Psych Vivas · Consultation-liaison psychiatry
Psycho-oncology — structured clinical viva
Fellowship viva covering distress/depression/demoralisation/delirium/steroid toxicity, SMaRT collaborative care, Kelly interaction, Agar palliative delirium, Temel/Breitbart interfaces, and capacity.
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Interpretation
Reveal interpretationShowHide
Open with a syndrome map, not a single label. Hold major depression, demoralisation, steroid neurotoxicity, and possible nocturnal delirium as concurrent possibilities in advanced lung cancer.[5]
Risk first. Passive or active wish to die after cancer requires structured suicide assessment; Fang data support elevated risk after diagnosis — safety planning, means, observation intensity, and treatable depression/delirium work-up.[6]
Depression care. Name SMaRT Oncology-2 (mixed cancers) and SMaRT Oncology-3 (lung/poor prognosis) collaborative care for major depression outcomes.[1][2]
Steroids. Link sleepless irritability to dexamethasone; reduce if safe; short-term safety pharmacology only if danger.[5]
Reject QID haloperidol as delirium cure. Cite Agar: antipsychotics worse than placebo for palliative delirium symptoms — non-drug care and cause treatment first.[3]
If tamoxifen stem appears. Avoid paroxetine/fluoxetine (Kelly).[4]
Therapies. Meaning-centred psychotherapy is a structured, trial-supported intervention for advanced cancer well-being — not vague reassurance.[7] Early palliative care improves QoL/mood in metastatic NSCLC (Temel).[8]
Capacity. Decision-specific for treatment choices and end-of-life plans; reassess after optimising delirium/steroid/mood factors.[5]
References8ShowHide
- [1]Sharpe M, Walker J, Holm Hansen C, et al. Integrated collaborative care for comorbid major depression in patients with cancer (SMaRT Oncology-2): a multicentre randomised controlled effectiveness trial Lancet, 2014.PMID 25175478
- [2]Walker J, Hansen CH, Martin P, et al. Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): a multicentre randomised controlled trial in patients with lung cancer Lancet Oncol, 2014.PMID 25175097
- [3]Agar MR, Lawlor PG, Quinn S, et al. Efficacy of Oral Risperidone, Haloperidol, or Placebo for Symptoms of Delirium Among Patients in Palliative Care: A Randomized Clinical Trial JAMA Intern Med, 2017.PMID 27918778
- [4]Kelly CM, Juurlink DN, Gomes T, et al. Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: a population based cohort study BMJ, 2010.PMID 20142325
- [5]Warrington TP, Bostwick JM Psychiatric adverse effects of corticosteroids Mayo Clin Proc, 2006.PMID 17036562
- [6]Fang F, Fall K, Mittleman MA, et al. Suicide and cardiovascular death after a cancer diagnosis N Engl J Med, 2012.PMID 22475594
- [7]Breitbart W, Rosenfeld B, Pessin H, et al. Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer J Clin Oncol, 2015.PMID 25646186
- [8]Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer N Engl J Med, 2010.PMID 20818875