Demoralization and the C-L Psychiatrist: Engaging Educational Challenges

Thursday, November 10, 2022

3:30 PM – 5:00 PM

Location: Salon West

CE: 1.5 CME

Lead Speaker(s)

John Peteet, MD

Attending Psychiatrist
Brigham and Women's Hospital
Boston, Massachusetts

Speaker(s)

HA

Hermioni L. Amonoo, MD, MPP

Associate Program Director
Brigham and Women's Hospital/Harvard Medical School Psychiatry Residency Program
Boston, Massachusetts
Stephanie C. Tung, MD (she/her/hers)

Psychiatrist
Dana-Farber Cancer Institute
Boston, Massachusetts

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Damien Miran, MD

Director, DFCI Inpatient Psychiatry Consult Service
Dana-Farber Cancer Institute
Boston, Massachusetts
Angela Landerholm, MD

CL and Psychosocial Oncology Fellow
Brigham and Women's Hospital/Dana Farber Cancer Institute
Boston, Massachusetts

Abstract: Demoralization is highly prevalent in patients with medical illnesses and a frequent indication for psychiatric consultation. Characterized by a sense of disempowerment and helplessness, demoralization is often associated with other negative affective states, including depression. However, demoralization differs from depression in that patients experience normal fluctuations in mood and improvement in dysphoric symptoms as adverse events resolve.

Relatively little attention has been given to the role of C-L psychiatrists in educating others about demoralization. This workshop will explore how C-L psychiatrists can instruct colleagues, trainees, patients, and families on this important topic. Workshop participants will be provided with an overview of the literature as it relates to demoralization and its treatments. Four clinical cases will be used to illustrate specific educational challenges and strategies for overcoming them.

The first case will focus on a patient with suicidal ideation in the context of a recent cancer diagnosis. This case will be used to emphasize the importance of looking beyond DSM diagnoses when crafting clinical formulations, a key skill for C-L psychiatry fellows. Attendees will then be presented with the case of a young patient with a prolonged hospitalization, receiving treatment with antidepressants and ketamine in the ICU. Attendees will explore strategies for addressing caregiver helplessness, an essential skill for residents and fellows. The third case involves a retired professor asking for help dealing with his impending death. Attendees will be encouraged to consider approaches for educating patients and family members. In the final case, attendees will be presented with a scenario in which a medical student feels sad and flooded in the face of unrelieved suffering of a patient. Through this case, attendees will be asked to consider educational strategies for addressing trainee vulnerabilities and countertransference. This workshop will conclude with a summary of effective techniques used to treat demoralization, including the hope modules, meaning-centered and dignity therapies, and the psychodynamic life narrative. Remaining questions will be addressed during a Q&A.

Ten minutes will be spent on the introductory review. Each case will be allotted 15 minutes. Two cases will be discussed as a large group and two will be discussed in breakout groups. The final 20 minutes will be dedicated to a summary/wrap-up and Q&A.

References:
1) Amonoo HL, Massey CN, Freedman ME, et al. Psychological Considerations in Hematopoietic Stem Cell Transplantation. Psychosomatics. Jul-Aug 2019;60(4):331-342. doi:10.1016/j.psym.2019.02.004

2) Sansone RA, Sansone LA. Demoralization in patients with medical illness. Psychiatry (Edgmont). Aug 2010;7(8):42-5.

3) Tecuta L, Tomba E, Grandi S, Fava GA. Demoralization: a systematic review on its clinical characterization. Psychol Med. Mar 2015;45(4):673-91. doi:10.1017/s0033291714001597
Learning Objectives:
Distinguish demoralization from depression, and identify strategies for addressing it effectively within the medical setting
Appreciate the unique challenges involved in teaching and learning about demoralization when communicating with patients, clinical teams and trainees
Identify strategies for supporting learners develop their ability to identify, assess, and manage demoralization.