Subject(s)
Delirium , Delirium/diagnosis , Delirium/etiology , Delirium/therapy , Diagnosis, Differential , Female , Humans , Male , Sleep StagesSubject(s)
Delirium , Psychomotor Agitation , Terminal Care , Delirium/diagnosis , Delirium/etiology , Delirium/physiopathology , Delirium/therapy , Disease Management , Humans , Psychomotor Agitation/diagnosis , Psychomotor Agitation/etiology , Psychomotor Agitation/physiopathology , Psychomotor Agitation/therapy , Terminal Care/methods , Terminal Care/psychology , Terminally Ill/psychologyABSTRACT
OBJECTIVES: Delirium is characterized by disturbances of consciousness and changes in cognition that develop rapidly and fluctuate. It is common in palliative care, affecting up to 88% of patients with advanced cancer, yet often remains insufficiently diagnosed and managed. This study sought to compare rates of screening, documentation, and management of delirium across three palliative care settings - two hospices and one hospital team - and to determine whether definitive documentation of delirium as a diagnosis is associated with improved management of the disorder. METHODS: A retrospective review of patient case notes was performed in three U.K. palliative care settings for the presence of: cognitive screening tools on first assessment; the term "delirium" as a stated documented diagnosis; documented terms, descriptions, and synonyms suggestive of delirium; and management plans aimed at addressing delirium. RESULTS: We reviewed 319 notes. The prevalence of delirium as a documented diagnosis ranged from 0 to 8.4%, rising to 35.7-39.2% when both documented delirium and descriptions suggestive of delirium were taken into account. An abbreviated mental test score (AMTS) was determined for 19.6 (H1) and 26.8% (H2) of hospice admissions and for 0% of hospital assessments. Symptoms suggestive of delirium were managed in 56.3% of cases in hospital, compared with 66.7 (H1) and 72.2% (H2) in hospices. SIGNIFICANCE OF RESULTS: Use of the term "delirium" was infrequent in both hospital and hospice palliative care settings, as was the use of routine screening. Many identified cases did not receive targeted management. The definitive use of the term as a diagnosis was associated with clearer management plans in hospital patients. The authors suggest that better screening and identification remains the first step in improving delirium management.
Subject(s)
Delirium/diagnosis , Delirium/therapy , Documentation/methods , Palliative Care/methods , Adolescent , Adult , Aged , Aged, 80 and over , Female , Hospices/statistics & numerical data , Humans , Male , Mass Screening/methods , Middle Aged , Palliative Care/statistics & numerical data , Prevalence , Retrospective Studies , United KingdomABSTRACT
BACKGROUND: Anxiety disorders are commonly treated with antidepressants and psychological treatments. Some patients may prefer alternative approaches such as exercise. OBJECTIVE: To investigate the treatment effects of exercise compared with other treatments for anxiety disorders. DATA SOURCES: Randomised controlled trials (RCTs) of exercise interventions for anxiety disorders were identified by searching six online databases (July 2011). A number of journals were also hand searched. MAIN RESULTS: Eight RCTs were included. For panic disorder: exercise appears to reduce anxiety symptoms but it is less effective than antidepressant medication (1 RCT); exercise combined with antidepressant medication improves the Clinical Global Impression outcomes (1 RCT, p<0.05); exercise combined with occupational therapy and lifestyle changes reduces Beck Anxiety Inventory outcomes (1 RCT, p=0.0002). For social phobias, added benefits of exercise when combined with group cognitive behavioural therapy (CBT) were shown (p<0.05). There was no significant difference between aerobic and anaerobic exercise groups (1 RCT, p>0.1) with both seeming to reduce anxiety symptoms (1 RCT, p<0.001). It remains unclear as to which type of exercise; moderate to hard or very light to light, is more effective in anxiety reduction (2 RCTs). CONCLUSIONS: Exercise seems to be effective as an adjunctive treatment for anxiety disorders but it is less effective compared with antidepressant treatment. Both aerobic and non-aerobic exercise seems to reduce anxiety symptoms. Social phobics may benefit from exercise when combined with group CBT. Further well-conducted RCTs are needed.
Subject(s)
Anxiety Disorders/therapy , Exercise Therapy/methods , Adjustment Disorders/therapy , Adolescent , Adult , Aged , Antidepressive Agents/therapeutic use , Cognitive Behavioral Therapy/methods , General Practice , Humans , Obsessive-Compulsive Disorder/therapy , Occupational Therapy/methods , Randomized Controlled Trials as Topic , Risk Reduction Behavior , Selection Bias , Stress Disorders, Post-Traumatic/therapy , Stress, Psychological/therapy , Young AdultABSTRACT
Depression, anxiety, emotionalism, irritability, and apathy are common findings in the neurological rehabilitation setting and are associated with poorer outcomes. This chapter outlines the importance of detecting and attending to these disorders. The authors recommend the systematic use of self-report measures, tailored for those with cognitive or motor difficulties, in combination with interview-based assessments where suspicion of the presence of a disorder is aroused. A stepped care scheme for coordinating rehabilitation services is presented which highlights the importance of training all staff to be aware of the possibility of patients presenting with emotional disorders and the need to equip all staff with the skills to make emotional enquiries and to carry out brief interventions where indicated. Interventions should be based upon a combination of watchful waiting and optimization of clinical care followed by evidence-based brief therapies such as problem solving, motivational interviewing, and behavioral activation. Antidepressant prescribing should be reserved for the more severe cases and protocols should involve a system for reviewing and time-limiting prescriptions. This chapter aims to aid those designing services to produce simple and widely understood programs that meet the needs of this inherently heterogeneous client base.
Subject(s)
Disease Management , Mood Disorders/etiology , Mood Disorders/rehabilitation , Nervous System Diseases/complications , Humans , Mood Disorders/classificationABSTRACT
OBJECTIVES: Emotional distress, including depression, is an important issue for cancer patients and their families. Guidelines recommend the use of antidepressant drugs (ADs) for the management of depression in cancer. This study explores the views of oncology professionals about the inclusion of ADs in treatment plans. DESIGN: Semi-structured interview study. Data were analysed using framework analysis. SETTING: A specialist cancer centre and six district general hospitals across the Yorkshire Cancer Network. PARTICIPANTS: 18 randomly selected professionals from lung, breast, urology and colorectal cancer teams: oncologists (n=8), surgeons (n=3), clinical nurse specialists (n=2) and ward nurses (n=5). RESULTS: Three main themes emerged relating to professionals' attitudes, knowledge and behaviour. Positive attitudes were primarily expressed by nurses. However, negative views were expressed about the potential for over-reliance on ADs, and their use constituting 'giving in'. Doctors reported a lack of confidence in the use of and knowledge about ADs with an associated reluctance to prescribe. The general practitioner (GP) was regarded as the most appropriate professional to prescribe ADs. CONCLUSIONS: Cancer professionals highlighted a need for training in the appropriate use of ADs. Further, this research suggests that negative attitudes towards antidepressants may be a factor in their exclusion from treatment plans. The GP is seen to have a key prescribing role for AD therapy; however, it is unclear whether the GPs is asked to do this. This research raises questions about the adequacy of ADs in cancer care and to what extent the GP is able to meet this need.
