Search

Communicating Prognosis and Expectations in Advanced Disease - A Balancing Act in Practice Abstract. To prepare the end of life, to plan important things, to spend the remaining time of life not only with medical treatments, but to live - these are frequently expressed wishes of people with progressive diseases. Prognostic statements are feared by professionals. At the same time, when talking about what lies ahead for those affected, professionals very often make over-optimistic promises. A broader definition of the term prognosis as well as a careful handling of expectations can help to define realistic goals together.

Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense? Abstract. Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reduction for patients (travel, accessibility) and reduction in the care burden for relatives. Additional benefits compared to the physical visit for symptom-control, quality of life and costs are unclear. Risks are influenced by the lack of physical interaction and data security. To what extent telepalliative care makes sense in a high-density health system is difficult to predict. It is therefore important to use these new tools in a carefully adapted and scientifically verified way.

Background: Authors compared plasma concentrations of citalopram (CIT) enantiomers and their metabolites in patients with depression administered either intravenously (IV) or as oral racemic CIT. Then, plasma concentrations were related to the metabolism of probes used for phenotyping patients with depression for CYP2C19 and CYP2D6 activity and cardiovascular functions., Methods: Dextromethorphan-mephenytoin-phenotyped patients with depression were administered racemic CIT (days 1 and 2: 20 mg/d; days 3-10: 40 mg/d) either orally or as a slow-drop infusion for 10 days and were then orally administered the drug for another 32 days. Blood probes were collected at the time of minimal and maximal concentrations on day 10, immediately before and 2 hours after drug administration, and on days 21 and 42. Plasma CIT and its metabolites were assayed by stereoselective high-performance liquid chromatography., Results: The following concentrations (ng/mL) were noted in the group receiving active IV infusion (IV-POS group, n = 27) of racemic CIT on day 10, before drug administration: escitalopram (S-CIT): 24 ± 10.2; R-citalopram (R-CIT): 45 ± 14.5; S-desmethyl-CIT: 13 ± 4.4; and R-desmethyl-CIT: 17 ± 8.2. In patients receiving oral administration (POS-POS group, n = 25), the values were 30 ± 12.7, 51 ± 17.4, 13 ± 4.6, and 17 ± 7.9 ng/mL, respectively. In the IV-POS group, 3 patients were poor dextromethorphan (CYP2D6) metabolizers; in the POS-POS group, one was a poor mephenytoin (CYP2C19) metabolizer. On day 10, before CIT treatment, S/R-CIT and S/R-mephenytoin ratios were significantly correlated, determined at baseline. Overall, CIT reduced the heart rate but did not significantly modify QTc. No relationship was found between any cardiovascular parameters and pharmacokinetic and pharmacogenetic data., Conclusions: Owing to CIT's high bioavailability, the plasma concentrations of its enantiomers remained largely independent on the administration route. CYP2C19 preferentially demethylated S-CIT after CIT therapy., Competing Interests: The authors declare no conflict of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: The use of electroconvulsive therapy (ECT) in treatment-resistant depressed patients is supported by numerous international guidelines. This study aims to describe what type of patients are actually referred to treatment with ECT., Methods: We included all patients referred to two main ECT-treatment centers in Switzerland during the period of August 2008 to February 2011. We collected data on the diagnosis, severity of illness, and the history of treatment., Results: Most of the patients (n = 104) were referred after an average of 124 weeks of an index episode of unipolar depression. The patients were severely and chronically ill and had been treated on average for more than a decade. Eighty-three percent of the patients were referred for ECT treatment for the first time., Conclusions: The surveyed practice of referral does not concur with evidence-based guidelines for the use of ECT in the treatment of depression., (© Georg Thieme Verlag KG Stuttgart · New York.)

In order to assess the observance of international guidelines, 88 psychiatrists and 88 general practitioners (GPs) were asked about their pharmacotherapeutic concepts for depressive and schizophrenic patients with a questionnaire. 47% of the psychiatrists and 72% of the GPs returned their answers. 29% of the psychiatrists and 24% of the GPs treat their depressive patients after an acute episode for six months (in accordance with WHO consensus). 32% of the psychiatrists and 47% of the GPs would suggest prophylactic treatment after two or more depressive episodes as proposed by the WHO. After one or more episodes within the last five years 2.7% of the psychiatrists and 12% of the GPs would start prophylactic treatment as suggested by the WHO. 16% of the psychiatrists and 17% of the GPs would treat a schizophrenic patient after a first episode for 12 to 24 months as proposed by the International Consensus Conference. After two or more psychotic episodes, 16% of the psychiatrists and 31% of the GPs would treat their patients in accordance with international guidelines. The consensus of the WHO for the treatment of depression and the international guidelines for relapse prevention in schizophrenics are hardly known by the examining psychiatrists and GPs and rarely used as treatment guidelines.

An intravenous (0.2 mg) and an oral (40 mg) TRH-test was performed on 21 depressed patients (4 psychogenous, 17 endogenous); TSH, HGH, HRr, Cortisol, T3, T4 and RT4 were measured. The test was redone after 3 weeks of antidepressive treatment. Using an oral stimulation, it looks like there would be a possibility to differentiate into different groups according to the severity of illness. It also seems that the oral stimulation is a possibility to get information on the beginning effectiveness of antidepressive treatment. The responsiveness to the oral stimulus returns earlier than the response to the i.v. stimulation. Roughly, one can also differentiate between endogenous and psychogenous depression with an oral TRH test.