Psychotropic Medication Prescriptions for Home-Based Palliative Care Oncology Patients.

Objective: To examine the complexities of psychotropic medication prescription in home-based palliative care for oncology patients.Methods: A retrospective analysis of 125 medical records of patients receiving palliative home care for cancer was conducted at a tertiary hospital, with a specific focus on the prescription patterns of psychotropic medications. The data were collected in September 2023.Results: Among 125 cases, the mean age was 64.4 ± 14.9 years, with 50.4% females. Breast cancer (14.4%) and lung cancer (13.6%) were the most common diagnoses. Psychotropic medication was administered to 35.2% of patients. Treatment was initiated by palliative care doctors in 75% of cases, while psychiatrists handled 25%. Medication selection was predominantly symptom driven (63%), with anxiety prompting benzodiazepine prescriptions in 50% of cases, depression resulting in antidepressant use in 22%, and psychosis leading to antipsychotic treatment in 18%. Specific diagnoses were the target in only 36% of prescriptions, with delirium (27%) being the most prevalent, followed by depression and bipolar disorder. Benzodiazepines were the most commonly prescribed class of medications (56.8%), with clonazepam being the most prevalent (40.9%), followed by alprazolam and lorazepam (15.9%). Atypical antipsychotics made up 43.1% of prescriptions, with quetiapine being the most frequently prescribed (34%), along with olanzapine and risperidone (11%). Antidepressants accounted for 31.8% of prescriptions, including selective serotonin reuptake inhibitors at 18% and mirtazapine and amitriptyline at 6% each. Haloperidol, a typical antipsychotic, was prescribed in 13.6% of cases. Polypharmacy was observed in 35.6% of patients.Conclusion: In palliative home care, psychotropic medications are frequently prescribed by palliative doctors primarily for symptom management, with limited psychiatric consultations and challenges in accessing psychological evaluations. Collaborative efforts among regional or institutional medical bodies, including psychiatrists, psychologists, palliative doctors, and social workers, are needed to establish ethical guidelines for appropriate and effective psychotropic prescription.Prim Care Companion CNS Disord 2024;26(2):23m03668. Author affiliations are listed at the end of this article.

Psychological Morbidity Among COVID-19 Survivors: A Cross-Sectional Study Among Health Care Workers.

Objective: A range of psychiatric morbidities such as persistent depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) has been observed in coronavirus disease 2019 (COVID-19) survivors. The objective of this study was to explore the psychological status of health care workers after recovery from COVID-19 and to examine the sociodemographic and clinical factors associated with psychiatric morbidity.Methods: A cross-sectional study was conducted among health care workers of a tertiary care hospital in South India. The study included health care workers who tested positive for COVID-19 according to the provisional guidelines of the World Health Organization. The data were collected after they tested negative for COVID-19 from September 2020 to October 2020. The study used a semistructured proforma and rating scales such as the 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale, and Posttraumatic Stress Disorder Checklist for DSM-5 to assess for depression, anxiety, and PTSD.Results: The results indicate that the prevalence of depression, anxiety, and PTSD among 107 post-COVID patients was 26.2%%, 12.1%, and 3.7%%, respectively. Female sex (P = .017), patients with post-COVID persistent physical symptoms (P = .05), and the duration of fever during the acute phase of COVID-19 infection (P = .005) were found to have a statistically significant association with a higher rate of depression among the study population.Conclusions: The study findings indicate that all COVID-19 survivors working in the health care sector should be screened for depression and anxiety disorders regularly for early detection and effective management.

Waldenstrom's Macroglobulinemia: A case report.

Waldenstrom's macroglobulinemia (WM) is a rare and slowly progressive disorder, a variant of lymphoplasmacytic lymphoma, which needs therapy only when patient becomes symptomatic. WM presents usually with constitutional symptoms, organomegaly, cytopenias, and hyperviscosity syndrome. This neoplasm is composed of small lymphocytes, plasmacytoid lymphocytes, and plasma cells that typically involve the bone marrow, and it is associated with an immunoglobulin M (IgM) gammopathy. Here we report the case a 60-year-old male with WM who initially presented with anemia and fatigue. The patient had no lymphadenopathy or any organomegaly. The diagnosis of WM was made after morphological and immunohistochemical examination of bone marrow of the patient along with an elevated serum IgM level. The patient responded well to plasmapheresis and chemotherapy. This case is unusual because the patient lacked the common clinical features of WM. A thorough clinical and hematological work up including serum electrophoresis, bone marrow study, and immunohistochemistry helps in distinguishing WM from other lymphomas and plasma cell dyscrasias.