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Vente T. Antidepressant Prescribing Practices of Pediatric Palliative Care Providers. J Palliat Med 2024. [PMID: 38471104 DOI: 10.1089/jpm.2023.0671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2024] Open
Abstract
Background: Mental health diagnoses can co-occur with complex medical illness in pediatric patients. Pediatricians may not feel comfortable with managing psychopharmacology for patients and access to child psychiatrists can be limited. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns; however, education in managing psychologic distress for pediatric palliative care (PPC) providers is limited. Objective: This study seeks to describe the antidepressant prescribing practices of PPC providers and describe their level of training and comfort in assessing for anxiety and depression and prescribing psychotropic medications. Methods: An electronic survey approved by the American Academy of Hospice and Palliative Medicine was distributed nationally to PPC providers. Results: A total of 58 providers responded to the survey (response rate 12.3%). Most reported prescribing a variety of antidepressants (79%). Very few used formal assessment tools to screen for depression (7%) or anxiety (16%). Less than a third of providers consulted child psychiatry before prescribing antidepressants (29%). More than half of providers (54.5%) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (70%) reported feeling comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (82.5%). Conclusions: Limited training in assessing mental health concerns, prescribing, and managing psychopharmacology suggests an opportunity for more targeted education for pediatric PC providers regarding antidepressant prescribing practices.
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Affiliation(s)
- Teresa Vente
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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Kozlov E, Eghan C, Moran S, Herr K, Reid MC. Palliative Care Providers' Practices Surrounding Psychological Distress Screening and Treatment: A National Survey. Am J Hosp Palliat Care 2018; 35:938-944. [PMID: 29212346 PMCID: PMC5786500 DOI: 10.1177/1049909117743960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To investigate how inpatient palliative care teams nationwide currently screen for and treat psychological distress. METHODS A web-based survey was sent to inpatient palliative care providers of all disciplines nationwide asking about their practice patterns regarding psychological assessment and treatment. Descriptive statistics were used to characterize the sample and responses, and analysis of variance was conducted to determine whether certain disciplines were more likely to utilize specific treatment modalities. RESULTS A total of N = 236 respondents were included in the final analyses. Providers reported that they encounter psychological distress regularly in their practice and that they screen for distress using multiple methods. When psychological distress is detected, providers reported referring patients to an average of 3 different providers (standard deviation = 1.46), most frequently a social worker (69.6%) or chaplain (65.3%) on the palliative care team. A total of 84.6% of physicians and 54.5% of nurse practitioners reported that they prescribe anxiolytics or selective serotonin reuptake inhibitors to patients experiencing psychological distress. DISCUSSION AND CONCLUSIONS This study revealed significant variability and redundancy in how palliative care teams currently manage psychological distress. The lack of consistency potentially stems from the variability in the composition of palliative care teams across care settings and the lack of scientific evidence for best practices in psychological care in palliative care. Future research is needed to establish best practices in the screening and treatment of psychological distress for patients receiving palliative care.
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Affiliation(s)
- Elissa Kozlov
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Claude Eghan
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Sheila Moran
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - Keela Herr
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
| | - M. Carrington Reid
- Division of Geriatric and Palliative Medicine, New York–Presbyterian Hospital/Weill Cornell Medicine, New York City, NY, USA
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Schillani G, Capozzo MA, Aguglia E, De Vanna M, Grassi L, Conte MA, Giraldi T. 5-HTTLPR Polymorphism of Serotonin Transporter and Effects of Sertraline in Terminally Ill Cancer Patients: Report of Eleven Cases. TUMORI JOURNAL 2018; 94:563-7. [DOI: 10.1177/030089160809400419] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Depression is difficult to detect in cancer patients, though its determination offers an opportunity to relieve patients’ suffering in palliative care. Selective serotonin reuptake inhibitors (SSRIs) are the treatment of choice for mood disorders, but they show a highly variable response. The short allelic variants “s/s” and “s/l” of the 5-HTTLPR polymorphism in the promoter region of the serotonin transporter gene has been consistently associated with a poorer response to SSRIs. The aim of this study has therefore been to examine depression, anxiety and mental adaptation to cancer in terminally ill and depressed cancer patients, in relation to treatment with sertraline and to the 5-HTTLPR genetic polymorphism. Eleven consecutive depressed patients with different forms of advanced cancer who were admitted to the Hospice of the Casa di Cura “Pineta del Carso” (Trieste, Italy) were treated with sertraline for two weeks and their response was determined and related to 5-HTTLPR. Sertraline significantly reduced the average depression and anxiety subscale scores of HADS, as well as the scores of the subscales of Mini-MAC. When the effects of sertraline were analyzed in relation to the 5-HTTLPR polymorphism, only patients with the “l/l” allelic variant had significantly lower scores of HADS anxiety, Mini-MAC hopelessness-helplessness and anxious preoccupation, and a higher score for the fighting spirit of Mini-MAC; the depression score was significantly reduced in patients with both allelic variants. These data indicate that sertraline is effective after two weeks of treatment in terminally ill cancer patients, acting not only on depression but also on anxiety and mental adaptation to cancer. Moreover, the effect of sertraline significantly depended on the genetic polymorphism of the serotonin transporter, being more pronounced in patients carrying the “l/l” genetic variant; these findings seem to encourage the examination of a larger sample of patients.
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Affiliation(s)
- Giulia Schillani
- Section of Pharmacology, Department of Biomedical Sciences, University of Trieste, Trieste
| | - Maria Anna Capozzo
- Section of Pharmacology, Department of Biomedical Sciences, University of Trieste, Trieste
| | - Eugenio Aguglia
- Psychiatric Clinic, Faculty of Medicine, University of Trieste, Trieste
| | - Maurizio De Vanna
- Psychiatric Clinic, Faculty of Medicine, University of Trieste, Trieste
| | - Luigi Grassi
- Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara
| | | | - Tullio Giraldi
- Section of Pharmacology, Department of Biomedical Sciences, University of Trieste, Trieste
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Schillani G, Capozzo MA, Era D, De Vanna M, Grassi L, Conte MA, Giraldi T. Pharmacogenetics of escitalopram and mental adaptation to cancer in palliative care: Report of 18 cases. TUMORI JOURNAL 2018; 97:358-61. [DOI: 10.1177/030089161109700317] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background In palliative care, few data are available on the diagnosis and treatment of mood disorders and of difficulties of mental adaptation to cancer for patients in the advanced phases of the disease. SSRI antidepressants are the treatment of choice; the 5-HTTLPR genetic polymorphism of the serotonin transporter (SERT) has been shown in psychiatry to significantly determine the therapeutic response and the incidence of adverse effects. The aim of the present investigation has been therefore to examine the effects of the SSRI antidepressant escitalopram, also considering 5-HTTLPR, on depression, anxiety and mental adaptation to cancer in palliative care. Methods and study design Eighteen consecutive depressed patients with different forms of advanced cancer admitted to the Hospice Ass 6 of S. Vito al Tagliamento (Pordenone, Italy) were genotyped for the “s” and “l” variants of 5-HTTLPR and were treated with escitalopram. Their response after two weeks of treatment was psycho-metrically evaluated. Results Treatment with escitalopram significantly decreased anxiety scores on the Hospital Anxiety and Depression Scale (HADS) (P = 0.006) as well as anxious preoccupation (P = 0.007) and hopelessness-helplessness (P = 0.017) scores on the Mini Mental Adjustment to Cancer (Mini-MAC) scale. When patients were stratified by SERT genotype, HADS anxiety was significantly decreased in patients carrying the “s/s” and “s/l” variants (P = 0.024), whereas those with an “l/l” genotype displayed a significant reduction of Mini-MAC anxious preoccupation (P = 0.018). Conclusions The results of this study indicate that the use of SSRI antidepressants is effective in the palliative care of cancer patients, and their action affects not only depression but also the patients' mental adaptation to the disease. These results encourage further examination of these drugs in a larger cohort of patients. The significant contribution of pharmacogenetics indicates the possibility of personalized treatment with SSRIs in palliative care.
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Affiliation(s)
- Giulia Schillani
- Section of Pharmacology, Department of Life Sciences, University of Trieste, Trieste
| | - Maria Anna Capozzo
- Section of Pharmacology, Department of Life Sciences, University of Trieste, Trieste
| | - Daniel Era
- Section of Pharmacology, Department of Life Sciences, University of Trieste, Trieste
| | - Maurizio De Vanna
- Psychiatric Clinic, Faculty of Medicine, University of Trieste, Trieste
| | - Luigi Grassi
- Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara
| | | | - Tullio Giraldi
- Section of Pharmacology, Department of Life Sciences, University of Trieste, Trieste
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Capozzo MA, Schillani G, Aguglia E, De Vanna M, Grassi L, Conte MA, Giraldi T. Serotonin Transporter 5-HTTLPR Polymorphism and Response to Citalopram in Terminally ill Cancer Patients: Report of Twenty-One Cases. TUMORI JOURNAL 2018; 95:479-83. [DOI: 10.1177/030089160909500412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to examine the effects of the SSRI antidepressant drug citalopram on anxiety, depression and mental adjustment to cancer in terminally ill cancer patients, considering also the 5-HTTLPR genetic polymorphism. A group of twenty-one consecutive patients admitted to the hospice of the Casa di Cura Pineta del Carso (Trieste, Italy) with different types of advanced cancer, who were clinically judged to require treatment with an antidepressive drug, was treated with citalopram for two weeks. The response was determined and related to 5-HTTLPR. Citalopram significantly reduced the scores on the depression and anxiety subscales of the Hospital Anxiety and Depression Scale (HADS). When the effects of citalopram were analyzed in relation to the 5-HTTLPR polymorphism, the HADS depression score was significantly decreased only in patients with the “l/l” allelic variant of the serotonin transporter conferring high functional activity, while the score of the Mini-MAC fatalism scale was significantly increased in patients carrying at least one “s” allele. These preliminary findings seem to indicate that two weeks of treatment with citalopram are effective in reducing depressive symptoms in terminally ill cancer patients. Moreover, the effects of citalopram on fatalism as a strategy of mental adaptation to cancer, and on depressive symptoms depend on the allelic variants of the 5-HTTLPR genotype of the patients. These results seem to encourage the examination of a larger patient sample and of different treatment schedules, as well as a more thorough characterization of fatalism as a coping strategy in cancer patients.
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Affiliation(s)
- Maria Anna Capozzo
- Section of Pharmacology, Department of Biomedical Sciences, Faculty of Medicine, University of Trieste, Trieste, Italy
| | - Giulia Schillani
- Section of Pharmacology, Department of Biomedical Sciences, Faculty of Medicine, University of Trieste, Trieste, Italy
| | - Eugenio Aguglia
- Psychiatric Clinic, Faculty of Medicine, University of Trieste, Trieste, Italy
| | - Maurizio De Vanna
- Psychiatric Clinic, Faculty of Medicine, University of Trieste, Trieste, Italy
| | - Luigi Grassi
- Section of Psychiatry, Department of Medical Sciences of Communication and Behavior, University of Ferrara, Ferrara, Italy
| | | | - Tullio Giraldi
- Section of Pharmacology, Department of Biomedical Sciences, Faculty of Medicine, University of Trieste, Trieste, Italy
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The Complexity of Assessment and Treatment for Anxiety in Patients With a Terminal Illness. J Hosp Palliat Nurs 2016. [DOI: 10.1097/njh.0000000000000223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Depression bei onkologischen PatientInnen. Wien Med Wochenschr 2015; 165:297-303. [DOI: 10.1007/s10354-015-0363-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 06/01/2015] [Indexed: 01/06/2023]
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Depression and anxiety in palliative care inpatients compared with those receiving palliative care at home. Palliat Support Care 2012; 9:393-400. [PMID: 22104415 DOI: 10.1017/s1478951511000411] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study compared the prevalence of anxiety and depression as measured on the Hospital Anxiety and Depression Scale (HADS) in palliative care patients being treated at home with those being treated as inpatients. METHOD The participants were palliative care patients being treated at home (n = 46) and palliative care inpatients (n = 46). Subjects were assessed for functionality on the Karnofsky Performance Status Scale (KPS) and anxiety and depression were measured on the HADS. RESULTS The results showed that ~20% of all patients were depressed and anxious as measured on the HADS, regardless of the cutoff criteria. There was no significant difference in depression and anxiety between the two groups when socioeconomic status and functionality were controlled for. Functionality, as measured on the KPS, was uniquely a predictor of depression, and younger patients were shown to have greater anxiety. SIGNIFICANCE OF RESULTS The results suggest that home-based palliative care patients and palliative care inpatients should receive equal psychological support, and that clinicians need to be aware of the psychological vulnerability of younger and less-functional patients. The prevalence of depression and anxiety indicates that all palliative care patients should be screened for psychological distress, to identify those who need further assessment and treatment.
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Rasmussen KG, Richardson JW. Electroconvulsive Therapy in Palliative Care. Am J Hosp Palliat Care 2010; 28:375-7. [DOI: 10.1177/1049909110390203] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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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Affiliation(s)
- Keith G. Rasmussen
- Department of Psychiatry and Psychology, Hospice and Palliative Medicine, Mayo Clinic, Rochester, MN, USA,
| | - Jarrett W. Richardson
- Department of Psychiatry and Psychology, Hospice and Palliative Medicine, Mayo Clinic, Rochester, MN, USA
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Shiroma PR, Geda YE, Mohan A, Richardson J. Antidepressant prescription pattern in a hospice program. Am J Hosp Palliat Care 2010; 28:193-7. [PMID: 21051782 DOI: 10.1177/1049909110385539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Prevalence of treatable depression is as high as 25% among terminally ill patients. The incidence of antidepressant use was ascertained at the Mayo Hospice Program in Rochester, Minnesota, from June 1, 2007, to December 31, 2008. The 18-month cumulative probability to receive an antidepressant during hospice was estimated at 11.7%. Depression and selective serotonin reuptake inhibitors (SSRIs) were the most common clinical indication and class of antidepressant, respectively. Survival was the main predictor to receive an antidepressant with an odds ratio of 2.71 (95%CI: 1.60-4.60) for each additional day in hospice. Proper diagnostic tools for this population, education about the benefits of antidepressants in palliative care, and clear guidelines about antidepressant class and dosages are needed.
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Affiliation(s)
- Paulo R Shiroma
- Geriatric Psychiatry Clinic, Mental Health Service Line, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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Erkkilä J, Gold C, Fachner J, Ala-Ruona E, Punkanen M, Vanhala M. The effect of improvisational music therapy on the treatment of depression: protocol for a randomised controlled trial. BMC Psychiatry 2008; 8:50. [PMID: 18588701 PMCID: PMC2474861 DOI: 10.1186/1471-244x-8-50] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 06/28/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Music therapy is frequently offered to individuals suffering from depression. Despite the lack of research into the effects of music therapy on this population, anecdotal evidence suggests that the results are rather promising. The aim of this study is to examine whether improvisational, psychodynamically orientated music therapy in an individual setting helps reduce symptoms of depression and improve other health-related outcomes. In particular, attention will be given to mediator agents, such as musical expression and interaction in the sessions, as well as to the explanatory potential of EEG recordings in investigating emotion related music perception of individuals with depression. METHODS 85 adults (18-50 years of age) with depression (ICD-10: F 32 or F33) will be randomly assigned to an experimental or a control condition. All participants will receive standard care, but the experimental group will be offered biweekly sessions of improvisational music therapy over a period of 3 months. A blind assessor will measure outcomes before testing, after 3 months, and after 6 months. DISCUSSION This study aims to fill a gap in knowledge as to whether active (improvisational) music therapy applied to people with depression improves their condition. For the first time in this context, the mediating processes, such as changes in musical expression and interaction during the course of therapy, will be objectively investigated, and it is expected that the results will provide new insights into these processes. Furthermore, the findings are expected to reveal whether music related emotional experiences, as measured by EEG, can be utilized in assessing a depressive client's improvement in the therapy. The size and the comprehensiveness of the study are sufficient for generalizing its findings to clinical practice as well as to further music therapy research. TRIAL REGISTRATION ISRCTN84185937.
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Affiliation(s)
- Jaakko Erkkilä
- University of Jyväskylä, Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, P,O Box 35, FI-40014, University of Jyväskylä, Finland.
| | - Christian Gold
- University of Bergen, The Grieg Academy Music Therapy Research Centre, 5020 Bergen, Norway
| | - Jörg Fachner
- University of Jyväskylä, Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, P.O Box 35, FI-40014, University of Jyväskylä, Finland
| | - Esa Ala-Ruona
- University of Jyväskylä, Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, P.O Box 35, FI-40014, University of Jyväskylä, Finland
| | - Marko Punkanen
- University of Jyväskylä, Finnish Centre of Excellence in Interdisciplinary Music Research, Department of Music, P.O Box 35, FI-40014, University of Jyväskylä, Finland
| | - Mauno Vanhala
- Central Finland Health Care District, Keskussairaalantie 19, 40620 Jyväskylä, Finland
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Rousseau PC. Recent Literature. J Palliat Med 2006. [DOI: 10.1089/jpm.2006.9.1023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Paul C. Rousseau
- Department of Geriatrics and Extended Care, VA Medical Center, Phoenix, AZ 85012
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Ali RR, Winkfield KM, Galanos AN. Letter to the Editor. Am J Hosp Palliat Care 2006; 23:267; author reply 267-8. [PMID: 17060289 DOI: 10.1177/1049909106290381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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