“When Will All of This End?”: A 65-Year-Old Man With Amyotrophic Lateral Sclerosis and Psychiatric Distress

May combine two claims.

A study found that ALS patients are more agreeable and less neurotic than controls.

“A study titled “Are People With ALS Particularly Nice?” showed that ALS patients are more agreeable and less neurotic than controls.4”

• cites [4] 4. P u b M e d C r o s s R e f 6. Tarbi EC, Meghani SH. A concept analysis of the existential experience of adults with advanced cancer. Nurs Outlook. 2019;67(5):540-557. sourceCould not verify

  The Results > Attributes section discusses existential experiences of adults with advanced cancer, not personality comparisons in ALS. Searches for “Are People With ALS Particularly Nice?” and for ALS patients being more agreeable and less neurotic than controls found no passage addressing the claim. The cited paper’s full-text copy therefore cannot verify it. (LLM, conf=0.78)

  Experimental — accuracy not yet measured

May combine two claims.

Michael completed 20 sessions and showed improvements in his mood.

“Michael completed 20 sessions and evinced improvements in his mood.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Trazodone 50 mg at bedtime produced sedating effects and was discontinued.

“I recommended a trial of trazodone 50 mg at bedtime.Unfortunately, trazodone produced similar sedating effects and was discontinued.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Michael's case contains many dialectics, including simultaneous present-moment concerns and awareness of mortality, wish to live and wish to hurry death, and hope and hopelessness.

“Michael's case is full of dialectics-many true, often painful things for which there is no one answer: his intense present-moment concerns about physical symptoms and caregiver and family relationships on the one hand, and looming awareness of his mortality on the other.The wish to live and the wish to hurry death along.Hope and hopelessness.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael had a lifetime history of major depressive disorder, recurrent moderate, beginning in late childhood.

“Michael had a lifetime history of major depressive disorder (MDD; recurrent, moderate), which began in late childhood.”

May combine two claims.

Michael died a little less than 2 years after the initial referral, after emergency room admission with new onset respiratory distress and resuscitation attempts.

“Michael died a little less than 2 years after the initial referral.Records indicated he was admitted to the emergency room with new onset respiratory distress, and after rapid worsening and 20 minutes of resuscitation attempts, he was pronounced dead.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael reported waking up 5-6 times each night without reason.

“He reported waking up 5-6 times each night without reason.”

May combine two claims.

At 6 months, Michael had some stability in overall mental health, with less anger and frustration but persistent sadness from his illness and diminishing relationship with his children.

“He had demonstrated some stability in his overall mental health, noting less anger and frustration overall, but still endorsed persistent sadness from his illness and diminishing relationship with his children.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Michael had no voluntary muscle control and used long-term ventilation with BiPAP 24/7 for breathing.

“He had no voluntary muscle control and used long-term ventilation (BiPAP 24/7) for breathing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Aripiprazole 2 mg at bedtime was discontinued due to sedation.

“I recommended switching olanzapine to aripiprazole 2 mg at bedtime, which could be less sedating; however, he discontinued this as well due to sedation.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Slow letter-by-letter communication reduced the content of psychotherapy visits, while emails gave the patient a freer voice.

“Slow letter-by-letter communication shrank the content of psychotherapy visits; emails gave him a freer voice.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Olanzapine benefited Michael's mood, but he could not tolerate it even after cutting the dose in half.

“Michael communicated that although his mood benefited from olanzapine, he was unable to tolerate it even after cutting the dose in half.”

May combine two claims.

Michael met DSM-5 criteria for major depressive disorder, recurrent moderate; generalized anxiety disorder with panic attacks; and adjustment disorder with anxious and depressed mood.

“He met DSM-5 criteria for MDD, recurrent moderate; generalized anxiety disorder with panic attacks; and adjustment disorder with anxious and depressed mood.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael could not communicate through his own speech and instead used eye-tracking software and text-to-speech technology.

“He could not communicate through his own speech and instead used eyetracking software and text-to-speech technology.”

May combine two claims.

Michael used DBT interpersonal effectiveness skills and shared thoughtful emails with his children, ultimately rebuilding the relationship.

“Michael used these skills and wrote out thoughtful emails prior to the next scheduled session with the clinician and shared these emails with his children with positive outcomes, ultimately rebuilding the relationship with his children.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Neuroleptics do not suppress respiration, but long-acting ones caused too much daytime sedation for this patient.

“Neuroleptics do not suppress respiration, but long-acting ones caused too much daytime sedation.”

May combine two claims.

Increasing venlafaxine to 37.5 mg twice daily produced significant improvement of Michael's affective symptoms with good tolerability.

“venlafaxine was increased to 37.5 mg twice a day with significant improvement of his affective symptoms and good tolerability.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Michael wanted to live but also wanted to know when his suffering would end; he was aggressive and sometimes controlling of others but longed for more connections with his family, friends, and caregivers.

“He wanted to live but also wanted to know when his suffering would end; he was aggressive and sometimes controlling of others but longed for more connections with his family, friends, and caregivers.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Michael used guilt induction, financial control, and passive aggression to keep people close.

“He used guilt induction, financial control, and passive aggression to keep people close.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael managed his own care, including hiring, managing, and paying his caregiver employees.

“Michael managed his own care (ie, hiring, managing, paying his caregiver employees).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael lacked a means to act on suicidal thoughts given his functional condition.

“he lacked a means to do so given his functional condition.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Michael had both passive and active suicidal ideation during treatment of his mood symptoms and thought about his death often, with no acts of furtherance.

“Michael had both passive and active suicidal ideation during treatment of his mood symptoms and thought about his death often, with no acts of furtherance.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael was completely dependent on caregivers for all activities of daily living.

“He was unable to control any parts of his body other than the eyes and was completely dependent on his caregivers for all activities of daily living.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Guidelines for ALS patient care recommend incorporating a palliative approach from the time of diagnosis.

“The guidelines for ALS patient care recommend incorporating a palliative approach from the time of diagnosis.”

• Also stated in: § Dr Yvan Beaussant · plain

  “The guidelines for ALS patient care recommend incorporating a palliative approach from the time of diagnosis.11”

• cites [11] 11. P u b M e d C r o s s R e f 13. Freud S. The Ego and the Id. In: Strachey J (trans. ed.). The Standard Edition of the Complete Psychological Works of Sigmund Freud. Vol. XIX. The Hogarth Press; 1923:26.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

The risk of respiratory suppression made benzodiazepines dangerous for this patient.

“The risk of respiratory suppression made benzodiazepines dangerous for this patient.”

Probably not a substantial claim: may not pass S2 (checkable).

Humans often struggle to reconcile opposing thoughts, feelings, needs, or points of view.

“This is a problem for us humans, however, because oftentimes we struggle to reconcile opposing thoughts, feelings, needs, or points of view.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Both reactive and organic depression can benefit from psychotherapy and antidepressants.

“both “reactive” and “organic” depression can benefit from both psychotherapy and antidepressants.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

In life, suffering often occurs in the denial of simultaneous and opposite truths.

“In life, suffering often occurs in the denial of simultaneous and opposite truths-that we can love and hate the same person, that we can think we do not need help but yearn for it at the same time, and that we can both want to die and want to live.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Catastrophic illness can be a catalyst for either growth or regression.

“Catastrophic illness can be a catalyst for either growth or regression.”

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Candid discussions about the desire for death can help patients feel less alone, make life-as-it-is feel more possible, and undermine the desire to die.

“Candid discussions about the desire for death can help patients feel less alone, make life-as-it-is feel more possible, and actually undermine the desire to die.”

Classified as probably not a substantial claim.

Facing the end of his life was at the heart of what Michael meant by wanting a space to talk.

“Of all the things he meant by this, facing the end of his life was at the heart of the matter.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Homebound ALS patients rarely see full daylight, so phototherapy can help both circadian dysregulation and mood.

“Homebound ALS patients rarely see full daylight, so phototherapy can help both circadian dysregulation and mood.”

Classified as probably not a substantial claim. May combine two claims.

Michael's concerns are both contemporary worries and proxies for grievances of a painful past.

“Michael's concerns are both contemporary worries and proxies for grievances of a painful past.”

May combine two claims.

Frontotemporal dementia can protect against depression, at least in late stages, because it causes prominent apathy and lack of empathy.

“FTD can protect against depression, at least in late stages, because it causes prominent apathy and lack of empathy.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

As functional capacity declines, decisions about life-sustaining measures such as non-invasive ventilation and G-tube feeding become increasingly complex.

“As his functional capacity declines, decisions regarding life-sustaining measures such as non-invasive ventilation and G-tube feeding become increasingly complex.”

Probably not a substantial claim: may not pass S2 (checkable).

Using more clinical perspectives, rather than fewer, can often improve the handling of clinical challenges.

“Cross Talk demonstrates that clinical challenges can often be improved upon by leveraging more, rather than fewer, clinical perspectives.”

Probably not a substantial claim: may not pass S4 (based).

Patients with progressive, terminal neurodegenerative diseases like ALS are at increased risk for emotional distress secondary to their illness.

“Patients with progressive, terminal neurodegenerative diseases like amyotrophic lateral sclerosis (ALS) are at increased risk for emotional distress secondary to their illness.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

By taking an integrated, multidisciplinary approach to ALS care and prioritizing mental health, we can begin to address additional challenges that patients with ALS face.

“By taking an integrated, multidisciplinary approach to ALS care, and by prioritizing mental health, we can begin to address the additional challenges that patients with ALS face as part of their illness experience.”

• AssumptionRests on an assumption: There are no guidelines for treating emotional and cognitive symptoms of ALS, and psychotropic drug choice is based on individual factors.
• AssumptionRests on an assumption: There are currently no empirically supported interventions or best practices for adjustment to ALS.
• AssumptionRests on an assumption: Complex psychosocial factors can pose additional burdens for ALS patients and produce more rapid and devastating health declines.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Many interventions for these patients are primarily biomedical, and comparatively less attention has been paid to interventions addressing co-occurring psychological and psychiatric impacts of the illness.

“Many interventions for these patients are primarily biomedical, and comparatively less attention has been paid to interventions addressing co-occurring psychological and psychiatric impacts of the illness.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

This case illustrates the importance of working together in a multidisciplinary effort to provide the highest quality care to patients most in need.

“This case illustrates the importance of working together in a multidisciplinary effort to provide the highest quality care (medical, psychological, social) to our patients most in need.”

Classified as probably not a substantial claim. May combine two claims.

When Michael said "It is too much to handle" and "When will all of this end?" he expressed desire for and fear of death.

“When Michael says, “It is too much to handle” and “When will all of this end?” he expresses his desire for/fear of death.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Binswanger considered that we do not just have a body; we are a body.

“Binswanger considered that we don't just have a body; we are a body.14”

• cites [14]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Freud states that the ego is first and foremost a bodily ego.

“Freud states that, “The ego is first and foremost a bodily ego.” 13”

• cites [13]Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

ALS physical symptoms guide treatment more than the cause of depression does.

“ALS physical symptoms guide treatment more than cause does.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

In psychodynamic theory, unconscious conflict leads to compromises that can cause suffering.

“In psychodynamic theory, unconscious conflict leads to compromises that can cause suffering.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

For Michael, isolated and alone inside an unmoving body, being seen and understood was almost certainly a lifeline.

“Isolated and alone inside an unmoving body, the experience of being seen and understood was almost certainly a lifeline.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Michael's self-absorption and need to control others may be an artifact of illness, psychological adaptation, or exacerbation of character style.

“This patient's self-absorption and need to control others may be an artifact of illness, psychological adaptation, or exacerbation of character style.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing). May combine two claims.

Physicality is integral to identity, so understanding Michael's previous relationship to his body could be useful.

“Physicality is integral to identity, so understanding Michael's previous relationship to his body could be useful.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

DBT points to validation as a core therapeutic tool for difficult, dialectical situations.

“DBT points to validation as a core therapeutic tool for difficult, dialectical situations.”

Probably not a substantial claim: may not pass S2 (checkable).

This case emphasizes the essential role of a multidisciplinary approach over and above any particular theoretical modality.

“the essential role of a multidisciplinary approach over and above any particular theoretical modality.”

May combine two claims.

In 2017, NIH research dollars per patient were $0.49 for dementia, $305 for Parkinson disease, and $2,053 for ALS.

“In 2017, NIH research dollars per patient were $0.49 for dementia, $305 for Parkinson disease, and $2,053 for ALS. 5”

• cites [5] 5. P u b M e d C r o s s R e f 7. Bolmsjö I. Existential issues in palliative care: interviews of patients with amyotrophic lateral sclerosis. J Palliat Med. 2001;4(4):499-505.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

DBT is rooted in dialectical philosophy, a basic tenet of which is that two or more opposing things can be true simultaneously.

“Underpinning the skills toolbox, DBT is rooted in dialectical philosophy, a basic tenet of which is that two (or more) opposing things can be true simultaneously.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Risk from assessments of Michael's suicidal ideation was deemed low.

“Risk from these assessments was deemed low.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Michael's evaluation was limited by the use of telemedicine and his reliance on a text-to-speech synthesizer.

“His evaluation was limited by the use of telemedicine and his reliance on a text-to-speech synthesizer.”