Mini-case: Psychiatry in Pediatric Palliative Care

January 14, 2015

This case of a 14-year-old female patient with end-stage cystic fibrosis illustrates the psychiatrist's critical role in ensuring quality end-of-life care.

This case is a fictional account and details have been changed to make identification of any one person impossible.Case VignetteSophia, a 14-year-old with end-stage cystic fibrosis, reported symptoms of depressed mood all of the time.Patient Reports/Symptoms“I’m dying!”: Anhedonia“I used to enjoy watching my little sister play with her friends, now I don’t”: Profound irritability, hopelessness, pervasive worrying, inability to make decisions“I can’t even tell my mom what I want for dinner”: Marked negative ruminationsDiagnosisA diagnosis of major depressive disorder was made. Prognosis at the time of the consultation was weeks to months.TreatmentA trial of methylphenidate, 5 mg every morning, was initiated. The dose was titrated over 2 days to 10 mg every morning and noon. The patient responded with complete remission of all symptoms of depression within 4 days. There were no notable adverse effects.OutcomeSophia was able to enjoy her younger sister’s birthday party a week before she passed away.Her mother related, “Thank you for giving me the Sophia she had always been. I will now remember her as the person she always was.”Discussion
• Pediatric palliative care is a new and rapidly expanding medical specialty
• Psychiatrists have a critical role to play to ensure the patient and family will have the quality end-of-life careRelated content:For more on this topic, please see "The Psychiatrist’s Role on the Pediatric Palliative Care Team," by Jeremy M. Hirst, MD, on which this case was based.