5E: Hunting for Help: Can Psychosis be Terminal and is Palliative Sedation an Option?

Caroline White, MSW, LICSW; Samuel Maiser, MD; Callie Schnitker, MD

We will discuss treatment refractory psychosis (TRP) by presenting a case of TRP treated with palliative sedation (PS) in a patient with Huntington’s disease. We will review TRP in a variety of medical conditions as well as the ethical principles to consider when using PS in otherwise non-hospice eligible patients.

By the end of the session, learners will be able to:

• Identify medical conditions and clinical circumstances that can result in psychosis near the end of life and describe the essential characteristics and management strategies for treatment-refractory psychosis
• Apply the ethical principles surrounding the use of palliative sedation for refractory psychosis in patients with terminal conditions and identify difficulties related to palliative sedation for treatment-refractory psychosis in otherwise non-hospice eligible patients
• Describe the psycho-social-spiritual needs of patients/families, medical teams, and support staff when using palliative sedation for refractory psychosis