Cuidados paliativos y esquizofrenia: una reflexión sobre la dificultad de los cuidados paliativos en pacientes con esquizofrenia
DOI:
https://doi.org/10.33448/rsd-v12i5.41427Palabras clave:
Cuidados paliativos; Salud mental; Esquizofrenia.Resumen
Introducción: La esquizofrenia es una enfermedad psiquiátrica crónica y grave, además de extremadamente debilitante y que conlleva un estigma muy grande para sus portadores. Es una de las enfermedades que más discapacidad provoca y por lo tanto el paciente necesita una atención integral, buscando no sólo la resolución del cuadro psiquiátrico, sino también la mejora del bienestar y la reducción del sufrimiento. Objetivo: Este trabajo tiene como objetivo revisar la literatura sobre cuidados paliativos en pacientes con esquizofrenia e identificar la aplicabilidad e importancia de tal práctica. Método: revisión narrativa de la literatura, utilizando las bases de datos: Scientific Electronic Library Online (ScieELO), UpToDate y Medical Literature Analysis and Retrieval System Online (MEDLINE). Utilizando las siguientes palabras clave: “Cuidados paliativos”, “Esquizofrenia” y “Salud mental”. Se aplicaron criterios de inclusión y exclusión y se utilizaron un total de 61 artículos. Resultados y Discusión: La esquizofrenia es una enfermedad mental crónica grave que resulta en marginación y estigma para los pacientes. Aproximadamente de cuatro a siete millones de personas en todo el mundo sufren de esquizofrenia grave resistente al tratamiento. Estos pacientes pueden tener un alto nivel de síntomas negativos, lo que conduce a un deterioro de la calidad de vida y el funcionamiento social. La gama de enfoques de cuidados paliativos en medicina es muy amplia, desde medidas específicas a corto plazo para el alivio de síntomas angustiantes hasta la sedación paliativa. Los servicios de cuidados paliativos para personas con esquizofrenia deben adoptar un enfoque inclusivo. Conclusión: Los cuidados paliativos pueden ofrecer consuelo a los pacientes con esquizofrenia y sus familias, especialmente a las personas marginadas.
Citas
Arksey, H. & O’Malley, L. (2005). Scoping studies: towards a methodological framework. Int J Soc Res Methodol. 8(1):19–32.
Backer, T. E., & Howard, E. A. (2007). Cognitive impairments and the prevention of homelessness: research and practice review. The journal of primary prevention, 28(3-4), 375–388. https://doi.org/10.1007/s10935-007-0100-1
Baez, M. A., & Avery, J. D. (2010). Terminally ill schizophrenic patients: an ignored population. Journal of palliative medicine, 13(3), 237. https://doi.org/10.1089/jpm.2009.0328
Bassirpour, G., Mahr, G., Lee, B., & Torres, M. (2011). The use of hospice care in end-stage psychiatric patients. Journal of palliative medicine, 14(1), 107–108. https://doi.org/10.1089/jpm.2009.0431
Berk, M., Berk, L., Udina, M., Moylan, S., Stafford, L., Hallam, K., Goldstone, S., & McGorry, P. D. (2012). Palliative models of care for later stages of mental disorder: maximizing recovery, maintaining hope, and building morale. The Australian and New Zealand journal of psychiatry, 46(2), 92–99. https://doi.org/10.1177/0004867411432072
Block S. D. (2006). Psychological issues in end-of-life care. Journal of palliative medicine, 9(3), 751–772. https://doi.org/10.1089/jpm.2006.9.751
Bonnot, O., Anderson, G. M., Cohen, D., Willer, J. C., & Tordjman, S. (2009). Are patients with schizophrenia insensitive to pain? A reconsideration of the question. The Clinical journal of pain, 25(3), 244–252. https://doi.org/10.1097/AJP.0b013e318192be97
Buhagiar, K., Parsonage, L., & Osborn, D. P. (2011). Physical health behaviours and health locus of control in people with schizophrenia-spectrum disorder and bipolar disorder: a cross-sectional comparative study with people with non-psychotic mental illness. BMC psychiatry, 11, 104. https://doi.org/10.1186/1471-244X-11-104
Candilis, P. J., Foti, M. E., & Holzer, J. C. (2004). End-of-life care and mental illness: a model for community psychiatry and beyond. Community mental health journal, 40(1), 3–16. https://doi.org/10.1023/b:comh.0000015214.24404.cc
Cai, X., Cram, P., & Li, Y. (2011). Origination of medical advance directives among nursing home residents with and without serious mental illness. Psychiatric services (Washington, D.C.), 62(1), 61–66. https://doi.org/10.1176/ps.62.1.pss6201_0061
Caraceni, A., Nanni, O., Maltoni, M., Piva, L., Indelli, M., Arnoldi, E., Monti, M., Montanari, L., Amadori, D., & De Conno, F. (2000). Impact of delirium on the short term prognosis of advanced cancer patients. Italian Multicenter Study Group on Palliative Care. Cancer, 89(5), 1145–1149. https://doi.org/10.1002/1097-0142(20000901)89:5<1145::aid-cncr24>3.0.co;2-x
Charlson, F. J., Ferrari, A. J., Santomauro, D. F., Diminic, S., Stockings, E., Scott, J. G., McGrath, J. J., & Whiteford, H. A. (2018). Global Epidemiology and Burden of Schizophrenia: Findings From the Global Burden of Disease Study 2016. Schizophrenia bulletin, 44(6), 1195–1203. https://doi.org/10.1093/schbul/sby058
Chochinov, H. M., Martens, P. J., Prior, H. J., & Kredentser, M. S. (2012). Comparative health care use patterns of people with schizophrenia near the end of life: a population-based study in Manitoba, Canada. Schizophrenia research, 141(2-3), 241–246. https://doi.org/10.1016/j.schres.2012.07.028
Chong, H. Y., Teoh, S. L., Wu, D. B., Kotirum, S., Chiou, C. F., & Chaiyakunapruk, N. (2016). Global economic burden of schizophrenia: a systematic review. Neuropsychiatric disease and treatment, 12, 357–373. https://doi.org/10.2147/NDT.S96649
Chwastiak, L. A., & Tek, C. (2009). The unchanging mortality gap for people with schizophrenia. Lancet (London, England), 374(9690), 590–592. https://doi.org/10.1016/S0140-6736(09)61072-2
Craig, T. K., Rus-Calafell, M., Ward, T., Leff, J. P., Huckvale, M., Howarth, E., Emsley, R., & Garety, P. A. (2018). AVATAR therapy for auditory verbal hallucinations in people with psychosis: a single-blind, randomised controlled trial. The lancet. Psychiatry, 5(1), 31–40. https://doi.org/10.1016/S2215-0366(17)30427-3
Davie, E. (2006). A social work perspective on palliative care for people with mental health problems. Eur J Palliat Care. 13(1):26-28.
Dickerson, F., Origoni, A., Schroeder, J., Adamos, M., Katsafanas, E., Khushalani, S., Savage, C. L. G., Schweinfurth, L. A. B., Stallings, C., Sweeney, K., & Yolken, R. (2018). Natural cause mortality in persons with serious mental illness. Acta psychiatrica Scandinavica, 137(5), 371–379. https://doi.org/10.1111/acps.12880
De Roo, M. L., Leemans, K., Claessen, S. J., Cohen, J., Pasman, H. R., Deliens, L., Francke, A. L., & EURO IMPACT (2013). Quality indicators for palliative care: update of a systematic review. Journal of pain and symptom management, 46(4), 556–572. https://doi.org/10.1016/j.jpainsymman.2012.09.013
Engels, G., Francke, A. L., van Meijel, B., Douma, J. G., de Kam, H., Wesselink, W., Houtjes, W., & Scherder, E. J. (2014). Clinical pain in schizophrenia: a systematic review. The journal of pain, 15(5), 457–467. https://doi.org/10.1016/j.jpain.2013.11.005
Ferris, F. D., Balfour, H. M., Bowen, K., Farley, J., Hardwick, M., Lamontagne, C., Lundy, M., Syme, A., & West, P. J. (2002). A model to guide patient and family care: based on nationally accepted principles and norms of practice. Journal of pain and symptom management, 24(2), 106–123. https://doi.org/10.1016/s0885-3924(02)00468-2
Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., Garcia, P., Unützer, J., Hough, R., & Jeste, D. V. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. The American journal of psychiatry, 162(2), 370–376. https://doi.org/10.1176/appi.ajp.162.2.370
Gillum L. A. (2015). Palliative care and neurology: time for a paradigm shift. Neurology, 84(11), 1184. https://doi.org/10.1212/WNL.0000000000001384
Griffith L. J. (2007). Brief Supportive Psychotherapy for a Patient with Chronic Schizophrenia Who is Dying. Psychiatry (Edgmont (Pa. : Township)), 4(12), 49–54.
Howard, L. M., Barley, E. A., Davies, E., Rigg, A., Lempp, H., Rose, D., Taylor, D., & Thornicroft, G. (2010). Cancer diagnosis in people with severe mental illness: practical and ethical issues. The Lancet. Oncology, 11(8), 797–804. https://doi.org/10.1016/S1470-2045(10)70085-1
Irwin, K. E., Henderson, D. C., Knight, H. P., & Pirl, W. F. (2014). Cancer care for individuals with schizophrenia. Cancer, 120(3), 323–334. https://doi.org/10.1002/cncr.28431
Lanzoni, G.M.M. & Meirelles, B.H.S. (2011). Leadership of the nurse: an integrative literature review. Revista Latino-Americana de Enfermagem. v. 19, n. 3 <https://doi.org/10.1590/S0104-11692011000300026>. Epub 07 Mar 2012. ISSN 1518-8345. https://doi.org/10.1590/S0104-11692011000300026.
Lavin, K., Davydow, D. S., Downey, L., Engelberg, R. A., Dunlap, B., Sibley, J., Lober, W. B., Okimoto, K., Khandelwal, N., Loggers, E. T., Teno, J. M., & Curtis, J. R. (2017). Effect of Psychiatric Illness on Acute Care Utilization at End of Life From Serious Medical Illness. Journal of pain and symptom management, 54(2), 176–185.e1. https://doi.org/10.1016/j.jpainsymman.2017.04.003
Lawrence, D., & Kisely, S. (2010). Inequalities in healthcare provision for people with severe mental illness. Journal of psychopharmacology (Oxford, England), 24(4 Suppl), 61–68. https://doi.org/10.1177/1359786810382058
Lindblad, A., Helgesson, G., & Sjöstrand, M. (2019). Towards a palliative care approach in psychiatry: do we need a new definition?. Journal of medical ethics, 45(1), 26–30. https://doi.org/10.1136/medethics-2018-104944
Martens, P. J., Chochinov, H. M., & Prior, H. J. (2013). Where and how people with schizophrenia die: a population-based, matched cohort study in Manitoba, Canada. The Journal of clinical psychiatry, 74(6), e551–e557. https://doi.org/10.4088/JCP.12m08234
Massie M. J. (2004). Prevalence of depression in patients with cancer. Journal of the National Cancer Institute. Monographs, (32), 57–71. https://doi.org/10.1093/jncimonographs/lgh014
McCasland, L.A. (2007). Providing hospice and palliative care to the seriously and persistently mentally ill. J Hosp Palliat Nurs. 9(6):305–315.
McGinty, E. E., Baller, J., Azrin, S. T., Juliano-Bult, D., & Daumit, G. L. (2015). Quality of medical care for persons with serious mental illness: A comprehensive review. Schizophrenia research, 165(2-3), 227–235. https://doi.org/10.1016/j.schres.2015.04.010
McNamara, B., Same, A., Rosenwax, L., & Kelly, B. (2018). Palliative care for people with schizophrenia: a qualitative study of an under-serviced group in need. BMC palliative care, 17(1), 53. https://doi.org/10.1186/s12904-018-0309-1
Meier, D. E., & Brawley, O. W. (2011). Palliative care and the quality of life. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 29(20), 2750–2752. https://doi.org/10.1200/JCO.2011.35.9729
Meyer, A. A., Hwang, M., Farasatpour, M., Janardhan, R., Margenthaler, J. A., Virgo, K. S., & Johnson, F. E. (2013). Metastatic breast cancer in patients with schizophrenia. Molecular and clinical oncology, 1(2), 359–364. https://doi.org/10.3892/mco.2012.44
Millan, M. J., Andrieux, A., Bartzokis, G., Cadenhead, K., Dazzan, P., Fusar-Poli, P., Gallinat, J., Giedd, J., Grayson, D. R., Heinrichs, M., Kahn, R., Krebs, M. O., Leboyer, M., Lewis, D., Marin, O., Marin, P., Meyer-Lindenberg, A., McGorry, P., McGuire, P., Owen, M. J., … Weinberger, D. (2016). Altering the course of schizophrenia: progress and perspectives. Nature reviews. Drug discovery, 15(7), 485–515. https://doi.org/10.1038/nrd.2016.28
Miovic, M., & Block, S. (2007). Psychiatric disorders in advanced cancer. Cancer, 110(8), 1665–1676. https://doi.org/10.1002/cncr.22980
Mitchell, A. J., Chan, M., Bhatti, H., Halton, M., Grassi, L., Johansen, C., & Meader, N. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. The Lancet. Oncology, 12(2), 160–174. https://doi.org/10.1016/S1470-2045(11)70002-X
Miyamoto, S., Jarskog, L. F., & Fleischhacker, W. W. (2015). Schizophrenia: when clozapine fails. Current opinion in psychiatry, 28(3), 243–248. https://doi.org/10.1097/YCO.0000000000000159
Relyea, E., MacDonald, B., Cattaruzza, C., & Marshall, D. (2019). On the Margins of Death: A Scoping Review on Palliative Care and Schizophrenia. Journal of palliative care, 34(1), 62–69. https://doi.org/10.1177/0825859718804108
Saha, S., Chant, D., & McGrath, J. (2007). A systematic review of mortality in schizophrenia: is the differential mortality gap worsening over time?. Archives of general psychiatry, 64(10), 1123–1131. https://doi.org/10.1001/archpsyc.64.10.1123
Shalev, D., Brewster, K. K., & Levenson, J. A. (2017). End-of-Life Care for Patients with Schizophrenia #332. Journal of palliative medicine, 20(7), 787–788. https://doi.org/10.1089/jpm.2017.0164
Shalev, D., Brewster, K., Arbuckle, M. R., & Levenson, J. A. (2017). A staggered edge: End-of-life care in patients with severe mental illness. General hospital psychiatry, 44, 1–3. https://doi.org/10.1016/j.genhosppsych.2016.10.004
Simeone, J. C., Ward, A. J., Rotella, P., Collins, J., & Windisch, R. (2015). An evaluation of variation in published estimates of schizophrenia prevalence from 1990─2013: a systematic literature review. BMC psychiatry, 15, 193. https://doi.org/10.1186/s12888-015-0578-7
Stienstra, D., & Chochinov, H. M. (2012). Palliative care for vulnerable populations. Palliative & supportive care, 10(1), 37–42. https://doi.org/10.1017/S1478951511000563
Stoll, J., Mathew, A., Venkateswaran, C., Prabhakaran, A., Westermair, A. L., & Trachsel, M. (2022). Palliative Psychiatry for Patients With Severe and Persistent Mental Illness: A Survey on the Attitudes of Psychiatrists in India Compared to Psychiatrists in Switzerland. Frontiers in psychiatry, 13, 858699. https://doi.org/10.3389/fpsyt.2022.858699
Strand, M., Sjöstrand, M., & Lindblad, A. (2020). A palliative care approach in psychiatry: clinical implications. BMC medical ethics, 21(1), 29. https://doi.org/10.1186/s12910-020-00472-8
Swiss Academy of Medical Sciences (SAMS). (2013). Medical-ethical guidelines and recommendations on palliative care. Basel, Switzerland; 2006, Swiss Academy of Medical Sciences (SAMS).
Tajima-Pozo, K., de Castro Oller, M. J., Lewczuk, A., & Montañes-Rada, F. (2015). Understanding the direct and indirect costs of patients with schizophrenia. F1000Research, 4, 182. https://doi.org/10.12688/f1000research.6699.2
Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J. (2010). Early palliative care for patients with metastatic non-small-cell lung cancer. The New England journal of medicine, 363(8), 733–742. https://doi.org/10.1056/NEJMoa1000678
Terpstra, T. L., Williamson, S., & Terpstra, T. (2014). Palliative care for terminally ill individuals with schizophrenia. Journal of psychosocial nursing and mental health services, 52(8), 32–38. https://doi.org/10.3928/02793695-20140522-01
Teunissen, S. C., Wesker, W., Kruitwagen, C., de Haes, H. C., Voest, E. E., & de Graeff, A. (2007). Symptom prevalence in patients with incurable cancer: a systematic review. Journal of pain and symptom management, 34(1), 94–104. https://doi.org/10.1016/j.jpainsymman.2006.10.015
Trachsel, M., Irwin, S. A., Biller-Andorno, N., Hoff, P., & Riese, F. (2016). Palliative psychiatry for severe persistent mental illness as a new approach to psychiatry? Definition, scope, benefits, and risks. BMC psychiatry, 16, 260. https://doi.org/10.1186/s12888-016-0970-y
Trachsel, M., Irwin, S. A., Biller-Andorno, N., Hoff, P., & Riese, F. (2016). Palliative psychiatry for severe and persistent mental illness. The lancet. Psychiatry, 3(3), 200. https://doi.org/10.1016/S2215-0366(16)00005-5
Vita, A., & Barlati, S. (2018). Recovery from schizophrenia: is it possible?. Current opinion in psychiatry, 31(3), 246–255. https://doi.org/10.1097/YCO.0000000000000407
Webber, T. (2012) End of life care for people with mental illness. J Ethics Ment Health. 7:1–4.
Westermair, A. L., Buchman, D. Z., Levitt, S., Perrar, K. M., & Trachsel, M. (2022). Psiquiatria paliativa em um sentido estreito e amplo: Um esclarecimento de conceito. A revista de psiquiatria da Austrália e Nova Zelândia, 56(12), 1535–1541. https://doi.org/10.1177/00048674221114784
World Health Organization (WHO). (2014). WHO definition of palliative care. www.who.int/cancer/palliative/definition/en/
World Health Organization (WHO) 2016. Schizophrenia. Fact sheet. http://www.who.int/mediacentre/factsheets/fs397/en/
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Mylena Miuki Ogatha Takatori; Rosangela Silva Rigo
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
Los autores que publican en esta revista concuerdan con los siguientes términos:
1) Los autores mantienen los derechos de autor y conceden a la revista el derecho de primera publicación, con el trabajo simultáneamente licenciado bajo la Licencia Creative Commons Attribution que permite el compartir el trabajo con reconocimiento de la autoría y publicación inicial en esta revista.
2) Los autores tienen autorización para asumir contratos adicionales por separado, para distribución no exclusiva de la versión del trabajo publicada en esta revista (por ejemplo, publicar en repositorio institucional o como capítulo de libro), con reconocimiento de autoría y publicación inicial en esta revista.
3) Los autores tienen permiso y son estimulados a publicar y distribuir su trabajo en línea (por ejemplo, en repositorios institucionales o en su página personal) a cualquier punto antes o durante el proceso editorial, ya que esto puede generar cambios productivos, así como aumentar el impacto y la cita del trabajo publicado.
