1: Psychiatr Serv. 2005 May;56(5):585-91. End-of-life treatment preferences of persons with serious mental illness. Foti ME, Bartels SJ, Van Citters AD, Merriman MP, Fletcher KE. University of Massachusetts Medical School, Worcester, MA, USA. maryellen.foti@dmh.state.ma.us OBJECTIVE: The goal of this study was to ascertain preferences for end-of-life care among persons with serious mental illness. METHODS: The participants were 150 community-residing adults with serious mental illness. The Health Care Preferences Questionnaire was administered to obtain information about treatment preferences in response to hypothetical medical illness scenarios: use of pain medication in the case of incurable cancer and use of artificial life support in the case of irreversible coma. Participants were asked what their treatment preferences would be for an imaginary person in each scenario ("other") as well as their preferences for themselves ("self"). RESULTS: For the scenario involving pain medication for incurable cancer, most participants chose aggressive pain management even if cognition might be affected (64 percent of respondents under the "other" scenario and 66 percent under the "self" scenario). Few participants thought a doctor should provide patients with enough medication to end their life (34 percent for self and 24 percent for other). For the scenario involving irreversible coma, respondents were divided in their choice regarding life support. Approximately one-quarter said that they would prefer to immediately terminate life support (28 percent of respondents for other and 29 percent for self), and half said they would choose to turn it off after a defined period (48 percent for other and 45 percent for self). CONCLUSIONS: Persons with serious mental illness were able to designate treatment preferences in response to end-of-life health state scenarios. Future research is needed to test advance care planning methods, assess stability of choices over time, and ascertain the utility of scenario-based preferences to guide end-of-life care decisions in this population. MeSH Terms: Acute Disease Adult Advance Directives* Female Humans Male Massachusetts Mental Disorders* Middle Aged Patient Participation Patient Satisfaction* Questionnaires Research Support, Non-U.S. Gov't Terminal Care/methods* PMID: 15872168 [PubMed - indexed for MEDLINE] 2: Psychiatr Serv. 2005 May;56(5):576-84. Medical advance care planning for persons with serious mental illness. Foti ME, Bartels SJ, Merriman MP, Fletcher KE, Van Citters AD. University of Massachusetts Medical School, Worcester, MA, USA. maryellen.foti@dmh.state.ma.us OBJECTIVE: This study examined preferences regarding medical advance care planning among persons with serious mental illness, specifically, experience, beliefs, values, and concerns about health care proxies and end-of-life issues. METHODS: A structured interview, the Health Care Preferences Questionnaire, was administered to a convenience sample of 150 adults with serious mental illness who were receiving community-based services from the Massachusetts Department of Mental Health. Clinical information and demographic data were also collected. RESULTS: A total of 142 participants completed the questionnaire. Although more than one-quarter had thought about their medical treatment preferences in the event that they became seriously medically ill, very few had discussed these preferences. A majority of respondents (72 percent) believed that someone should be designated to make medical health care decisions for a person who is too sick to make or communicate these decisions him- or herself. Common end-of-life concerns included financial and emotional burdens on family, pain and suffering, interpersonal issues such as saying "goodbye," spiritual issues, and funeral arrangements. Participants were most uneasy about the prolonging or stopping of life support by proxy decision makers. A total of 104 respondents (69 percent) expressed interest in formally selecting a health care proxy. CONCLUSIONS: Although persons with serious and persistent mental illness have little experience with medical advance care planning, they show substantial interest in it. Furthermore, they are able to consider and communicate their preferences. This study supports the feasibility, acceptability, and utility of a standardized approach to medical advance care planning with this population. MeSH Terms: Acute Disease Adult Advance Care Planning* Comparative Study Female Humans Male Massachusetts Mental Disorders/therapy* Middle Aged Patient Satisfaction/statistics & numerical data* Proxy Questionnaires Research Support, Non-U.S. Gov't Terminal Care PMID: 15872167 [PubMed - indexed for MEDLINE] 3: Issues Ment Health Nurs. 2005 Jan;26(1):91-9. Rapid change in status: the case of William. Specht J, Puntil C. John A. Hartford Center for Geriatric Nursing Excellence, University of Iowa College of Nursing, Iowa City, Iowa, USA. janet-specht@uiowa.edu In most geropsychiatric inpatient settings, the focus of care is reduction, management, or alleviation of psychiatric signs and symptoms through a combination of behavioral and pharmacologic interventions. However, unidentified or evolving medical conditions among frail older patients may precipitate rapid and unanticipated changes in status. The case of "William" illustrates how prompt adjustments in nursing care, collaboration within and between the geropsychiatric unit and other hospital services, and close working relationships with family may facilitate unexpected end-of-life decisions and promote quality of care. Publication Types: Case Reports MeSH Terms: Aged Aged, 80 and over Alzheimer Disease/complications Alzheimer Disease/nursing* Comorbidity Disorders of Excessive Somnolence/etiology Frail Elderly Geriatric Assessment Geriatric Nursing/organization & administration* Geriatric Psychiatry/organization & administration* Heart Diseases/etiology Hospitalization Humans Male Mental Disorders/etiology Nursing Assessment Nursing Diagnosis Outcome Assessment (Health Care) Patient Care Planning Psychiatric Nursing/organization & administration* Terminal Care/organization & administration PMID: 15842108 [PubMed - indexed for MEDLINE] 4: Clin Geriatr Med. 2004 Nov;20(4):621-40, v-vi. Symptom management in the older adult. Brown JA, Von Roenn JH. Department of Medicine, Division of Hematology/Oncology, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 850, Chicago, IL 60611-2927, USA. Palliative care begins at the time of diagnosis of a life-threatening illness and continues beyond the time of death. Defined in the broadest sense, the goal of palliative care is to provide aggressive symptom management and address the psychological and spiritual needs of the patient and the family. This article reviews the management of some symptoms commonly observed in older patients, highlighting treatment considerations specific to the older population. Ultimately the approach to symptoms must be individualized, and treatment decisions must reflect the patient's goals of care. Although symptom management in older patients may be challenging, it is possible to provide care that significantly enhances quality of life throughout the course of illness. Publication Types: Review Review, Tutorial MeSH Terms: Aged Gastrointestinal Diseases/prevention & control Geriatric Assessment* Humans Mental Disorders/prevention & control Pain/prevention & control Palliative Care/methods* Patient Care Planning* Respiratory Tract Diseases/prevention & control Terminal Care PMID: 15541616 [PubMed - indexed for MEDLINE] 5: J Neurosurg. 2004 Oct;101(4):574-5; discussion 575-6. Comment on: J Neurosurg. 2004 Oct;101(4):682-6. Deep brain stimulation and psychosurgery. Cosgrove GR. Publication Types: Comment Editorial MeSH Terms: Alzheimer Disease/therapy* Electric Stimulation Therapy* Humans Mental Disorders/therapy* Obsessive-Compulsive Disorder/therapy* Palliative Care Patient Selection PMID: 15481708 [PubMed - indexed for MEDLINE] 6: Issues Law Med. 2004 Summer;20(1):73-9. Dutch euthanasia: the new government ordered study. Fenigsen R. Willem-Alexander Hospital, 's-Hertogenbosch, the Netherlands. MeSH Terms: Adolescent Adult Advance Directives/legislation & jurisprudence Advance Directives/statistics & numerical data Aged Child Child, Preschool Euthanasia, Active, Voluntary/legislation & jurisprudence Euthanasia, Active, Voluntary/statistics & numerical data* Euthanasia, Active, Voluntary/trends* Euthanasia, Passive/legislation & jurisprudence Euthanasia, Passive/statistics & numerical data* Euthanasia, Passive/trends* Humans Infant Mentally Ill Persons/statistics & numerical data Netherlands Palliative Care/statistics & numerical data Physician's Practice Patterns/legislation & jurisprudence Questionnaires Suicide, Assisted/legislation & jurisprudence Suicide, Assisted/statistics & numerical data PMID: 15382748 [PubMed - indexed for MEDLINE] 7: Rev Neurol (Paris). 2004 Jun;160 Spec No 1:5S210-9. [Children with drug-resistant partial epilepsy: criteria for the identification of surgical candidates] [Article in French] Hirsch E, Arzimanoglou A. Departement de Neurologie, Hopitaux Universitaires, 1 place de l'hopital, 67092 Strasbourg, France. Edouard.Hirsch@chru-strasbourg.fr The majority of candidates for epilepsy surgery, in both children and adults, belong to the syndromic category of partial epilepsies. However, particularly in children, the clinical expression of epilepsy may sometimes be misleading, as paroxysmal events may present as generalized seizures although having a focal onset. The spectrum of surgical possibilities for early-onset epilepsy has tended to widen rapidly and to include not only other focal epilepsies but also more difficult types. This is because developmental lesions that are the major cause of infantile epilepsy are often poorly localized, involve extensive brain areas and require extensive operations (e.g. hemispherotomy). Surgery is also used for progressive conditions such as Rasmussen's encephalitis or Sturge-Weber syndrome. Some forms of generalized symptomatic epilepsy may also benefit from palliative surgical procedures (callosotomy in cases with repetitive drop attacks often as a manifestation of a Lennox-Gastaut syndrome). The timing of surgery partly depends on the probable effectiveness of the operation available for each particular patient. Candidates for epilepsy surgery must be identified early in the process of the disease, thus increasing the chances for a satisfactory cognitive and behavioral outcome. The decision should be taken by experienced multidisciplinary groups, that will also ensure post-operative follow-up, both in terms of medical management and psycho-social integration. Prospective studies are still needed, to evaluate the long-term cognitive evolution of children operated on early for their epilepsy and cured. Increasing evidence indicates that drug therapy is likely to fail to achieve control of the seizures when two-three of the major drugs, properly chosen by competent clinicians, have not obtained satisfactory results, i.e. full control of seizures and absence of side effects. Testing of all possible drugs is not advisable, because this process would be excessively long when surgery is a reasonable possibility. The requirements for resective surgery in children with partial drug-resistant epilepsy vary with the type of resection considered. Three basic requirements apply to almost all cases: (a) the epileptogenic area must be localized to a territory whose removal is contemplated; (b) that no other independent epileptogenic area exists in those areas that are not included in the planned resection, and (c) that any possible deficit resulting from resection must be acceptable. The current experience confirms that the complete resection of the epileptogenic area is the major condition for a satisfactory surgical result. The possibilities for resective surgery depend upon the localization of the ictal onset zone, its relationship with adjacent functional brain areas and the availability of convergent data that point to a single localization. Epilepsy surgery mandates a multidisciplinary approach that requires special skills and sophisticated instruments and materials that cannot be improvised. A global evaluation of risks and expected benefits is always required. All decisions require a close collaboration between the epilepsy team, the patient and the family. With the exception of high quality MRI and video-EEG recording of seizures, the need to perform any other complementary presurgical investigation should be evaluated on an individual basis. Publication Types: Review MeSH Terms: Anticonvulsants/therapeutic use Brain Neoplasms/complications Brain Neoplasms/surgery Child Child, Preschool Combined Modality Therapy Diagnostic Imaging Disease Progression Drug Resistance English Abstract Epilepsies, Partial/diagnosis Epilepsies, Partial/drug therapy Epilepsies, Partial/surgery* Epilepsy, Temporal Lobe/surgery Humans Infant Mental Disorders/complications Mental Retardation/complications Neurosurgical Procedures/contraindications Neurosurgical Procedures/methods* Palliative Care Patient Care Team Patient Selection* Postoperative Complications Syndrome Substances: Anticonvulsants PMID: 15331969 [PubMed - indexed for MEDLINE] 8: Eur J Cancer Care (Engl). 2004 Mar;13(1):36-44. An investigation of inpatient referrals to a clinical psychologist in a hospice. Alexander P. East Kent Hospitals Trust, Kent and Canterbury Hospital, Canterbury, Kent, UK. Paul.Alexander@ekht.nhs.uk A clinical psychologist, in a new post in a hospice, developed an assessment, therapeutic and consultation role. A retrospective, diary-based audit was made of the inpatients referred during the first 2 years, allowing an examination of referral practices and changes over time as the psychologist's role developed. During the 2 years 11% of the hospice inpatients were referred, consistent with previous published work in this area. Referrals increased from 10% in year 1 to 12% in year 2. Referrals were not skewed in terms of patient gender or diagnosis but younger patients were referred more. Comparison with other studies suggests the psychologist's gender may influence referral rates of woman patients. Referrals for depression and anxiety increased in year 2 but decreased for pain. The number of patients seen with marital/family stresses also increased with time. Such patients required the most psychological input. Patients with problems of alcohol misuse or dementia were particularly challenging for the hospice team and specific training was developed. The psychologist's role is discussed in the light of these findings, particularly in enhancing the multidisciplinary team's holistic approach to the patient and their family, by emphasizing the patient's experience and the collaborative basis of care. MeSH Terms: Adult Age Distribution Aged Female Hospice Care/organization & administration* Humans Male Mental Disorders/rehabilitation* Middle Aged Neoplasms/psychology* Palliative Care/organization & administration Professional Role Psychology, Clinical/statistics & numerical data* Referral and Consultation/standards* Referral and Consultation/statistics & numerical data PMID: 14961774 [PubMed - indexed for MEDLINE] 9: Community Ment Health J. 2004 Feb;40(1):3-16. End-of-life care and mental illness: a model for community psychiatry and beyond. Candilis PJ, Foti ME, Holzer JC. Department of Psychiatry, University of Massachusetts Medical School, USA. End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment. MeSH Terms: Bioethics Chronic Disease Community Psychiatry* Decision Making Health Services Research Humans Mental Competency Mental Disorders* Models, Theoretical Research Support, Non-U.S. Gov't Risk Assessment Stereotyping Suicide Terminal Care* United States PMID: 15077725 [PubMed - indexed for MEDLINE] 10: Schweiz Rundsch Med Prax. 2004 Jan 28;93(5):135-9. [When the soul shatters] [Article in German] Kurmann J. Psychiatriezentrum Luzern-Stadt, Kantonsspital Luzern. Clinically relevant psychiatric disorders are very common in palliative medicine. Depending on severity, their influence on the patient's quality of life can be very unfavorable. Because of the fact that mental disorders usually have multifactor roots, an interdisciplinary approach to diagnostic and treatment procedures is necessary. In our daily clinical work we are often far away from realizing this approach. While treating these patients, the doctor is often left alone and feels powerless. The following remarks are meant as an aid to the doctor working in the field of palliative medicine, to enable him to recognize the psychiatric disorder and treat the illness accordingly. Besides the clinically relevant psychiatric disorders, many other psychological and social problems and also spiritual aspects are to be kept in mind when caring for these chronically ill patients. Due to lack of space it will not be possible to deal with all of these important issues in this paper. MeSH Terms: Diagnosis, Differential English Abstract Humans Mental Disorders/diagnosis* Mental Disorders/drug therapy Mental Disorders/psychology Palliative Care/psychology* Patient Care Team* Physician-Patient Relations Psychotropic Drugs/therapeutic use Quality of Life/psychology* Referral and Consultation Risk Factors Sick Role* Substances: Psychotropic Drugs PMID: 15008429 [PubMed - indexed for MEDLINE] 11: Clin Geriatr Med. 2003 Nov;19(4):841-56, vii-viii. End-of-life care in geriatric psychiatry. Goy E, Ganzini L. Portland Veterans Affairs Medical Center, Mental Health, P3MHDC, P.O. Box 1034, Portland, OR 97207, USA. goye@ohsu.edu Depression, anxiety and delirium are relatively common during the final stages of terminal disease, and each can profoundly impact the quality of those last days for both patient and involved family. In this article the authors review the assessment and treatment of each syndrome in the context of palliative care for older adults. Treatment of mental disorders at the end of life warrants special consideration due to the need to balance the benefits of treatment against the potential burden of the intervention, especially those that might worsen quality of life. Dementia and the complications of depression and behavioral disturbance within dementia are also discussed. Finally, caregivers of dying patients are vulnerable to stress, depression, grief, and complicated bereavement. Interventions for caregivers who are debilitated by these states are briefly summarized. Publication Types: Review Review, Tutorial MeSH Terms: Aged Anxiety/diagnosis Anxiety/drug therapy Caregivers/psychology Delirium/diagnosis Delirium/drug therapy Delirium/etiology Dementia/diagnosis Dementia/therapy Depression/diagnosis Depression/drug therapy Humans Mental Disorders/etiology Mental Disorders/therapy* Palliative Care* Research Support, U.S. Gov't, Non-P.H.S. Stress, Psychological/therapy Terminal Care* PMID: 15024815 [PubMed - indexed for MEDLINE] 12: JAMA. 2003 Aug 13;290(6):806-14. Comment in: JAMA. 2004 Jan 28;291(4):492. Overcoming the false dichotomy of curative vs palliative care for late-stage HIV/AIDS: "let me live the way I want to live, until I can't". Selwyn PA, Forstein M. Department of Family Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. selwyn@aecom.yu.edu Recent advances in human immunodeficiency virus (HIV) therapy have significantly reduced HIV-related mortality in the developed world, but mortality rates have plateaued, and AIDS remains a leading cause of serious illness and death for young adults. The chronic nature of the HIV disease course and the increasing burden of cumulative HIV-related morbidity and treatment-related toxic effects pose new challenges to the care of patients over time. Uncertainties about prognosis and the promise and limitations of rapidly evolving therapies have made decision making about advance care planning and end-of-life issues more complex and elusive than when the disease course was more uniform, rapid, and predictable. The emerging biomedical paradigm of highly active antiretroviral therapy (HAART) as the cornerstone of treatment has helped to transform HIV into a manageable chronic disease, yet at the same time has resulted in a more narrow focus and a de facto separation between disease-specific "curative" and symptom-specific "palliative" care for patients with HIV/AIDS. As patients survive longer in the latter stages of progressive HIV disease, they may in fact have increasing need for comprehensive symptom management as well as wide-ranging need for psychosocial, family, and care planning support. In the HAART era, the false dichotomy of curative vs palliative care for patients with HIV/AIDS must be supplanted by a more integrated model to provide comprehensive care for patients with advanced HIV disease and their families. Publication Types: Case Reports MeSH Terms: Acquired Immunodeficiency Syndrome/complications* Acquired Immunodeficiency Syndrome/psychology Acquired Immunodeficiency Syndrome/therapy* Adult Advance Care Planning* Antiretroviral Therapy, Highly Active/adverse effects Caregivers Chronic Disease Comorbidity Cost of Illness Humans Male Mental Disorders Palliative Care* Physician's Role* Prognosis Research Support, Non-U.S. Gov't Risk PMID: 12915434 [PubMed - indexed for MEDLINE] 13: J Palliat Med. 2003 Aug;6(4):661-9. "Do It Your Way": a demonstration project on end-of-life care for persons with serious mental illness. Foti ME. Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA. maryellen.foti@dmh.state.ma.us Over the last decade, America's health care systems have been challenged to incorporate advance care planning and end-of-life care into their service delivery systems to assure that persons with terminal illnesses receive compassionate individualized care. Despite the surge in new research and knowledge, some groups remain understudied and underserved, such as persons with serious mental illness. "Do It Your Way," a demonstration project, was developed and implemented in a Massachusetts public mental health system to improve access to advance care planning and end-of-life care among persons with serious mental illness. This report provides an overview of the project, including its rationale, setting, needs assessment, objectives, initiatives, preliminary evaluation, impact, and conclusions. Publication Types: Review Review, Tutorial MeSH Terms: Adult Advance Care Planning* Cross-Sectional Studies Delivery of Health Care/organization & administration* Delivery of Health Care/trends Humans Massachusetts Mental Disorders/therapy* Mental Health Services/organization & administration* Mental Health Services/trends Middle Aged Needs Assessment* Terminal Care/organization & administration* Terminal Care/trends PMID: 14516513 [PubMed - indexed for MEDLINE] 14: BMJ. 2003 Jul 26;327(7408):222. Comment on: BMJ. 2003 Jan 4;326(7379):30-4. In search of a good death: A good death is an oxymoron without consideration of mental health. Prigerson HG, Jacobs SC, Bradley EH, Kasl SV. Publication Types: Comment Letter MeSH Terms: Humans Mental Disorders/therapy* Quality of Life Terminal Care/standards* Terminally Ill PMID: 12881276 [PubMed - indexed for MEDLINE] 15: Curr Pain Headache Rep. 2003 Apr;7(2):89-97. The psychiatric management of end-of-life pain and associated psychiatric comorbidity. Cole BE. American Academy of Pain Management, 13947 Mono Way #A, Sonora, CA 95370, USA. kmit@ix.netcom.com Involvement by psychiatrists in the care of patients who are terminally ill has been limited historically; however, psychiatrists increasingly are participating in the care of these people who are facing the most challenging times of their lives. Pain management is considered to be an area of subspecialization for psychiatrists beyond their traditional role of being psychopharmacologists and psychotherapists. Biologically focused psychiatrists are able to address neuropsychiatric disorders, including pain and depression in the medically ill, and actively improve the quality of life for dying patients and their family members. This article provides a review of the recent literature that has addressed the involvement of psychiatrists in end-of-life care. Beginning with an example of the scientific aspects of cancer-related treatment from a patient's perspective, and into the major treatment considerations, this article addresses pain, its recognition, and management challenges when the end of life approaches. The prompt recognition of frequently overlooked and underestimated concomitant depressions, delirium, dementia, and other mental disorders is important for mental health specialists. The importance of psychiatric care for patients who are terminally ill and the role of psychiatrists in the phase of care also are discussed. Publication Types: Review Review, Tutorial MeSH Terms: Humans Mental Disorders/etiology Mental Disorders/psychology* Mental Disorders/therapy* Pain/complications Pain/psychology* Pain/therapy* Psychotherapy* Terminal Care/psychology* Terminally Ill/psychology* PMID: 12628050 [PubMed - indexed for MEDLINE] 16: Neurosurg Clin N Am. 2003 Apr;14(2):303-19, ix-x. From psychosurgery to neuromodulation and palliation: history's lessons for the ethical conduct and regulation of neuropsychiatric research. Fins JJ. Division of Medical Ethics, Departments of Medicine and Public Health, Weill Medical College of Cornell University, New York-Weill Cornell Medical Center, 525 East 68th Street, F-173, New York, NY, USA. jjfins@med.cornell.edu As we contemplate the emerging era of neuromodulation and imagine the utility of deep brain stimulation for disease entities in neurology and psychiatry, our enthusiasm is immediately tempered by history. Just a generation ago, other confident investigators were heralding invasive somatic therapies like prefrontal lobotomy to treat psychiatric illness. That era of psychosurgery ended with widespread condemnation, congressional calls for a ban, and avow that history should never repeat itself. Now, just 30 years later, neurologists, neurosurgeons, and psychiatrists are implanting deep brain stimulators for the treatment of Parkinson's disease and contemplating their use for severe psychiatric illnesses, such as obsessive-compulsive disorder and the modulation of consciousness in traumatic brain injury. Publication Types: Historical Article Review MeSH Terms: Biomedical Research/ethics* Biomedical Research/history Brain/surgery* History, 20th Century Humans Mental Disorders/history* Mental Disorders/surgery Palliative Care/history* Palliative Care/methods Psychosurgery/ethics Psychosurgery/history* Psychosurgery/instrumentation United States PMID: 12856496 [PubMed - indexed for MEDLINE] 17: Palliat Med. 2003 Mar;17(2):212-8. Psychiatric disorder in a palliative care unit. Ita D, Keorney M, O'Slorain L. Department of Psychiatry, Shelton Hospital, Bicton Heath, Shrewsbury, UK. cdim@tesco.net INTRODUCTION: Studies have shown varying prevalence rates of psychiatric disorders in patients with terminal illness. On average it is expected that between 33 and 50% of this population will require psychological support. Despite this, up to 50% of psychiatric disorders remain unrecognized by medical and nursing personnel. The objectives of this study were to assess clinically the prevalence of psychiatric disorder occurring in the study population and to ascertain whether this disorder had been detected and treated prior to admission. METHOD: Following assessment of the patient, the presence or absence of a psychiatric diagnosis was determined according to the criteria laid down by the ICD-10 Diagnostic Criteria for Research. RESULTS: One hundred and thirty-nine (62%) patients met ICD-10 diagnostic criteria for psychiatric disorder. Thirty-three (24%) patients had dual diagnoses. The commonest diagnoses were organic disorders followed by neurotic and stress-related disorders and depression (27%, 16% and 16%, respectively). One hundred and twenty-six (91%) patients with a psychiatric disorder had been symptomatic on admission. Of these, 35% were receiving incorrect or inadequate treatment. CONCLUSION: Almost two-thirds of the palliative care population studied had comorbid psychiatric illness. One-third of these disorders had not been identified or treated appropriately prior to admission. Future research needs to identify effective methods of detecting and diagnosing these disorders to enable early and efficient treatment programmes be initiated. MeSH Terms: Adult Aged Aged, 80 and over Female Hospices/statistics & numerical data* Humans Ireland/epidemiology Male Mental Disorders/diagnosis Mental Disorders/epidemiology* Middle Aged Palliative Care/psychology* Prevalence Psychiatric Status Rating Scales PMID: 12701854 [PubMed - indexed for MEDLINE] 18: Aten Primaria. 2002 Jul-Aug;30(3):179-82. [Palliative treatment: Psychiatric, neurological and skin complications in patients with terminal illness] [Article in Spanish] Benitez Del Rosario MA, Cabrejas Sanchez A, Fernandez Dias R, Perez Suarez MC. Medico de Familia, Jefe de la Seccion de Cuidados Paliativos del Centro Hospitalario La Candelaria, Tenerife, Espana. mabenitez@comtf.es MeSH Terms: Anxiety/etiology Anxiety/therapy Comparative Study Delirium/etiology Delirium/therapy Depression/etiology Depression/therapy Female Humans Lymphedema/etiology Lymphedema/therapy Male Mental Disorders/etiology* Mental Disorders/therapy Neoplasms/complications Neoplasms/psychology Nervous System Diseases/etiology* Nervous System Diseases/therapy Palliative Care* Pruritus/etiology Pruritus/therapy Risk Factors Skin Diseases/etiology* Skin Diseases/therapy Skin Ulcer/etiology Skin Ulcer/therapy Sleep Initiation and Maintenance Disorders/etiology Sleep Initiation and Maintenance Disorders/therapy Spinal Cord Compression/etiology Spinal Cord Compression/therapy Terminally Ill* PMID: 12139856 [PubMed - indexed for MEDLINE] 19: Public Health Nurs. 2002 Mar-Apr;19(2):94-103. Home care nursing in Japan: a challenge for providing good care at home. Murashima S, Nagata S, Magilvy JK, Fukui S, Kayama M. Department of Community Health Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan. murashima-tky@umin.ac.jp Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients. MeSH Terms: Community Health Nursing/organization & administration* Home Care Services/organization & administration* Humans Japan Mental Disorders/nursing Nurse's Role* Terminal Care PMID: 11860594 [PubMed - indexed for MEDLINE] 20: Przegl Lek. 2002;59(4-5):355-7. [Palliative care problems in the elderly patients] [Article in Polish] de Walden-Galuszko K. Zaklad Medycyny Paliatywnej Akademia Medyczna w Gdansk. galuszko@amedec.amg.gda.pl Palliative care has rapidly developed due to increasing of cancer disease and ageing of society as well. Philosophy of palliative care means: holistic care, good quality of life as it's main goal and acceptance of death. Good palliative care means also that the terminally ill elderly patients should be divided into two groups: 1. Persons with good psychic health state (but with some specific features of "senile personality"); 2. Patients with psychiatric disorders (dementia, delirium, aggressive behavior). The prompt recognition and treatment of both psychiatric and psychic healthy terminally ill patients becomes very important to the effective and good palliative care. Publication Types: Review Review, Tutorial MeSH Terms: Aged English Abstract Female Humans Male Mental Disorders/etiology Mental Disorders/therapy Neoplasms/psychology* Neoplasms/therapy* Palliative Care/psychology* PMID: 12184006 [PubMed - indexed for MEDLINE] 21: Schmerz. 2001 Oct;15(5):339-43. [Neuropsychiatric symptoms in palliative care] [Article in German] Voltz R, Borasio GD. Neurologische Klinik, Institut fur Klinische Neuroimmunologie und Interdisziplinare palliativmedizinische Einrichtung, Klinikum der Universitat Munchen-Grosshadern, Munchen. rvoltz@nro.med.uni-muenchen.de Up to 80% of patients in palliative care suffer from neurological and/or psychiatric symptoms. For many of those symptoms, there are effective treatment options which should be known to the treating physician. The following article reviews clinical, etiological and diagnostic aspects as well as treatment options. For this, a systematic literature search is combined with clinical experience. Pure motor restlessness often is caused by aggravated physical symptoms. Delirium paradoxically often is reversible, even in the palliative setting, but may also be irreversible and a sign of impending death. Fear and depression must not be overlooked as they may effectively be treated. Suicidal ideation may be dealt with without transfer to a psychiatric ward. Physician assisted suicide is critically discussed. MeSH Terms: Delirium, Dementia, Amnestic, Cognitive Disorders/psychology Delirium, Dementia, Amnestic, Cognitive Disorders/therapy* English Abstract Humans Mental Disorders/psychology Mental Disorders/therapy* Palliative Care/methods* Patient Care Team Suicide, Assisted/psychology Terminal Care/psychology* PMID: 11810374 [PubMed - indexed for MEDLINE] 22: J Psychiatr Ment Health Nurs. 2001 Feb;8(1):61-6. The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part two. Cutcliffe JR, Black C, Hanson E, Goward P. Mental Health Nursing, University of Ulster and RCN Institute, Oxford, UK. This is the second of a two-part paper which explores the areas of commonality and synchronicity between palliative care (PC) nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation and the focus on physical care. Part one focused on the first three areas of commonality, whereas this paper focuses on the fourth commonality, the locus of control. It also focuses on key differences and the implications of such similarity. The paper highlights the practice, education and research implications of this alleged commonality. It suggests, given the evidence that clients perceive the therapeutic relationship as the vital and unique aspect of PC nursing, that those working within palliative care need to question whether or not RGN registration is an essential requirement, or whether those with other skills, such as psychiatric/mental health (P/MH) nurses, should be considered for such roles. It highlights the need for the provision of post-basic counselling courses and the potential value for PC nurses of receiving clinical supervision from P/MH nurses or mental health liaison nurses. Lastly, it posits that the research issues arising out of this alleged commonality centre on the potential impact such transitions in care delivery may have on the care delivered, on the nurses themselves and on the clients. MeSH Terms: Curriculum Education, Nursing, Diploma Programs Great Britain Holistic Nursing* Humans Internal-External Control Mental Disorders/nursing Nurse's Role/psychology* Nurse-Patient Relations Palliative Care* Psychiatric Nursing*/education PMID: 11879495 [PubMed - indexed for MEDLINE] 23: J Psychiatr Ment Health Nurs. 2001 Feb;8(1):53-9. The commonality and synchronicity of mental health nurses and palliative care nurses: closer than you think? Part one. Cutcliffe JR, Black C, Hanson E, Goward P. Mental Health Nursing, University of Ulster and RCN Institute, Oxford, UK. The role of the palliative care nurse emphasizes the need for holistic care, and as this role has developed it has become evident that palliative care nurses require skills which, arguably, not all registered general nurses possess; particularly, skills pertaining to the psychological, social and spiritual domains of the person. In order to identify the skills that such nurses may require, there may be merit in considering other specialities of nursing which pay particular attention to the psychological, social and spiritual domains of the person. Consequently, this two-part paper explores the areas of commonality and synchronicity between palliative care nurses and mental health nurses. The authors argue that this commonality is best articulated under the headings: defining the needs of the client group, the role of the nurse in non-physical care, the nurse--client relationship, and the locus of control. They also argue that the differences between these groups of nurses are best articulated under the headings: facilitation/confrontation, and the focus on physical care. Part one of this paper therefore focuses on the first three areas of alleged commonality, with part two focusing on the fourth commonality, the key differences and the implications of such similarity. Given these areas of similarity the authors argue there is a case for reconsidering if the RGN qualification is an essential requirement for working within palliative care or if those with other skills -- skills based on 'being with' rather than 'doing for' -- such as RMNs, should be thought of for such roles. MeSH Terms: Holistic Nursing* Humans Internal-External Control Mental Disorders/nursing Nurse's Role/psychology* Nurse-Patient Relations Palliative Care* Psychiatric Nursing* PMID: 11879494 [PubMed - indexed for MEDLINE] 24: Adv Psychosom Med. 2001;23:17-36. Psychooncology in Japan. Hosaka T. Department of Psychiatry and Behavioral Science, Tokai University School of Medicine, Bohseidai, Isehara, Kanagawa, Japan. MeSH Terms: Adaptation, Psychological Comorbidity Disease Progression Humans Japan Mental Disorders/diagnosis Mental Disorders/psychology Mental Disorders/therapy Neoplasms/psychology* Patient Care Team Quality of Life Referral and Consultation Sick Role Terminal Care/psychology PMID: 11579899 [PubMed - indexed for MEDLINE] 25: Thorax. 2000 Dec;55(12):1000-6. Comment in: Thorax. 2000 Dec;55(12):979-81. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Gore JM, Brophy CJ, Greenstone MA. Faculty of Health, University of Hull, Hull, East Yorkshire. BACKGROUND: Patients with severe chronic obstructive pulmonary disease (COPD) have a poor quality of life and limited life expectancy. This study examined whether these patients were relatively disadvantaged in terms of medical and social care compared with a group with inoperable lung cancer. METHODS: An open two group comparison was made of 50 patients with severe COPD (forced expiratory volume in one second (FEV(1)) <0.75 l and at least one admission for hypercapnic respiratory failure) and 50 patients with unresectable non-small cell lung cancer (NSCLC). A multi-method design was used involving standardised quality of life tools, semi-structured interviews, and review of documentation. RESULTS: The patients with COPD had significantly worse activities of daily living and physical, social, and emotional functioning than the patients with NSCLC (p<0.05). The Hospital Anxiety and Depression Scale (HADS) scores suggested that 90% of patients with COPD suffered clinically relevant anxiety or depression compared with 52% of patients with NSCLC. Patients were generally satisfied with the medical care received, but only 4% in each group were formally assessed or treated for mental health problems. With regard to social support, the main difference between the groups was that, while 30% of patients with NSCLC received help from specialist palliative care services, none of the patients with COPD had access to a similar system of specialist care. Finally, patients in both groups reported a lack of information from professionals regarding diagnosis, prognosis and social support, although patients' information needs were disparate and often conflicting. CONCLUSION: This study suggests that patients with end stage COPD have significantly impaired quality of life and emotional well being which may not be as well met as those of patients with lung cancer, nor do they receive holistic care appropriate to their needs. MeSH Terms: Aged Carcinoma, Non-Small-Cell Lung/psychology Carcinoma, Non-Small-Cell Lung/therapy* Comparative Study Female Health Status Indicators Home Care Services/supply & distribution Humans Lung Diseases, Obstructive/psychology Lung Diseases, Obstructive/therapy* Lung Neoplasms/psychology Lung Neoplasms/therapy* Male Mental Disorders/etiology Middle Aged Palliative Care/standards* Patient Education/standards Patient Satisfaction Psychometrics Quality of Health Care* Quality of Life* Questionnaires Research Support, Non-U.S. Gov't Self-Help Devices/supply & distribution PMID: 11083884 [PubMed - indexed for MEDLINE] 26: Tidsskr Nor Laegeforen. 2000 Nov 10;120(27):3275-9. [Occurrence and diagnosis of psychiatric conditions in palliative medicine] [Article in Norwegian] Loge JH, Kaasa S. Institutt for medisinske atferdsfag, Universitetet i Oslo, Postboks 1111 Blindern 0317 Oslo. j.h.loge@medisin.uio.no BACKGROUND: The aims of the study are to describe the prevalence of psychiatric disorders in palliative care and how to diagnose these disorders. MATERIAL AND METHODS: Literature search including cancer patients, palliative care, psychiatric conditions and diagnostics. RESULTS: Neuropsychiatric conditions such as delirium, dementia and amnestic disorder are prevalent (> 20%), especially in the terminal phase. Anxiety and depressive symptoms are also common and may be caused by the patients' medical condition. Probably less than 10% have anxiety or depressive disorders. However, methodological limitations make comparisons across studies difficult. The interview is the main basis for assessment of mental status. Doctor-centered interviewing techniques are needed in the assessment of neuropsychiatric disorders. Emotional symptoms are best explored by open-ended questions and facilitating techniques. Psychiatric somatic symptoms such as weight loss, fatigue or insomnia are not valid diagnostic criteria. Selfreport questionnaires and short-form screening instruments are best suited for monitoring the course of the disorders, but must be adapted for this specific population. INTERPRETATION: Neuropsychiatric conditions are the most prevalent psychiatric disorders in palliative care. Good interviewing skills are the main element in the diagnostic workup. Publication Types: Review Review, Tutorial MeSH Terms: Anxiety Disorders/complications Anxiety Disorders/diagnosis Anxiety Disorders/therapy Depressive Disorder/complications Depressive Disorder/diagnosis Depressive Disorder/therapy English Abstract Humans Mental Disorders*/complications Mental Disorders*/diagnosis Mental Disorders*/epidemiology Mental Disorders*/therapy Neoplasms/complications Neoplasms/psychology* Neoplasms/therapy Palliative Care/psychology* Prevalence Research Support, Non-U.S. Gov't Terminal Care/psychology* PMID: 11187168 [PubMed - indexed for MEDLINE] 27: Patient Educ Couns. 2000 Aug;41(1):107-13. Palliative care in chronic psycho-geriatrics: a case-study. Bakker TJ. Psychiatric-Skilled Nursing Home, DrieMaasStede, Schiedam, The Netherlands. svnwn@wxs.nl In this case-study the relevance of psycho-social interventions for providing palliative care in the terminal phase of life of psycho-geriatric patients with functional-psychiatric co-pathology is described. The know-how, interventions and facilities such as available in a reactivation unit in a 'psychiatric-skilled' Dutch nursing home, were highly relevant to tune palliative care to the needs and abilities of the patient. The application of the four main-dimensions of the method of Dynamic System Analysis (particularly Cognitive functions, Psychological functions, Social context and Biology) can stimulate professionals to use an integral perspective both to the psycho-social needs of terminal psycho-geriatric patients and their relatives and to the biological aspects. To establish the value of the DSA method for providing palliative care to psycho-geriatric patients with functional-psychiatric co-pathology scientific research is recommended to determine the prognostic profile of patients who benefit most from an actual palliative care program. Publication Types: Case Reports MeSH Terms: Aged Female Humans Mental Disorders/therapy* Palliative Care/methods* Terminal Care/methods* PMID: 10900372 [PubMed - indexed for MEDLINE] 28: Tidsskr Nor Laegeforen. 2000 Apr 10;120(10):1186-90. [Examples of the use of music in clinical medicine] [Article in Norwegian] Myskja A, Lindbaek M. Seksjon for allmennmedisin, Universitetet i Oslo. Music has been an element in medical practice throughout history. There is growing interest in music as a therapeutic tool. Since there is no generally accepted standard for how, when and where music should be applied within a medical framework, this literature study endeavours to present an overview of central areas of application of music in medicine. It further attempts to find tentative conclusions that may be drawn from existing clinical research on the efficacy of music as a medical tool. Traditionally, music has been linked to the treatment of mental illness, and has been used successfully to treat anxiety and depression and improve function in schizophrenia and autism. In clinical medicine several studies have shown analgetic and anxiolytic properties that have been used in intensive care units, both in diagnostic procedures like gastroscopy and in larger operations, in preoperative as well as postoperative phases, reducing the need for medication in several studies. The combination of music with guided imagery and deep relaxation has shown reduction of symptoms and increased well-being in chronic pain syndromes, whether from cancer or rheumatic origin. Music has been used as support in pregnancy and gestation, in internal medicine, oncology, paediatrics and other related fields. The use of music with geriatric patients could prove to be especially fruitful, both in its receptive and its active aspect. Studies have shown that music can improve function and alleviate symptoms in stroke rehabilitation, Parkinson's disease, Alzheimer's disease and other forms of dementia. The role of music in medicine is primarily supportive and palliative. The supportive role of music has a natural field of application in palliative medicine and terminal care. Music is well tolerated, inexpensive, with good compliance and few side effects. Publication Types: Historical Article Review Review, Tutorial MeSH Terms: Analgesia/psychology Dementia/therapy English Abstract Female Geriatric Psychiatry History, 18th Century History, 19th Century History, 20th Century Humans Mental Disorders/therapy Music Therapy*/history Nervous System Diseases/therapy Palliative Care/psychology Pregnancy Relaxation PMID: 10863351 [PubMed - indexed for MEDLINE] 29: Krankenpfl Soins Infirm. 2000 Apr;93(4):25. [Not an easy life] [Article in German] Kunz M. MeSH Terms: Comorbidity Female Humans Leukemia, Myelocytic, Acute/nursing* Leukemia, Myelocytic, Acute/psychology Mental Disorders/nursing* Mental Disorders/psychology Nurse's Role/psychology Nurse-Patient Relations* Terminal Care/psychology* PMID: 11941776 [PubMed - indexed for MEDLINE] 30: Semin Oncol. 2000 Feb;27(1):24-33. Common symptoms in advanced cancer. Komurcu S, Nelson KA, Walsh D, Donnelly SM, Homsi J, Abdullah O. Harry R. Horvitz Center for Palliative Medicine and the Taussig Cancer Center, The Cleveland Clinic Foundation, OH 44195, USA. The relief of physical and psychological symptoms is an essential part of palliative care. Advanced cancer is an acute process; because the clinical picture changes rapidly, symptoms must be reassessed regularly, and a careful history is essential. Defining the relationship of the symptoms to the disease can defuse fear and encourage a sense of control in patients and their families. We review the pathophysiology, causes, prevalence, consequence, and management of common symptoms in advanced cancer. Publication Types: Review Review, Tutorial MeSH Terms: Disease Progression Gastrointestinal Diseases/etiology Gastrointestinal Diseases/therapy Humans Mental Disorders/etiology Mental Disorders/therapy Neoplasms/complications Neoplasms/physiopathology* Neoplasms/therapy* Palliative Care* Respiratory Tract Diseases/etiology Respiratory Tract Diseases/therapy PMID: 10697019 [PubMed - indexed for MEDLINE] 31: Aten Primaria. 1999 Dec;24 Suppl 1:133-92. [Prevention of mental health disorders in primary health care. Group for Prevention in Mental Health of the PAPPS] [Article in Spanish] Buitrago Ramirez F, Ciurana Misol R, Chocron Bentata L, Fernandez Alonso C, Garcia Campayo J, Monton Franco C, Redondo Granado MJ, Tizon Garcia JL. Publication Types: Guideline Practice Guideline MeSH Terms: Adolescent Adult Aged Anxiety/prevention & control Child Depression/prevention & control Family Health Female Grief Humans Language Disorders/prevention & control Learning Disorders/prevention & control Male Mental Disorders/prevention & control* Parents Pregnancy Primary Health Care Retirement Single-Parent Family Suicide/prevention & control Terminal Care PMID: 10666930 [PubMed - indexed for MEDLINE] 32: J Pain Symptom Manage. 1999 Dec;18(6):447-8. Comment in: J Pain Symptom Manage. 1999 Dec;18(6):448-9. J Pain Symptom Manage. 1999 Dec;18(6):449-50. Case presentation: end-of-life care and mental illness: the case of Ms. W. Candilis PJ, Foti ME. Department of Psychiatry, University of Massachusetts Medical School, USA. Publication Types: Case Reports MeSH Terms: Aged Female Humans Mental Disorders/therapy* Research Support, Non-U.S. Gov't Terminal Care/methods* PMID: 10641471 [PubMed - indexed for MEDLINE] 33: Health Serv Manage Res. 1999 Nov;12(4):205-11. Shared care for high-dependency patients: mental illness, neurological disorders and terminal care--a review. Walker Z, McKinnon M, Townsend J. Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK. z.a.k.walker@herts.ac.uk Changes in the structure of health services in the UK have increased the need to identify and formalize shared responsibilities between primary and secondary care for patients with chronic conditions. There are well-established schemes for the management of patients with some chronic diseases but very little for other high-dependency groups. This review examines the extent of systematic and shared care for some of the less well served groups: these are mental illness, neurological disorders and terminal care. Examples of good practice are highlighted. Publication Types: Review Review, Tutorial MeSH Terms: Case Management* Chronic Disease Family Practice/organization & administration* Great Britain Humans Mental Disorders/therapy* Nervous System Diseases/therapy* Primary Health Care/organization & administration Research Support, Non-U.S. Gov't Specialties, Medical/organization & administration* State Medicine/organization & administration Terminal Care/organization & administration* PMID: 10622798 [PubMed - indexed for MEDLINE] 34: Psychiatr Serv. 1999 May;50(5):664-6. Comment in: Psychiatr Serv. 1999 Aug;50(8):1087-8. Psychiatr Serv. 2000 Nov;51(11):1452-3. Balancing efficiency and need in allocating resources to the care of persons with serious mental illness. Callahan D. Hastings Center, Garrison, NY 10524-5555, USA. callahan@thehastingscenter.org The care of patients with serious mental illness, for whom a cure is unlikely and costs are high, is difficult to justify using ordinary standards of efficient resource allocation. The author examines the difficulties of using conventional utilitarian, cost-benefit, moral, and political arguments to justify allocation of resources to the care of persons with serious mental illness and offers an alternative approach to this problem based on the goals of medicine. Although care for persons with serious mental illness may not meet the usual standards of efficient health care spending, their treatment is justified by central and long-standing goals of medicine such as relief of pain and suffering and care of those who cannot be cured. This approach suggests that the idea of efficiency in health care spending should be adapted to the goals of medicine rather than making those goals adapt to the idea of efficiency. MeSH Terms: Chronic Disease Efficiency, Organizational/standards* Ethics, Medical Health Care Rationing/standards* Health Priorities Health Services Needs and Demand Humans Long-Term Care/economics Long-Term Care/standards Mental Disorders*/economics Mental Disorders*/therapy Mental Health Services/organization & administration Mental Health Services/supply & distribution* Palliative Care/economics Palliative Care/standards United States PMID: 10332903 [PubMed - indexed for MEDLINE] 35: Sante Publique. 1999 Mar;11(1):29-39. [How are palliative care needs estimated in short-stay establishments? Apropos of an experience in Cote d'Or] [Article in French] Boute C, Millot I, Ferre P, Devilliers E, Piegay C, Lemery B, Cyvoct C, Simon I, Gisselmann A. Faculte de medecine de Dijon, departement de Sante publique. The evaluation of needs and means concerning the care of patients in palliative treatment is among the problems seen as priority by the High Committee for Public Health. We have thus tried to characterise, in a specific health sector, the patients receiving palliative care in short-stay establishments in order to evaluate their care needs. We carried out an exhaustive descriptive survey among all public and private short-stay establishments in the Cote d'Or region. Of the 2116 patients in the hospital on the day of the survey, roughly 30% were considered as eligible for palliative care (patients suffering from serious, chronic and progressive illnesses). The average age of these patients is 63.9 years (standard deviation 19.7). They mainly suffer from tumours (50%), circulatory pathologies (15%), mental illness (7%), or neurological illnesses (6%). Among the patients that may need palliative care, 38% say they feel pain despite treatment with pain-killers among 25.3% of them. The personnel providing care is insufficiently trained in palliative care or in pain, as only a maximum of 18% of nurses and 5% of doctors in short-stay establishments have been trained in these areas. MeSH Terms: Age Factors Analgesics/therapeutic use Chronic Disease English Abstract Female France/epidemiology Health Services Needs and Demand/statistics & numerical data* Hospitals, Private/statistics & numerical data Hospitals, Public/statistics & numerical data Humans Male Mental Disorders/epidemiology Middle Aged Neoplasms/epidemiology Nervous System Diseases/epidemiology Nurses/statistics & numerical data Pain, Intractable/epidemiology Palliative Care/statistics & numerical data* Physicians/statistics & numerical data Research Support, Non-U.S. Gov't Vascular Diseases/epidemiology Substances: Analgesics PMID: 10361835 [PubMed - indexed for MEDLINE] 36: Ethics Behav. 1999;9(2):159-83. Mental health professionals and assisted death: perceived ethical obligations and proposed guidelines for practice. Werth JL. I have three purposes in this article: (a) to briefly review the legal obligations a mental health professional has when working with a client who is talking about taking some action that could lead to his or her death, (b) to clarify the positions of the 4 major national mental health organizations regarding the acceptable roles of their members with clients who are discussing the possibility of receiving assisted death, and (c) to propose a set of guidelines for practice for mental health professionals working with clients who are considering assisted death that comport with the various laws and codes of ethics. Publication Types: Guideline Practice Guideline MeSH Terms: Attitude Codes of Ethics Confidentiality Counseling* Dangerous Behavior Disclosure Duty to Warn Ethics, Professional Guidelines* Health Personnel* Humans Informed Consent Jurisprudence Legislation Mental Competency Mental Disorders Mental Health Organizational Policy* Palliative Care Practice Guidelines* Professional Role* Psychiatry Psychology Psychotherapy* Quality of Life Referral and Consultation* Social Work Societies Societies, Scientific* State Government Suicide Suicide, Assisted* Terminally Ill United States PMID: 11657205 [PubMed - indexed for MEDLINE] 37: Palliat Med. 1999 Jan;13(1):45-50. Physical and psychological needs of patients dying from colo-rectal cancer. Maguire P, Walsh S, Jeacock J, Kingston R. Cancer Research Campaign, Psychological Medicine Group, Trafford General Hospital, Manchester, UK. Sixty-one patients suffering from terminal colo-rectal cancer were interviewed in depth by trained research nurses. The nurses used a semistructured interview, a concerns checklist and the Psychiatric Assessment Schedule to determine patients' key physical complaints, their main concerns and whether or not an affective disorder was present. The interviewers' estimates of these aspects were then compared with the assessments of 48 carers and 58 general practitioners (GPs). The congruence between patients' and carers' reports was reasonable for appetite loss (77%), nausea and vomiting (75%) and pain (72%), and the rate of false positive reporting was low. However, there was much less congruence for breathlessness (48%) and pyrexia (32%). There was even less congruence between the estimates of patients' physical symptoms and GPs' perceptions. The highest congruence was for pain (42%). The congruence was low for appetite loss (8%) and breathlessness (5%). The congruence between patients' and carers' perceptions of the patients' major concerns was low, being at best 33% for patients' concerns about their physical illness. The rate of false positive reporting by carers was high. The carers' major concerns included the patients' illness (47%), the future (33%) and the emotional demands being put on them (23%). Thirteen (22%) of the 59 patients completing a full interview were suffering from an affective disorder. This had been recognized by the GP in only five cases and six patients who had a normal mood were wrongly diagnosed as being depressed. Of the carers interviewed, 22 (46%) considered symptom control had been inadequate and 23 (48%) felt they had no relief from the burden of caring or had too little help. Sixteen (33%) had recently suffered from a major depressive illness, generalized anxiety disorder or adjustment disorder. It is concluded that it is unreliable to rely on carers' proxy reports of the symptoms experienced by terminally ill patients; more accurate personal assessments are needed where possible. It is likely that this will only be achieved by ensuring that those health professionals involved in palliative care have training in the relevant assessment skills. MeSH Terms: Aged Caregivers/psychology Colonic Neoplasms*/complications Colonic Neoplasms*/psychology Female Humans Male Mental Disorders/etiology* Nausea/etiology Pain/etiology Palliative Care* Quality of Life Research Support, Non-U.S. Gov't Terminal Care* Vomiting/etiology PMID: 10320875 [PubMed - indexed for MEDLINE] 38: Psychosomatics. 1999 Jan-Feb;40(1):1-4. Psychiatric aspects of excellent end-of-life care. Ad Hoc Committee on End-of-Life Care. The Academy of Psychosomatic Medicine. Shuster JL Jr, Breitbart W, Chochinov HM. Publication Types: Editorial MeSH Terms: Humans Mental Disorders/psychology* Patient Care Team Quality of Life* Research Support, Non-U.S. Gov't Sick Role* Terminal Care/psychology* PMID: 9989115 [PubMed - indexed for MEDLINE] 39: Am Fam Physician. 1998 Nov 1;58(7):1577-86, 1589-90. Advances in the treatment of Alzheimer's disease. Sloane PD. University of North Carolina at Chapel Hill School of Medicine, USA. Management of the most common type of dementia--Alzheimer's disease--is becoming increasingly sophisticated. Differentiation of Alzheimer's disease from vascular dementia has become therapeutically important, since the choice of treatments depends on the diagnosis. Two cholinesterase inhibitors, donepezil and tacrine, are labeled for use in patients with Alzheimer's disease. Other therapies, such as estrogen, nonsteroidal anti-inflammatory drugs and vitamin E, are sometimes used and show promise in delaying the progression of this dementia. Behavior problems, which often accompany the disease, can be managed using environmental modification, alterations in caregiving and medication. In the terminal phase of the illness, quality care involves implementing advance directives, communicating with the family, individualizing care and attending to patient comfort. Publication Types: Review Review, Tutorial MeSH Terms: Algorithms Alzheimer Disease/complications Alzheimer Disease/diagnosis Alzheimer Disease/drug therapy* Anti-Inflammatory Agents, Non-Steroidal/therapeutic use Cholinesterase Inhibitors/therapeutic use Decision Trees Diagnosis, Differential Disease Progression Estrogens/therapeutic use Humans Mental Disorders/etiology Terminal Care Vitamin E/therapeutic use Substances: Anti-Inflammatory Agents, Non-Steroidal Cholinesterase Inhibitors Estrogens Vitamin E PMID: 9824956 [PubMed - indexed for MEDLINE] 40: BMJ. 1998 Oct 10;317(7164):969. Australian euthanasia law throws up many difficulties. Wise J. Publication Types: News MeSH Terms: Australia Depressive Disorder* Diagnosis Dissent and Disputes Euthanasia* Euthanasia, Active, Voluntary* Group Processes Humans Jurisprudence* Mental Disorders Neoplasms Northern Territory Palliative Care Physicians Politics Prognosis* Terminally Ill* PMID: 11645108 [PubMed - indexed for MEDLINE] 41: Continuum. 1998 Jul-Aug;18(4):14-20. The Families and Health Care Project--moving family caregivers to the forefront. [No authors listed] MeSH Terms: Caregivers/psychology* Caregivers/statistics & numerical data Chronic Disease Disabled Persons Family* Health Planning Home Nursing/manpower* Humans Mental Disorders Pilot Projects Social Responsibility Social Support* Terminal Care United States PMID: 10185902 [PubMed - indexed for MEDLINE] 42: Psychooncology. 1998 Jul-Aug;7(4):346-58. The uses of psychotropics in symptom management in advanced cancer. Bruera E, Neumann CM. Palliative Care Program, Grey Nuns Community Hospital and Health Center, Edmonton, AB, Canada. Approximately 50% of patients diagnosed with cancer die because of progressive disease. Psychotropic drugs are frequently used for the management of physical and psychosocial symptoms in these patients. Thalidomide, cannabinoids and melatonin are emerging agents for the management of cachexia. Psychostimulants have a defined role in the management of opioid-induced sedation. Haloperidol, tricyclic anti-depressants and newer anti-depressants also have an established role in the management of neuropsychiatric symptoms such as delirium or depression. Cancer patients present unique challenges for successful psychotropic therapy including older age, malnutrition, autonomic failure, borderline cognition, opioid and psychotropic therapy. A practical clinical approach which defines a specific target symptom, an outcome latency period, expected side effects, and reviews possible drug interactions, and frequent monitoring is outlined. Continued research is needed to further define the role of psychotropics in the management of the different physical and psychosocial symptoms in advanced cancer patients. Publication Types: Review Review, Tutorial MeSH Terms: Cachexia/drug therapy Disease Progression Humans Mental Disorders/drug therapy* Neoplasms/complications Neoplasms/psychology* Pain/drug therapy Palliative Care Psychotropic Drugs/therapeutic use* Substances: Psychotropic Drugs PMID: 9741073 [PubMed - indexed for MEDLINE] 43: Semin Oncol Nurs. 1998 May;14(2):110-20. Psychosocial aspects of palliative care. Pasacreta JV, Pickett M. Yale University School of Nursing, New Haven, CT 06536-0740, USA. OBJECTIVES: To provide information about factors that affect psychosocial adjustment among individuals and families who are faced with chronic illness; to discuss assessment guidelines and risk factors that may indicate a need for professional intervention; and to review psychosocial interventions that are used to minimized distress and promote adaptation. DATA SOURCES: Research studies, review articles, and book chapters. CONCLUSIONS: The majority of cancer patients experience emotional turmoil that occurs at transition points along the illness trajectory. Psychosocial issues faced by patients and their families are influenced by individual, sociocultural, medical, and family factors. IMPLICATIONS FOR NURSING PRACTICE: Supportive psychotherapeutic measures help to minimize distress, enhance feelings of control, and improve quality of life. Publication Types: Review Review, Tutorial MeSH Terms: Adaptation, Psychological* Caregivers/psychology Humans Mental Disorders/drug therapy Mental Disorders/etiology Mental Disorders/therapy* Neoplasms/nursing* Neoplasms/psychology* Neoplasms/therapy Palliative Care/psychology* Psychotherapy Psychotropic Drugs/therapeutic use Quality of Life Substances: Psychotropic Drugs PMID: 9580934 [PubMed - indexed for MEDLINE] 44: Prescrire Int. 1998 Apr;7(34):57-63. Terminal care: not just pain management. [No authors listed] Palliative care should aim at being rapidly effective on all symptoms. Several disorders are common and require routine management: mouth problems, constipation, nausea. Skin care is essential for comfort and dignity. Team-work is a pre-requisite for home-based palliative care. Publication Types: Review MeSH Terms: Gastrointestinal Diseases/therapy Hospice Care* Humans Mental Disorders/therapy Pain/therapy Palliative Care Patient Care Team Respiration Disorders/therapy Terminal Care* Urination Disorders/therapy PMID: 10183388 [PubMed - indexed for MEDLINE] 45: Stud Christ Ethics. 1998;11(1):63-76. Tired of living, afraid of dying: reflections on the practice of euthanasia in the Netherlands. Veldhuis R. MeSH Terms: Attitude Catholicism Decision Making Empirical Research Ethics Euthanasia* Euthanasia, Active* Euthanasia, Active, Voluntary Euthanasia, Passive Evaluation Studies Humans Infant, Newborn Jurisprudence Mandatory Reporting Mentally Ill Persons Netherlands Palliative Care Physicians Probability Public Opinion Research Statistics Stress, Psychological Uncertainty Wedge Argument PMID: 11657712 [PubMed - indexed for MEDLINE] 46: Palliat Med. 1997 May;11(3):240-4. Adjuvant psychological therapy for cancer patients. Greer S, Moorey S. St Raphael's Hospice, Surrey, UK. Adjuvant psychological therapy (APT), a brief, problem-focused, cognitive-behavioural treatment for patients with cancer, is described. A previously published randomized trial demonstrated a significant reduction in cancer-related emotional distress. APT is recommended for cancer patients suffering from such distress. Publication Types: Case Reports MeSH Terms: Adult Behavior Therapy/methods* Cognitive Therapy/methods Family Therapy Female Humans Mental Disorders/etiology Mental Disorders/therapy* Neoplasms/psychology* Palliative Care/methods* Psychotherapy, Brief/methods* PMID: 9205658 [PubMed - indexed for MEDLINE] 47: Palliat Med. 1997 Mar;11(2):145-51. An analytical study of the changing health of a hospice population 1978-89. Duke S. Oxford Radcliffe NHS Trust, UK. This study explores the changing characteristics of patients admitted to Sir Michael Sobell House, Oxford, between 1978-89. These dates represent the period between the first available records and the first computerized records. Analysis is between these dates and has been undertaken to enable future comparison between the early life of the unit with more recent developments. Using secondary sources the following areas were compared statistically: information related to general characteristics such as sex and age; information related to referral such as the number of referrals; diagnosis on referral and reasons for referral; information related to problems presented and place of death. Significant findings included an increase in referrals and patient survival; an increase in patients dying at home; a decrease in symptoms presented on referral and fewer referrals for terminal care; and an increase in referral for rehabilitation, assessment and support. Reasons for these changes are suggested. MeSH Terms: Aged England/epidemiology Female Health Status* Home Care Services/trends Hospices/statistics & numerical data Hospices/trends Hospices/utilization* Humans Male Mental Disorders/etiology Middle Aged Neoplasms/complications Neoplasms/mortality Referral and Consultation/trends* Sex Distribution Terminal Care/trends PMID: 9156111 [PubMed - indexed for MEDLINE] 48: Psychooncology. 1997 Mar;6(1):47-64. Psychological aspects of cancer surgery: surgeons' attitudes and opinions. Burton MV, Parker RW. Walsgrave Hospital NHS Trust, Coventry, West Midlands, UK. Fifty-one surgical consultants, registrars and senior registrars in NHS hospitals in the West Midlands (UK) were interviewed about psychological aspects of cancer surgery: information given to patients, the bad news interview, psychological risk factors in surgery, psychiatric morbidity, difficult patients, and care of the dying. Information that tended to be provided infrequently included the cause of the disease, the effects of surgery on sexual functioning, and psychological side-effects of the surgery. Surgeons most often answered incompletely patients' questions about prognosis, effects of surgery on sexual functioning, the presence of malignancy, and probable length of life. Concerning the disclosure of malignancy, 37% said they always tell the patient; 8% tell virtually all patients; 49% tell the patient depending on the patient's and relatives' wishes; and 6% tell the relatives and possibly the patient. A common strategy among 49% is to use the word 'growth' and wait for the patient to ask further. Few surgeons took even the briefest psychiatric history, and only the most severe post-operative psychological complications were referred to psychiatrists. The most difficult patients for surgeons to manage were emotionally labile, angry, demanding, controlling, refusing treatment, or predicting failure. The surgeons in this sample clearly struggled with their role as giver of bad news and with the consequent emotional reactions of the patient. MeSH Terms: Attitude of Health Personnel* Communication Defense Mechanisms England Female Humans Male Mentally Ill Persons Neoplasms/psychology Neoplasms/surgery* Patient Care Team Patient Education Physician-Patient Relations Postoperative Complications/psychology Research Support, Non-U.S. Gov't Risk Assessment Surgery* Terminal Care/psychology Truth Disclosure PMID: 9126715 [PubMed - indexed for MEDLINE] 49: Cancer. 1996 Sep 1;78(5):1131-7. Comment in: Cancer. 1997 May 1;79(9):1848-50. Psychiatric morbidity in terminally ill cancer patients. A prospective study. Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K. Department of Psychiatry and Neurosciences, Hiroshima University School of Medicine, Japan. BACKGROUND. In the study by Derogatis et al., which included patients with all stages of cancer, 47% of the patients met the DSM-III criteria for a psychiatric disorder, with adjustment disorders being the most common. Although the cancer stage is one factor that influences the nature and incidence of psychiatric disorders, no study has demonstrated the extensive range of psychiatric disorders in terminally ill cancer patients. METHODS. Ninety-three terminally ill cancer patients were systematically assessed using the Mini-Mental State Examination (MMSE) and Structured Clinical Interview for DSM-III-R (SCID) within 1 week of admission. RESULTS. Of this sample population, 53.7% met the DSM-III-R criteria for a psychiatric disorder and 42% had a cognitive impairment. Delirium was observed in 26 patients (28%), dementia in 10 (10.7%), adjustment disorders in 7 (7.5%), amnestic disorder and major depression in 3 (3.2%), and a generalized anxiety disorder in 1 (1.1%). CONCLUSIONS. This preliminary investigation of the prevalence of psychiatric disorders in terminally ill cancer patients showed that more than half of the patients met the criteria for a DSM-III-R psychiatric disorder; delirium was the most common type of psychiatric disturbance. Further prospective trials are critically important to establishing treatment modalities that promote the psychiatric well-being of patients with terminal illnesses. MeSH Terms: Aged Delirium/diagnosis Delirium/epidemiology Delirium/etiology* Dementia/diagnosis Dementia/epidemiology Dementia/etiology Depressive Disorder/epidemiology Depressive Disorder/etiology Female Humans Male Mental Disorders/diagnosis Mental Disorders/epidemiology Mental Disorders/etiology* Middle Aged Neoplasms/complications* Prevalence Prospective Studies Psychiatric Status Rating Scales Research Support, Non-U.S. Gov't Terminal Care/psychology PMID: 8780554 [PubMed - indexed for MEDLINE] 50: Hastings Cent Rep. 1996 Sep-Oct;26(5):43. The game of life. [No authors listed] Publication Types: News MeSH Terms: Australia Decision Support Techniques* Humans Informed Consent Jurisprudence* Mental Competency Mental Disorders Northern Territory Palliative Care Physicians* Referral and Consultation Stress, Psychological Suicide, Assisted* Terminally Ill PMID: 11644872 [PubMed - indexed for MEDLINE] 51: World Ir Nurs. 1996 Sep-Oct;4(5):19-20. If music be the food of recovery, play on.... McGarry N. MeSH Terms: Disabled Persons/rehabilitation Humans Mental Disorders/therapy Music Therapy* Palliative Care PMID: 9456918 [PubMed - indexed for MEDLINE] 52: AIDS Patient Care STDS. 1996 Aug;10(4):246-9. Risperidone for AIDS-associated dementia: a case series. Belzie LR. Linroc Nursing Home, Brookdale Medical Center, Brooklyn, NY, USA. OBJECTIVE: To determine the effect of low-dose risperidone on behavioral disturbances associated with AIDS dementia in young-to-middle-age nursing home patients. Neuroleptics are commonly used for behavioral control in this population, but these drugs often fail to control symptoms, and carry a high risk of movement disorders. Because the AIDS virus attacks the basal ganglia, these patients are highly susceptible to neuroleptic-induced movement disorders that increase the risk of falling. However, low-dose risperidone reportedly carries little risk of movement disorders. METHOD: Nine nursing home patients with AIDS dementia received risperidone for behavioral disturbances (psychomotor agitation, aggressiveness, social withdrawal, uncooperativeness) or psychotic symptoms. Seven were switched to risperidone because their symptoms were unresponsive to conventional neuroleptics and adjunct benzodiazepines, antidepressants, or methylphenidate. One patient was switched because of a neuroleptic-induced movement disorder, and one had no history of antipsychotic medication. Patients were followed up only for periods ranging from 2 weeks to 4 months, because AIDS dementia is a terminal-stage condition for AIDS patients. RESULTS: Patients varied in age from 28 to 57 years. Risperidone dosages ranged from 0.5 mg daily to 1 mg twice daily. Most patients received an adjunct benzodiazepine, antidepressant, or mood stabilizer. Within a week or so after starting risperidone, six of the nine patients exhibited brighter mood, were less agitated or aggressive and more cooperative, and participated more frequently in social activities. Two patients became increasingly agitated or psychotic, and came under control only after risperidone was stopped and replaced with haloperidol. One patient was transferred to a psychiatric unit, because of increased paranoid delusions and auditory hallucinations. CONCLUSIONS: Risperidone effectively controlled behavioral disturbances associated with AIDS dementia in 6 of 9 patients. Risperidone may be an alternative to conventional neuroleptics in patients susceptible to neuroleptic-induced movement disorders or unresponsive to neuroleptics and adjunct psychotropic agents. Publication Types: Case Reports MeSH Terms: AIDS Dementia Complex/drug therapy* AIDS Dementia Complex/psychology Adult Antipsychotic Agents/therapeutic use* Female Follow-Up Studies Humans Male Mental Disorders/virology Middle Aged Nursing Homes Risperidone/therapeutic use* Terminal Care Treatment Outcome Substances: Antipsychotic Agents Risperidone PMID: 11361596 [PubMed - indexed for MEDLINE] 53: Psychiatr Serv. 1996 Aug;47(8):879. Comment on: Psychiatr Serv. 1996 Feb;47(2):117. Psychiatric hospices. Van Norman JR, Stone S. Publication Types: Comment Letter MeSH Terms: Hospices* Humans Mental Disorders/psychology Mental Disorders/therapy* Mental Health Services* Mental Retardation/psychology Mental Retardation/therapy* Palliative Care PMID: 8837169 [PubMed - indexed for MEDLINE] 54: Hematol Oncol Clin North Am. 1996 Feb;10(1):235-59. Psychiatric emergencies in terminally ill cancer patients. Roth AJ, Breitbart W. Department of Psychiatry, Memorial Sloan-Kettering Cancer Center, New York, New York, USA. Delirium, depression, suicidal ideation, and severe anxiety are among the most commonly occurring psychiatric complications encountered in cancer pain patients. When severe, these disorders require as urgent and aggressive attention as do other distressing physical symptoms, such as escalating pain. Early diagnosis and treatment can result in effective management of these psychiatric emergencies. Publication Types: Review Review, Tutorial MeSH Terms: Anxiety Disorders/therapy Cognition Disorders/etiology Cognition Disorders/therapy Delirium/etiology Delirium/therapy Emergencies Humans Mental Disorders/etiology Mental Disorders/therapy* Neoplasms/psychology* Neoplasms/therapy Risk Factors Suicide/psychology Terminal Care/methods* PMID: 8821570 [PubMed - indexed for MEDLINE] 55: Harvard J Legis. 1996 Winter;33(1):1-34. A model state act to authorize and regulate physician-assisted suicide. Baron CH, Bergstresser C, Brock DW, Cole GF, Dorfman NS, Johnson JA, Schnipper LE, Vorenberg J, Wanzer SH. MeSH Terms: Adult Coercion Cognition Comprehension Confidentiality Conscience Decision Making Euthanasia Euthanasia, Active Freedom Government Regulation* Humans Informed Consent Jurisprudence* Legislation* Liability, Legal Mandatory Reporting Mental Competency Mentally Ill Persons Oregon Palliative Care Patients Personal Autonomy Physicians* Prejudice Privacy Prognosis Referral and Consultation Right to Die Risk Risk Assessment Social Control, Formal* State Government* Stress, Psychological Suicide, Assisted* Terminally Ill Time Factors United States PMID: 11660807 [PubMed - indexed for MEDLINE] 56: Important Adv Oncol. 1996;:281-91. Is there a role for physician-assisted suicide in cancer? No. Siegler M. MacLean Center for Clinical Medical Ethics, Department of Medicine, University of Chicago, Illinois, USA. Publication Types: Review MeSH Terms: Adult Aged Analgesics/administration & dosage Analgesics/poisoning Analgesics/therapeutic use Attitude to Death Child Cost Control Ethics, Medical* Euthanasia Euthanasia, Passive Female Homicide/legislation & jurisprudence Humans Infant, Newborn Male Mental Competency Mental Disorders/psychology Mental Retardation Middle Aged Neoplasms/psychology* Netherlands Pain, Intractable/drug therapy Pain, Intractable/psychology Physician's Role* Physician-Patient Relations Physicians/psychology Social Values Stress, Psychological Suicide, Assisted*/legislation & jurisprudence Suicide, Assisted*/psychology Terminal Care United States Substances: Analgesics PMID: 8791143 [PubMed - indexed for MEDLINE] 57: J Affect Disord. 1995 Dec 24;36(1-2):11-20. Mental disorders in cancer suicides. Henriksson MM, Isometsa ET, Hietanen PS, Aro HM, Lonnqvist JK. Department of Mental Health National Public Health Institute, Helsinki, Finland. Mental disorders among suicide victims who had suffered from cancer were investigated using psychological autopsy data on all suicides in Finland over 1 year. Retrospective DSM-III-R consensus diagnoses were assigned to all 60 cancer suicides and to 60 age- and sex-matched comparison suicides without a cancer history. Depressive syndromes were equally common along cancer suicides (80%) and others (82%). Alcohol dependence and personality disorders were more frequent among noncancer suicides. Major depression and substance abuse were more common among victims with cancer in remission than in terminal stages. Only a small minority of cancer suicides seem to occur in the absence of mental disorders. MeSH Terms: Adult Aged Aged, 80 and over Depressive Disorder/diagnosis Depressive Disorder/psychology Female Finland Humans Male Mental Disorders/diagnosis* Mental Disorders/psychology Middle Aged Neoplasms/psychology* Personality Assessment Psychiatric Status Rating Scales Risk Factors Sick Role Substance-Related Disorders/diagnosis Substance-Related Disorders/psychology Suicide/psychology* Terminal Care/psychology PMID: 8988260 [PubMed - indexed for MEDLINE] 58: Psychiatry Clin Neurosci. 1995 Mar;49(1):53-7. A survey of Japanese physicians' attitudes and practice in caring for terminally ill cancer patients. Uchitomi Y, Okamura H, Minagawa H, Kugaya A, Fukue M, Kagaya A, Oomori N, Yamawaki S. Department of Psychiatry and Neurosciences, Hiroshima University School of Medicine, Japan. To clarify the psychiatric liaison issues in cancer care, questionnaires were distributed to physicians at 31 teaching hospitals in Japan, including cancer centers and psychiatrists at 197 teaching hospitals. Data from 329 physicians and 156 psychiatrists showed that the majority of the physicians felt troubled by the psychiatric problems of terminally ill patients. However, actual psychiatric referrals were infrequent. An important factor that interferes with appropriate psychiatric referrals for cancer patients is that most physicians do not usually inform patients of a cancer diagnosis. This, it seems that close communication between physicians and psychiatrists is essential in caring for terminally ill cancer patients in the context of Japanese culture, when the psychiatric consultations are offered. MeSH Terms: Adult Attitude of Health Personnel* Female Humans Male Mental Disorders/psychology Neoplasms/therapy* Physicians* Psychiatry* Questionnaires Referral and Consultation Research Support, Non-U.S. Gov't Terminal Care* PMID: 8608435 [PubMed - indexed for MEDLINE] 59: Med Law Int. 1995;1(4):347-86. Recent developments in the Netherlands concerning euthanasia and other medical behavior that shortens life. Griffiths J. Publication Types: Biography Historical Article MeSH Terms: Advance Directives Advisory Committees Attitude Congenital, Hereditary, and Neonatal Diseases and Abnormalities Decision Making* Dementia Ethics Euthanasia* Euthanasia, Active* Euthanasia, Active, Voluntary Euthanasia, Passive* Freedom History, 20th Century Humans Infant, Newborn Intention Jurisprudence* Life Support Care Medical Futility Mental Competency Mentally Ill Persons Motivation Netherlands Nutritional Support Organizational Policy* Parental Consent Paternalism Persistent Vegetative State Personal Autonomy Pharmaceutical Preparations Physicians* Prognosis Public Policy* Quality of Life Stress, Psychological Suicide, Assisted Terminal Care* Third-Party Consent Treatment Refusal Wedge Argument Withholding Treatment Personal Name as Subject: Chabot B Substances: Pharmaceutical Preparations PMID: 11660021 [PubMed - indexed for MEDLINE] 60: Omega (Westport). 1995-1996;32(3):179-96. How health care institutions in the Netherlands approach physician assisted death. van der Kloot Meijburg HH. MeSH Terms: Administrative Personnel Aged Chronic Disease Communication Conscience Decision Making* Ethics, Institutional* Euthanasia* Euthanasia, Active, Voluntary* Food Freedom Health Facilities* Hospitals Hospitals, Psychiatric Humans Jurisprudence Mental Competency Mentally Disabled Persons Mentally Ill Persons Netherlands Nursing Homes Organizational Policy* Patient Advocacy Patient Care Team* Personal Autonomy Physicians* Public Policy Statistics Stress, Psychological Suicide, Assisted* Terminal Care Terminally Ill Treatment Refusal PMID: 11654968 [PubMed - indexed for MEDLINE] 61: Support Care Cancer. 1994 Nov;2(6):333. Cancer patients' attitudes to final events in life. [No authors listed] Publication Types: News MeSH Terms: Attitude to Death* Attitude to Health* Euthanasia/psychology Humans Life Change Events* Mental Disorders/complications Mental Disorders/psychology Neoplasms/complications Neoplasms/psychology* Terminal Care/psychology PMID: 7858924 [PubMed - indexed for MEDLINE] 62: Arch Intern Med. 1994 Sep 26;154(18):2039-47. Patient requests to hasten death. Evaluation and management in terminal care. Block SD, Billings JA. Massachusetts Mental Health Center, Boston. Terminally ill patients often hope that death will come quickly. They may broach this wish with their physicians, and even request assistance in hastening death. Thoughts about accelerating death usually do not reflect a sustained desire for suicide or euthanasia, but have other important meanings that require exploration. When patients ask for death to be hastened, the following areas should be explored: the adequacy of symptom control; difficulties in the patient's relationships with family, friends, and health workers; psychological disturbances, especially grief, depression, anxiety, organic mental disorders, and personality disorders; and the patient's personal orientation to the meaning of life and suffering. Appreciation of the clinical determinants and meanings of requests to hasten death can broaden therapeutic options. In all cases, patient requests for accelerated death require ongoing discussion and active efforts to palliate physical and psychological distress. In those infrequent instances when a patient with persistent, irremediable suffering seeks a prompt and comfortable death, the physician must confront the moral, legal, and professional ramifications of his or her response. Rarely, acceding to the patient's request for hastening death may be the least terrible therapeutic alternative. Publication Types: Review Review, Tutorial MeSH Terms: Attitude to Death Disclosure Dissent and Disputes* Euthanasia Euthanasia, Active, Voluntary* Group Processes* Humans Interpersonal Relations Mentally Ill Persons Moral Obligations Palliative Care* Personal Autonomy Physician's Role Right to Die* Social Values Stress, Psychological Suicide, Assisted Terminal Care/psychology Terminal Care/standards* Time Factors PMID: 7522432 [PubMed - indexed for MEDLINE] 63: J Med Ethics. 1994 Sep;20(3):131-2, 187. Comment on: J Med Ethics. 1994 Sep;20(3):135-8. J Med Ethics. 1994 Sep;20(3):139-43; discussion 144-5. Palliative care ethics: non-provision of artificial nutrition and hydration to terminally ill sedated patients. Gillon R. Publication Types: Comment Editorial MeSH Terms: Dissent and Disputes Ethics, Medical* Fluid Therapy/standards* Group Processes Humans Mentally Ill Persons Moral Obligations Parenteral Nutrition/standards* Practice Guidelines Risk Assessment Social Values Stress, Psychological Terminal Care/standards* Withholding Treatment* PMID: 7996556 [PubMed - indexed for MEDLINE] 64: J Med Ethics. 1994 Sep;20(3):139-43; discussion 144-5. Comment in: J Med Ethics. 1994 Sep;20(3):131-2, 187. J Med Ethics. 1995 Feb;21(1):55. On withholding nutrition and hydration in the terminally ill: has palliative medicine gone too far? Craig GM. This paper explores ethical issues relating to the management of patients who are terminally ill and unable to maintain their own nutrition and hydration. A policy of sedation without hydration or nutrition is used in palliative medicine under certain circumstances. The author argues that this policy is dangerous, medically, ethically and legally, and can be disturbing for relatives. The role of the family in management is discussed. This issue requires wide debate by the public and the profession. Publication Types: Case Reports MeSH Terms: Aged Dissent and Disputes Double Effect Ethics Ethics, Medical* Euthanasia, Passive Family Fluid Therapy/standards* Group Processes Humans Hypnotics and Sedatives/administration & dosage* Intention Male Mentally Ill Persons Palliative Care/standards* Parenteral Nutrition/standards* Patient Participation Stress, Psychological Terminal Care/standards* Uncertainty Withholding Treatment* Substances: Hypnotics and Sedatives PMID: 7527863 [PubMed - indexed for MEDLINE] 65: Clin Ethics Rep. 1994 Summer-Fall;8(2-3):1-24. Medical behavior that shortens life: current developments in the Netherlands. Griffiths J. MeSH Terms: Adult* Advance Directives Aged Coercion Congenital, Hereditary, and Neonatal Diseases and Abnormalities Decision Making Dementia* Euthanasia* Euthanasia, Active* Euthanasia, Passive* Freedom Guidelines Humans Infant, Newborn* Intention Jurisprudence Liability, Legal Life Support Care Medical Futility Mental Competency Mentally Ill Persons* Motivation Netherlands Nutritional Support Pain Parents Patient Participation Persistent Vegetative State* Personal Autonomy Physicians Prognosis Quality of Life Societies Statistics Stress, Psychological Suicide, Assisted* Terminal Care Third-Party Consent Treatment Refusal Withholding Treatment PMID: 11659938 [PubMed - indexed for MEDLINE] 66: Death Stud. 1994 Jul-Aug;18(4):431-5. Consent and experiments with the dying. [No authors listed] MeSH Terms: California Human Experimentation* Humans Informed Consent/legislation & jurisprudence* Mental Disorders Michigan Patient Advocacy Suicide, Assisted/legislation & jurisprudence Terminal Care/standards* PMID: 10136998 [PubMed - indexed for MEDLINE] 67: Hastings Cent Rep. 1994 Jul-Aug;24(4):25-6. Comment in: Hastings Cent Rep. 1995 Nov-Dec;25(6):2-3. Easing the passing. Capron AM. Pacific Center for Health Policy and Ethics, University of Southern California, Los Angeles. Publication Types: Legal Cases MeSH Terms: Advisory Committees Ethics, Medical* Humans Judicial Role Life Support Care/legislation & jurisprudence Mental Competency/legislation & jurisprudence Mentally Ill Persons Michigan Right to Die/legislation & jurisprudence* Suicide, Assisted/legislation & jurisprudence* Terminal Care/legislation & jurisprudence Washington PMID: 7960701 [PubMed - indexed for MEDLINE] 68: Suicide Life Threat Behav. 1994 Winter;24(4):326-33. Physician-assisted suicide: a mental health perspective. Conwell Y. University of Rochester Medical Center, NY 14642, USA. Despite their wealth of relevant clinical and research experience, mental health professionals have contributed relatively little to the active and ongoing debate about physicians assisting in the suicide of their patients. Methodologies developed for the study of completed suicide, the knowledge they have revealed, and the complex questions that remain unanswered, all must be considered. Similarly, psychiatry's extensive contributions to our understanding of the doctor-patient relationship, fundamental to the practice of psychodynamically informed treatments, have been almost completely ignored. Mental health care providers have much to contribute to, and should become actively involved in, this important public health and policy debate. MeSH Terms: Attitude to Death Brain Diseases Countertransference (Psychology) Humans Mentally Ill Persons Personality Disorders/psychology Physician-Patient Relations* Research Support, U.S. Gov't, P.H.S. Social Values Suicide/legislation & jurisprudence Suicide/prevention & control Suicide/psychology* Suicide, Assisted/legislation & jurisprudence Suicide, Assisted/psychology* Terminal Care/legislation & jurisprudence Terminal Care/psychology Transference (Psychology) Grant Support: MH-51201/MH/NIMH PMID: 7740590 [PubMed - indexed for MEDLINE] 69: Ethics Med. 1993 Spring;9(1):10-6. Euthanasia and medical practice in the UK. Healthcare Opposed to Euthanasia (HOPE). MeSH Terms: Aged Coercion Euthanasia* Euthanasia, Active, Voluntary* Euthanasia, Passive Freedom Great Britain Health Care Rationing Homicide Human Rights Humans Informed Consent Intention Jurisprudence Mentally Ill Persons Motivation Organizational Policy* Patient Care Personal Autonomy Physician-Patient Relations Physicians* Prognosis Public Policy Quality of Life Resource Allocation Right to Die Risk Risk Assessment Social Change Social Justice Socioeconomic Factors Stress, Psychological Terminal Care Terminally Ill Value of Life PMID: 11652737 [PubMed - indexed for MEDLINE] 70: J Clin Ethics. 1993 Spring;4(1):74-80. Comment on: J Clin Ethics. 1993 Spring;4(1):46-50. The PSDA and the depressed elderly: "intermittent competency" revisited. Shamoo AE, Irving DN. Publication Types: Comment Editorial MeSH Terms: Advance Directives/legislation & jurisprudence* Aged Decision Making Depressive Disorder/psychology* Freedom* Government Regulation Humans Informed Consent/legislation & jurisprudence* Mentally Ill Persons* Personal Autonomy* Right to Die/legislation & jurisprudence* Sick Role Terminal Care/legislation & jurisprudence Terminal Care/psychology PMID: 8490228 [PubMed - indexed for MEDLINE] 71: Union Med Can. 1992 May-Jun;121(3):147. [Mental diseases are not popular] [Article in French] Maziade M. Publication Types: Editorial MeSH Terms: Adult Child Humans Mental Disorders/therapy* Palliative Care Research Schizophrenia/therapy PMID: 1377427 [PubMed - indexed for MEDLINE] 72: Int Dig Health Legis. 1992;43(2):299-304. Circular No. 70 of 17 May 1991 on information and consent, etc.: "Physicians' duties and patients' rights. Denmark. MeSH Terms: Blood Transfusion Child Civil Rights Commitment of Mentally Ill Denmark Disclosure Enteral Nutrition Euthanasia, Passive Human Experimentation Humans Informed Consent* Jurisprudence* Legislation Mentally Ill Persons Parental Consent Patient Advocacy* Patient Care Patient Rights* Patients Physicians Research Subjects Risk Risk Assessment Terminal Care Third-Party Consent Treatment Refusal PMID: 11651635 [PubMed - indexed for MEDLINE] 73: Am Fam Physician. 1991 Dec;44(6):2065-72. Psychosocial issues in symptomatic HIV infection. Sadovsky R. Department of Family Practice, State University of New York Health Science Center, Brooklyn. Psychosocial issues are a major factor in the quality of life of a patient with advanced human immunodeficiency virus infection. To provide effective, supportive care, the physician must assess the patient's psychosocial needs, with an understanding of the patient's sociocultural background. Good communication and a multidisciplinary team approach are essential aspects of successful management. Unconditional emotional support and both verbal and nonverbal expressions of caring increase patient compliance and comfort. Appropriate treatment of neuropsychiatric syndromes and debilitating physical symptoms also add significantly to the patient's quality of life. Most importantly, the patient must be given the opportunity to be an active participant in decisions about treatment and lifestyle. Publication Types: Review Review, Tutorial MeSH Terms: Acquired Immunodeficiency Syndrome/complications Acquired Immunodeficiency Syndrome/psychology* Acquired Immunodeficiency Syndrome/therapy Humans Mental Disorders/complications Mental Disorders/drug therapy Patient Care Team Physician's Role* Social Support Stress, Psychological Terminal Care/psychology* PMID: 1746388 [PubMed - indexed for MEDLINE] 74: Nurs Health Care. 1991 Dec;12(10):544-5. Hospice care for the living dead. Schuman WH. Publication Types: Case Reports MeSH Terms: Hospitals, Psychiatric Hospitals, State Humans Male Mental Disorders/psychology* Quality of Life* Terminal Care/standards* PMID: 1754123 [PubMed - indexed for MEDLINE] 75: Hastings Cent Rep. 1991 Nov-Dec;21(6):2. The Dutch & the dying. de Wachter MA. Publication Types: News MeSH Terms: Disclosure* Euthanasia/statistics & numerical data* Euthanasia, Active* Euthanasia, Active, Voluntary* Government Regulation Humans Mentally Ill Persons Netherlands Patient Participation/statistics & numerical data* Physician's Practice Patterns/statistics & numerical data* Terminal Care/statistics & numerical data* Withholding Treatment PMID: 1765459 [PubMed - indexed for MEDLINE] 76: S Afr Med J. 1991 Jan 5;79(1):44-7. Frail aged persons residing in South African homes for the aged who require hospitalisation. Part II. Rural areas. Whittaker S, Prinsloo FR, Wicht CL, Janse van Rensburg MP. Administration House of Assembly, Department of Health Services and Welfare, Bellville, CP. The numbers and characteristics of white residents identified by medical and nursing staff to require more staff time and/or expertise and/or medical equipment than was available in rural homes for the aged in the Orange Free State were assessed. In the opinion of institution staff, 12.6% of extremely infirm aged persons would benefit by admission to a hospital catering for the chronically ill. The conditions affecting these residents are described and recommendations relating to their management are made. MeSH Terms: Aged Aged, 80 and over Frail Elderly* Homes for the Aged* Hospitalization*/statistics & numerical data Hospitals, Rural Humans Mental Disorders/epidemiology Nursing Care Rural Population South Africa Terminal Care PMID: 1986451 [PubMed - indexed for MEDLINE] 77: S Afr Med J. 1991 Jan 5;79(1):39-44. Frail aged persons residing in South African homes for the aged who require hospitalisation. Part I. Urban areas. Whittaker S, Prinsloo FR, Wicht CL, Janse van Rensburg MP. Administration House of Assembly, Department of Health Services and Welfare, Bellville, CP. The numbers and characteristics of white residents identified by medical and nursing staff as requiring more staff time and/or expertise and/or medical equipment than is available in homes for the aged were assessed. Only 27 out of 2,447 (1.1%) extremely infirm aged persons resident in 93 homes for the aged would, in the opinion of institutional staff, benefit by admission to a long-term care hospital catering for chronically ill. The conditions affecting these residents are described and recommendations relating to their management made. MeSH Terms: Aged Aged, 80 and over Frail Elderly* Homes for the Aged* Hospitalization*/statistics & numerical data Humans Income/statistics & numerical data Mental Disorders/epidemiology Nursing Care Rehabilitation South Africa Terminal Care Urban Population PMID: 1986449 [PubMed - indexed for MEDLINE] 78: World Health Organ Tech Rep Ser. 1990;804:1-75. Cancer pain relief and palliative care. Report of a WHO Expert Committee. [No authors listed] Publication Types: Review Review, Tutorial Technical Report MeSH Terms: Analgesics, Opioid/therapeutic use Drug and Narcotic Control/legislation & jurisprudence Ethics, Professional Health Occupations/education Humans Mental Disorders/therapy Neoplasms/physiopathology* Neoplasms/psychology Neoplasms/therapy Pain/psychology Pain/therapy* Palliative Care/methods* Pastoral Care Social Support Substances: Analgesics, Opioid PMID: 1702248 [PubMed - indexed for MEDLINE] 79: Arch Dis Child. 1989 May;64(5):697-702. Comment in: Arch Dis Child. 1990 Apr;65(4):468. Life threatening illness and hospice care. Stein A, Forrest GC, Woolley H, Baum JD. Department of Psychiatry, University of Oxford, Warneford Hospital. A retrospective study was undertaken of 25 families and their 26 ill children attending the first children's hospice in the United Kingdom. The study examined the family's perceptions of the care offered and the impact of chronic and life threatening illness. Eighteen (72%) of the families felt they had been well supported by the hospice and valued the family like atmosphere, perceiving the staff to be friendly, approachable, and helpful. The actual nature of hospice care, in an environment with other terminally ill children, was, however, considered a drawback for a few families. A number of families still had unmet needs, notably appropriate child minding when away from the hospice. The impact of chronic life threatening illness on the families was substantial. The parents (particularly the mothers), the index children, and their siblings all experienced much higher levels of psychological symptomatology than would have been expected from normal samples. While families felt greatly helped over symptom control, a proportion remained very worried about certain symptoms, particularly breathlessness, seizures, and pain. A high proportion of families were experiencing financial and employment difficulties as a result of their children's illnesses. MeSH Terms: Adolescent Attitude to Health Bereavement Child Child, Preschool Consumer Satisfaction Employment Family Health Hospices* Humans Marriage Mental Disorders/psychology Parents Professional-Family Relations Research Support, Non-U.S. Gov't Respite Care* Retrospective Studies Social Support Terminal Care/psychology* PMID: 2730123 [PubMed - indexed for MEDLINE] 80: J Palliat Care. 1988 Dec;4(4):50-3. The psychiatric and neuropsychiatric aspects of HIV disease. Woo SK. MeSH Terms: Acquired Immunodeficiency Syndrome/psychology* Acquired Immunodeficiency Syndrome/therapy Delirium/therapy Delirium, Dementia, Amnestic, Cognitive Disorders/therapy Dementia/therapy Depressive Disorder/therapy Humans Mental Disorders/complications* Mental Disorders/therapy Mood Disorders/therapy Palliative Care* PMID: 2463360 [PubMed - indexed for MEDLINE] 81: N Z Nurs J. 1988 Jan;81(1):24-6. Music for health. Harcourt L. MeSH Terms: Aged Child Humans Mental Disorders/therapy Mental Retardation/therapy Music Therapy* Palliative Care PMID: 2448713 [PubMed - indexed for MEDLINE] 82: West State Univ Law Rev. 1987 Spring;14(2):465-78. The therapist's duty to disclose communicable diseases. Peter AP, Sanchez H. MeSH Terms: Acquired Immunodeficiency Syndrome Civil Rights Communicable Diseases* Confidentiality* Contact Tracing Counseling* Dangerous Behavior* Duty to Warn* Health Personnel Humans Jurisprudence* Liability, Legal Mentally Ill Persons* Professional-Patient Relations Psychotherapy* Public Health* Sexuality Sexually Transmitted Diseases* Social Responsibility Stress, Psychological Terminal Care Terminally Ill* United States PMID: 11651890 [PubMed - indexed for MEDLINE] 83: Rev Med Liege. 1986 Sep 1;41(17):622-30. [Psychological and psychiatric aspects in cancerology] [Article in French] Razavi D. Publication Types: Review MeSH Terms: Adaptation, Psychological Brain Neoplasms/complications Humans Mental Disorders/etiology* Neoplasms/complications Neoplasms/psychology* Paraneoplastic Syndromes Terminal Care PMID: 3532273 [PubMed - indexed for MEDLINE] 84: Med Clin North Am. 1986 May;70(3):707-20. Routine care and psychosocial support of the patient with the acquired immunodeficiency syndrome. Abrams DI, Dilley JW, Maxey LM, Volberding PA. Due to the magnitude of the AIDS epidemic in San Francisco, centralization of services has been essential for providing maximal patient care and support, and allowing for efficient performance of clinical investigation. While other locales with fewer numbers of documented cases may not have the need for such extensive organization, lessons can be adopted from the San Francisco experience. It is never an easy task to provide routine medical care and psychosocial support for a young patient with an ultimately fatal illness. Close cooperation of the medical establishment and the community at large, with governmental assistance and support, facilitates this difficult undertaking. MeSH Terms: Acquired Immunodeficiency Syndrome/complications Acquired Immunodeficiency Syndrome/diagnosis Acquired Immunodeficiency Syndrome/psychology Acquired Immunodeficiency Syndrome/therapy* California Counseling Depressive Disorder/etiology Housing Humans Male Mental Disorders/etiology Social Environment* Social Support* Terminal Care PMID: 3959664 [PubMed - indexed for MEDLINE] 85: J Am Geriatr Soc. 1985 Nov;33(11):790-4. When patients resist feeding. Medical, ethical, and legal considerations. Dresser R. In the recent past, public and professional attention has focused on the question of whether and when it is appropriate to discontinue nutritional support from patients unable or unwilling to ingest food orally. This article addresses the special problems raised by patients who resist medical feeding. It discusses the following issues relevant to this patient group: competency to make treatment choices, decision making on behalf of incompetent patients, the competent patient's right of self-determination, and procedures for reviewing treatment decisions. Legal decisions bearing on the nourishment question are analyzed as well. Although the author concludes that cessation of nourishment is morally and legally permissible in a few cases, she also cautions that the option should be carefully and narrowly applied. MeSH Terms: Aged Ethics Committees, Clinical Ethics, Medical* Female Humans Legislation, Hospital Male Mental Disorders Nursing Homes/legislation & jurisprudence Parenteral Nutrition Patient Advocacy/legislation & jurisprudence* Patient Compliance* Personal Autonomy Risk Assessment Starvation Terminal Care/legislation & jurisprudence United States Withholding Treatment PMID: 3932504 [PubMed - indexed for MEDLINE] 86: Nurs Times. 1985 Oct 9-15;80(41):24-6. Jack: a study in anguish. White C. MeSH Terms: Adult Anxiety* Family Female Humans Interpersonal Relations Male Mental Disorders/complications Mental Disorders/nursing* Retroperitoneal Neoplasms/complications Retroperitoneal Neoplasms/nursing* Retroperitoneal Neoplasms/psychology Terminal Care PMID: 3851318 [PubMed - indexed for MEDLINE] 87: J Am Diet Assoc. 1985 Oct;85(10):1289-92. Discontinuing nutrition support: a review of the case law. Dresser R. Publication Types: Case Reports MeSH Terms: Aged Euthanasia* Euthanasia, Passive* Female Humans Judicial Role* Male Mentally Ill Persons Parenteral Nutrition* Patient Acceptance of Health Care* Patient Advocacy/legislation & jurisprudence* Terminal Care/legislation & jurisprudence* United States Withholding Treatment* PMID: 3930592 [PubMed - indexed for MEDLINE] 88: Am J Public Health. 1985 Jun;75(6):685-8. Fashion and freedom: when artificial feeding should be withdrawn. Annas GJ. KIE: Appellate courts in three states have now ruled that there is no legal difference between artificial feeding and any other medical treatment and that therefore feeding may be refused by a competent patient or, in appropriate circumstances, by the family or guardian of an incompetent patient. Annas discusses the ethical and legal problems presented by these cases--California's Barber v. Superior Court, New Jersey's In re Conroy, and Massachusetts' In re Hier. He concludes that statutes are needed that would enhance the rights of competent individuals to refuse any treatment and to execute a living will or assign a durable power of attorney. Legislation is also needed to protect incompetents by providing a mechanism for legal guardians to refuse treatment. Publication Types: Case Reports MeSH Terms: Adult Aged California Chlorpromazine/administration & dosage Euthanasia* Euthanasia, Passive* Female Humans Judicial Role* Male Massachusetts Mentally Ill Persons New Jersey Parenteral Nutrition* Parenteral Nutrition, Total* Personal Autonomy Risk Assessment Terminal Care/legislation & jurisprudence* Withholding Treatment* Substances: Chlorpromazine PMID: 3923847 [PubMed - indexed for MEDLINE] 89: J Am Geriatr Soc. 1983 Aug;31(8):489-98. What older people do about their day-to-day mental and physical health symptoms. Brody EM, Kleban MH, Moles E. In four detailed "yesterday" interviews, old people (n = 132) were studied to identify their day-to-day mental and physical symptoms. Previous reports have described the nature, frequency, and severity of the symptoms reported. This paper describes the actions taken by old people to alleviate discomfort from their symptoms. Some action was taken to treat four fifths of the complaints but virtually none of the symptoms were reported to health care professionals. Among the authors' findings are that about 20 per cent of the drug doses taken by the interviewees could not be identified and the remaining 80 per cent were divided equally between prescription drugs and over-the-counter medications. It is evident that there is a world of day-to-day health experiences and practices of which health care professionals are unaware. Sensitive questioning is needed to elicit information about that world from elderly patients, who in turn are often in considerable need of health education from professional sources. MeSH Terms: Aged* Drugs, Non-Prescription Fatigue/therapy Gastrointestinal Diseases/therapy Humans Mental Disorders/therapy Palliative Care Prescriptions, Drug Research Support, Non-U.S. Gov't Research Support, U.S. Gov't, P.H.S. Self Care/methods* Urination Disorders/therapy Substances: Drugs, Non-Prescription Grant Support: MH27361/MH/NIMH PMID: 6192162 [PubMed - indexed for MEDLINE] 90: Dimens Health Serv. 1983 Apr;60(4):26-7, 29-30. Refusing medical treatment: incompetent adults. Barnes G. Publication Types: Case Reports MeSH Terms: Adult Aged Canada Child Ethics, Medical* Female Humans Judicial Role Jurisprudence* Life Support Care/legislation & jurisprudence* Male Mental Disorders/complications Patient Compliance* Terminal Care/legislation & jurisprudence United States Value of Life Withholding Treatment PMID: 6852401 [PubMed - indexed for MEDLINE] 91: S Afr Med J. 1983 Mar 26;63(13):492-4. Terminal illness in a psychiatric patient--issues and ethics. Levin SM, Feldman MB. A woman with paranoid psychosis and terminal breast cancer refused palliative radiation, demanding pain-killers and permission to leave hospital to go into the mountains and die on her own. Was it ethical to allow her to do so, or should a court order have been sought to impose hospital treatment on her? Should she have been persuaded to accept hospital care? When do those in charge deem a terminally ill patient unable to understand the issues, and dictate treatment? Our aim in this article is to highlight a number of ethical matters regarding patient care, as well as to try and determine the role a hospice should play with regard to the terminally ill patient with associated psychiatric disorder. Publication Types: Case Reports MeSH Terms: Adult Breast Neoplasms/complications Ethics, Medical* Female Humans Mentally Ill Persons* Patient Compliance Schizophrenia, Paranoid*/complications Terminal Care* PMID: 6836429 [PubMed - indexed for MEDLINE] 92: J Med Ethics. 1982 Jun;8(2):65-71. Are pseudo-patient studies justified? Bulmer M. Pseudo-patient studies are studies in which a medical sociologist or anthropologist masquerades as a patient. Medical treatment is sought without revealing that the 'patient' is really a covert research worker. When access has thus been gained to a medical setting--typically a hospital ward--social interaction between medical staff and patients is then observed over a period of days or weeks. Important studies have been carried out in this way of psychiatric treatment and of the care of the terminally-ill. Is the use of the method justified? What ethical problems does its use raise? How do the undoubted advantages of the approach compare with the clear drawbacks and objections which can be made to its use? KIE: Pseudo-patient studies are those in which a medical sociologist or anthropologist gains access to a medical setting by masquerading as a patient and covertly observes the treatment process and interaction between staff and patients. Important studies of the mentally ill and terminally ill have been done this way, but many researchers question whether the method is justified. Using the well-known Rosenhan (1973), Buckingham (1976), and Caudill (1952) studies as examples, Bulmer outlines the arguments for and against the use of the pseudo-patient approach. He concludes that while other methods of investigation are preferable, the careful use of pseudo-patient studies cannot be ruled out. MeSH Terms: Behavioral Research* Ethics, Medical* Humans Mental Disorders/diagnosis Mentally Ill Persons Patients* Physician-Patient Relations Quality of Health Care Research/methods* Risk Risk Assessment* Terminal Care/standards United States PMID: 7108909 [PubMed - indexed for MEDLINE] 93: Compr Ther. 1981 Dec;7(12):65-70. The psychologic care of the cancer patient. Kardinal CG, Porter GH 3rd. Publication Types: Case Reports MeSH Terms: Adult Aged Female Humans Male Mental Disorders/etiology Mental Disorders/therapy Neoplasms/psychology* Neoplasms/therapy Recurrence Terminal Care PMID: 7318408 [PubMed - indexed for MEDLINE] 94: Curr Psychiatr Ther. 1981;20:275-83. The psychedelic drug therapies. Grinspoon L, Bakalar JB. MeSH Terms: Alcoholism/drug therapy Hallucinogens/therapeutic use* Humans Mental Disorders/drug therapy* Psychotherapy Terminal Care Substances: Hallucinogens PMID: 7326971 [PubMed - indexed for MEDLINE] 95: Z Gerontol. 1981 Jan-Feb;14(1):48-60. [Psychotherapy in old age - experiences with individual therapy in geriatric and geronto-psychiatric patients] [Article in German] Bircher M. Individual psychotherapy with the old is being described and analyzed on the basis of treatment experiences with 48 geriatric and gerontopsychiatric patients aged 80 to 96. Furthermore conditions of successfully integrating psychotherapists in the team of geriatric hospital are examined. Special problems in treating the chronically and terminally ill are dealt with and resulting therapeutical aims are discussed. MeSH Terms: Aged Anxiety Disorders/psychology Chronic Disease Depressive Disorder/psychology English Abstract Female Humans Male Mental Disorders/rehabilitation* Psychotherapy/methods* Sick Role Terminal Care/psychology* PMID: 7222916 [PubMed - indexed for MEDLINE] 96: Nurse Pract. 1980 Sep-Oct;5(5):39, 44, 52. Out-of-home placement of children. Alston JF. MeSH Terms: Child Child Abuse/prevention & control Child Care* Disabled Persons Foster Home Care* Humans Mental Disorders/therapy Mental Retardation Terminal Care PMID: 6448967 [PubMed - indexed for MEDLINE] 97: Acta Neurochir Suppl (Wien). 1980;30:161-7. The effect of medial amygdalotomy and anterior hippocampotomy on behavior and seizures in epileptic patients. Mempel E, Witkiewicz B, Stadnicki R, Luczywek E, Kucinski L, Pawlowski G, Nowak J. In 70 patients with epilepsy and severe behavioural disturbances with EEG changes in the temporal regions, we performed EEG investigations of deep temporal structures, temporal cortex and scalp, using Talairach's stereotactic apparatus. Taking into account the recorded changes we performed 115 stereotactic lesions on the medial amygdala (both unilaterally and bilaterally) and on the anterior hippocampus (cornu Ammonis). The results in epileptic processes were: total recovery in 11.4%, evident clinical improvement in 74.3% and no improvement in 14.3%. Similar results were obtained in behavioural disturbances. Bilateral amygdalotomy and unilateral hippocampotomy in selected cases may produce recovery or amelioration and make possible return to normal social life for epileptic patients with severe behavioural changes. MeSH Terms: Adolescent Adult Amygdala/surgery* Child Comparative Study Epilepsy/complications* Epilepsy/surgery Female Hippocampus/surgery* Humans Male Mental Disorders/complications* Mental Disorders/surgery Palliative Care PMID: 6162367 [PubMed - indexed for MEDLINE] 98: Lamp. 1979 Dec;36(11):43-52. Report: music therapy study tour to USA, Canada & UK, June 1979. Bright R. MeSH Terms: Adult Aged Canada Chaplaincy Service, Hospital Child Geriatric Nursing* Great Britain Hospitals, Psychiatric Humans Mental Disorders/therapy* Music Therapy* Palliative Care Terminal Care* United States Voluntary Workers PMID: 92618 [PubMed - indexed for MEDLINE] 99: Nurs Clin North Am. 1979 Sep;14(3):389-482. Symposium on child psychiatric nursing. [No authors listed] MeSH Terms: Child Child Abuse Child Advocacy Chronic Disease/psychology Humans Mental Disorders/prevention & control Mental Status Schedule Pediatric Nursing* Professional-Family Relations Psychiatric Nursing* Psychosexual Development Sudden Infant Death Systems Analysis Terminal Care PMID: 258380 [PubMed - indexed for MEDLINE] 100: Science. 1979 Aug 31;205(4409):882-3, 885. Withholding medical treatment. Kolata GB. MeSH Terms: Ethics, Medical* Humans Judicial Role* Jurisprudence* Mental Disorders/therapy Terminal Care/standards* Withholding Treatment* PMID: 472710 [PubMed - indexed for MEDLINE] 101: Br J Psychiatry. 1979 Jul;135:7-14. Psychotherapy of the dying patient. Stedeford A. The psychotherapeutic aspects of the care of the 49 terminally ill patients described in the preceeding paper are discussed. Their differing ways of coping with the stress of dying and the range of psychotherapeutic strategies used in treatment are described. The work suggests that the therapist's use of psychological insights can improve his understanding of the emotional pain of terminal illness, and well-aimed psychotherapy can contribute to its relief. Publication Types: Case Reports MeSH Terms: Attitude to Death* Denial (Psychology) Dependency (Psychology) Depression/therapy Displacement (Psychology) Family Female Humans Interpersonal Relations Mental Disorders/therapy Middle Aged Projection Psychotherapy* Terminal Care/psychology* PMID: 497629 [PubMed - indexed for MEDLINE] 102: Br J Psychiatry. 1979 Jul;135:1-6. The psychiatrist in the terminal care unit. Stedeford A, Bloch S. The types of problems of 49 patients referred to a psychiatrist in a terminal care unit are reported and their management reviewed. The findings suggest that a psychiatrist can play a useful role in such a unit, particularly in supervising medical and nursing staff in the psychological care of patients and in helping more directly in the management of psychiatrically complicated cases. MeSH Terms: Adult Aged Female Humans Male Mental Disorders/etiology Mental Disorders/therapy Middle Aged Neoplasms/psychology Psychotherapy Terminal Care/psychology* PMID: 497612 [PubMed - indexed for MEDLINE] 103: J Reprod Med. 1979 Mar;22(3):151-5. Practical aspects of full-time liaison psychiatry in gynecology. Small EC, Mitchell GW Jr. A full-time liason psychiatrist can work within a department of obstetrics and gynecology. The full-time position described here includes administrative, clinical, teaching and research aspects within a general hospital affiliated with a medical school. The liason role can be established within a department outside psychiatry where medical and psychologic treatment can be rendered to patients simultaneously and the mediating role between psychiatry and medicine is truly a viable phenomenon. MeSH Terms: Ambulatory Care/psychology Female Genital Diseases, Female/psychology Gynecology*/education Humans Male Mental Disorders/diagnosis Mental Disorders/therapy Obstetrics and Gynecology Department, Hospital Physician's Role Psychiatry*/education Referral and Consultation* Sex Disorders/psychology Surgical Procedures, Operative/psychology Terminal Care/psychology PMID: 571473 [PubMed - indexed for MEDLINE] 104: Am J Psychiatry. 1978 Jun;135(6):728-31. The family practitioner as psychiatrist. Feldman A. The author describes attitudes held by nonpsychiatric physicians that are responsible for poor psychological handling of patients, including low interest in psychosocial aspects of illness, judgment of and disinterest in hypochondriasis or conversion reaction, avoidance of psychotic or terminally ill patients, and anger toward patients with unpleasant characteristics. He discusses reasons for these attitudes and suggests that medical schools increase psychological education and psychiatry departments increase the relevance of their teaching. MeSH Terms: Attitude of Health Personnel* Defense Mechanisms Education, Medical Family Practice* Humans Mental Disorders/diagnosis Personality Physician-Patient Relations Physicians, Family Psychiatry*/education Psychophysiologic Disorders/diagnosis Terminal Care PMID: 655284 [PubMed - indexed for MEDLINE] 105: Am J Psychiatry. 1976 Nov;133(11):1306-9. Cancer, emotions and mental illness: the present state of understanding. Surawicz FG, Brightwell DR, Weitzel WD, Othmer E. The authors review recent and current literature on the relationship between psychological factors and cancer. They discuss the roles of predisposing personality patterns and emotional stress in the development, site, and course of cancer; the influence of awareness of terminal illness on the behavior of cancer patients; and the management of psychiatric symptoms in these patients. MeSH Terms: Anxiety/etiology Attitude to Death Awareness Depression/etiology Humans Mental Disorders/complications Neoplasms/complications Neoplasms/etiology* Personality Psychophysiologic Disorders* Psychosexual Development Psychotherapy Self Concept Stress, Psychological* Terminal Care PMID: 984221 [PubMed - indexed for MEDLINE] 106: Int J Psychiatry Med. 1976-77;7(2):123-31. Psychiatric day hospital treatment of terminally ill patients. Slivkin SE. The psychiatric Day Hospital offers a forum for working out bereavement issues of terminally ill patients. Through individual and group psychotherapy, patients and their families are assisted in coping with the issues of death and dying. Coordination of medical, surgical, and psychiatric treatment of dying patients is enhanced by Day Hospital educational and treatment programs which afford continuity of care at the interface area between treatment specialties. Publication Types: Case Reports MeSH Terms: Adult Attitude of Health Personnel Attitude to Death Day Care* Home Care Services Hospitals, Psychiatric* Hospitals, Veterans Humans Interprofessional Relations Male Mental Disorders/therapy* Middle Aged Psychotherapy Psychotherapy, Group Terminal Care* PMID: 1052087 [PubMed - indexed for MEDLINE] 107: Sov Med. 1975 Dec;(12):68-72. [Psychic functions in patients with terminal renal insufficiency] [Article in Russian] Ermolenko VM, Vinarskaia EN, Nikiforov AS, Soldatova SA. MeSH Terms: Adult English Abstract Female Humans Kidney Failure, Chronic/complications Kidney Failure, Chronic/physiopathology* Male Mental Disorders/etiology Mental Processes* Middle Aged Terminal Care PMID: 1224250 [PubMed - indexed for MEDLINE] 108: Surg Clin North Am. 1975 Apr;55(2):363-76. Pancreatic cancer. Diamond D, Fisher B. Publication Types: Review MeSH Terms: Abdomen Biopsy Carcinoma, Intraductal, Noninfiltrating/pathology Celiac Disease/etiology Cholecystokinin/blood Diabetes Mellitus/etiology Hepatomegaly/etiology Humans Jaundice/etiology Laparotomy Mental Disorders/etiology Pain Palliative Care Pancreatectomy/adverse effects Pancreatectomy/mortality Pancreatic Neoplasms*/diagnosis Pancreatic Neoplasms*/pathology Pancreatic Neoplasms*/therapy Prednisolone/diagnostic use Prognosis Radioisotopes Radionuclide Imaging Secretin/blood Selenium Substances: Radioisotopes Secretin Prednisolone Selenium Cholecystokinin PMID: 48284 [PubMed - indexed for MEDLINE] 109: JAMA. 1975 Jan 13;231(2):195-6. A death in the family. Krant MJ. MeSH Terms: Attitude of Health Personnel Attitude to Death* Death* Empathy Family* Grief*/complications Humans Mental Disorders/etiology Mental Disorders/therapy Psychotherapy Terminal Care PMID: 1172692 [PubMed - indexed for MEDLINE] 110: Am J Psychiatry. 1975 Jan;132(1):28-32. Obstacles in the treatment of dying patients. Levinson P. Mount Sinai School of Medicine of the City University of New York, N.Y. 10029. Theory and practice in the management of the dying patient have moved forward in the past two decades. However, the author believes the benefits of this progress have not reached a large segment of the population of dying patients--those individuals who have a higher level of psychopathology or are from a lower socioeconomic group. Obstacles in the treatment of such patients are described and illustrated by case histories; the author makes specific recommendations related to the care of these more difficult cases. Publication Types: Case Reports MeSH Terms: Adult Borderline Personality Disorder/psychology Female Humans Male Mental Disorders/psychology* Middle Aged Neoplasms/psychology Physician-Patient Relations Social Class Terminal Care* PMID: 1088835 [PubMed - indexed for MEDLINE] 111: Mod Hosp. 1973 Aug;121(2):70-2. Study indicates which patients nurses don't like: the unpleasant, the long-term, the mentally ill, the hypochondriacs, and the dying. Nelson BK. MeSH Terms: Attitude of Health Personnel* Female Humans Hypochondriasis London Long-Term Care Male Mental Disorders Nurse-Patient Relations* Nursing Staff, Hospital Patients Personality Terminal Care PMID: 4206689 [PubMed - indexed for MEDLINE] 112: Am J Psychiatry. 1973 Apr;130(4):472-3. Suicide and the right to die. Murphy GE. MeSH Terms: Ethics, Medical* Euthanasia Forensic Medicine Human Rights* Humans Mental Disorders Mentally Ill Persons* Suicide* Terminal Care PMID: 4691307 [PubMed - indexed for MEDLINE] 113: Med J Aust. 1973 Feb 24;1(8):403-7. Hospital care from general practitioners. Stevens JA. MeSH Terms: Adolescent Adult Age Factors Aged Child Child, Preschool Convalescence Family Practice* Female Hospitalization* Hospitals, Community/utilization* Humans Infant Infant, Newborn Length of Stay Mental Disorders/therapy Middle Aged Morbidity Mortality Poisoning/therapy Pregnancy Quality of Health Care Referral and Consultation Rehabilitation Terminal Care PMID: 4698682 [PubMed - indexed for MEDLINE] 114: Proc R Soc Med. 1972 Nov;65(11):1035-8. Psychiatric consultation in fatal illness. Hinton J. MeSH Terms: Adolescent Adult Affective Symptoms/etiology Aged Anxiety/etiology Attitude Death Depression/etiology Female Grief Humans Interview, Psychological Male Mental Disorders*/drug therapy Mental Disorders*/etiology Mental Disorders*/therapy Middle Aged Neoplasms/complications Psychotherapy Terminal Care* PMID: 4642008 [PubMed - indexed for MEDLINE] 115: Geriatrics. 1971 May;26(5):105-16. Decision-making in the death process of the ill aged. Miller MB. MeSH Terms: Adjustment Disorders Aged Attitude Brain Neoplasms/complications Breast Neoplasms/complications Cerebrovascular Disorders/complications Coma Death* Decision Making* Depression Family Female Fractures, Spontaneous/etiology Geriatrics* Heart Failure, Congestive/complications Hemiplegia Hospital Administration Humans Hysteria Interpersonal Relations Intracranial Arteriosclerosis/complications Male Mental Disorders/complications Nursing Service, Hospital Osteoporosis/complications Parkinson Disease/complications Pelvic Neoplasms/complications Rectal Neoplasms/complications Skilled Nursing Facilities Stomach Neoplasms/complications Terminal Care* Thoracic Vertebrae PMID: 5556470 [PubMed - indexed for MEDLINE] 116: Psychiatry Med. 1971 Apr;2(2):108-15. The nurse as a psychiatric consultation team member. Barton D, Kelso MT. MeSH Terms: Adaptation, Psychological Adolescent Adult Dialysis Female Health Occupations/education Hospitals, General Humans Interprofessional Relations Lung Neoplasms Male Mental Disorders/diagnosis* Mental Disorders/therapy Middle Aged Nurse-Patient Relations Nursing Care Patient Care Team* Psychiatric Nursing* Referral and Consultation* Research Scoliosis Stress, Psychological Terminal Care PMID: 5148519 [PubMed - indexed for MEDLINE] 117: Ann N Y Acad Sci. 1970 Jan 21;169(2):503-8. Drug evaluation problems in academic and other contexts. Lasagna L. Publication Types: Clinical Trial MeSH Terms: Adult Age Factors Child Clinical Trials Drug Therapy* Ethics, Medical* Human Experimentation* Humans Jurisprudence Mental Disorders/drug therapy National Institutes of Health (U.S.) Organizations* Physician-Patient Relations Prisons Research* Students, Medical Terminal Care United States United States Food and Drug Administration PMID: 4907496 [PubMed - indexed for MEDLINE]