ABSTRACT
Psychiatric symptoms due to
medical illness constitute an integral but widely neglected area of psychiatry.
Depressive disorder is the commonest psychiatric disorder as consequence of
chronic medical illness. Depression in patient with pancreatic carcinoma can be
chronic stress, persistent pain, side effect of anticancer drug and
radiotherapy.
The subject included 14
diagnosed cases of pancreatic carcinoma taken from surgical department. This study shows that pancreatic carcinoma is
highly associated with depressive disorder. Data shows 71.43% of patients with pancreatic
carcinoma developed depression using ICD -10 DCR. Among them highest number were found mild
depression (N-6, 42.86%), followed by moderate (N-3,21.43%) and severe
depression was (N-1,7.14%).
INTRODUCTION
Depressive disorder is the most common
psychiatric problem seen in primary care. Prevalence figures for major
depression varies substantially between surveys1 Psychiatric
symptoms due to medical illness constitute an integral but widely neglected
area of psychiatry. With
the development of consultation liaison psychiatry, lots of attempt has been
made to establish this relationship in clinical and research works. Ten years prospective study in Zurich estimated the
lifetime prevalence of major depression, as about 16 percent2. They are consistently
increased women across different culture. The reasons for increased rates among
women are uncertain. Depression is more common among the unemployed; divorced
and medical illness people.The phenomenology of depression was known and well
documented in ancient Hindu medicine known as "aruveda” which recognize
depression as kaphonmoda. Athrva veda (700 BC) described the role of psychotherapy,
drugs and divine agents in treatment of depression as well as other mental
disorder.3 Depressive disorder is the commonest
psychiatric disorder as consequence of chronic medical illness. All
medical illness and their treatment can cause a non-specific stressor, which
may leads to mood disorder in predisposed subjects. Examples are brain disease,
chronic infection, and carcinoma endocrine disorder.
Patients
with pancreatic cancer experience significantly more depression than patients
with other types of cancer 4.The mean age at
onset of major depression of 29.9 year.5
Major depression is a well-documented risk factor for
suicide in cancer patients as well as in the general population. More than half
of the patients with cancer who at the same time meet the diagnosis of
depression express suicidal ideation 6. This study highlights the association of pancreatic carcinoma with depressive disorder
MATERIAL AND METHOD
Objectives:
1) To identify depression in patient with
pancreatic carcinoma
2) To detect severity of depression
Tools
:
1 Self designed semi structured
Performa.
2 ICD - 10 DCR
The Diagnosis was done on the basis of I.C.D. - 10 diagnostic research
criteria (WHO, 1992)7.
3 Hamilton's Depression Rating Scale8, this
scale was developed by Maxwell Hamilton in 1967. This is objective test.
4 Beck's
Depression InventY9 Developed by Beck et al, 1961. This is subjective test.
RESULTS
Table 1
DISTRIBUTION ON THE BASIS OF SEX
|
SEX
|
CASE
|
|
|
|
NO
|
%
|
|
MALE
|
8
|
57.14%
|
|
FEMALE
|
6
|
42.86%
|
|
TOTAL
|
14
|
100%
|
Data shows total numbers of male were 8(57.14%) and
female were 6 (42.86%).
Table -2
DISTRIBUTION ON THE BASIS OF MARIETAL STATUS
|
MARIETAL STATUS
|
CASE
|
|
|
|
NO
|
%
|
|
MARRIED
|
12
|
86.61%
|
|
UNMARRIED
|
1
|
2.27%
|
|
WIDOW
|
1
|
2.27%
|
|
TOTAL
|
14
|
100%
|
Data shows highest numbers of
cases were married (N-12, 86.61%).
Table 3
DISTRIBUTION ON THE BASIS OF RELIGION
|
RELEGION
|
CASE
|
|
|
|
NO
|
%
|
|
HINDU
|
12
|
85.71%
|
|
BUDDHIST
|
2
|
14.29%
|
|
CHRISTIAN
|
0
|
0%
|
|
TOTAL
|
14
|
100%
|
Data shows
highest numbers of patients were Hindu (N-12,85.71 %).
Table 4
DISTRIBUTION ON THE BASIS OF EDUCATIONAL STATUS
|
EDUCATION
|
CASE
|
|
|
|
NO
|
%
|
|
ILITRATE
|
6
|
42.46%
|
|
PRIMARY
|
3
|
21.23%
|
|
MIDDLE
|
2
|
14.29%
|
|
SLC
|
1
|
7.14%
|
|
INTERMEDIATE
|
1
|
7.14%
|
|
GRADUATE
|
1
|
7.14%
|
|
TOTAL
|
14
|
100%
|
Data shows highest number of patients were Illiterate (
N-6, 42.46%)followed by education up to primary level were (N-3,21.23%).
Table 5
DISTURIBUTION ON THE BASIS OF OCCUPATION
|
OCCUPATION
|
CASE
|
|
|
|
NO
|
%
|
|
FARMER
|
8
|
57.14%
|
|
LABOUR
|
1
|
7.14%
|
|
SERVICE
|
2
|
14.28%
|
|
UNEMPLOYED
|
2
|
14.28%
|
|
OTHER
|
1
|
7.14%
|
|
TOTAL
|
14
|
100%
|
Data shows most of cases were farmer (N-8, 57.14 %).
TABLE -6
DIAGNOSIS OF DEPRESSION BY USING ICD-10 DIAGNOSTIC
RESEARCH CRITERIA (ICD-10 DCR)
|
DEPRESSON
|
MALE
|
FEMALE
|
TOTAL
|
%
|
|
MILD
|
3
|
3
|
6
|
42.86%
|
|
MOD
|
2
|
1
|
3
|
21.43%
|
|
SEV
|
0
|
1
|
1
|
7.14%
|
|
TOTAL DEPRESSION
|
5
|
5
|
10
|
71.43%
|
By using ICD 10 diagnostic criteria for research (ICD-10,
DCR) highest cases were found mild depression (N-6,
42.86%), followed by moderate (N-3,21.43%) and severe depression was
(N-1,7.14%)
DISCUSSION
The samples were collected from 1/11/2000 to
31/7/2001.Total no of patients with pancreatic carcinoma, who attended surgery
department of TUTH, Katmandu, Nepal
was taken as cases. The rapport was established with the patient to get
enough information. The semi structured Performa was filled with adequate
information The Performa composed of Name, Age, Sex, Marital Status, Religion,
Education and Occupational status. The Diagnosis was made on the basis of
I.C.D. - 10 diagnostic research criteria. The mean age of the cases was 52.26. The two rating scales were used to make
result accurate, which were Hamilton's Depression Rating Scale (HDRS) and Beck
Depressions Inventory (BDI). This study shows that 71.43% of pancreatic carcinoma developed depression
using ICD -10 DCR. By using ICD 10
diagnostic criteria for research (ICD-10, DCR) highest
cases were found mild depression followed by moderate and severe
depression. Data shows mild depression is the commonest i.e. (N-6, 42.86%), Moderate depression covered (N-3,21.43%) and sever depression covered only(N-1,7.14%). Depression in patient with pancreatic
carcinoma can be chronic stress, persistent pain, side effect of anticancer
drug and radiotherapy.
References:
1 Smith, AL and Weissman (1992) Epidemiology,
In: handbook of affective disorder PP III-124, Churchill Livingston,
Edinburgh.
2 Angst.
J. (1992) How recurrent and
predictable is depressive illness. In long term treatment of depression
(edition S. Montgomery and F Rouillon) PP 1-3 Wiley, Chichester.
3 Mubbashar, M.H. (1981) Savage
Voyage, Shifa. Journal of Rawalpendi Medical Collage.
4 Holland, J.C. and Rowland, J.H. (1989) Handbook of psychology. Psychological care
of the patient with cancer. Oxford University press, New York.
5
de Graaf R,Bijil RV,Beekman AT,et al (2003):Temporal sequencing of lifetime mood disorders in relation to comorbid
anxiety and substance use disorder:finding from the Netharlands Mental Health Survey and
Incidence Study.Soc.Psychiatry Epidemol38,1-11,2003.
6 Wada,S.,Munoz,N. andFerlay,J(1998) Whom the diagnosis is cancer;Patients communication experience
andpreference.Cancer,15,26-37.
7 WHO (1992) International Classification of disease and related heath
problems, Tenth revision: Clinical description and diagnostic guideline; Geneva: World Health Organization.
8 Hamiltan M.(1960) A Rating scale for depression, J. neurol
Neurosurg. Psychiatry 28, 56.
9Beck
A.T.,Ward,C.H.,Mendelson,M.,et al(1961) An inventory for measuring depression.Archives of general psychiatry 4,561-85.
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