Psycho-oncology

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Red flags

• New confusion or fluctuating inattention in a cancer patient — treat as delirium until proven otherwise; do not start antidepressants alone
• Active suicidal ideation after a new or progressive cancer diagnosis — early post-diagnosis period is high risk
• Paroxetine or fluoxetine co-prescribed with tamoxifen — strong CYP2D6 inhibition may reduce endoxifen exposure
• High-dose corticosteroids with acute mania, psychosis, or severe insomnia — consider steroid neurotoxicity before a primary bipolar label
• Routine antipsychotics for palliative delirium without non-drug care — Agar RCT showed worse symptom scores than placebo
• Treatment refusal or major financial decisions while delirious, manic on steroids, or severely depressed without capacity assessment
• Uncontrolled pain, hypercalcaemia, hyponatraemia, brain metastases, or infection presenting as 'depression' or 'agitation'