Improving Psychiatric Interventions at the End of Life

改善临终精神病干预

• 批准号: 8725384
• 负责人: SCOTT A IRWIN
• 金额: $ 15.3万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN DIEGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-11-01 至 2016-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8725384
• 关键词: Improving; Psychiatric; Interventions; End; Life

Project Summary / Abstract: Introduction: This is a proposal to continue a career development program for the study of psychiatric issues and interventions for people near the end-of-life, specifically major depressive disorders. The public health burden of issues such as depression at the end-of-life is enormous, not only for the patients, but their loved ones. Improved psychiatric care and interventions in this population would improve the lives of over a million people a year, allowing patients and families to be engaged in their final hours together, rather than to spend them in misery. Current evidence- based interventions for depression do not work fast enough or frequently enough for patients with only weeks to live. Small studies and our pilot work have provided initial evidence for the safety and efficacy of methylphenidate for rapidly treating depression in hospice settings. A mentoring team continuing to be led by Dilip Jeste and Charles von Gunten will guide the development of the candidate in the transformation from a successful basic scientist to an independent patient oriented researcher and clinical trialist, with a special focus on conducting clinical trials in vulnerable and medically-ill populations. The overall goal is to develop the candidate into an independent scientist who would obtain RO1 funding in a new and critically important area, psychiatric hospice and palliative care. This proposal is consistent with the NIMH strategic plan of strengthening the application of mental health interventions in diverse care settings by examining community and intervention delivery approaches , how they may affect intervention outcomes, and potentially providing a knowledge base to move evidence- based interventions into practice. SPECIFIC AIMS: In patients receiving hospice care with a current major depressive episode, a 28-day double-blind, comparator controlled, flexible dose trial of methylphenidate vs. citalopram monotherapy was conducted to assess both: 1) the comparative efficacy and onset of action, and 2) the comparative safety and tolerability of using these medications for treating major depressive episodes in this population. We hypothesized that treatment with methylphenidate would both: 1) Reduce the severity of depressive symptoms and 2) Induce a response of major depressive episodes significantly faster than citalopram. Methods: A 28-day double-blind, comparator controlled, flexible dose trial of methylphenidate monotherapy vs. citalopram monotherapy investigating the safety, tolerability, efficacy, and time to efficacy for the treatment of major depression in patients receiving hospice care was conducted. Doses were titrated to tolerable effects or side-effects in the first fifteen days. Patients remained on the final stable dose for the remainder of the study. As noted in the progress reports, this trial was a useful tool for training about clinical trial issues; however, the trial itself was cancelled due to lack of enrollment. Several other studies have been completed investigating ketamine for the rapid treatment of depression in hospice patients, as well as studies of cognitive impairments, hospice caregiver stress, and suicide in hospice patients. Conclusions: There are very few psychiatrists working in end-of-life care, and even fewer who are investigators. Continued funding of this proposal will give me the rest of the experience necessary to improve the science of recognizing and treating psychiatric issues at the end-of-life and become and independent investigator. Effective treatments have significant relevance for patients, their loved ones, and caregivers. Under this award, several studies have been completed looking at various psychiatric issues affecting those in hospice care, including two investigating the use of ketamine for the rapid treatment of depression in hospice patients. The results of these investigations will now be used for the remainder of this award to design and pilot larger-scale randomized controlled studies of patients with serious advanced illnesses receiving pre-hospice (palliative) care.

项目摘要/摘要： 简介：这是一项继续研究职业发展计划的提案 临终者的精神问题和干预措施，特别是重度抑郁症 失调。临终抑郁症等问题给公共卫生带来的负担是巨大的， 不仅为了患者，也为了他们的亲人。改善精神科护理和干预措施 人口每年将改善超过一百万人的生活，使患者和家庭能够 一起度过最后的时光，而不是在痛苦中度过。目前的证据—— 对抑郁症的干预措施对患者来说效果不够快或不够频繁 只剩下几周的生命了。小型研究和我们的试点工作为这一点提供了初步证据 哌醋甲酯在临终关怀机构中快速治疗抑郁症的安全性和有效性。一个 继续由 Dilip Jeste 和 Charles von Gunten 领导的指导团队将指导 候选人在从成功的基础科学家到科学家的转变过程中的发展 独立的以患者为导向的研究人员和临床试验员，特别注重进行 在弱势群体和患有疾病的人群中进行临床试验。总体目标是发展 候选人成为一名独立科学家，他将在一个新的、关键的领域获得 RO1 资助 重要领域，精神科临终关怀和姑息治疗。该提案符合 NIMH 加强心理健康干预在不同领域应用的战略计划 通过检查社区和干预提供方法以及它们如何进行护理设置 影响干预结果，并可能提供知识库来转移证据- 将干预措施付诸实践。具体目标：在接受临终关怀的患者中 当前重度抑郁发作，28天双盲，对照对照，灵活剂量 进行哌醋甲酯与西酞普兰单药治疗的试验以评估以下两点：1) 比较功效和起效，以及 2) 使用的比较安全性和耐受性 这些药物用于治疗该人群的重度抑郁症发作。我们假设 哌醋甲酯治疗可以：1）减轻抑郁症的严重程度 症状和 2) 对重度抑郁发作的反应明显快于 西酞普兰。方法：一项为期 28 天的双盲、比较对照、灵活剂量试验 哌醋甲酯单药治疗与西酞普兰单药治疗的安全性、耐受性、 接受临终关怀的重性抑郁症患者的治疗效果和起效时间 进行了护理。在前十五次中将剂量滴定至可耐受的效果或副作用 天。在研究的剩余时间里，患者仍保持最终稳定剂量。如中所述 进度报告，该试验是临床试验问题培训的有用工具；然而， 由于注册人数不足，试验本身被取消。其他几项研究已经完成 研究氯胺酮用于快速治疗临终关怀患者的抑郁症，以及 关于临终关怀患者的认知障碍、临终关怀者压力和自杀的研究。 结论：从事临终关怀工作的精神科医生很少，从事临终关怀工作的精神科医生就更少了。 是调查员。继续资助该提案将为我提供其余的经验 有必要提高临终时识别和治疗精神问题的科学 并成为独立调查员。有效的治疗具有重要意义 患者、他们的亲人和护理人员。在该奖项的资助下，开展了多项研究 完成了对影响临终关怀人员的各种精神问题的研究，其中包括两个 研究使用氯胺酮快速治疗临终关怀患者的抑郁症。这 这些调查的结果现在将用于该奖项的其余部分来设计和 对患有严重晚期疾病的患者进行大规模随机对照试点研究 接受临终关怀前（姑息治疗）护理。