Electroconvulsive Therapy in Palliative Care
Department of Psychiatry and Psychology, Hospice and Palliative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN55905, USA.The American journal of hospice & palliative care (Impact Factor: 1.38). 11/2010; 28(5):375-7. DOI: 10.1177/1049909110390203
Electroconvulsive therapy (ECT) is a highly effective psychiatric treatment for states of depression, mania, psychosis, or behavioral agitation in dementia. As it does involve intravenous access, general anesthesia, and significant side effects, it may be viewed as too ''invasive'' for patients on palliative care measures. However, we describe several patients treated on our busy ECT service at a tertiary hospital, who were receiving palliative care who, on balance, were felt to have better quality of life with continued use of ECT. We conclude that ECT should not be automatically discarded in patients receiving palliative care and offer some guidelines for its use in this population.
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ABSTRACT: Psychiatric conditions are common among patients with advanced illness who are referred to palliative care services. Psychiatric illness can cause considerable distress to both patients and their families. In order to improve end-of-life care for patients, it is necessary to diagnose psychiatric conditions and treat them appropriately. This review considers delirium, dementia, depression, anxiety, and suicidal ideation. It considers the prevalence, aetiology, diagnosis and management of these conditions.
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ABSTRACT: Electroconvulsive therapy (ECT) is seldom used in a palliative setting. Although literature on the application of ECT in terminally ill patients is sparse, ECT may be useful to rapidly improve the quality of life in these patients. We present the case of a 71-year-old man with metastasized pancreas carcinoma complicated by severe depression. After 3 ECT sessions, the communication between the patient and his family in the last moments of his life improved. We conclude that ECT should be considered to treat mood disorders in terminally ill patients when every day of improvement counts.
Article: Depression in Medically Ill Patients[Show abstract] [Hide abstract]
ABSTRACT: In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.
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