Lauren Leiby, PharmD, BCPP
Behavioral Health Patient Care Pharmacist
Nationwide Children’s Hospital Big Lots Behavioral Health Pavilion
Columbus, Ohio
Outside of conversations around suicide, disease progression, death, and dying are not commonly discussed in psychiatric practice. Palliative care for patients with mental illness is not typically considered beyond the context of terminal medical illness. While patients with SPMI (severe and persistent mental illness) would not routinely be considered terminally ill, many individuals who live with SPMI do not achieve adequate control of their symptoms and live with significant, distressing, and impairing problems.
Palliative psychiatry has recently been defined as:
“An approach that improves the quality of life of patients and their families in facing the problems associated with life-threatening severe persistent mental illness (SPMI) through the prevention and relief of suffering by means of a timely assessment and treatment of associated physical, mental, social, and spiritual needs. Palliative psychiatry focuses on harm reduction and on avoidance of burdensome psychiatric interventions with questionable impact”.1
A palliative psychiatric care model may be helpful in times when a curative approach is either unrealistic, or impossible in the face of significant side effect burden.1,2 We know that with consecutive ineffective medication trials, the probability of achieving full symptom reduction decreases, and the risk of unwanted side effects increases.3 In these cases of significant, treatment resistant SPMI, a futility and goals of care conversation is warranted. This topic brings up many complex ethical discussions. Among those are appropriate staging of psychiatric illness, benefits and possible risks of separating psychiatric palliative care from medical palliative care, and even physician aid in dying.
The Program Committee for the 2024 AAPP Annual Meeting is excited to welcome Dr. Diana V. Punko, MD, MS to discuss taking a palliative approach to psychiatric care in patients with SPMI.
The learning objectives for this session include:
Dr. Punko is an attending psychiatrist at Massachusetts General Hospital (MGH) where she specializes in consultation-liaison psychiatry. At MGH she provides clinical care, supervises trainees, and conducts scholarly work in the areas of emergency psychiatry, transplant psychiatry, and perinatal psychiatry for persons with substance use disorders with the goal of enhancing clinical knowledge and improving quality of patient care. She has an academic appointment as instructor of psychiatry at Harvard Medical School and is involved in the education of medical students, psychiatry residents, clinical fellows, and other trainees.
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