BACKGROUND:Demoralization is common in palliative psycho-oncology settings. Although its relationship with other psycho-existential conditions has been scrutinized, its co-occurrence with adjustment disorder, as measured by the Adjustment Disorder New Module-20 (ADNM-20), remains unexamined. AIM:Estimate frequency and co-occurrence of demoralization and adjustment disorder symptom domains among palliative outpatients and examine sociodemographic and psycho-existential factors. METHODS:A single-site, cross-sectional survey at an academic cancer center used self-reported web-based screening questionnaires. Analyses included descriptive statistics, association tests, and hierarchical logistic regression models. RESULTS:Moderate-to-severe demoralization symptoms occurred in 43.3% (90% CI: 36.9-49.7) of the 164 outpatients. Among these, co-occurrence with high-risk adjustment disorder symptoms reached 77.6% (90% CI: 69.5-85.8) versus 54.9% (90% CI: 45.2-64.6) for moderate-to-severe depression symptoms (p < 0.001). High-risk adjustment disorder was also frequent (44.1%, 90% CI: 34.4-53.8.3) and, along with moderate-to-severe depression (OR 7.23 and 8.67, p < 0.01), was independently associated with moderate-to-severe demoralization. CONCLUSIONS:Approximately half of oncology outpatients screened positive for demoralization or adjustment disorder, with substantial co-occurrence reflecting their conceptually defined shared disruption of adaptive capacities. Demoralization demonstrates incomplete overlap at the symptom-domain level and appears to capture a distinct existential dimension of distress. This pattern supports consideration of routine screening and further empirical evaluation of its potential diagnostic positioning. Clinician-administered longitudinal studies incorporating item-level analyses are warranted to clarify temporal relationships, refine discriminant validity, and further evaluate demoralization as a distinct diagnostic entity. Such work may enhance recognition of existential suffering and inform targeted integrative interventions.

L’espoir est une attente positive que quelque chose de souhaitable va arriver sans qu’il n’y en ait aucune certitude. Comment comprendre l’espoir dans le champ de la psychologie et des pratiques soignantes ? Chaque patient, chaque soignant investit cette dimension de l’espoir en fonction de son histoire ou de sa personnalité. Dès la demande de soins, cet espoir supposé faire contrepoids à la maladie donne à réfléchir. Dans la maladie chronique, il arrive que les patients perdent tout espoir ou qu’ils se raccrochent à un espoir de guérison. Aux fonctions de l’espoir chez les patients vient en écho la façon dont les soignants y répondent : est-ce leur préoccupation ou s’agit-il simplement de répondre à la demande des patients ? Faut-il redonner ou entretenir l’espoir et jusqu’à quel prix ? Nous proposons une réflexion sur les enjeux de l’espoir au cœur de la relation de soins pour tenter de comprendre le besoin d’espérer comme étant un besoin qui s’accompagne.

Psychedelic substances have experienced a resurgence of clinical interest in recent years, particularly for their promising effects in the treatment of psychiatric disorders such as depression and anxiety. While evidence regarding their role in chronic pain management remains limited, emerging studies suggest potential therapeutic benefits. This case report describes a patient with persistent somatoform pain disorder and recurrent depressive disorder who underwent four sessions of psilocybin-assisted psychotherapy. The intervention was associated with a reduction in the negative impact of pain on daily life, increased pain acceptance, improved quality of life, and reduction in depressive symptoms. These findings contribute to the growing body of literature suggesting that psychedelics, when combined with psychotherapy, may offer a novel and holistic approach to the treatment of chronic pain. Further controlled studies are needed to explore the safety, efficacy, and underlying mechanisms.

Psychedelics are emerging as a therapeutic innovation in psychiatry and their use in chronic pain is worth exploring. In fact, they can modulate the serotonergic system, affecting central pain sensitization mechanisms. Ketamine, used for chronic analgesia, can lead to pain reduction, but additional studies are needed to assess its longterm effectiveness. "Classic" psychedelics are recently attracting renewed interest for their potential effects on chronic pain. Despite limited studies, evidence suggests analgesic benefits, an effect on inflammation, and potential impacts on certain functional disorders. These results pave the way for further research in this ever-evolving field.

IntroductionOlder adults comprise a large portion of back pain (BP) sufferers but are under-represented in the literature. Patients over age 65 present with different clinical characteristics and psychosocial needs than younger patients. Therefore, recommended patient-centered outcomes for BP may not be relevant to older patients.Research QuestionWhat treatment outcomes are most important to adults over 65 years of age?Materials and MethodsWe queried older adults seeking treatment for BP using qualitative methods. Participants were asked about their goals and expectations of treatment in an audio-taped interview. Audiotapes were transcribed, coded and analyzed by the investigators. Using thematic analysis, main themes and constructs were extracted and interpreted by the investigators. From there we were able to generate hypotheses about what older patients want from spine treatment.ResultsFor all participants, age played a role in their treatment goals as a moderator or motivator. They were most concerned with returning to usual activities and preventing further physical limitations to maintain independence. Goals that reflect important outcomes such as increasing walking tolerance and improving balance were of particular importance. Confidence in the provider acted as a facilitator of goals.Discussion and ConclusionUnlike their younger cohorts, they did not emphasize work-related outcomes and pain relief. These findings can be tested in future quantitative studies and will help to develop protocols for outcomes assessment in older adults. This study is a first step towards understanding and improving the quality of care for older patients with back pain.

Psychedelics are emerging as a therapeutic innovation in psychiatry and their use in chronic pain is worth exploring. In fact, they can modulate the serotonergic system, affecting central pain sensitization mechanisms. Ketamine, used for chronic analgesia, can lead to pain reduction, but additional studies are needed to assess its longterm effectiveness. "Classic" psychedelics are recently attracting renewed interest for their potential effects on chronic pain. Despite limited studies, evidence suggests analgesic benefits, an effect on inflammation, and potential impacts on certain functional disorders. These results pave the way for further research in this ever-evolving field.

Chronic pain requires an integrative approach. The prescription of opioids is increasing in Europe, including Switzerland, for the -treatment of chronic pain, despite their modest effectiveness. Mindfulness-based interventions have demonstrated their effectiveness in the management of chronic pain. The MORE program (Mindfulness-Oriented Recovery Enhancement) is an integrative therapy that uses mindfulness practices to help patients develop new positive beliefs and regain meaning, motivation and pleasure. The MORE program has been proven effective in reducing opioids and increasing well-being in patients suffering from chronic pain and thus constitutes a promising therapeutic approach.

We report the case of a 67-year-old left-handed female patient with disabling medically refractory essential tremor who underwent successful right-sided magnetic resonance-guided focused ultrasound (MRgFUS) of the ventral intermediate nucleus after ipsilateral gamma knife radiosurgery (GKRS) thalamotomy performed 3 years earlier. The GKRS had a partial effect on her postural tremor without side effects, but there was no reduction of her kinetic tremor or improvement in her quality of life (QoL). The patient subsequently underwent a MRgFUS thalamotomy, which induced an immediate and marked reduction in both the postural and kinetic tremor components, with minor complications (left upper lip hypesthesia, dysmetria in her left hand, and slight gait ataxia). The MRgFUS-induced lesion was centered more medially than the GKRS-induced lesion and extended more posteriorly and inferiorly. The MRgFUS-induced lesion interrupted remaining fibers of the dentatorubrothalamic tract (DRTT). The functional improvement 1-year post-MRgFUS was significant due to a marked reduction of the patient's kinetic tremor. The QoL score (Quality of Life in Essential Tremor) improved by 88% and her Clinical Rating Scale for Tremor left hand score by 62%. The side effects persisted but were minor, with no impact on her QoL. The explanation for the superior efficacy of MRgFUS compared to GKRS in our patient could be due to either a poor response to the GKRS or to a better localization of the MRgFUS lesion with a more extensive interruption of DRTT fibers. In conclusion, MRgFUS can be a valuable therapeutic option after unsatisfactory GKRS, especially because MRgFUS has immediate clinical effectiveness, allowing intra-procedural test lesions and possible readjustment of the target if necessary.

Chronic pain requires an integrative approach. The prescription of opioids is increasing in Europe, including Switzerland, for the -treatment of chronic pain, despite their modest effectiveness. Mindfulness-based interventions have demonstrated their effectiveness in the management of chronic pain. The MORE program (Mindfulness-Oriented Recovery Enhancement) is an integrative therapy that uses mindfulness practices to help patients develop new positive beliefs and regain meaning, motivation and pleasure. The MORE program has been proven effective in reducing opioids and increasing well-being in patients suffering from chronic pain and thus constitutes a promising therapeutic approach.La douleur chronique nécessite une approche intégrative. La prescription des opiacés augmente de plus en plus en Europe, y compris en Suisse, pour le traitement de la douleur chronique, malgré leur efficacité modeste. Les interventions basées sur la méditation de pleine conscience ont démontré leur efficacité quant à la prise en charge de la douleur chronique. Le programme MORE (Mindfulness-Oriented Recovery Enhancement) est une thérapie intégrative qui utilise des pratiques de pleine conscience afin d’aider les patients à développer des nouvelles croyances positives et de retrouver le sens, la motivation et le plaisir. Ce programme a été prouvé ­efficace quant à la réduction des opiacés et l’augmentation du bien-être chez les patients souffrant de douleurs chroniques. Il constitue ainsi une approche thérapeutique prometteuse.

The literature has clearly stressed that patients suffering from chronic pain are at high risk of suicidal behavior (SB). Hence the need to improve the characterization of this behavior risk profile in these patients. Some findings indicate a possible relationship between demoralization and pain, with functional disability found to be correlated with demoralization. The primary objective of this study was to investigate the relationship between demoralization and suicidal ideation (SI) in patients with chronic pain. The secondary objective was to verify whether demoralization can occur independently of depression in these patients. Inclusion criteria were patients with chronic pain, with SI or not, matched for age and gender, aged > 18 years. Seventy patients with SI and 70 patients without SI were included. Between-group difference was statistically significant (F=1.064; t= 7.21, p<0.001, d=1.22), confirming the presence of numerous and intense depressive symptoms in the patients of the SI group. Regarding the Demoralization Scale (DS), the difference between the two groups was statistically highly significant (F=1.49; t=9.44; p<0.001, d=1.6). There was also a strong positive correlation between DS and Beck Depression Inventory (BDI-II) (R=0.749; p<0.001 for the study group and R=0.704; p<0.001 for the control group). Furthermore, there was a strong positive correlation between the DS and the Scale for Suicide Ideation (SSI) in the SI patients group, meaning that high demoralization is associated with higher suicidal ideation as well. Our findings did not allow us to distinguish between the notions of depression and demoralization, since the two constructs show almost the same strong positive correlation with suicidal thoughts, the two also being strongly correlated with each other.

BACKGROUND:Chronic pain is associated with an elevated risk of suicidal ideation (SI). OBJECTIVE:We aimed to examine if the presence or the search for Meaning in Life (MiL) are associated with less SI and explore whether MiL profiles emerge in our cohort. These profiles can be described as high presence-high search, high presence-low search, low presence-low search, and low presence-high search. METHODS:In this observational study, we recruited 70 patients who were referred to the Multidisciplinary Pain Center of the Geneva University Hospitals and who answered positively to question 9 on the Beck Depression Inventory, 2nd Edition, investigating SI. Patients who agreed to participate in the study were further investigated; they participated in a structured diagnostic interview to screen for psychiatric diagnoses. During this interview, they completed the Meaning in Life Questionnaire and the semistructured Scale for Suicide Ideation (SSI) to assess the characteristics and severity of SI. RESULTS:There was a statistically significant correlation between the presence of MiL subscale and the SSI. These 2 scales had a negative and statistically highly significant correlation (R=-.667; P<.001). The results also showed a negative and statistically highly significant correlation between the score of the search for MiL and the SSI (R=-.456; P<.001). The results thus pointed to the presence of MiL as a potential protective factor against the severity of SI, while the search for MiL is also a possible resiliency factor, although to a lesser extent. The profile low presence-low search grouped the vast majority (47%) of the patients; in these patients, the mean SSI score was 14.36 (SD 5.86), much higher compared with that of the other subgroups. CONCLUSIONS:This study's results point to MiL as a concept of interest regarding devising psychotherapeutic interventions for chronic pain patients in order to reduce the suicidal risk and more accurately determine patients' suffering.

Psychomotor agitation in somatic units is a medical and psychiatric emergency requiring rapid intervention by the team in charge of the patient and the liaison psychiatrist. Verbal de-escalation is attempted throughout the treatment. Securing the surroundings is needed to protect both the patient and the team. The etiology of the agitation, somatic and/or psychiatric, should be investigated to allow the administration of an adequate treatment. Antipsychotics and benzodiazepines are often recommended. Physical restraint measures can be applied as a last resort if necessary. The continuation of care is decided jointly between the team in charge and the liaison psychiatrist. An intervention protocol has been drawn up by the HUG liaison psychiatry team.

OBJECTIVE:In psychiatric literature, few original studies exist on the topic of demoralization in suicide. In this review, we aim to identify original studies on suicidal ideation (SI)/suicidal behavior (SB) and demoralization in populations of community-dwellers and patients with somatic or psychiatric disorders.METHODS:We employed a systematic approach that followed PRISMA guidelines, searching through four major electronic databases (PubMed/MEDLINE, Scopus, Science Direct, and PsychINFO) for relevant titles/abstracts published from January 1980-June 2021. We included original studies that explicitly mentioned the investigation of a potential association between SI/SB and demoralization.RESULTS:A total of 18 studies met our inclusion criteria. Their synthesis revealed that demoralization can be associated with SI/SB in a wide range of populations (community dwellers, patients with somatic or psychiatric disorders) and lead to significantly higher suicide risk (odds ratios of >6 were encountered in community dwellers experiencing financial hardship or isolation). Moreover, demoralization alone (about half the patients who were demoralized did not meet the criteria for an affective disorder nor were they clinically depressed) or together with depression has been identified as a major risk factor for SI/SB. Regarding the crucial issue of progression from SI to SA, in the context of the "ideation-to-action" frame, some authors found that the interaction of demoralization and over-arousal could be a useful predictor for this progression, while others found that depression alone was sufficient to differentiate attempters from non-attempters or the interaction with shutdown (helplessness and low positive emotions).CONCLUSION:These results emphasize the possibility to identify demoralization as an independent risk factor for suicide. In patients with psychiatric disorders, the association between demoralization and SI/SB may be transnosographic. Overall, from the clinical implications perspective, our findings highlight that: i. Assessment of demoralization may contribute to a more comprehensive suicide risk detection. This appears particularly relevant in Emergency Departments (EDs) where heterogeneous population typologies are usually admitted and a clinical diagnosis of depression is often difficult to be defined. ii. Additionally, since meaninglessness is considered one of the demoralization subcomponents, meaning-centered psychotherapeutic approaches prove to be indicated and they can be initiated already at the EDs upon first contact with the patient. Further studies are necessary to confirm these findings.

The reduction or suspension of psychotropic treatment may be necessary for various medical reasons. This can have serious consequences for patients, including clinical manifestations, both physical and psychological. These manifestations, which are often unpleasant, can compromise care during hospitalization and undermine the therapeutic alliance. Their early detection, readjustment of treatment, when necessary, as well as regular communication with the patient and among specialists are important tips to take into account from caregivers.

The reduction or suspension of psychotropic treatment may be necessary for various medical reasons. This can have serious consequences for patients, including clinical manifestations, both physical and psychological. These manifestations, which are often unpleasant, can compromise care during hospitalization and undermine the therapeutic alliance. Their early detection, readjustment of treatment, when necessary, as well as regular communication with the patient and among specialists are important tips to take into account from caregivers.La diminution ou mise en suspens d’un traitement psychotrope peut être imposée par des raisons médicales diverses. Cela peut avoir d’importantes conséquences pour les patients, notamment des manifestations cliniques, tant physiques que psychologiques. Elles sont souvent désagréables, peuvent compromettre l’adhésion aux soins lors d’une hospitalisation et mettre à mal le lien thérapeutique. Leur détection précoce, le réajustement du traitement quand nécessaire, ainsi que la communication régulière avec le patient et entre spécialistes sont des éléments importants à prendre en compte lors de ces prises en charge.

Faire semblant ou souffrir vraiment ?Questions des soignants face au trouble facticeLe diagnostic de trouble factice ne peut émerger que lorsque les soignants sont en difficulté dans la prise en soins de leur patient.Ce trouble est un véritable défi pour les équipes soignantes tout au long de la prise en charge, de sa découverte à sa prise en soins.Mise en échec, secret et lésions auto-infligées sont autant de composantes avec lesquelles nous pouvons être mal à l'aise comme soignants.La problématique factice demande une prise en charge bien coordonnée entre les divers spécialistes et, souvent, questionne nos pratiques.Dans cet article, nous traitons des questions fréquemment posées par les équipes de soins aux psychiatres de liaison que nous sommes, en s'occupant de l'identification du problème en clinique, des enjeux thérapeutiques et de l'attitude à tenir. To pretend or to really suffer ? Questions from caregivers about the factitious disorderThe diagnosis of factitious disorder can only emerge when caregivers are in difficulty in caring for their patient.This disorder is a real challenge for healthcare teams throughout the treatment, from its discovery to its treatment.Secrecy and self-inflicted injuries are components that we can be uncomfortable with as caregivers.The factitious problem requires well-coordinated care between the various specialists and often questions our practices.In this article we deal with the questions frequently asked by the care teams to the liaison psychiatrists that we are, by working on the identification of the problem in the clinic, the therapeutic issues and the attitude to adopt.