RESUMO
This is a complex case of post-traumatic stress disorder (PTSD) with comorbid panic disorder occurring in a woman in her mid-60s, with a family history of neurotic illness. PTSD arose in the context of treatment for terminal lung cancer. This patient who had been close to her father watched him die of cancer, when he was about her age. Her diagnosis and treatment prompted traumatic recollections of her father's illness and death that resulted in her voluntary withdrawal from cancer treatment. The goals of treatment were to promptly reduce anxiety, minimise use of sedating pharmacotherapy, promote lucidity and prolong anxiety-free state thereby allowing time for important family interactions. Prompt, sustained relief of severe anxiety was necessary to achieve comfort at the end of life. Skilled additions of psychological therapies (eye movement desensitisation reprocessing, clinical hypnosis and breathing exercises) with combined pharmacotherapy (mirtazepine and quetiapine) led to control of anxiety and reduction of post-traumatic stress.
Assuntos
Morte , Neoplasias Pulmonares/psicologia , Cuidados Paliativos , Transtorno de Pânico/terapia , Transtornos de Estresse Pós-Traumáticos/terapia , Assistência Terminal , Ansiolíticos/uso terapêutico , Ansiedade/terapia , Exercícios Respiratórios , Comorbidade , Dibenzotiazepinas/uso terapêutico , Dessensibilização e Reprocessamento através dos Movimentos Oculares , Feminino , Humanos , Hipnose , Neoplasias Pulmonares/complicações , Mianserina/análogos & derivados , Mianserina/uso terapêutico , Pessoa de Meia-Idade , Mirtazapina , Transtorno de Pânico/tratamento farmacológico , Transtorno de Pânico/etiologia , Fumarato de Quetiapina , Transtornos de Estresse Pós-Traumáticos/tratamento farmacológico , Transtornos de Estresse Pós-Traumáticos/etiologiaRESUMO
BACKGROUND: Balancing pressures of the 4-h wait in Accident and Emergency (A&E) and the National Institute for Clinical Excellence (NICE) requirement for a psychosocial assessment (PSA) before leaving hospital for patients presenting with self-harm is a challenge. This paper suggests a new method for coping with this demand. METHODS: A score of 5 or above on the Modified Sad Persons Scale (MSPS), rated by general hospital staff, would result in an automatic admission to the general hospital for detailed PSA by the dedicated liaison psychiatry team the following day. RESULTS: Most patients are usually admitted due to medical concerns. Only a small number of patients needed further psychiatric inpatient admission. CONCLUSIONS: This integrated care pathway (ICP) is evidence of true multidisciplinary working resulting in mutually beneficial outcomes for both the acute and mental health trusts.