Cancer treatment and associated psychiatric problems

The side effects of chemotherapy, especially the loss of hair, can lead to serious psychological problems. The patient needs to be informed in advance about the side effects, the mechanisms of likely problems, whether the symptoms are reversible or not, and their duration. Discussing these issues with the patient minimises the risk of psychological problems.

There are various precautions that can be taken against nausea caused by chemotherapy. It is a known fact that nausea and vomiting are very effective in creating conditioned reflexes. Some patients who are no longer on chemotherapy, still get the urge to vomit whenever they are confronted with anything that reminds them of the chemotherapy. This condition can continue for many more months after chemotherapy comes to an end. In psychotherapy a behavioural approach is recommended to overcome this situation. The techniques used are desensitisation and relaxation.

Radiotherapy can affect short-term memory and can lead to a loss of IQ in the order of 10-25 points. Other side effects of radiotherapy are cicatrix in the vaginal wall of women and impotence in men. In spite of these facts it is possible to take certain precautions to help remove these side effects. It is advisable to bravely voice such complaints so that treatment options can be found. For example, vaginal dilatation and dyspareunia (painful sexual intercourse) can easily be treated.

The toxicity of chemotherapeutics on the CNN (Central Nervous System) can establish itself directly or indirectly through metabolic disturbances or damage to various organs. For example, if these drugs are administered intrathecal (into the spine) the patient may initially experiences some mild cognitive dysfunction, emotional state disturbances, or personality changes. It is possible that this is followed by a picture of permanent dementia. The following chemotherapeutics can cause mood disorders or psychosis:

  • Vinblastine (reversible depression, gustative (related to taste) and olfactory (related to smell) hallucinations,
  • Vincristine (%5 hallucinations),
  • L-Asparaginase (reversible depression),
  • Interferon (in high doses – thoughts of suicide),
  • Steroids (emotional lability, manic depression),
  • Tamoxifen (depression, delusions).

Most of the psychiatric pictures presented by chemotherapeutics are reversible and disappear when the drug is stopped. Symptomatic treatment is suggested if the drug that is causing the problem has to be continued.