Demoralization in Context: Leveraging Innovative Interdisciplinary Approaches to Manage Demoralization Across the Medical System (Sponsored by the Psychological Considerations SIG)

Virtual

Lead Speaker(s)

Katiuska J. Ramirez, MD (she/her/hers)

Associate Director, Psychiatric Consultation-Liaison Service
Beth Israel Deaconess Medical Center
Boston, Massachusetts

Speaker(s)

Damien M. Miran, MD

Clinical Director, Inpatient Psychiatry Consult Service
Dana-Farber Cancer Institute
Boston, Massachusetts

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JOHN M. DE FIGUEIREDO, MD, ScD

Clinical Professor of Psychiatry
Yale Univrsity School of Medicine
CHESHIRE, Connecticut
Can M. Kilciksiz, MD (he/him/his)

Clinical Assistant Professor
New York University School of Medicine
New York, New York

Abstract:

Background:

Demoralization impacts a substantial number of patients, cutting across diagnostic frameworks, clinical settings, and care models^1-3. Its pernicious nature impacts patient quality of life and contributes to caregiver and provider burnout^1-3. C-L psychiatrists are well-poised to contribute significantly to the management of demoralization in patients with serious medical illnesses. As patients continue to live longer with these illnesses, the prevalence of demoralization will likely continue to rise, placing higher demands on providers to consider demoralization in a whole-health approach to patient wellbeing. Demoralization remains a topic of significant interest for attendees of the ACLP annual meeting given its position at the intersection of mental health, physical health, spiritual wellbeing, and overall health.

Approach:

In this interactive general session, our content experts, representing four different institutions and varying levels of training and experience, will review the latest literature in demoralization and discuss the presentation and management of demoralization in various clinical settings. A specific focus on the approach to care for underserved populations will be incorporated throughout the session with case examples specifically selected to best represent the diversity of patients who experience demoralization and whom C-L psychiatrists can expect to evaluate.

By attending this general session, audience members will gain an understanding of current demoralization literature, how demoralization manifests in various clinical settings, and how to recruit other clinicians to develop innovative approaches to overall patient well-being.

Format:

Following the introduction of presenters, Dr. Ramirez will conduct a brief audience poll soliciting audience topics of interest. Dr. de Figueiredo will then review the conceptualization of demoralization in patients with significant medical illnesses.

In the second part of the session:

Dr. Kilciksiz will discuss a patient with a history of chronic medical illness presenting to the ED reporting death wishes and hopelessness. This case will explore safety evaluations in medically complex patients.

Dr. Ramirez will present a medically admitted primarily Spanish-speaking Latina patient with a prolonged hospital course. Cultural considerations that may contribute to demoralization will be discussed.

Dr. Miran will present a young adult presenting to clinic after cancer recurrence. This case will highlight an interdisciplinary approach including how other care team members can assist in managing demoralization including spiritual care services, psychologists, and social workers.

Finally, Dr. Ramirez will review high-yield points and moderate an interactive Q&A session followed by a brief audience reflective writing exercise.

The session will make use of interactive technology to encourage audience engagement and foster conversations. Audience members will be asked to participate in online polling, and large-group discussions will be employed at key points in the session.

References:

1. Tecuta, L., Tomba, E., Grandi, S., & Fava, G. A. (2015). Demoralization: a systematic review on its clinical characterization. Psychological medicine, 45(4), 673–691. https://doi.org/10.1017/S0033291714001597

2. de Figueiredo, J. M. (2013). Distress, demoralization and psychopathology: Diagnostic boundaries. European Journal of Psychiatry, 27(1), 61–73. https://doi.org/10.4321/S0213-61632013000100008

3. Kilciksiz, C. M., Julnes, P. S. S., & Owoso, A. (2023). Demoralization and co-morbid PTSD: A case report and literature review. Psychiatry Research Case Reports, 2(1), 100125. https://doi.org/10.1016/j.psycr.2023.100125

Content Contributors:

Diversity, Equity, and Inclusion: This session will be led by Dr. Ramirez, a first-generation Latina early-career C-L psychiatrist. Our speaker panel reflects different nationalities, genders, age-groups, and levels of training including one trainee (Dr. Kilciksiz), two early-career C-L psychiatrists (Drs. Ramirez and Miran), and a senior academic psychiatrist (Dr. de Figueiredo), who is an internationally known expert in cultural psychiatry and psychiatric epidemiology. Demoralization is a widespread clinical phenomenon associated with lower socioeconomic status. The appropriate diagnosis and treatment of demoralization may improve access to care and optimize treatment of medically ill underserved populations.
Learning Objectives:
Develop an approach to the differential diagnosis and management of patients experiencing existential distress in the setting of medical illness.
Differentiate demoralization from primary psychiatric conditions in patients with medical illnesses.
Predict potential psychosocial risk factors for demoralization across various clinical settings.