암환자들의 정신과 자문의뢰의 임상적 특성과 항우울제 사용에 대한 국내 다기관 연구
Clinical Characteristics and Use of Antidepressants among Cancer Patients Referred for Psychiatric Consultation : A Korean Multicenter Survey
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초록
본 연구는 국내 여러 대학병원 정신과에 의뢰된 암환자들을 대상으로 내과 및 정신과적 임상 특징과 정신과적 약물 치료 경향에 대해 조사하였다. 대상자들은 우울과 불안을 비롯하여 자살사고, 불면, 의욕감소, 통증 등 여러 증상을 경험하고 있으며 상당수는 우울장애와 불안장애로 진단받았다. 이러한 증상들이 암환자의 삶의 질과 치료 경과에 직접적인 영향을 주는 것으로 알려져 있는 반면 이에 대한 치료 지침은미비한 실정이다. 본 연구는 실제 임상에서 환자들이 호소하는 주된 문제와 함께 약물 치료 경향 및 치료 기간에 대해 제시 하였다. 여러 제한점에도 불구하고 본 조사 결과는 임상의들에게 암환자들의 정신과적 문제와 치료 현황에 대해 정보를 제공하며, 추후 치료 지침 수립에 있어 기초 자료로 활용될 수 있을 것이다.
Abstract
Objectives Antidepressants are frequently used for treatment of psychological distress among cancer patients. The aim of this study is to investigate the characteristics of psychiatric consultations and antidepressant use for cancer patients. Methods Participants in the study included cancer patients who had been referred for psychiatric consultation. A total of 488 patients were recruited from nine general hospitals in Korea. Questionnaires based on medical records, including antidepressants prescribed, were investigated by psychiatrists. Results The most common psychiatric diagnosis of subjects was depressive disorders (72.4%),followed by anxiety disorders (13.0%), and adjustment disorders (7.3%). Antidepressants were prescribed for 96.3% of subjects and escitalopram, mirtazapine, and paroxetine were prescribed frequently, in order. Anxiolytics and hypnotics were used for 58.2% of the subjects, for which lorazepam and alprozolam were preferred. During the study period, 226 (46.8%) subjects discontinued treatment and the most common cause was improvement of symptoms (123, 54.4%). Conclusion Our results showed a tendency of prescription of antidepressants and anxiolytics and common psychiatric problems in Korean cancer patients. We suppose that these data would be helpful to clinicians who manage psychiatric symptoms of cancer patients.
참고문헌 (39)
- Statistics Korea, "Annual Report on the Cause of Death Statistics" (2010), Statistics Korea
- Derogatis LR, "The prevalence of psychiatric disorders among cancer patients", JAMA, 249, pp.751~757 (1983)
- Massie MJ, "Prevalence of depression in patients with cancer", J Natl Cancer Inst Monogr, pp.57~71 (2004)
- Castelli L, "Depression in lung cancer patients: is the HADS an effective screening tool?", Support Care Cancer, 17, pp.1129~1132 (2009)
- Holland JC, "Anxiety and cancer: the patient and the family", J Clin Psychiatry, 50(Suppl), pp.20~25 (1989)
- Andrykowski MA, "Prevalence, predictors, and course of anticipatory nausea in women receiving adjuvant chemotherapy for breast cancer", Cancer, 62, pp.2607~2613 (1988)
- Mitchell AJ, "Prevalence of depression, anxiety, and adjustment disorder in oncological,haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies", Lancet Oncol, 12, pp.160~174 (2011)
- Massie MJ, "Diagnosis and treatment of depression in the cancer patient", J Clin Psychiatry, 45(3 Pt 2), pp.25~29 (1984)
- Filiberti A, "Suicide and suicidal thoughts in cancer patients", Tumori, 88, pp.193~199 (2002)
- Ashbury FD, "Antidepressant prescribing in community cancer care", Support Care Cancer, 11, pp.278~285 (2003)
- Kissane DW, "Psychiatric disorder in women with early stage and advanced breast cancer: a comparative analysis", Aust N Z J Psychiatry, 38, pp.320~326 (2004)
- Colleoni M, "Depression and degree of acceptance of adjuvant cytotoxic drugs", Lancet, 356, pp.1326~1327 (2000)
- Lloyd-Williams M, "Depression--an independent predictor of early death in patients with advanced cancer", J Affect Disord, 113, pp.127~132 (2009)
- Lansky SB, "Absence of major depressive disorder in female cancer patients", J Clin Oncol, 3, pp.1553~1560 (1985)
- Bellini M, "Increased suicide risk in cancer patients", Minerva Psichiatr, 35, pp.175~186 (1994)
- Reiche EM, "Stress, depression, the immune system, and cancer", Lancet Oncol, 5, pp.617~625 (2004)
- Fisch MJ, "Fluoxetine versus placebo in advanced cancer outpatients: a double-blinded trial of the Hoosier Oncology Group", J Clin Oncol, 21, pp.1937~1943 (2003)
- Morrow GR, "Differential effects of paroxetine on fatigue and depression: a randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program", J Clin Oncol, 21, pp.4635~4641 (2003)
- McGeeney BE, "Adjuvant agents in cancer pain", Clin J Pain, 24(Suppl 10), pp.14~20 (2008)
- Kim SW, "Effectiveness of mirtazapine for nausea and insomnia in cancer patients77. with depression", Psychiatry Clin Neurosci, 62, pp.75~83 (2008)
- Triozzi PL, "Contributions of benzodiazepines to cancer therapy", Cancer Invest, 6, pp.103~111 (1988)
- Glass RM, "Psychiatric disorders among cancer patients", JAMA, 249, pp.782~783 (1983)
- Akechi T, "Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors", J Clin Oncol, 22, pp.1957~1965 (2004)
- Akechi T, "Gender differences in factors associated with suicidal ideation in major depression among cancer patients", Psychooncology, 19, pp.384~389 (2010)
- Clinical Psychiatry, "Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences", pp.2007, Sadock BJ
- Gnanadesigan N, "Interaction of serotonergic antidepressants and opioid analgesics: is serotonin syndrome going undetected?", J Am Med Dir Assoc, 6, pp.265~269 (2005)
- Goetz MP, "The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen", Breast Cancer Res Treat, 101, pp.113~121 (2007)
- Koriech OM, "Fluoxetine treatment comprises the antiemetic efficacy of ondansetron in cancer patients", Clin Oncol (R Coll Radiol), 7, pp.371~372 (1995)
- Rao N, "The clinical pharmacokinetics of escitalopram", Clin Pharmacokinet, 46, pp.281~290 (2007)
- Brøsen K, "Review of pharmacokinetic and pharmacodynamic interaction studies with citalopram", Eur Neuropsychopharmacol, 11, pp.275~283 (2001)
- Theobald DE, "An open label pilot study of citalopram for depression and boredom in ambulatory cancer patients", Palliat Support Care, 1, pp.71~77 (2003)
- Möslinger-Gehmayr R, "A double-blind comparative study of the effectiveness and tolerance of paroxetine and amitriptyline in treatment of breast cancer patients with clinically assessed depression", Zentralbl Gynakol, 122, pp.195~202 (2000)
- Bishop JF, "Lorazepam: a randomized, double-blind, crossover study of a new antiemetic in patients receiving cytotoxic chemotherapy and prochlorperazine", J Clin Oncol, 2, pp.691~695 (1984)
- Kris MG, "Antiemetic control and prevention of side effects of anti-cancer therapy with lorazepam or diphenhydramine when used in combination with metoclopramide plus dexamethasone. A double-blind, randomized trial", Cancer, 60, pp.2816~2822 (1987)
- Razavi D, "Prevention of adjustment disorders and anticipatory nausea secondary to adjuvant chemotherapy: a double-blind, placebocontrolled study assessing the usefulness of alprazolam", J Clin Oncol, 11, pp.1384~1390 (1993)
- Holland JC, "A randomized clinical trial of alprazolam versus progressive muscle relaxation in cancer patients with anxiety and depressive symptoms", J Clin Oncol, 9, pp.1004~1011 (1991)
- Cohn JB, "Low-sedation potential of buspirone compared with alprazolam and lorazepam in the treatment of anxious patients: a double-blind study", J Clin Psychiatry, 47, pp.409~412 (1986)
- American Psychiatric Association, "Diagnostic and Statistical Manual of Mental Disorders" (1994), American Psychiatric Press
- Kathol RG, "Diagnosing depression in patients with medical illness", Psychosomatics, 31, pp.434~440 (1990)