[MOL] Undiagnosed depression can ad to dying patients' suffering....... [01250] Medicine On Line


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[MOL] Undiagnosed depression can ad to dying patients' suffering.......



>Lancet 2000; 355: 553 - 560 Download PDF (101 Kb)
>
>Undiagnosed depression can add to dying patients' suffering, writes Susan Block (Harvard University, Cambridge, MA, USA) in a paper
>for the American College of Physicians and American Society of Internal Medicine (ACP-ASIM) End-of-Life Care Consensus Panel.
>
>Psychological distress may go unrecognised for several reasons, says Block. Patients and physicians may fail to distinguish the
>"natural, existential distress" of the dying process from clinical depression. In addition, the physician may hesitate to explore
>psychological issues for fear of causing further distress, and may have a sense of "therapeutic nihilism" when caring for a
>terminally ill patient, she suggests.
>
>The "gold standard" for diagnosing depression is the interview, says Block. Signs of depression include sadness, hopelessness,
>inability to derive pleasure from once-favoured activities, or refusal of treatment. Pain is a major risk factor, especially in
>patients with cancer. "The first step in treating depression in terminally ill patients is assessing and controlling pain", she
>notes (Ann Intern Med 2000; 132: 209-18).
>
>David Reuben (University of California at Los Angeles, CA, USA) comments that "just because someone has a terminal illness, it
>doesn't mean it's normal or appropriate to have depressive symptoms". However, he says, not all terminally ill patients who want to
>die are clinically depressed. "Some people have made a rational decision that quality of life is not acceptable and want to end
>their lives." Block notes that 40% of terminally ill patients who consider suicide may not be depressed. "But they may have other
>fears, of pain or of being a burden to their families. The challenge is to distinguish depression from a rational choice to end
>one's life", she says.
>
>Lois Snyder (Center for Ethics and Professionalism for ACP-ASIM; www.acponline.org/ethics) notes that in its approach to the
>terminally ill, the USA is behind countries such as Australia and the UK, which have a longer tradition of hospice care. "Our goal
>is to make a difference in end-of-life care. We want to improve communication about the dying process."
>
>Norra MacReady
>
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Warmly, lillian
 
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