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The purpose of this study is to identify psychiatric disorders and stress factors experienced by staff members in cancer hospitals who were referred to psychiatric consultation service, and to investigate the association between psychiatric disorders and stress factors.
A retrospective descriptive study using clinical practice data on staff members referred to psychiatric consultation service, obtained for 8 years, was conducted at two National Cancer Center Hospitals in Japan. Psychiatric disorders were identified according to DSM-IV. Stress factors were extracted from a chief complaint at the initial visit in medical charts, using a coding approach, and grouped as job stress or personal stress. The frequencies of the stress factors were determined by two coders who were unaware of the categorized procedure. Fisher's exact test was used to determine the association between psychiatric disorders and stress factors.
Of 8077 psychiatric consultations, 65 (1%) staff members were referred. The most common psychiatric disorder was adjustment disorder (n = 26, 40%), followed by major depression (n = 17, 26%). Eight stress factors were identified from 76 meaning units and were grouped into five job stresses and three personal stresses. Of the five job stresses, four were most frequently experienced in adjustment disorders, and “failure to adapt to job environmental change” was significantly associated (p = 0.014). Two of the three personal stresses were most frequently experienced in psychiatric disorders other than major depressive disorder and adjustment disorders, and “suffering from mental disease” was significantly associated (p = 0.001).
Significance of results:
We found that very few staff members were provided with psychiatric consultation service. A comprehensive support system for job stress might be needed to prevent adjustment disorders, as those are suggested to be the most common psychiatric disorders among staff members in cancer hospitals.
Psychological distress of cancer patients' family members is treated by psychiatric consultation service for outpatients at National Cancer Center Hospitals in Japan. The purpose of this study was to identify psychiatric disorders and explore background characteristics of cancer patients' family members referred to psychiatric consultation service, so that we could better understand current utilization of this psychiatric consultation service for cancer patients' family members.
A retrospective descriptive study using clinical practice data obtained for 5 years (from January 2000 to December 2004) was conducted at two National Cancer Center Hospitals. We reviewed the psychiatric consultation database, computerized patient database of the National Cancer Center Hospitals, and medical charts of cancer patients' family members who were referred to psychiatry and their cancer patients.
Out of a total of 4992 psychiatric consultations, 118 (2%) were for cancer patients' family members. The most common psychiatric disorders among cancer patients' family members were adjustment disorders (n = 69, 58%), followed by major depression (n = 30, 25%). Female (n = 101, 86%), spouse (n = 87, 74%), married (n = 92, 78%), and housewife (n = 63, 53%) were the most common background characteristics of the family members. Sixty-four percent of cancer patients (n = 75) were hospitalized at the time of their family members' referral and 34% of cancer patients (n = 40) had already received psychiatric consultation service and 55% of cancer patients (n = 65) had delivered bad news prior to their family members' referral.
Significance of the research:
We found that very few family members were provided with psychiatric consultation service at two National Cancer Center Hospitals. Adjustment disorders are suggested to be the most common psychiatric disorders among cancer patients' family members.
Objective: Although depression is a prevalent and burdensome
psychiatric problem in end-of-life cancer patients, little is known about
its susceptibility to treatment, especially when patients reach very close
to the end of life. This study was conducted to evaluate response rate of
that end-of-life depression to psychiatric intervention and to assess the
feasibility of conventional evidence-based pharmacological therapy for
Methods: The medical records of 20 patients who were referred
to the psychiatry division for major depressive disorder and died within 3
months after the referral were reviewed. The Clinical Global
Impression–Improvement (CGI-I) Scale was used for each case, and
responders were defined as patients whose scores were much or very much
improved. All pharmacological treatments were extracted, and the doses of
the antidepressant prescribed were compared to their
evidence-based-defined therapeutic doses.
Results: Of the 20 patients, seven were responders, but no
response was achieved when the survival time was less than 3 weeks. Most
patients were treated with antidepressants, but the doses prescribed were
far less than the defined doses, especially the doses of the tricyclic
Significance of results: These results suggested that
patients' survival time largely determines susceptibility to
psychiatric treatment, and it is hard to achieve response in patients
whose survival time was less than about 1 month. Implementation of
conventional evidence-based pharmacological treatment is difficult,
especially with TCAs, and various antidepressants, which can be
administrated by other routes, are needed when oral intake is
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