-psychological assistance by the depressive patient improves efficiency of the main therapy.
The depression reasons at oncological patients
The depression at an oncological disease can have mainly neurotic or somatogenic origin. The exact reasons to establish quite difficult as the emotional condition of the patient is result of his perception of a disease, the biochemical shifts caused by development of a new growth, application beam and chemotherapy. The factors promoting a depression can be grouped as follows:
- Psychological. News of a disease becomes the psychoinjuring event. The depression is formed because of deterioration of life – pains, the exhausting medical procedures, stay in a hospital, uncertainty of the future, risk of a lethal outcome.
- Physiological. The tumors located in endocrine glands and nervous tissue change neurohumoral regulation, it is shown by emotional and is moved chesky frustration. Cages of new growths of any localization emit toxic substances which negatively influence work of nervous system.
- Therapeutic. Long deterioration in health when using himio-and radiation therapy – nausea, vomiting, weakness, inability to concentrate, conduct a conversation, provokes a depression to carry out daily affairs. At use of some medicines it is possible side effect.
At oncological patients the depression develops as result of a psychotrauma, long stress, neuroendocrine violations. After confirmation of the diagnosis of cancer there is resistance stage – patients refuse to trust doctors, become irritable, irascible, demand additional inspections. Then the depression phase is inevitable – information on a disease is accepted, prospects are estimated is pessimistic regardless of the real forecast. At the physiological level exchange of biogenous amines (neurotransmitters) – serotonin, noradrenaline and gamma aminooleic acid is broken. Speed and an orientation of momentum transfer changes that is shown by decrease in mood and working capacity. Other mechanism of development of a depression – increase in activity gipotalamo-adrenalovo-nadpochechnikovoy axes, caused by development of a tumor in endocrine glands or a brain, existence of a pain syndrome, cancer intoxication.
Depression symptoms at oncological patients
Patients are in the suppressed mood, test fatigue, depression. They become not contact, answer questions of doctors and relatives monotonously, in monosyllables. Communication even with the closest people weighs. Patients find pretexts for the termination of a conversation – fatigue, feeling sick, need to have a sleep, leave on procedures. At the heavy course of a depression communication completely is absent, patients turn away from interlocutors, silently go to other room. The depression badly affects efficiency of the main treatment, slows down recovery process. Patients refuse procedures, ask to transfer them for an indefinite term, pleading fatigue, the need for rest, need to go to other city on affairs. Do not observe the mode recommended by the doctor, do not eat food, speak about lack of appetite.
The speech and thought processes are slowed down. The heavy depression is shown by apathy, unwillingness to get out of a bed, lack of interest to surrounding and to earlier carrying away occupations. Patients do not come for walks, do not read the book. Can look for days on end at the screen of the TV or for a window, but the events do not perceive, do not remember. Any movements carry out with a great effort, need assistance for commission of medical and hygienic procedures, meal. Sometimes refuse to wash, have a shave, change clothes of clothes. The condition of a depression considerably complicates holding clinical poll, patients poorly describe health, are inclined to confirm or on the contrary to disprove all assumptions of the doctor (everything hurts, hurts everywhere).
The depression at oncological pathology is capable to result in suicide behavior. Patients with a late stage of cancer when the hope for recovery is lost treat group of high risk on commission of suicide, and death is perceived as an inevitable event. Other factors increasing probability of a suicide are the severe pains which are not giving in to medicamentous correction, nervous exhaustion, fatigue, inefficiency of the main therapy, the adverse medical forecast, sharp disorder of consciousness, lack of control of behavior.
Detection of a depression at patients with an oncopathology – the psychiatrist's task. Patients extremely seldom ask for the help, examination is conducted at the initiative of relatives or the attending physician. Diagnostics is aimed at detection of characteristic symptoms, assessment of expressiveness of emotional frustration, determination of risk of suicide behavior. The following methods are applied:
- Clinical conversation. Survey of the patient, relatives is conducted. The main complaints – the suppressed mood, tearfulness, apathy, refusal of food, medical actions. The patient reluctantly keeps up the conversation, answers in monosyllables.
- Observation. The psychiatrist estimates features of behavior, emotional reactions of the patient. Sluggishness, slackness, lack of motivation to inspection is characteristic.
- Psychodiagnostics. In view of bystry fatigue, exhaustion of patients express techniques are used: questionnaire of a depression of Beck, questionnaire of depressions (QD) and others. The test of color elections (Lyusher's test), the drawing of the person is in addition carried out.
Treatment of a depression at oncological patients
The help to oncological patients with a depression is directed to knocking over of symptoms, of which apathy, and also on restoration of social activity, change of the relation to a disease, to the future is key. Treatment and rehabilitation are performed by efforts of the psychiatrist, psychotherapist, relatives. An integrated approach includes:
- Individual psychotherapy. Sessions are held in the form of a confidential conversation. Technicians of cognitive and existential psychotherapy whose purpose – to bring the patient to judgment of a disease, its influences on life, to understanding of basic values, accepting liability for the state are used.
- Visit of support groups. Communication with other patients helps to overcome despair, feeling of loneliness and alienation. Elimination of a depression is promoted by open discussion of the difficulties connected with a disease and process of treatment, receiving emotional support, exchange of experience of overcoming crisis.
- Application of medicines. The scheme of treatment is defined by the psychiatrist individually with the used chemotherapeutic medicines, expressiveness and characteristics of a depression. Psychoexcitants, neuroleptics, tranquilizers, antidepressants are appointed analeptical.
- Family consultations. Psychological assistance is also necessary for close relatives of the patient. The psychotherapist leads discussions, makes recommendations of change of the relations with the patient. Support has to promote restoration of activity, a positive spirit, it is important not to substitute it for pity and hyper guardianship.
Forecast and prevention
The course of a depression depends on a set of factors: age of the patient, stage of cancer, efficiency of treatment, presence of relatives. The forecast is defined individually, but the probability of restoration of a normal emotional state is higher with complex support of medical experts and close people. For the prevention of a depression it is necessary to stimulate positive emotions and social activity of the patient. It is necessary to talk, listen, support, involve it in interesting occupations (games, cooking, viewing of comedies with discussion), to compensate a lack of activity – to help to organize daily rituals, walks, meetings with friends, visits of movie theater.