Letter to the Editor

Total Care (Spirituality, Positive Psychology, and Surgical Home) to Minimize Demoralization Syndrome in Intensive Care Unit Setting

Authors: Duraiyah Thangathurai, MD, Peter Roffey, MD, Earl Strum, MD

Abstract

To the Editor

Demoralization syndrome is a condition of existential distress that occurs in patients with serious and advanced diseases. It was described more than a decade ago in the palliative care setting by Kissane and colleagues, who distinguished it from depression and other psychological illnesses.1 The core features of the syndrome include loss of meaning, fear of loss of dignity, and the subjective sense of incompetence or helplessness. Other associated manifestations include disability, social isolation, fear of disfigurement, feelings of dependence, and the perception of being a burden on others. This syndrome often is associated with suicidal ideation.2,3

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References

1. Kissane DW, Clarke DM, Street AF. Demoralization syndrome—a relevant psychiatric diagnosis for palliative care. J Palliat Care. 2001; 17: 12–21.
 
2. Kissane DW, Wein S, Love A, et al. The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care. 2004; 20: 269–276.
 
3. Mangelli L, Fava GA, Grandi S, et al. Assessing demoralization and depression in the setting of medical disease. J Clin Psychiatry. 2005; 66: 391–394.
 
4. Chan MC, Spieth PM, Quinn K, et al. Circadian rhythms: from basic mechanisms to the intensive care unit. Crit Care Med. 2012; 40: 246–253.