Trastornos del estado de ánimo al final de la vida¿desmoralización o depresión?

  1. García Soriano, Gemma
  2. Barreto Martín, María Pilar
Revista:
Revista de psicopatología y psicología clínica

ISSN: 1136-5420

Año de publicación: 2008

Volumen: 13

Número: 2

Páginas: 123-133

Tipo: Artículo

DOI: 10.5944/RPPC.VOL.13.NUM.2.2008.4055 DIALNET GOOGLE SCHOLAR lock_openAcceso abierto editor

Otras publicaciones en: Revista de psicopatología y psicología clínica

Objetivos de desarrollo sostenible

Resumen

This paper analyzes problems that result in an alteration of mood, particularly in the sadness found in people with a serious physical illness at the end of life. The problems and implications of an faulty diagnosis, the confusions associated with a diagnosis of depression, and the importance of differen-tiation between �normal� mood reactions to illness, and pathological reactions, are analyzed. Several studies are reviewed and analyzed that propose the incorporation of a new syndrome to the traditional psychiatric classifications: demoralization. Finally the implications, advantages, and inconveniences of including a demoralization syndrome are discussed.

Referencias bibliográficas

  • American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders. (Text revised). Washington, DC: APA.
  • Block, S.D. (2000). Assessing and managing depression in the terminally ill patient. ACP-ASIM End-of-Life Care Annals of Internal Medicine, 132, 209-18.
  • Breitbart, W., Rosenfeld, B., Pessin, H., Kaim, M., Funesti-Esch, J., Galietta, M., Nelson, C.J., y Brescia, R. (2000). Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA: Journal of the American Medical Association, 284, 2907-2911.
  • Brugha, T. (1993). Depression in the terminally ill. British Journal of Hospital Medicine, 50, 175-181.
  • Cassell, E.J. (1982). The nature of suffering and the goals of medicine. New England Journal of Medicine, 306, 639-645.
  • Cassem, E.H. (1995). Depressive disorders in the medically ill An overview. Psychosomatics, 36, S2-S10.
  • Chochinov, H.M., Wilson, K.G., Enns, M., y Lander, S. (1997). Are you depressed? Screening for depression in the Terminally Ill. American Journal of Psychiatry, 154, 674-676.
  • Chochinov, H.M., Wilson, K.G., Enns, M., y Lander, S. (1994). Prevalence of Depression in the Terminally Ill: effects od diagnostic criteria and symptom threshold judgments. American Journal of Psychiatry, 151, 537-540.
  • Chochinov, M.D., y Wilson, K.G. (1998). Are you depressed? Screening for depression in the Terminally Ill. Reply. American Journal of Psychiatry, 155, 994- 995.
  • Clarke, D.M., y Kissane, D.W. (2002). Demoralization: its phenomenology and importance. Australian and New Zealand Journal of Psychiatry, 36, 733-742.
  • Clarke, D.M., Mackinnon, A.J., Smith, G.C., McKenzie, D.P., y Hermna, H.E. (2000). Dimensions of psychopatology in the medically ill: a latent trait analysis. Psychosomatics, 41, 418-425.
  • Clarke, D.M., Smith, G.C., Dowe, D.L., y McKenzie, D.P. (2003). An empirically derived taxonomy of common distress syndromes in the medically ill. Journal of Psychosomatic Research, 54, 323-330.
  • Cox, J., Holden, J., y Sagovsky, R. (1987). Detection of postnatal depression: development of 10 item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.
  • De Figueiredo, J.M., y Frank, J.D. (1982). Subjective Incompetence, the Clinical Hallmark of Demoralization. Comprehensive Psychiatry, 23, 353-363.
  • De Figueiro, J.M. (1993). Depression and Demoralization: Phenomenologic Differences and Research Perspectives. Comprehensive Psychiatry, 34, 308-311.
  • Derogatis, L.R., Morrow, G.R., Fetting, J., Penman, D., Piasetsky, S., y Schmale, A.M. (1983). The prevalence of psychiatric disorders among cancer patients. JAMA: Journal of the American Medical Association, 249, 751-7.
  • Dohrenwend, B.P., Shrout, P.E., Ergi, G., y Mendelsonh, F.S. (1980). Nonspecific Psychological Distress and Other Dimensions of Psychopathology. Archives of General Psychiatry, 37, 1229-1236.
  • Doyle, D., Hanks, G.W.C., y MacDonald, N. (Ed.). (1993). Oxford textbook of palliative medicine. Oxford: Oxford University Press.
  • Endicott, J., y Spizer, R.L. (1978). A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia. Archives of General Psychiatry, 35, 837-844.
  • Endicott, J. (1984). Measurement of Depression in Patients with Cancer. Cancer, 53, 2243-2248.
  • Engel, G.L. (1985). A psychological setting of somatic disease: the «giving up-give up complex». Proceedings of the Royal Society of Medicine, 1967, 553-555.
  • Fava, G.A., Freyberger, H.J., Bech, P., Christodoulou, G., Sensky, T., y Theorell, T. (1995). Diagnostic criteria for use in psychosomatic research. Psychotherapy & Psychosomatics, 63, 1-8.
  • Frank, J. (1973). Persuasion and haling. Baltimore, MD: John Hopkins University Press.
  • Gilbert, P., Pehl, J., y Allan, S. (1994). The phenomenology of shame and guilty: an empirical investigation. British Journal Clinical Psychology, 67, 23-36.
  • Gruenberg, E.M. (1967). The social breakdown syndrome: some origins. American Journal of Psychiatry, 123, 1481-1489.
  • Holtom, N., y Barraclough. (2000). Is the Hospital Anxiety and Depression Scale (HADS) useful in assessing depression in palliative care? Palliative Medicine, 14, 219-220.
  • Hotopf, M., Chidgey, J., Addington-Hall, J., y Lan Ly, K. (2002). Depression in advanced diseased: a systematic review. Part 1. Prevalence and case finding. Palliative Medicine, 16, 81-97.
  • Kathol, R., Mutgi, A., Williams, J., Clamon, G., y Noyes, R. (1990). Diagnosis of Major Depression in Cancer patients according to Four Sets Criteria. American Journal of Psychiatry, 147, 1021-1024.
  • Kelly, B., y Robertson, M. (2002). Terminally ill cancer patients’ wish to hasten death. Palliative Medicine, 16, 339-345.
  • Kissane, D.W., y Kelly, B.J. (2000). Demoralization, depression and desire for death: problems with the Dutch guidelines for euthanasia of the mentally ill. Australian and New Zealand Journal of Psychiatry, 34, 325-333.
  • Kissane, D.W., Clarke, D.M., y Street, A.F. (2001). Demoralization syndrome -a relevant psychiatric diagnosis for palliative care. Journal of Palliative Care, 17, 12- 21.
  • Kissane, D.W. (1998). Models of psychological response to suffering. Progressing Palliative Care, 6, 197-204.
  • Klein, D.F., Gittelman, R., Quitkin, F., y Rifkin, A. (1980). Diagnosis and drug treatment of Psychiatric disorders: adults and children. Baltimore, MD: Williams and Wilkins.
  • Le Fevre, P., Devereux, J., Smith, S., et al. (1999). Screening for psychiatric illness in palliative care inpatient setting: a comparison between the Hospital Anxiety and Depression Scale and the General Health Questionnaire-12. Palliative Medicine, 13, 399-407.
  • Lloyd-Williams, M., y Payne, S. (2002) Nurse specialist assessment and management of palliative care patients who are depresseda study of perceptions and attitudes. Journal of Palliative Care, 18, 270-274.
  • Lloyd-Williams, M., y Spiller, J. (2003). Which depression screening tools should be used in palliative care? Palliative Medicine, 17, 40-43.
  • Lloyd-Williams, M., Friedman, T., y Rudd, N. (2001). An analysis of the Validity of the Hospital Anxiety and Depression Scale as a screening tool in patients with advanced metastatic cancer. Journal of Pain and Symptom Management, 22, 990-996.
  • Lloyd-Williams, M., Friedman, T., y Rudd, N. (2000). Criterion validation of the Edinburgh postnatal depression scale as a screening tool for depression in patients with advanced metastatic cancer. Journal of Pain and Symptom Management, 20, 259-65.
  • Noyes R. Jr., y Kathol, R.G. (1986). Depression and cancer. Psychiatric Developments, 2, 77-100.
  • Oneschuk, D., y Fainsinger, R. (2001). Medical and ethical dilemmas when an advanced cancer patient discontinues dialysis. Journal of Palliative Care, 18, 123-126.
  • Page, R.M., y Cole, G.E. (1992). Demoralization and living alone: outcomes from an urban community study. Psychological Reports, 70, 275-280.
  • Passik, S.D., Dugan, W., McDonald, M.V., Rosenfeld, B., Theobald, D., y Edgerton, S. (1998). Oncologists’ Recognition of Depression in Their Patients With Cancer. Journal of Clinical Oncology, 16, 1594- 1600.
  • Rickelman, B.L. (2002). Demoralization as a precursor to serious depression. Journal of the American Psychiatric Nurses Association, 8, 9-17.
  • Schmale, A.H. (1972). Giving up as a final common pathway to changes in health. Advances in Psychosomatic Medicine, 8, 20-40.
  • Silverstone, P. (1994). Poor efficacy of the hospital anxiety and depression scale in the diagnosis of major depressive disorder in both medial and psychiatric patients. Journal Psychosomatic Research, 38, 441-450.
  • Slavney, P.R. (1999). Diagnosing Demoralization in consultation. Psychiatry. Psychosomatics, 40, 325-329.
  • Spitzer, R.L., Endicott, J., y Robins, E. (1978). Research Diagnosis Criteria: rationale and reliability. Archives of General Psychiatry, 35, 773-782.
  • Spitzer, R.L., Gibbon, M., y Williams, J.B.W. (1996). En W.Breitbart, B. Rosenfeld, H. Pessin, M. Kaim, J. Funesti-Esch, M. Galietta, C.J. Nelson, y R. Brescia (2000), Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA: Journal of the American Medical Association, 284, 2907-2911.
  • Zatura, A., Guarnaccia, C.A., y Reich, J.W. (1988). Factor structure of mental health measures for older adults. Journal of Consulting and Clinical Psychology, 36, 514-519.
  • Zigmond, A.S., y Snaith, R.P. (1993). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370.