Psychiatric and Biochemical Correlates of Respiratory Decompensation in a Terminal and Non-Terminal Chronic Pulmonary Disease Patient

Abstract

A psychiatric and biochemical study was undertaken at the request of two patients who were thought to be terminally ill by the medical staff. One patient accepted dying and expired from her disease. The other patient wished to continue living and did not die. The dying patient exhibited abnormally high levels of catecholamine excretion which were not associated with verbal reports of anxiety or discomfort and did not seem upset or uncomfortable to the physician and nurses caring for her. The patient who lived had relatively low levels of catecholamine excretion and was anxious, irritable and uncomfortable. The behavior of these two patients differed during the period of acute respiratory failure. The dying patient had given up and felt that she was engaging in goal-directed activity which she would or could not shut off. The patient who lived was frightened of dying and felt that she would overcome her current difficulties and that she was not ready or willing to die. The major cardiovascular differences were those of a significantly lower blood pressure and higher heart rate in the patient who died.