| Category |
Percentage
of our
sample
|
Distinguishing features | Suggested interventions |
| Depressed | 29% | -Emotional symptoms: Depressed mood, anhedonia -Cognitive symptoms: concentration problems, indecisiveness, negative thoughts, irrational guilt -Physical symptoms: changes in sleep, appetite, energy |
Initiate psychotherapy with or without antidepressants |
|
Demoralized - difficulty in coping with medical illness |
23% | Close temporal association with illness. Few neurovegetative symptoms. Able to maintain future orientation/hope |
-Compassion, recognition, and normalization. -illness-specific supports (groups, social work, chaplaincy). -Physical therapy (eg, PT/OT). |
| Disaffiliated - grief | 3% | Few neurovegetative symptoms. Able to maintain future orientation/hope. Improvement typical as time since loss increases |
-Supportive therapy -Spiritual support |
| “Difficult” - patients have a breakdown in the therapeutic alliance with their treatment team | 15% | Mood changes often intense, immediate, and reactive to situation. Frequent breakdowns in communication with care team. Care team more distressed by patient’s symptoms than the patient |
-Frequent communication among care team members -Multidisciplinary care conferences to clarify salient issues -Provide patients with consistent information and expectations |
| Delusional | 2% | Suspicious about care team/procedures. Seems frightened or scans the room. On antipsychotics at admission. Slowly developing symptoms over several days after home medications are held |
Acquire collateral history (an |
| Dulled - cognitive deficits | 2% | Baseline impairments in memory and/or independent functioning |
Acquire collateral history. Perform |
| Drugged - substance use or withdrawal | 12% | Acute presentation closely mimicking mood, anxiety, or psychotic disorders. Emotional symptoms present when intoxicated or withdrawing and resolved during sobriety |
Implement safety interventions to |
| Delirious | 11% | Disoriented and inattentive. Onset over hours to days. Waxing and waning throughout the day. Possible hallucinations (often visual or tactile) |
Identify and correct underlying |