Subject(s)
Delirium/chemically induced , Postoperative Complications/drug therapy , Ranitidine/adverse effects , Aged , Carcinoma, Squamous Cell/surgery , Colostomy , Delirium/diagnosis , Dose-Response Relationship, Drug , Female , Humans , Infusions, Intravenous , Lymph Node Excision , Mental Status Schedule , Postoperative Complications/psychology , Ranitidine/administration & dosage , Reoperation , Vulvar Neoplasms/surgeryABSTRACT
BACKGROUND: Hallucinations as a symptom of central neurotoxicity are a known but poorly described side effect of ifosfamide. Most cases of ifosfamide-induced hallucinations have been reported with other mental status changes. METHODS: The authors interviewed six persons with ifosfamide-induced hallucinations in the presence of a clear sensorium. All patients were receiving high-dose ifosfamide as part of their bone marrow transplant procedure. RESULTS: Hallucinations occurred only when the patient's eyes were closed and, in all but one case, were reported as disturbing or frightening. Underreporting of these hallucinations by patients is likely. CONCLUSIONS: Hallucinations may be the sole or first manifestation of neurotoxicity. The incidence may be dose and infusion-time related. The clinician should be alerted for possible ifosfamide-induced hallucinations, which may occur without other signs of neurotoxicity. "Eyes-closed" hallucinatory experiences appear to be an unusual feature of this presentation. Patients anxious about this experience respond well to support and education about this occurrence. Optimal pharmacologic management of disturbed patients is unclear. If agitation becomes marked, high-potency neuroleptics (i.e., haloperidol) may be effective.
Subject(s)
Hallucinations/chemically induced , Ifosfamide/adverse effects , Adult , Bone Marrow Transplantation , Female , Humans , Ifosfamide/administration & dosage , Male , Middle Aged , Neoplasms/therapy , Nervous System/drug effectsABSTRACT
BACKGROUND: Public initiatives and legislative proposals have increased the likelihood that some states will legalize euthanasia and assisted suicide as a means of ending the suffering of patients with terminal illness. However, suggested safeguards that would guide physicians in such cases have not properly addressed the need to evaluate psychosocial factors that could motivate patients' requests for premature death. METHODS: Four cases of patients with cancer who expressed a wish to end their lives prematurely are described. These cases were evaluated with regard to mental and emotional functioning. RESULTS: Pain and suffering, organic mental disease, depression, and personality issues play significant roles in patients' requests for assistance in dying. CONCLUSION: Comprehensive psychosocial assessment is needed when evaluating requests for assistance in dying. This assessment may reveal hidden problems or conflicts that affect rational decision making, a prerequisite to informed consent for any procedure or intervention.
Subject(s)
Suicide, Assisted/psychology , Terminal Care/psychology , Aged , Female , Humans , Male , Middle Aged , Neoplasms/psychology , Psychiatry , Psychology , Referral and ConsultationABSTRACT
A national survey was conducted to assess the prevalence of teaching about death and dying issues in psychiatric training programs. Responses from 142 program directors indicated that 56% of responding programs offer specific lectures or didactics on this topic. Of residents surveyed (N = 286), 25.8% reported such lectures. Residents' feelings and experiences regarding death and dying are also explored. Psychiatric residency training programs are challenged to enhance their educational efforts on this topic in view of the demand for this knowledge resulting from many factors, which include the AIDS epidemic, issues of assisted suicide, and expectations from medical colleagues.
