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Psychiatric Emergencies

  • Seema M. ThekdiEmail author
  • Sara Wood
Part of the MD Anderson Cancer Care Series book series (MDCCS)

Abstract

The goal of this chapter is to provide an overview of the psychiatric emergencies that develop in cancer patients. In the section on agitation, a differential diagnosis is provided and discussed, as are workup and intervention strategies. Causes of agitation in the oncology setting are reviewed, specifically, delirium, adverse medication effects, substance intoxication and withdrawal, and exacerbation of psychiatric disorders. Specific medical and psychiatric conditions that may manifest as agitation in the cancer patient are detailed. Approaches to both nonpharmacologic and pharmacologic management of the agitated cancer patient are included. The ensuing section on suicide provides an understanding of the prevalence of suicide in cancer patients, risk factors associated with increased rates of suicide, and critical time points in the course of cancer treatment when clinical monitoring of suicidality and depression should be heightened. Tips on screening and evaluation as well as initial management steps are presented.

Keywords

Agitation Delirium Antipsychotics Substance intoxication and withdrawal Psychosis Depression Suicide Suicidal ideation, intent, and plan Suicide risk assessment 

Suggested Readings

  1. Boettger S, Breitbart W. Atypical antipsychotics in the management of delirium: a review of the empirical literature. Palliat Support Care. 2005;3:227–37.CrossRefPubMedGoogle Scholar
  2. Breitbart W, Alici Y. Delirium. In: Holland JC, Breitbart W, Jacobsen PB, Lederberg MS, Loscalzo MJ, McCorkle R, editors. Psycho-oncology. 2nd ed. New York, NY: Oxford University Press; 2010. p. 332–9.CrossRefGoogle Scholar
  3. Breitbart W, Marotta R, Platt MM, et al. A double-blind trial of haloperidol, chlorpromazine, and lorazepam in the treatment of delirium in hospitalized AIDS patients. Am J Psychiatry. 1996;153:231–7.CrossRefPubMedGoogle Scholar
  4. Breitbart W, Gibson C, Tremblay A. The delirium experience: delirium recall and delirium-related distress in hospitalized patients with cancer, their spouses/caregivers, and their nurses. Psychosomatics. 2002;43:183–94.CrossRefPubMedGoogle Scholar
  5. Damek DM. Cerebral edema, altered mental status, seizures, acute stroke, leptomeningeal metastases, and paraneoplastic syndrome. Emerg Med Clin North Am. 2009;27:209–29.CrossRefPubMedGoogle Scholar
  6. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
  7. Duffy J, Valentine A. Delirium. In: The MD Anderson handbook of psychosocial oncology. New York, NY: McGraw-Hill; 2013.Google Scholar
  8. Erkinjuntti T, Wikstrom J, Palo J, Autio L. Dementia among medical inpatients. Evaluation of 2000 consecutive admissions. Arch Intern Med. 1986;146:1923–6.CrossRefPubMedGoogle Scholar
  9. Fleishman S, Lesko L, Breitbart WS. Treatment of organic mental disorders in cancer patients. In: Psychiatric aspects of symptom management in cancer patients. Washington, DC: American Psychiatric Press; 1993. p. 23–47.Google Scholar
  10. Franco K, Litaker D, Locala J, Bronson D. The cost of delirium in the surgical patient. Psychosomatics. 2001;42:68–73.CrossRefPubMedGoogle Scholar
  11. Gaudreau JD, Gagnon P, Harel F, Roy MA, Tremblay A. Psychoactive medications and risk of delirium in hospitalized cancer patients. J Clin Oncol. 2005;23:6712–8.CrossRefPubMedGoogle Scholar
  12. Gerlach AT, Murphy CV, Dasta JF. An updated focused review of dexmedetomidine in adults. Ann Pharmacother. 2009;43:2064–74.CrossRefPubMedGoogle Scholar
  13. Helmstaedter C, Fritz NE, Kockelmann E, Kosanetzky N, Elger CE. Positive and negative psychotropic effects of levetiracetam. Epilepsy Behav. 2008;13:535–41.CrossRefPubMedGoogle Scholar
  14. Inouye SK. Delirium in older persons. N Engl J Med. 2006;354:1157–65.CrossRefPubMedGoogle Scholar
  15. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med. 1990;113:941–8.CrossRefPubMedGoogle Scholar
  16. Jacobson S, Jerrier H. EEG in delirium. Semin Clin Neuropsychiatry. 2000;5:86–92.PubMedGoogle Scholar
  17. Janicak PG, Davis JM, Preskorn SH, Ayd Jr FJ. Principles and practice of psychopharmacotherapy. 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 1997.Google Scholar
  18. Lawlor PG, Gagnon B, Mancini IL, et al. Occurrence, causes, and outcome of delirium in patients with advanced cancer: a prospective study. Arch Intern Med. 2000a;160:786–94.CrossRefPubMedGoogle Scholar
  19. Lawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED. Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: assessing delirium in advanced cancer. Cancer. 2000b;88:2859–67.CrossRefPubMedGoogle Scholar
  20. Lipowski ZJ. Delirium (acute confusional states). JAMA. 1987;258:1789–92.CrossRefPubMedGoogle Scholar
  21. Maldonado JR. Delirium in the acute care setting: characteristics, diagnosis and treatment. Crit Care Clin. 2008;24:657–722.CrossRefPubMedGoogle Scholar
  22. Mayo-Smith MF. Pharmacological management of alcohol withdrawal. A meta-analysis and evidence-based practice guideline. American Society of Addiction Medicine Working Group on Pharmacological Management of Alcohol Withdrawal. JAMA. 1997;278:144–51.CrossRefPubMedGoogle Scholar
  23. Miller M, Mogun H, Azrael D, Hempstead K, Solomon DH. Cancer and the risk of suicide in older Americans. J Clin Oncol. 2008;26:4720–4.CrossRefPubMedGoogle Scholar
  24. Misono S, Weiss NS, Fann JR, Redman M, Yueh B. Incidence of suicide in persons with cancer. J Clin Oncol. 2008;26:4731–8.PubMedCentralCrossRefPubMedGoogle Scholar
  25. Nock MK, Hwang I, Sampson NA. Mental disorders, comorbidity and suicidal behavior: results from the national comorbidity survey replication. Mol Psychiatry. 2009;15:868–76.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Pessin S, Amakawa L, Breitbart WS. Suicide. In: Holland JC, editor. Psycho-oncology. New York, NY: Oxford University Press; 2010. p. 319–23.CrossRefGoogle Scholar
  27. Peterson JF, Pun BT, Dittus RS, et al. Delirium and its motoric subtypes: a study of 614 critically ill patients. J Am Geriatr Soc. 2006;54:479–84.CrossRefPubMedGoogle Scholar
  28. Roth AJ, Levenson JA. Psychiatric emergencies. In: Holland JC, Greenberg DB, Hughes MK, editors. Quick reference for oncology clinicians: the psychiatric and psychological dimensions of cancer symptom management. Charlottesville, VA: IPOS Press; 2006.Google Scholar
  29. Roth AJ, Weiss TR. Psychiatric emergencies. In: Holland JC, Breitbart WS, Jacobsen PB, Lederberg MS, Loscalzo MJ, McCorkle R, editors. Psycho-oncology. 2nd ed. New York, NY: Oxford University Press; 2010. p. 297–302.CrossRefGoogle Scholar
  30. Schulberg HC, Bruce ML, Lee PW, Williams Jr JW, Dietrich AJ. Preventing suicide in primary care patients: the primary care physician’s role. Gen Hosp Psychiatry. 2004;26:337–45.CrossRefPubMedGoogle Scholar
  31. Sood A, Barton DL, Loprinzi CL. Use of methylphenidate in patients with cancer. Am J Hosp Palliat Care. 2006;23:35–40.CrossRefPubMedGoogle Scholar
  32. Spoletini I, Gianni W, Caltagirone C, Madaio R, Repetto L, Spalletta G. Suicide and cancer: where do we go from here? Crit Rev Oncol Hematol. 2011;78:206–19.CrossRefPubMedGoogle Scholar
  33. Trzepacz PT, Meagher DJ. Delirium. In: Levenson JL, editor. Textbook of psychosomatic medicine. Washington, DC: American Psychiatric Publishing; 2005. p. 91–130.Google Scholar
  34. Trzepacz PT, Mittal D, Torres R, Kanary K, Norton J, Jimerson N. Validation of the delirium rating scale-revised-98: comparison with the delirium rating scale and the cognitive test for delirium. J Neuropsychiatry Clin Neurosci. 2001;13:229–42.CrossRefPubMedGoogle Scholar
  35. Trzepacz P, Breitbart WS, Franklin J, Levenson J, Martini D, Wang P. Practice guideline for the treatment of patients with delirium. In: McIntyre JS, Charles SC, editors. Practice guidelines for the treatment of psychiatric disorders: compendium 2004. Arlington, VA: American Psychiatric Association; 2004. p. 29–66.Google Scholar
  36. Van Leeuwen PJ, Schroder FH. Risk factors: increased risk of suicide after prostate cancer diagnosis. Nat Rev Urol. 2010;7:369–70.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  1. 1.Department of Psychiatry, Unit 1454The University of Texas MD Anderson Cancer CenterHoustonUSA

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