Psycho Oncology[1]
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Transcript of Psycho Oncology[1]
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PSYCHO-ONCOLOGY
dr. A.Jayalangkara Tanra, SpKJ, PhD
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PSYCHO-ONCOLOGY
Psycho-oncology mencoba mempelajaripengaruh kanker pada fungsi psikologisdan peranan variabel psikologis &
behavioral pada resiko kanker dankemungkinan bertahan hidup (Survivalrate).
Penelitian psycho-oncology mrp studiintervensi yang berusaha mempengaruhiperjalanan penyakit pasien kanker.
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Hasil penelitian dari David Spiegelmenyatakan bahwa seorang penderitakanker yang mendapat psikoterapi akanbertahan hidup lebih lama daripada yg
tidak. Sementara studi lain menemukanbahwa pemberian psikoterapi menurunkanangka rekurensi dan angka mortalitas
pada penderita kanker.
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Kurang lebih separuh dari pasien kanker
mengalami gangguan mental/kejiwaan.Gangguan mental yang paling seringdidiagnosis/ditemukan adalah :
- gangguan penyesuaian (68%)- gangguan depresif mayor (13%)
- delirium (8%)
- dll
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The Prevalence of Distress
Rates range from 35% to 70%
(depending on the study, country etc;
e.g. Zabora et al, 2001, Carlson et
al., 2004) Pain - 26%
Anxiety - 24%
Depression - 26% Fatigue - 49%
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Medical conditions associated with delirium in cancerpatients :
Metabolic encephalopathy Vital organ failure
Electrolyte imbalance (such as hypercalcemia in patients withbony metastases or those receiving tamoxifen,
diethylstilbestrol, or chlorotrianisene) Hypoxia (especially in patients with pulmonary involvement
or severe anemia)
Nutritional deficiencies (such as thiamine, folic acid, & B12)
Infections (especially in immunosuppressed hosts) Vascular disorders (especially in patients with
coagulopathies)
Endocrine & hormonal abnormalities
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Causes of mood disorders common in cancerpatients :
Drugs- chemotherapeutic agents such as prednisone,
dexamethasone, vincristine, etc.
- additive effect of narcotics and many other drugs
known to cause depression, such asantihypertensives, benzodiazepines, etc.
Tumor effects
- hormone-secreting tumors
- central nervous system tumors
Associated medical conditions
- uremia
- viral encephalopathies
- electrolyte imbalances
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Reaksi-reaksi psikologis seseorang ygmengetahui bhw dirinya menderita kanker :
Fear of death, disfigurement, and disability
Fear of abandonment and loss of independence
Fear of disruption in relationships, role functioning, andfinancial standings
Denial, anxiety, anger, and guilt.
Walaupun pikiran dan keinginan bunuh diri sering
muncul pada pasien kanker, namun angka insidens-nya sedikit lebih tinggi daripada populasi
umum.
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Suicide vulnerability factors in cancer patients :
Depression and hopelessness
Poorly controlled pain
Mild delirium (disinhibition)
Feeling of loss of control
Exhaustion Anxiety
Preexisting psychopathology (substance abuse, characterpathology, major psychiatric disorder)
Family problems Treats and history of prior attemps of suicide
Positive family history of suicide
Other usually described risk factors in psychiatric patients
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Some examples of reasons forreferral
Anxiety Depression
Adjustment
Pain Grief
Difficulties with self image
Sexual dysfunction Relationship issues
Difficulties around treatment decisions
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Intervention strategies
(Knight, 2004)
Cognitive Behavioural Therapy (CBT) :Depression and conditioned aversiveresponses
Supportive and expressive therapies:exploration meaning, expression of emotion
Behavioural techniques: relaxation,
distraction, activity schedulingTraining in problem solving,
assertiveness, coping
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Kesimpulan
Dokter harus hati-hati dalam menilaitanda-tanda psikiatrik dan medik pada
setiap pasien kanker.
Perhatian khusus harus diberikan kepada
faktor keluarga, utamanya bila pernahterjadi konflik dalam keluarga, familyabandonment, dan family exhaustion.
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