A New Understanding: The Science of Psilocybin (2015)

Introduction

A New Understanding explores the treatment of end-of-life anxiety in terminally ill cancer patients using psilocybin, a psychoactive compound found in some mushrooms, to facilitate deeply spiritual experiences.

Outline

The documentary explores the confluence of science and spirituality in the first psychedelic research studies since the 1970’s with terminally ill patients.

As a society we devote a great deal of attention to treating cancer, but very little to treating the human being who is dying of cancer. The recent resurgence of psychedelic research is once again revealing the power of compounds like psilocybin to profoundly alter our understanding of both life and death. Through the eyes of patients, their loved ones, therapists, and researchers, A New Understanding examines the use of psilocybin in a controlled setting to reduce psychospiritual anxiety, depression, and physical pain.

The treatment aims to help the patient understand that a ‘good’ death is possible, and to help the patient’s family deal well with the dying process. A New Understanding shows patients and their families coming to terms with dying through the skillful treatment of the whole human being. If we can learn to work more skillfully with dying, we will also learn to take better care of life.

Production & Filming Details

  • Director(s): Roslyn Dauber.
  • Producer(s): Robert J Barnhart, Roslyn Dauber, Brady Dial, Matt Humble, Steve McDonald, Jeff Porter, and Mitch Schultz.
  • Music: Brian Satterwhite.
  • Editor(s): Jason Uson.
  • Studio: Red Phoenix Productions.
  • Production: Golden Teacher Films.
  • Release Date: March 2015 (US).
  • Running Time: 55 minutes.
  • Country: US.
  • Langauge: English.

What is the Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans?

Research Paper Title

The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis.

Background

Post-traumatic stress disorder (PTSD) can be exacerbated by subsequent trauma, but it is unclear if symptoms are worsened by impending death

PTSD symptoms, including hyperarousal, negative mood and thoughts, and traumatic re-experiencing, can impact end-of-life symptoms, including pain, mood, and poor sleep.

Thus, increased symptoms may lead to increased end-of-life healthcare utilisation.

Therefore, the purpose of this study was to determine if veterans with PTSD have increased end-of-life healthcare utilisation or medication use and to examine predictors of medication administration.

Methods

Secondary analysis of a stepped-wedge design implementation trial to improve end-of-life care for Veterans Affairs (VA) inpatients. Outcome variables were collected via direct chart review. Analyses included hierarchical, generalized estimating equation models, clustered by medical center.

Veterans, inpatient at one of six VA facilities, dying between 2005 and 2011.

Emergency room (ER) visits, hospitalisations, and medication administration in the last 7 days of life.

Results

Of 5341 veterans, 468 (8.76%) had PTSD.

Of those, 21.4% (100/468) had major depression and 36.5% (171/468) had anxiety. Veterans with PTSD were younger (mean age 65.4 PTSD, 70.5 no PTSD, p < 0.0001) and had more VA hospitalisations and ER visits in the last 12 months of life (admissions: PTSD 2.8, no PTSD 2.4, p < 0.0001; ER visits: 3.2 vs 2.5, p < 0.0001).

PTSD was associated with antipsychotic administration (OR 1.52, 95% CI 1.06-2.18). Major depression (333/5341, 6.2%) was associated with opioid administration (OR 1.348, 95% CI 1.129-1.609) and benzodiazepines (OR 1.489, 95% CI 1.141-1.943).

Anxiety disorders (778/5341, 14.6%) were only associated with benzodiazepines (OR 1.598, 95% CI 1.194-2.138).

Conclusions

PTSD’s association with increased end-of-life healthcare utilisation and increased antipsychotic administration in the final days of life suggests increased symptom burden and potential for terminal delirium in individuals with PTSD.

Understanding the burden of psychiatric illness and potential risks for delirium may facilitate the end-of-life care for these patients.

Reference

Bickel, K.E., Kennedy, R., Levy, C., Burgio, K.L. & Bailey, F.A. (2019) The Relationship of Post-traumatic Stress Disorder to End-of-life Care Received by Dying Veterans: a Secondary Data Analysis. Journal of General Internal Medicine. doi: 10.1007/s11606-019-05538-x. [Epub ahead of print].