Hostname: page-component-7c8c6479df-xxrs7 Total loading time: 0 Render date: 2024-03-28T02:09:51.469Z Has data issue: false hasContentIssue false

Psyche at the end of life: Psychiatric symptoms are prevalent in patients admitted to a palliative care unit

Published online by Cambridge University Press:  08 October 2015

Eva K. Masel*
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Anna S. Berghoff
Affiliation:
Department of Oncology, Medical University of Vienna, Vienna, Austria
Aleksandra Mladen
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Sophie Schur
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Bruno Maehr
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Magdalena Kirchhoff
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Ralph Simanek
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Martin Bauer
Affiliation:
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
Herbert H. Watzke
Affiliation:
Division of Palliative Care, AUPACS Group, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
Michaela Amering
Affiliation:
Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
*
Address correspondence and reprint requests to: Eva K. Masel, Division of Palliative Care, Department of Internal Medicine I, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. E-mail: eva.masel@meduniwien.ac.at.

Abstract

Objective:

Our aim was to evaluate the frequency and treatment of psychiatric symptoms in patients at palliative care units (PCUs).

Method:

Patients admitted to one of five participating PCUs in Austria were included. The short version of the Patient Health Questionnaire (PHQ–D) was used to evaluate their mental health status. Pain intensity was rated on a numeric rating scale (NRS) from 0 to 10 by patients and physicians. Patients with a previously diagnosed psychiatric disorder were compared to those without or with newly diagnosed psychiatric symptoms, based on PHQ–D results. Pain and psychopharmacological medication were assessed. Opioid doses were converted into oral morphine equivalents (OMEs).

Results:

Some 68 patients were included. Previously undetected psychiatric symptoms were identified in 38% (26 of 68), preexisting psychiatric comorbidities were evident in 25% (17), and no psychiatric symptoms were observed in 37% (25). Patients with a preexisting psychiatric comorbidity received antidepressants and benzodiazepines significantly more often than patients without or with previously undetected psychiatric symptoms (p < 0.001). Patient and physician median NRS ratings of pain intensity correlated significantly (p = 0.001). Median NRS rating showed no significant difference between patients with preexisting, previously undetected, or without psychiatric symptoms. OMEs did not differ significantly between preexisting, without, or previously undetected psychiatric symptoms. Patients with undetected and preexisting psychiatric comorbidities had a greater impairment in their activities of daily living than patients without psychiatric symptoms (p = 0.003).

Significance of Results:

Undetected psychiatric comorbidities are common in patients receiving palliative care. Screening for psychiatric symptoms should be integrated into standard palliative care to optimize treatment and reduce the psychosocial burden of the disease.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Anderson, R., Saiers, J.H., Abram, S., et al. (2001). Accuracy in equianalgesic dosing: Conversion dilemmas. Journal of Pain and Symptom Management, 21(5), 397406.CrossRefGoogle ScholarPubMed
Bender, R. & Lange, S. (2001). Adjusting for multiple testing: When and how? Journal of Clinical Epidemiology, 54(4), 343349.CrossRefGoogle ScholarPubMed
Breitbart, W. (2004). Psycho-oncology and palliative care: Opportunity for integration. Palliative & Supportive Care, 2(2), 113114.Google Scholar
Breitbart, W. (2006). The goals of palliative care: Beyond symptom control. Palliative & Supportive Care, 4(1), 12.Google Scholar
Breitbart, W., Chandler, S., Eagel, B., et al. (2000). An alternative algorithm for dosing transdermal fentanyl for cancer-related pain. Oncology, 14(5), 695705.Google Scholar
Brown, L.F., Kroenke, K., Theobald, D.E., et al. (2010). The association of depression and anxiety with health-related quality of life in cancer patients with depression and/or pain. Psycho-Oncology, 19(7), 734741.Google Scholar
Carlson, L.E., Angen, M., Cullum, J., et al. (2004). High levels of untreated distress and fatigue in cancer patients. British Journal of Cancer, 90(12), 22972304.Google Scholar
Ciaramella, A., Grosso, S., Poli, P., et al. (2004). When pain is not fully explained by organic lesion: A psychiatric perspective on chronic pain patients. European Journal of Pain, 8(1), 1322.Google Scholar
Cipriani, A., La Ferla, T., Furukawa, T.A., et al. (2010). Sertraline versus other antidepressive agents for depression. The Cochrane Database of Systematic Reviews, 14(4). doi: 10.1002/14651858.CD006117.pub2.Google Scholar
Cleeland, C.S., Gonin, R., Hatfield, A.K., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. The New England Journal of Medicine, 330(9), 592596.Google Scholar
Fasse, L., Flahault, C., Bredart, A., et al. (2015). Describing and understanding depression in spouses of cancer patients in palliative phase. Psycho-Oncology, 24(10), doi: 10.1002/pon.3777 [Epub ahead of print].Google Scholar
Furukawa, T.A., McGuire, H. & Barbui, C. (2002). Meta-analysis of effects and side effects of low-dosage tricyclic antidepressants in depression: Systematic review. BMJ, 325(7371), 991.Google Scholar
Gibson, C.A., Lichtenthal, W., Berg, A., et al. (2006). Psychological issues in palliative care. Anesthesiology Clinics, 24(1), 6180.Google Scholar
Grande, G.E. & Todd, C.J. (2000). Why are trials in palliative care so difficult? Palliative Medicine, 14(1), 6974.Google Scholar
Guidi, J., Fava, G.A., Bech, P., et al. (2011). The Clinical Interview for Depression: A comprehensive review of studies and clinimetric properties. Psychotherapy and Psychosomatics, 80(1), 1027.Google Scholar
Iliffe, S., Kharicha, K., Carmaciu, C., et al. (2009). The relationship between pain intensity and severity and depression in older people: Exploratory study. BMC Family Practice, 10(54), 14712296.Google Scholar
Irwin, S.A. & Ferris, F.D. (2008). The opportunity for psychiatry in palliative care. Canadian Journal of Psychiatry, 53(11), 713724.Google Scholar
Jaiswal, R., Alici, Y. & Breitbart, W. (2014). A comprehensive review of palliative care in patients with cancer. International Review of Psychiatry, 26(1), 87101.Google Scholar
Kapoor, S. (2013). Additional advantages of mirtazapine therapy in cancer patients: Beyond its role as an antidepressant. Journal of Pain and Symptom Management, 45(3), e3e4. doi: 10.1016/j.jpainsymman.2012.12.001 [Epub ahead of print January 29].Google Scholar
Kroenke, K., Spitzer, R.L. & Williams, J.B. (2001). The PHQ–9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606613.Google Scholar
Lemogne, C., Consoli, S.M., Melchior, M., et al. (2013). Depression and the risk of cancer: A 15-year follow-up study of the GAZEL cohort. American Journal of Epidemiology, 178(12), 17121720.CrossRefGoogle Scholar
Lin, C.C., Lai, Y.L. & Ward, S.E. (2003). Effect of cancer pain on performance status, mood states, and level of hope among Taiwanese cancer patients. Journal of Pain and Symptom Management, 25(1), 2937.CrossRefGoogle ScholarPubMed
Lloyd-Williams, M. (2000). Difficulties in diagnosing and treating depression in the terminally ill cancer patient. Postgraduate Medical Journal, 76(899), 555558.Google Scholar
Lloyd-Williams, M. (2001). Screening for depression in palliative care patients: A review. European Journal of Cancer Care, 10(1), 3135.Google Scholar
Lo, C., Zimmermann, C., Rydall, A., et al. (2010). Longitudinal study of depressive symptoms in patients with metastatic gastrointestinal and lung cancer. Journal of Clinical Oncology, 28(18), 30843089.Google Scholar
Lo, C., Calzavara, A., Kurdyak, P., et al. (2013). Depression and use of health care services in patients with advanced cancer. Canadian Family Physician, 59(3), e168174.Google Scholar
Miguel, C. & Albuquerque, E. (2011). Drug interaction in psycho-oncology: Antidepressants and antineoplastics. Pharmacology, 88(5–6), 333339.Google Scholar
Nekolaichuk, C.L., Bruera, E., Spachynski, K., et al. (1999). A comparison of patient and proxy symptom assessments in advanced cancer patients. Palliative Medicine, 13(4), 311323.Google Scholar
Nissim, R., Freeman, E., Lo, C., et al. (2012). Managing Cancer and Living Meaningfully (CALM): A qualitative study of a brief individual psychotherapy for individuals with advanced cancer. Palliative Medicine, 26(5), 713721.Google Scholar
Onitilo, A.A., Nietert, P.J. & Egede, L.E. (2006). Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. General Hospital Psychiatry, 28(5), 396402.Google Scholar
Pereira, J., Lawlor, P., Vigano, A., et al. (2001). Equianalgesic dose ratios for opioids: A critical review and proposals for long-term dosing. Journal of Pain and Symptom Management, 22(2), 672687.Google Scholar
Pessin, H., Galietta, M., Nelson, C.J., et al. (2008). Burden and benefit of psychosocial research at the end of life. Journal of Palliative Medicine, 11(4), 627632.Google Scholar
Rome, R.B., Luminais, H.H., Bourgeois, D.A., et al. (2011). The role of palliative care at the end of life. The Ochsner Journal, 11(4), 348352.Google Scholar
Satin, J.R. (2010). Review: Depression is associated with increased cancer mortality. Evidence-Based Mental Health, 13(2), 41.CrossRefGoogle ScholarPubMed
Scherrer, J.F., Salas, J., Lustman, P.J., et al. (2015). Change in opioid dose and change in depression in a longitudinal primary care patient cohort. Pain, 156(2), 348355.Google Scholar
Singer, S., Danker, H., Briest, S., et al. (2014). Effect of a structured psycho-oncological screening and treatment model on mental health in cancer patients (STEPPED CARE): Study protocol for a cluster randomized controlled trial. Trials, 15, 482. doi: 10.1186/1745-6215-15-482.Google Scholar
Spitzer, R.L., Williams, J.B., Kroenke, K., et al. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME–MD 1000 study. The Journal of the American Medical Association, 272(22), 17491756.Google Scholar
Spitzer, R.L., Kroenke, K. & Williams, J.B. (1999). Validation and utility of a self-report version of PRIME–MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. The Journal of the American Medical Association, 282(18), 17371744.Google Scholar
Theobald, D.E., Kirsh, K.L., Holtsclaw, E., et al. (2002). An open-label, crossover trial of mirtazapine (15 and 30 mg) in cancer patients with pain and other distressing symptoms. Journal of Pain and Symptom Management, 23(5), 442447.Google Scholar
Vignaroli, E., Pace, E.A., Willey, J., et al. (2006). The Edmonton Symptom Assessment System as a screening tool for depression and anxiety. Journal of Palliative Medicine, 9(2), 296303.Google Scholar
Walker, J., Hansen, C.H., Martin, P., et al. (2014). Integrated collaborative care for major depression comorbid with a poor prognosis cancer (SMaRT Oncology-3): A multicentre randomised controlled trial in patients with lung cancer. The Lancet. Oncology, 15(10), 11681176.Google Scholar
Wancata, J., Benda, N., Meise, U., et al. (1998). Use of psychotropic drugs in gynecological, surgical, and medical wards of general hospitals. International Journal of Psychiatry in Medicine, 28(3), 303314.Google Scholar
Whooley, M.A., Avins, A.L., Miranda, J., et al. (1997). Case-finding instruments for depression: Two questions are as good as many. Journal of General Internal Medicine, 12(7), 439445.Google Scholar
Workman, E.A., Hubbard, J.R. & Felker, B.L. (2002). Comorbid psychiatric disorders and predictors of pain management program success in patients with chronic pain. The Primary Companion to the Journal of Clinical Psychiatry, 4(4), 137140.Google Scholar
Zimmerman, M. & Mattia, J.I. (1999). Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Comprehensive Psychiatry, 40(3), 182191.Google Scholar