Psychological Aspects in Malignancy น พ อลงกรณ เถกงศกดากล

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Psychological Aspects in Malignancy น. พ. อลงกรณ เถกงศกดากล จตแพทย

Outlines • Common scenario • Kubler-Ross model (5 stages of grief) • Response strategy • Depression & Suicide

Annual check up F/U for other problems Minor illness Suspected for malignancy

(Suspected) MALIGNANCY !!

Malignancy = DEATH

Diagnosis Is it sure ? How to get actual diagnosis ? How long to get actual diagnosis ? Pain ? Cost ?

Treatment How ? Invasive ? Cost ? Side effects ? Options ? Pain & Suffer ? Travelling ? Appearance ?

Life Disability ? Dependence ? Job ? Lifestyles ? Hobbies ? House ? Car ? Family ? Pets ? Debt ?

Elisabeth Kubler-Ross (1926 -2004) Swiss psychiatrist Kubler-Ross model (5 stages of grief) 1) 2) 3) 4) 5) Denial & Shock Anger Bargaining Depression Acceptance Kübler-Ross, E. (2003). On death and dying. 1969. New York: Scribner’s.

Kubler-Ross model 1) Denial & Shock § Confused, Shock, Freezing § Need time for understand what is going on (minutes to forever) 2) Anger § WHY ME ? !? § Angry at previous doctor, current doctor, family, genetic, environment, GOD § Angry at his/herself Kübler-Ross, E. (2003). On death and dying. 1969. New York: Scribner’s.

Kubler-Ross model 3) Bargaining § Overpolite patients § Treatment : Herb, Chinese medicine, Alternative medicine § Supernatural : GOD, Shaman 4) Depression § Helpless, Hopeless and Worthless 5) Acceptance Kübler-Ross, E. (2003). On death and dying. 1969. New York: Scribner’s.

Not always linear / Can reversed

New wave of palliative care • Complexity of mind – Can’t be separated – Not present orderly • Mixed of mood • Missing some emotions – Fear – Humor Buckman, R. (2000). Communication in palliative care. Death, dying and bereavement, 146.

What should we do ?

Response strategy 1) Denial & Shock § Empathy / Don’t force patient to face reality § Time & space for understand § Some patients need 2 nd opinion 2) Anger § § Beware of physician’s anger ** Kindness & Calm Reflect feeling & expectations Goal directed = plan for management Stern, T. A. , Fricchione, G. L. , & Rosenbaum, J. F. (2010). Massachusetts General Hospital Handbook of General Hospital Psychiatry-E-Book. Elsevier Health Sciences.

Response strategy 3) Bargaining § Options : choose freely in the area of safety § Choice maker & Responsibility 4) Depression § Support / Don’t blame § Screening and refer to specialist 5) Acceptance § Praise & Anchoring positive parts Stern, T. A. , Fricchione, G. L. , & Rosenbaum, J. F. (2010). Massachusetts General Hospital Handbook of General Hospital Psychiatry-E-Book. Elsevier Health Sciences.

Depression & Suicide

Depression In the group of cancer patients

Depression Rate of major depression in cancer patient ≈ 38% Massie MJ. Prevalence of depression in patients with cancer, J Natl Cancer Inst Monogr, 2004, vol. 32 (pg. 57 -71)

Depression Rate of depression spectrum disorder in cancer patient ≈ 58% Massie MJ. Prevalence of depression in patients with cancer, J Natl Cancer Inst Monogr, 2004, vol. 32 (pg. 57 -71)