Dignity therapy resulted in a beneficial effect on depression and anxiety symptoms in end-of-life care. The therapeutic benefit of dignity therapy was sustained over a 30-day period. Having established its efficacy, future trials of dignity therapy may now begin, comparing it with other psychotherapeutic approaches within the context of terminal illness.

Objective: Dignity therapy (DT) is a short-term psychotherapy developed for patients living with a life-limiting illness. Our aim was to determine the influence of DT on symptoms of depression and anxiety in people with a life-threatening disease with high level of distress, referred to an inpatient palliative care unit.Method:This was an open-label randomized controlled trial. Sixty terminally ill patients were randomly assigned to one of two groups: intervention group (DTþ standard palliative care [SPC]) or control group (SPC alone). The main outcomes were symptoms of depression and anxiety, measured with the Hospital Anxiety and Depression Scale, assessed at baseline, day 4, day 15, and day 30 of follow-up.Results: Of the 60 participants, 29 were randomized to DTand 31 to SPC. Baseline characteristics were similar between the two groups. DT was associated with a significant decrease in depressive symptoms at day 4 and day 15 (mean ¼ 24.46, 95% CI, 26.91-2.02, p ¼ 0.001; mean¼ 23.96, 95% CI, 27.33 to 20.61; p ¼ 0.022, respectively), but not at day 30 (mean ¼ 23.33, 95% CI, 27.32-0.65, p ¼ 0.097). DTwas also associated with a significant decrease in anxiety symptoms at each follow-up (mean¼ 23.96, 95% CI, 26.66 to 21.25, p ¼ 0.005; mean¼ 26.19, 95% CI, 210.49 to 21.88, p ¼ 0.006; mean ¼ 25.07, 95% CI, 210.22 to 20.09, p ¼ 0.054, respectively).Significance of results: DT appears to have a short-term beneficial effect on the depression and anxiety symptoms that often accompany patients at the end of their lives. Future research with larger samples compared with other treatments is needed to better understand the potential benefits of this psychotherapy.

Dignity therapy had a beneficial effect on the psychological distress encountered by patients near the end of life. Our research suggests that DT is an important psychotherapeutic approach that should be included in clinical care programs, and it could help more patients to cope with their end-of-life experiences.

The end-of-life trajectory of cancer patients in palliative care (PC) elicits an anticipatory grief (AG) process in family caregivers (FCs). Although widely recognized, AG lacks conceptual clarification. This study aims to qualitatively explore the experience of FCs of patients with terminal cancer to identify the core characteristics and the specific adaptive challenges related to AG in the context of end-of-life caregiving. Data were collected through in-depth semi-structured interviews conducted in a clinical sample of 26 FCs of cancer patients in PC. Findings from thematic analysis suggest that the AG experience is characterized by traumatic distress from being exposed to life-threatening conditions and the separation distress induced by loss anticipation and current relational losses, challenging the FCs to long-term emotional regulation effort demands. These results contribute to the conceptualization of AG and may inform intervention programs for the main challenges the FCs face when adjusting to loss during end-of-life caregiving.

Chronic idiopathic urticaria (CIU) is a frequently disabling disease with a negative influence on the quality of life, and can cause psychopathological symptoms, such as anxiety. Our aim is to study further anxiety symptoms on CIU patients. Both CIU patients and the control group were studied by means of validated scales for psychopathology symptoms, psychological variables and quality of life. In this study, we reported high levels of anxiety symptoms. We found statistically significant correlations between anxiety symptoms, some personality dimensions, insecure attachment styles, alexithymia and with some quality of life dimensions. CIU patients exhibit high levels of psychological distress that could potentiate difficulties at several domains, namely social, emotional, general health perception and interpersonal relationships.

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The liver is the organ by which the majority of substances are metabolized, including psychotropic drugs. There are several pharmacokinetic changes in end-stage liver disease that can interfere with the metabolization of psychotropic drugs. This fact is particularly true in drugs with extensive first-pass metabolism, highly protein bound drugs and drugs depending on phase I hepatic metabolic reactions. Psychopharmacological agents are also associated with a risk of hepatotoxicity. The evidence is insufficient for definite conclusions regarding the prevalence and severity of psychiatric drug-induced liver injury. High-risk psychotropics are not advised when there is pre-existing liver disease, and after starting a psychotropic agent in a patient with hepatic impairment, frequent liver function/lesion monitoring is advised. The authors carefully review the pharmacokinetic disturbances induced by end-stage liver disease and the potential of psychopharmacological agents for liver toxicity.

Family caregivers play an important role in advanced disease patient care. The goal of this study was to characterize the family caregiver in palliative care, evaluating the circumstances and consequences of care and preparation for the loss of the loved one. This is a quantitative, prospective and longitudinal study. The sample consisted of 60 family caregivers, mostly women, married with an average age of 44.53 years. Most caregivers cohabit with the patient, and they spend the greater part of their day caring for the patient and a significant part quit their jobs or reduce working hours to be with the patient. The highest burden caregivers also showed higher levels of anxiety, depression, somatization and less social support. The most dysfunctional family caregivers reported little social support and those caregivers who were less prepared for the death of the patient showed more symptoms of peritraumatic dissociative experience. Most caregivers were aware of the severity of the illness of their family member and the proximity of death, and considered that the patient was very well taken care of in the palliative care service.