2022; Volume 23, Number 1, January
Under My Microscope
IAHPC Research Advisor Dr. Tania Pastrana selects one article from recently published medical literature and describes why it is worthwhile reading.
Dr. Tania Pastrana. Used with permission.
By Dr. Tania Pastrana
IAHPC Research Advisor
Psychedelics for the Treatment of Depression, Anxiety, and Existential Distress in Patients with a Terminal Illness: A systematic review
Schimmel N, Breeksema JJ, Smith-Apeldoorn SY, Veraart J, van den Brink W, & Schoevers RA. Psychopharmacology (Berl), 2021. DOI: 10.1007/s00213-021-06027-y
The interesting featured story written by my friend Dingle Spence, published in the December newsletter (2021; Vol. 22, No. 12)—concluded with the observation of “the growing interest in the success of psilocybin-facilitated therapies for improving psycho-emotional and spiritual well-being, both in palliative care and in wider mental health settings.”
Coincidentally, I came across this systematic review of psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients conducted by Nina Schimmel and colleagues from the Netherlands. It is common for patients in palliative care to experience these symptoms, and their treatment options are not always satisfactory for the short term.
The team identified 33 studies: 14 on classical psychedelics [dipropyltryptamine (DPT), lysergic acid diethylamide (LSD), and psilocybin]; and 19 on atypical psychedelics [4‑methylenedioxymethamphetamine (MDMA) and ketamine]. The authors found that “positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects.”
Psychedelics (both classical and atypical) seem to be a suitable option in palliative care, addressing also grief, existential, and spiritual issues. The results are promising, but—as in many fields of palliative medicine—larger and (qualitative and quantitative) methodologically stronger studies are needed.
I send you my best wishes for better days ahead in 2022!
Background: Terminally ill patients may experience existential distress, depression, or anxiety, limiting quality of life in the final stage. Existing psychotherapeutic or pharmacological interventions have (time) limited efficacy. Psychedelic treatment may be a safe and effective alternative treatment option.
Aim: Systematically review studies on psychedelic treatment with and without psychotherapy for existential distress, depression, and anxiety in terminally ill patients.
Methods: Medline, PsycINFO, and Embase were searched for original-data studies on the treatment of depression, anxiety, and existential distress with classical or a-typical psychedelics in patients with a terminal illness, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results: A total of 1850 records were screened, and 33 articles were included in this review: 14 studies on classical psychedelics (DPT, LSD, and psilocybin) and 19 studies on atypical psychedelics (MDMA and ketamine). Results of early pre-post studies are promising but have serious methodological flaws. Recent (controlled) trials with LSD, psilocybin, ketamine, and MDMA are of higher methodological quality and indicate positive effects on existential and spiritual well-being, quality of life, acceptance, and reduction of anxiety and depression with few adverse and no serious adverse effects.
Conclusions: Both classical and a-typical psychedelics are promising treatment options in patients with terminal illness. To draw final conclusions on effectiveness and safety of psychedelics, we need larger high-quality studies for classical psychedelics and MDMA. Ketamine studies should pay more attention to existential dimensions of well-being and the psychotherapeutic context of the treatment.
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Media Watch: Social workers
The articles below are selected from Barry R. Ashpole’s weekly report, Media Watch.
How Can Social Workers Be Meaningfully Involved in Palliative Care? A scoping review on the prerequisites and how they can be realised in practice
Palliative Care & Social Practice | Online – 30 November 2021 – Although the social aspects surrounding the end-of-life phase suggest a place for social work in it, the profession is often inadequately involved in daily practice. This contrasts strongly with the potential meaningful contributions of social workers in this field. To date, no comprehensive list of prerequisites for meaningful social work involvement in palliative care (PC) exists. This review aimed to gain more insight on the prerequisites for meaningful social work involvement in PC and how to realise them in practice. It could, therefore, provide pathways for future intervention development in enhancing the involvement of social workers and maximising their contributions in PC.
Hearts Above Water: Palliative care during a pandemic
Social Work in Health Care | Online – 7 February 2021 – Social workers and nurses, as members of interprofessional palliative medicine teams, faced unfamiliar challenges and opportunities as they endeavored to provide humanistic care to patients and families during the coronavirus (COVID-19) pandemic. Typical methods for engaging patients and families in medical decision-making became thwarted by visitation restrictions and patients’ dramatic health declines. The authors of this article present an innovative social work and nursing intervention aimed at enhancing humanistic patient/family care and advanced directive dialogs.
Social Justice, Organizational Commitment and Job Satisfaction for Palliative Care Social Workers
Human Service Organizations: Management, Leadership & Governance | Online – 25 January 2021 – Given the changing palliative care (PC) industry and the shift to privatization and managerialism, the primary purpose of this study was to explore how an organization’s support of social justice as an organizational norm, enhances affective commitment to the organization and lowers intentions to leave. The findings of this study suggests that for PC social workers, more than an individual orientation of social justice, the environment of social justice that the PC organization both provides and encourages (i.e., social justice norms) contributes to organizational commitment and intention to leave when mediated by job satisfaction.
Also: Social Justice and Palliative Care Policy
Media Watch monitors the literature and the lay press on issues specific to the quality of end-of-life care. It is international in scope and distribution. View current and back issues here.
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