What Should Clinicians Know About Palliative Psychopharmacology?

Abstract

The nature and scope of palliative psychiatry and associated ethical implications are debated in the literature. This article examines conceptual limitations of extant accounts of palliative psychiatry, with a focus on psychopharmacological practice, and suggests that modifiable and unmodifiable psychiatric illnesses exist on a spectrum along which broader or narrower palliative psychiatric care approaches can be outlined. The article also discusses how these approaches intersect with questions about whether and to what extent psychiatric medications have symptom-reducing or disease-modifying effects. The discussion leads to the conclusion that clinicians are ethically obliged to distinguish among and clearly formulate goals of care in a dynamic and ongoing process of shared decision making with patients.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Care considerations in medical assistance in dying for persons with mental illness as the sole underlying medical condition: a qualitative study of patient and family perspectives

“…When ongoing interventions are not effective, create more harm than benefit, and patients report intolerable suffering and poor quality of life, re-orientation of their goals of care toward a palliative approach can be considered [ 65 ]. Accordingly, the implications of our findings resonate with recent scholarship on ‘palliative psychiatry’, which focuses on palliative goals of care, such as improving quality of life and relief of suffering, for patients with serious mental illness who are not necessarily at the end of life [ 66 , 67 ]. Taken together, this calls for setting balanced expectations for patients and families through public awareness campaigns and goal of care discussions, along with transparent communication that MAiD MI-SUMC assessments include the consideration of patient needs and preferences in tandem with legal and medical criteria and safeguards.…”

Deprescribing as a therapeutic goal in palliative psychiatry

“…[ 4 ] Nevertheless, a recent article by Aftab in 2023 presents a more balanced perspective that hinges on the distinction between modifiable and unmodifiable facets of psychiatric illness. [ 5 ] According to this perspective, palliative care can coexist alongside standard care. Treatment decisions that aim not to alter the symptoms severity or the course of the illness but rather to enhance the patient’s quality of life are considered palliative in nature within this framework.…”

“…Treatment decisions that aim not to alter the symptoms severity or the course of the illness but rather to enhance the patient’s quality of life are considered palliative in nature within this framework. [ 5 ] These decisions should be informed by the complexity and dimensionality of symptoms, and the pragmatic considerations rooted in the risk/benefit ratio and the principle of futility. From this standpoint, deprescribing (an approach, designed to modify treatments to improve QoL) emerges as a therapeutic goal in palliative psychiatry, particularly for patients with SPMI who are on polypharmacy regimens with unfavorable risk–benefit profiles.…”

“…Such a patient-centered practice, grounded in clear communication and a mutual understanding of treatment goals concerning modifiable and unmodifiable factors, empowers patients to better comprehend the nature of their psychiatric care and ensures that clinicians do not overlook potentially modifiable contributors to their well-being. [ 5 ]…”