The Opportunity for Psychiatry in Palliative Care

Abstract

The need for psychiatrists to work with patients and families living with chronic life-threatening illnesses has never been greater. Further, psychiatrists may find exciting work within the relatively new field of palliative care, which is devoted to the prevention and relief of all suffering. Increasingly, individuals are living longer with multiple issues that cause suffering, interfere with their lives, and often lead to psychosocial sequelae. To ensure state-of-the-art care for patients and families throughout an illness and any ensuing bereavement period, many experienced psychiatrists are needed as consultants to, and as members of, interdisciplinary palliative care teams. This need presents limitless opportunities for psychiatrists to care for patients, provide education, and engage in research. The potential to make a difference is great.

Daily Oral Ketamine for the Treatment of Depression and Anxiety in Patients Receiving Hospice Care: A 28-Day Open-Label Proof-of-Concept Trial

“…13 Many of these are also indicated for anxiety, as are other medications, all of which have significant associated risks. 14 An appropriate standard antidepressant trial is considered four to six weeks, and multiple trials are frequently necessary. 15,16 As the average time patients receive hospice care in the United States is less than 10 weeks and the median is less than 3 weeks, 17 current standards for antidepressant trials do not adequately address the needs of hospice patients suffering from depression and anxiety.…”

Oral Ketamine for the Rapid Treatment of Depression and Anxiety in Patients Receiving Hospice Care

“…8 Many of these are also indicated for anxiety, as are other medications that have significant associated risks. 9 An appropriate standard antidepressant trial is considered 4-6 weeks, and multiple trials may be necessary. 10,11 Since the average time patients receive hospice care in the United States is less than 8 weeks and the median is less than 4 weeks, 12 current standard antidepressant trials oftentimes do not adequately address the needs of hospice patients suffering from depression.…”

Necessidades dos familiares de doentes terminais em cuidados paliativos: Revisão crítica da literatura

“…Não basta, por isso, que o foco da intervenção assente no controlo da sintomatologia. Deve, de igual modo, atender às dificuldades decorrentes da doença, dos indivíduos nela envolvidos (e.g., doente, família e restante rede) e aos desafios psicossociais que se lhes impõem (Irwin & Ferris, 2008;Rolland, 2005).…”

“…Com a progressão da doença e sem resposta à terapêutica administrada, os cuidados paliativos tornam-se a abordagem única de prestação de cuidados. No entanto, e especialmente nesta fase, ao contrário dos cuidados curativos que visam curar e modificar o curso da doença, os cuidados paliativos visam capacitar e promover nos doentes e suas famílias todo o seu potencial e qualidade de vida, intervir no sofrimento decorrente da doença e responder às necessidades experimentadas pelos doentes e famílias (Irwin & Ferris, 2008).…”

“…Devem promover-se estratégias de coping familiar, preparando-as para a morte, oferecendo um espaço para a ventilação de sentimentos e medos, explorando a narrativa do sentido da vida e da morte (Irwin & Ferris, 2008). Devem, ainda, ser potenciadas as forças familiares, um funcional ajustamento à doença e o restabelecimento do equilíbrio familiar, fomentando uma comunicação eficaz, um envolvimento colaborativo no processo de tomada de decisão (King & Quill, 2006), a coesão na unidade familiar e a preservação de relações com outros elementos da rede social (Irwin & Ferris, 2008).…”