Psych

Question 1

Difficulties in assessing mental disorders in PC

Answer 1

• Relatively small proportion of patients with mental disorder/psychosocial distress are identified by the healthcare team early and referred on for supports
• Often, difficulties in determining whether a symptom (e.g. impaired concentration, weight loss) is due to treatment or a symptom of a mental disorder
• Somatic symptoms of mental disorders may be attributed to other causes

Question 2

Difficulties in treating mental disorders in PC

Answer 2

• Identification and accessibility
• Time frame for interventions may be limited due to physical condition and course of disease
• Practitioners must have medical knowledge pertinent to the patient’s condition
• Difficulty of acceptance of clinical situation and adaptive coping, which may include hope.

Question 3

Objectives of supportive psychotherapy in palliative care

Answer 3

• Enhancement of adaptive coping
• Clarification of misunderstandings/mis-expectations
• Clarification/strengthening of personal relationships
• Mobilizing individual and family resources
• Reducing psych symptom burdens
• Maintaining hope and life goals
• Promoting acceptance
• Maintaining a sense of dignity
• Finding meaning in life and a sense of peace
• Strengthening of self-esteem
• Acknowledgement of strengths and achievements in the life of the patient
• Reduce feelings of isolation and loneliness of the patients
• Acknowledgement of feelings of grief and sadness about loss/saying goodbye

Question 4

Options for psychological treatment in palliative Care

Answer 4

CBT

• Can be effective in treating emotional distress and depression
• Avoid in organic mental syndromes, delirium, and schizo-affective disorder

Relaxation/image-based interventions

• Guided imagery, visualisation, PMR
• Easy to learn and may allow patients to regain a sense of control and mastery
• May also act as a coping skill for symptoms such as pain or nausea
• In some patients, visualization og body parts can increase anxiety or panic

Mindfulness interventions

• Promote self-regulating attention of immediate experience and curiosity, openness, and acceptance of one’s current experience
• Can reduce anxiety/depression and fear
• May improve hope and QOL

Meaning-centered psychotherapy

• Group or individual approach intended to promote hope, courage, and control
• Encourage future goals despite limited life expectancy

Dignity-centered psychotherapy

• Particularly designed for patients at EOL (survival > 2 weeks)
• Encourages patients to reflect on their memorable life events and includes an interview (hopes and dreams for loved ones) that are transcribed, edited, and shared with loved ones