Trial by Triad: substituted judgment, mental illness and the right to die

2021 ◽  
pp. medethics-2020-107154
Author(s):  
Jacob M Appel
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Substituted Judgment ◽  
Diminished Capacity ◽  
Accepted Standard ◽  
The Usa ◽  
Aid In Dying ◽  
Incapacitated Patients ◽  
The Right

Substituted judgment has increasingly become the accepted standard for rendering decisions for incapacitated adults in the USA. A broad exception exists with regard to patients with diminished capacity secondary to depressive disorders, as such patients’ previous wishes are generally not honoured when seeking to turn down life-preserving care or pursue aid-in-dying. The result is that physicians often force involuntary treatment on patients with poor medical prognoses and/or low quality of life (PMP/LQL) as a result of their depressive symptoms when similarly situated incapacitated patients without such depressive symptoms would have their previous wishes honoured via substituted judgment. This commentary argues for reconsidering this approach and for using a substituted judgment standard for a subset of EMP/LQL patients seeking death.

scholarly journals Effects of n-3 Polyunsaturated Fatty Acid Supplementation in the Prevention and Treatment of Depressive Disorders—A Systematic Review and Meta-Analysis

Nutrients ◽  
2021 ◽  
Vol 13 (4) ◽  
pp. 1070
Author(s):  
Maike Wolters ◽  
Annkathrin von der Haar ◽  
Ann-Kristin Baalmann ◽  
Maike Wellbrock ◽  
Thomas L. Heise ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Treatment Duration ◽  
Depressive Disorders ◽  
Meta Analysis ◽  
Pufa Supplementation ◽  
Depressive Symptomology ◽  
Beneficial Effects ◽  
Randomized Controlled ◽  
Significant Difference

N-3 polyunsaturated fatty acids (PUFAs) have been suggested to affect depressive disorders. This review aims to determine the effect of n-3 PUFAs on depressive symptoms in people with or without diagnosed depression. Medline, PsycINFO, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) assessing the association between n-3 PUFAs and depressive symptoms or disorders as outcomes. A random-effects meta-analysis of standardized mean difference (SMD) with 95% confidence intervals (CI) was performed. Twenty-five studies (7682 participants) were included. Our meta-analysis (20 studies) indicated that n-3 PUFA supplementation lowered depressive symptomology as compared with placebo: SMD = −0.34, 95% CI: −0.55, −0.12, I2 = 86%, n = 5836, but a possible publication bias cannot be ruled out. Subgroup analyses indicated no statistically significant difference by treatment duration of <12 vs. ≥12 weeks, presence of comorbidity, or severity of depressive symptoms. Nevertheless, beneficial effects were seen in the subgroups of studies with longer treatment duration and with no depression and mild to moderate depression. Subgroup analysis by eicosapentaenoic acid (EPA) dosage revealed differences in favor of the lower EPA dosage. Sensitivity analysis including studies with low risk of bias seems to confirm the overall result. Supplementation of n-3 PUFA appears to have a modest beneficial effect on depressive symptomology, although the quality of evidence is still insufficient.

Symptom Frequencies and Intensities in Hospitalized Patients With Advanced Cancer Having Depressive Disorder

2016 ◽  
Vol 34 (5) ◽  
pp. 456-460 ◽  
Author(s):  
Yong Liu ◽  
Fei Liu ◽  
Yang Yu ◽  
Qing Li ◽  
Xin Jin ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Advanced Cancer ◽  
Depressive Disorders ◽  
Depression Scale ◽  
Rank Correlation ◽  
Symptom Assessment ◽  
Hospitalized Patients ◽  
Assessment System ◽  
Wilcoxon Rank Sum Test

Aim: To explore the frequencies and intensities of depressive symptoms associated with hospitalized patients with advanced cancer. Methods: A total of 196 hospitalized patients with advanced cancer were surveyed with the Edmonton Symptom Assessment System and Self-Rating Depression Scale (SDS). The χ2 test and Wilcoxon rank-sum test were used to compare the frequency and intensity of symptoms between patients with and without depressive disorders. Spearman rank correlation was used to test the correlation between depression and symptoms. Results: Of the 196 enrolled patients, 115 (59%) were males. The median age of the patients was 58 (19-80) years. Seventy-six (39%) patients were diagnosed with depression (SDS ≥ 53). Patients with depressive disorders exhibited pain, drowsiness, and nausea along with a higher frequency and intensity of poor self-perception, appetite loss, anxiety, dyspnea, and fatigue. Depressive symptoms were positively correlated with the symptoms. Conclusion: Depressive disorders are very common and severe in hospitalized patients with advanced cancer. Identifying the frequencies and intensities of the symptoms enables early intervention to improve patients’ quality of life.

scholarly journals Untreated Depressive Symptoms Significantly Worsen Quality of Life of the Elderly and may Lead to the Misdiagnosis of Dementia: A Cross-Sectional Study

2020 ◽  
Author(s):  
Viktor Voros ◽  
Sandor Fekete ◽  
Tamas Tenyi ◽  
Zoltan Rihmer ◽  
Ilona Szili ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cognitive Impairment ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Early Recognition ◽  
The Elderly ◽  
Screening Tools ◽  
Adequate Treatment

Abstract Background: Several studies demonstrated the role of depressive mood and cognitive impairment in the background of elevated mortality and decreased Quality of Life (QoL) of the elderly.Methods: In the framework of the ICT4Life project self-administered questionnaires and clinical screening tools were used to assess QoL, depressive symptoms and cognitive functions of 60 elderly over the age of 65.Results: Males found to be depressed and cognitively declined more frequently; and had higher scores on the depression and lower on the QoL scales. Depressed elderly had lower cognitive levels and their QoL was significantly poorer than that of the non-depressed subjects. Depressive disorders were detected in a quarter of the elderly, and the majority of them did not receive adequate antidepressant medication.Conclusions: Close correlation between depression and cognitive impairment was confirmed, as well as the key role of depression in the background of QoL decline. Results also highlighted the problems of recognition and adequate treatment of depression and cognitive decline in elderly, which can be further complicated by the common symptoms of depressive pseudo-dementia. Early recognition of depressive symptoms is important not only to treat the underlying mood disorder, but also to improve QoL of the elderly.

scholarly journals Epidemiology of depressive disorders in people living with hypertension in Africa: a systematic review and meta-analysis

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037975
Author(s):  
Francky Teddy Endomba ◽  
Temgoua Ngou Mazou ◽  
Jean Joel Bigna
Keyword(s):  
Systematic Review ◽  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Data Extraction ◽  
Meta Analysis ◽  
Diagnostic Tools ◽  
Pool Data ◽  
Eligibility Criteria ◽  
Major Depressive Symptoms

ObjectivesBetter knowledge of epidemiology of depressive disorders in people living with hypertension can help to implement pertinent strategies to address its burden. The objective was to estimate the prevalence of depressive disorders and symptoms in people living with hypertension in Africa.DesignSystematic review and meta-analysis.Data sourcesPubMed, EMBASE, African Index Medicus, African Journals OnLine were searched up to 31 January 2020, regardless of the language of publication.Eligibility criteriaWe included studies conducted among adult patients with hypertension (≥18 years) living in Africa and reporting the prevalence of depressive disorders and symptoms.Data extraction and synthesisTwo independent investigators selected studies, extracted data and assessed the methodological quality of included studies by using the tools developed by Joanna Briggs Institute. Multivariate random-effects meta-analysis served to pool data by considering the variability between diagnostic tools used to identify patients with depressive disorders or symptoms.ResultsWe included 11 studies with 5299 adults with hypertension. Data were collected between 2002 and 2017, from South Africa, Nigeria, Ghana, Ethiopia and Burkina Faso. The mean age varied between 50.3 years and 59.6 years. The proportion of men ranged from 28% to 54%. The adjusted prevalence of depressive disorders taking into account the variance between diagnostic tools was 17.9% (95% CI 13.0% to 23.4%). The prevalence of depressive symptoms and major depressive symptoms was 33.3% (95% CI 9.9% to 61.6%) and 7.8% (95% CI 3.0% to 14.5%), respectively. There was heterogeneity attributable to the diagnostic tools for depressive disorders and symptoms. There was no publication bias.ConclusionNotwithstanding the representativeness lack of some (sub) regions of Africa, weakening the generalisability of findings to the entire region; depressive disorders and symptoms are prevalent in people living with hypertension in Africa, indicating that strategies from clinicians, researchers and public health makers are needed to reduce its burden in the region.

scholarly journals The Role of Iron Metabolism in Fatigue, Depression, and Quality of Life in Multiple Sclerosis Patients

2020 ◽  
Vol 17 (18) ◽  
pp. 6818
Author(s):  
Anna Knyszyńska ◽  
Aleksandra Radecka ◽  
Paulina Zabielska ◽  
Joanna Łuczak ◽  
Beata Karakiewicz ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Multiple Sclerosis ◽  
Depressive Symptoms ◽  
Iron Metabolism ◽  
Depressive Disorders ◽  
Binding Capacity ◽  
Iron Binding ◽  
Multiple Sclerosis Patients ◽  
Iron Binding Capacity

Multiple sclerosis (MS) is a chronic inflammatory disease of autoimmune origin for which there is currently no available cure. In the course of MS, next to neurological disorders, patients often present with chronic fatigue syndrome and depressive disorders, which impact on their daily function and quality of life. The aim of study was to analyse the relationship between serum parameters of iron metabolism and the severity of fatigue, depressive symptoms, and quality of life in MS patients. Methods: The study sample consisted of 90 people with a diagnosis of multiple sclerosis, age range 19–67 years, whose functional status evaluated using the Expanded Disability Status Scale in 90% of the participants did not exceed 3.5 points. Venous blood samples were collected for blood cell count determination and for the purposes of obtaining serum analysed for the concentrations of iron, ferritin, transferrin, transferrin saturation, unsaturated iron binding capacity (UIBC), and total iron binding capacity (TIBC). The participants were also evaluated according to the Fatigue Severity Scale, Beck Depression Inventory, and Functional Assessment of Multiple Sclerosis. Results: Ferritin levels were significantly correlated with the severity of depressive symptoms (r = −0.22; p = 0.04) and quality of life assessment (r = 0.22; p = 0.04) in the MS patients. Moreover, the severity of fatigue and depressive symptoms was significantly linked to a deterioration in quality of life. Conclusions: Ferritin deficiency in MS patients is associated with an exacerbation of depressive disorders and a decline in quality of life. Symptoms of fatigue in MS patients are inversely proportional to mood and quality of life.

Depressive symptoms and quality of life in patients with coronary artery disease after percutaneous coronary interventions

2011 ◽  
Vol 26 (S2) ◽  
pp. 2060-2060
Author(s):  
D. Dudek
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Disease ◽  
Depressive Symptoms ◽  
Coronary Artery ◽  
Coronary Angioplasty ◽  
Depressive Disorders ◽  
Sf 36 ◽  
Artery Disease

Depression contributing to cardiovascular disease is a major clinical problem both due to frequent occurrence and serious health effects. Studies confirm a relationship between depressive disorders and risk for the development and unfavorable course of coronary artery disease (CAD) and myocardial infarction.The aim of the study was to assess how the comorbidity of depressive symptoms and CAD influences the quality of life (QoL) in patients after the successful coronary angioplasty (PCI). 227 patients with CAD selected for PCI were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the interventions were included in one year follow-up. Patients’ status was assessed four times (one day before and at 1, 6 and 12 months after the intervention). Polish version of SF-36, Beck Depression Inventory (BDI), Rosenberg's Self-esteem Scale (RS), Beck's Hopelessness Scale (HS) and Authomatic Thoughts Questionnaires (ATQ) were used.In the whole group QoL after one months after PCI was significantly improved. This tendency persisted in further examinations. There was a significant correlation between SF-36, which measures QoL, severity of depressive symptoms (BDI) and parameters describing depressive thinking style (HS, RS and ATQ). The presence of depressive symptoms at each assessment during follow-up, was associated with the poorer quality of life.Presenting study indicate that depressive symptoms in patients with coronary artery disease significantly affect the quality of life, despite of the successful coronary angioplasty. Optimized comprehensive approach to CAD patients may require psychological assessment and inclusion of adequate psychological or psychiatric interventions.

Diabetes und depressive Störungen

2020 ◽  
Vol 15 (03) ◽  
pp. 211-224 ◽  
Author(s):  
Hanna Kampling ◽  
Johannes Kruse
Keyword(s):  
Depressive Symptoms ◽  
Depressive Disorders ◽  
Diabetes Education ◽  
Psychosocial Problems ◽  
Physical Activation ◽  
Treatment Regimes ◽  
Patients With Diabetes ◽  
The Relationship ◽  
Very High

AbstractDepressive disorders are highly prevalent in patients with diabetes. While depressive disorders themselves require therapy, they also contribute negatively to diabetes-related medical, social and psychological outcomes, and therefore need to be addressed. Disease burden is very high for both diabetes and depression, even more so in case of comorbidity. Comorbid depressive symptoms in patients with diabetes are associated with a reduced quality of life and adherence to treatment regimes, impaired coping abilities, as well as increased morbidity and mortality rates, diabetes-related distress, and economic burden.The interactions between diabetes and depression are bidirectional. Both diseases appear to have a variety of shared bio-psychosocial, as well as biological risk factors. Recent research implies that the interaction between diabetes and depression cannot be understood as a simple cause-effect relationship but might rather be explained by being part of a disturbed homeostasis of biological and psychological circuits.Regular depression screenings should be applied to identify depressive symptoms in patients with diabetes. To verify positive screening results, treating physicians have a key role in targeting depression by actively asking patients for depressive symptoms within the last 14 days. If symptoms are present, further diagnostics, and the exploration of psychosocial problems are necessary. In case of a depressive disorder, varieties of effective antidepressant treatments (psychotherapy, psychopharmacological medications) are available. Physical activation and diabetes education programs can be offered additionally. The current paper offers insights on epidemiology, symptoms, interactions, diagnostics, treatments as well as the relationship between physician and patient.

Internalized homophobia, social pain, severity of depressive symptoms and quality of sexual life among homosexual young adults

2016 ◽  
Vol 33 (S1) ◽  
pp. s266-s266
Author(s):  
A. Wiszniewicz ◽  
E. Wojtyna
Keyword(s):  
Young Adults ◽  
Depressive Symptoms ◽  
Minority Stress ◽  
Depressive Disorders ◽  
Internalized Homophobia ◽  
Sexual Life ◽  
Life Questionnaire ◽  
Social Pain ◽  
Cross Sectional

BackgroundBeing a homosexual may be burdened by several psychological problems. This is due to the minority stress that results from feeling excluded and it is characteristic of social minorities. Negative beliefs about their psychosexual orientation and sense of exclusion may be the cause of both depressive disorders and internalized homophobia. These factors can affect the quality of sexual life.AimThe aim of the study is to analyze the relationship between internalized homophobia, social pain and the severity of depressive symptoms and quality of sexual life.MethodsThe study included 103 young adults remaining in permanent homosexual relationships. The study was cross-sectional. The study used Beck Depression Inventory, Social Pain Thermometer, Internalized Homophobia Scale and Quality of Sexual Life Questionnaire.ResultsIt observed the significant correlations between the level of internalized homophobia and a sense of social pain and the severity of depressive symptoms. Both internalized homophobia, and severe social pain and depressive symptoms proved to be significant predictors of reduced quality of sexual life of homosexuals.ConclusionsDuring the treatment of depressive symptoms and discomfort associated with the sexual life of homosexuals, it is important to take into account the phenomenon of internalized homophobia.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Cathartic Effect of Suicide Attempts Not Limited to Depression

Crisis ◽  
2003 ◽  
Vol 24 (2) ◽  
pp. 73-78 ◽  
Author(s):  
Yves Sarfati ◽  
Blandine Bouchaud ◽  
Marie-Christine Hardy-Baylé
Keyword(s):  
Quality Of Life ◽  
Depressive Symptoms ◽  
Personality Traits ◽  
Rating Scales ◽  
Suicide Attempts ◽  
World Health ◽  
Life Questionnaire ◽  
Short Term

Summary: The cathartic effect of suicide is traditionally defined as the existence of a rapid, significant, and spontaneous decrease in the depressive symptoms of suicide attempters after the act. This study was designed to investigate short-term variations, following a suicide attempt by self-poisoning, of a number of other variables identified as suicidal risk factors: hopelessness, impulsivity, personality traits, and quality of life. Patients hospitalized less than 24 hours after a deliberate (moderate) overdose were presented with the Montgomery-Asberg Depression and Impulsivity Rating Scales, Hopelessness scale, MMPI and World Health Organization's Quality of Life questionnaire (abbreviated versions). They were also asked to complete the same scales and questionnaires 8 days after discharge. The study involved 39 patients, the average interval between initial and follow-up assessment being 13.5 days. All the scores improved significantly, with the exception of quality of life and three out of the eight personality traits. This finding emphasizes the fact that improvement is not limited to depressive symptoms and enables us to identify the relative importance of each studied variable as a risk factor for attempted suicide. The limitations of the study are discussed as well as in particular the nongeneralizability of the sample and setting.

ANALYSIS OF REGULATIONS REGARDING THE SETTLEMENT OF ISSUES ON THE REMOVAL AND RECOVERY OF PLANTATIONS IN THE RIGHT-OF-WAY OF PUBLIC ROADS

2020 ◽  
pp. 55-60
Author(s):  
Nataliia Kharytonova ◽  
Olha Mykolaienko ◽  
Tetyana Lozova
Keyword(s):  
Traffic Safety ◽  
Climatic Factors ◽  
Visual Orientation ◽  
Right Of Way ◽  
Adverse Weather ◽  
Overhead Power Lines ◽  
The Right ◽  
Neck Diameter ◽  
Proper Operation

Greening of roads contributes to the protection of roads and their elements from influence of adverse weather and climatic factors; it includes the measures for improvement and landscaping of roads, ensures the protection of roadside areas from transport pollution, provides visual orientation of drivers. The solution of these issues will ensure creation and maintenance of safe and comfortable conditions for travelers. Green plantings in the right-of-way road area include woody, bushy, flower and grass vegetation of natural and artificial origin. For proper operation of public roads and satisfaction of other needs of the industry, there may be the need in removing the greenery. The reason for the removal of greenery in the right-of-way road area may be due to the following factors: construction of the architectural object, widening of the motor road, repair works in the security zone of overhead power lines, water supply, drainage, heating, telecommunications facilities, cutting of hazardous, dry and fautal trees, as well as self-grown and brushwood trees with a root neck diameter not exceeding 5 cm, elimination of the consequences of natural disasters and emergencies. The removal of plantations in the right-of-way area is executed in order to ensure traffic safety conditions and to improve the quality of plantations composition and their protective properties. Nowadays, in Ukraine there is no clear procedure for issuing permits for removing of such plantations. In order to resolve this issue, there is a need in determining the list of regulations in the area of forest resources of Ukraine and, if needed, the list of regulatory acts that have to be improved; to prepare a draft of the regulatory legal act that would establish the procedure of plantations cutting, the methodology of their condition determination, recovery costs determination, the features of cutting. Keywords: plantations, cutting, right-of-way, woodcutting permit, order.

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