Weekly Mind Reader: Time to Rethink Psychotropics for Oncology Patients?

In the latest edition of the Weekly Mind Reader, we wonder if maybe it’s time to reconsider how we handle psychotropics in palliative home care settings, while a reader offers some feedback on a research paper on “poor person’s cocaine.”

The Problem with Psychotropics for Oncology Patients

A cancer diagnosis can make a profound impact on a patient – and for good reason. It can shake their psychological well-being, eliciting a host of fears, from mortality to a loss of autonomy.

The psychological issues that sometimes follow – such as depression and anxiety – aren’t uncommon among palliative care patients. Earlier research suggests it affects anywhere between a quarter to a third of patients. But home-based palliative settings can make it difficult to secure specialized psychiatric care.

Because of that, psychotropic medications can be crucial for managing psychiatric symptoms in palliative oncology patients. However, a research gap looms large when providers try to prescribe psychotropics in this context, possibly hampering care delivery.

To address this, researchers launched a retrospective study to review case documentation of 125 cancer patients in Kerala, India. The Primary Care Companion for CNS Disorders published the paper this week.

The study revealed that palliative care providers administered psychotropic medication to 35.2% of patients. Doctors chose medication based on symptoms, typically prescribing drugs such as benzodiazepines, antipsychotics, and antidepressants. Additionally, the researchers noted polypharmacy in more than a third of the patients.

The study highlights the importance of psychotropics in alleviating psychological symptoms in palliative care settings. But it also underscores challenges, such as limited access to specialized psychiatric care and the feasibility of consultations. Economic constraints also make providing comprehensive psychiatric care even more difficult for most patients.

The researchers offered a few proposals to improve outcomes:

• Collaborative efforts among medical professionals, including psychiatrists, psychologists, palliative care physicians, and social workers, could be crucial to establishing ethical guidelines for appropriate psychotropic prescriptions in palliative care.
• Moreover, providing ongoing mental health education and training to healthcare professionals can enhance their ability to address the psychological needs of cancer patients effectively.

In conclusion, while psychotropic medications play a significant role in managing psychiatric symptoms in palliative oncology patients, collaborative efforts and guidelines could help ensure their appropriate and effective use for this vulnerable population.

IN OTHER PSYCHIATRY AND NEUROLOGY NEWS

• A reader argues that providers shouldn’t overlook bupropion misuse, particularly via insufflation, because of its growing popularity and the increased potential for serious complications.
• New research reveals anemic clozapine initiation rates among chronic psychotic disorder patients, hovering below 2% within a year of indication. It’s even worse among minority populations.
• Another Journal of Clinical Psychiatry study shows that pairing LAI antipsychotics alongside clozapine significantly lowers the risk of rehospitalization compared to both clozapine combined with OAPs and clozapine monotherapy.
• In PsychCase360, Joseph Goldberg, MD, walks viewers through two case profiles of patients with bipolar I disorder, including assessment, diagnosis, and treatment, with a focus on cardiometabolic safety.
• And, finally, we highlight a trio of studies that help demystify some of the confusion around tardive dyskinesia.