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PG Fellowship in Palliative Medicine
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2006| January-June | Volume 12 | Issue 1
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Depression and demoralization as distinct syndromes: Preliminary data from a cohort of advanced cancer patients
Juliet C Jacobsen, Lauren C Vanderwerker, Susan D Block, Robert J Friedlander, Paul K Maciejewski, Holly G Prigerson
January-June 2006, 12(1):8-15
The term demoralization has been used to describe existential distress and despair of patients with advanced disease.
This study sought to determine whether a cluster of symptoms interpreted as demoralization could be identified and distinguished from a cluster of depressive symptoms.
Materials and Methods:
As part of the Coping with Cancer Study, a federally funded multi-site study of advanced cancer patients, 242 patients were interviewed on a broad range of mental health parameters related to depression, grief, quality of life, self-efficacy, coping and religiousness/spirituality.
A principal components analysis revealed separate depression and demoralization/despair factors. Seven symptoms constituted the demoralization/despair factor: loss of control, loss of hope, anger/bitterness, sense of failure, feeling life was a burden, loss of meaning and a belief that life's meaning is dependent on health and were found to be internally consistent (Cronbach's a = 0.78). Only 14.8% of subjects with "syndromal demoralization" met DSM-IV criteria for Major Depression (MDD); 7.4% for Minor Depression. Of those with MDD only 28.6% had syndromal level demoralization. Prior history of MDD predicted current MDD, but not syndromal demoralization. Demoralization, not MDD, was significantly associated with the patient's reported level of inner peacefulness. When compared with MDD, syndromal demoralization was more strongly associated with wish to live and wish to die and equally predictive of mental health service use.
The symptoms of demoralization are distinct from depressive symptoms and appear to be associated with the patient's degree of inner peacefulness.
The management of terminal delirium
January-June 2006, 12(1):22-28
Delirium is a distressing and disturbing clinical event. Palliation of the symptoms by multi-component interventions can be effective. The goal of interventions is to raise the deliriant threshold by combined symptom relief, environmental, psychological and pharmacological interventions. Haloperidol remains the drug of choice for delirium. For intractable delirious symptoms at the end of life terminal sedation may be indicated.
Psycho-oncology in India: Emerging trends from Kerala
Chitra Venkateswaran, T Manoj Kumar
January-June 2006, 12(1):34-38
It is estimated that around 2.5 million people suffer from cancer at any given time in India. Almost 80% of patients reach hospitals in advanced stages of the disease. The majority needs palliative care, whereas only a minority of the needy receives this input. The challenge in the developing world is to evolve a culturally and socio-economically appropriate and acceptable system of care, while addressing psychosocial issues along with long-term care needs, that is accessible to the majority of those who need it. The evolution of a specific service for psychosocial care for persons and families started in the 1970s, initial work focusing mainly on research. Contributions from persons in varied topics have been outlined. Only a few organized clinical services function as part of large tertiary hospitals, oncology centers or palliative care units. The emerging trend in Northern Kerala is based on an integrated service linking training, clinical services and research activities which are linked at several levels, involving volunteers in the community. Future hopes lie in developing core groups; establishing specific clinical services liaising with cancer care teams, large scale research projects and discussion with policy makers to develop guidelines at national level.
Perspectives on psycho-neuro-immunology in oncology
January-June 2006, 12(1):29-33
Psycho-oncology and psycho-neuro-immunology are both powerful new disciplines. Although a lot of literature exists in both of these fields the evidence is often controversial. This paper gives a brief perspective on the origins of psycho-neuro-immunology and discusses how our current understanding of this subject can be translated into clinical practice in an Indian setting.
Psychosocial issues in palliative care
January-June 2006, 12(1):2-3
Guidelines for conducting ethical research in psychosocial issues in palliative care
Colin Murray Parkes
January-June 2006, 12(1):17-21
While it is unethical to introduce services for the terminally ill and their families that are not well founded or evaluated there are special problems in research conducted with this population. This has deterred some from carrying out research in this field and has caused others to place obstacles in the way of would-be researchers. This paper describes the ethical difficulties and provides guidelines that should enable worthwhile research to be carried out without harm to those who offer their help and without vitiating the scientific value of the research.
Systematic reviews of randomized controlled trials and evidence informed palliative care
Prathap Tharyan, Prasanna Jebaraj
January-June 2006, 12(1):39-41
Pain and beyond
January-June 2006, 12(1):4-7
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