Approaching to Death: a Study About Dream Contents and Self-images in Hospice

This research is focused on a large sample of patients in a specialized ward for palliative therapies of 12 bed-places (hospice), aiming at the treatment of pain and psychological disorders in patients in terminal state of their disease (mainly cancer). The aim of the research is to find a rapport among antalgic (FANS (Farmaci Antiinfiammatori Non Steroidei)⎯NSAID (non-steroidal anti-inflammatory drugs)) and opiate therapies protocols, emotional and affective changes, structures and contents of dreams in both self-report and as recalled during a semi-structured interview. A total of 34 subjects, ranging from 32 to 84 years old, with a clear and awake consciousness state, all studied with multi-testing for pain scaling: Visual Analogic Scale; Verbal Numerical Scale; measure PQRST (provokes/alleviates, quality, irradiation, severity, time (continuous, discontinuous, nocturnal, and diurnal)), together with dream-content diary self-report at wake-up and clinical interview (averaging nearly 3/ss, up to a total of 97 interviews) by which patients recall various qualities of their dreaming experiences (affective tone, density, and speed of changes) and describe main dream contents (identities, characters, backgrounds, recurrent themes in the stories, realism vs. symbolism). There is little difference, in rapport with age, gender, and antalgic treatment with FANS-NSAID, as for the number of dream, but age and male gender are associated with an important average number increase when opiate treatment is begun or raised. Themes can be categorized within a twofold type: type A⎯mainly symbolic, or type B⎯mainly realistic and obsessive. There is a shift towards type B or mixed relating to age (elders) and opiate treatment increasing. The affective quality of dreams is less threatening, mainly in elders of male gender, in association with opiate treatment beginning and/or increase. As opiate does control the affective components of pain only, promoting both REM (rapid eye movements) phase sleeping and emotional detachment, results in dream contents and affective qualities are to be expected, but further research is needed as for differences associated with age and gender variables. Keywords: hospice, dream-contents, opiates, pain control, affective shifts