Skip to main content
SpringerLink
Log in

Psychological Distress and Psychiatric Comorbidities in Palliative Care

  • Chapter
  • First Online:
Essentials of Palliative Care

  • 3364 Accesses

Abstract

Palliative care medicine has expanded awareness of, and the refinement of treatment efforts directed at, alleviating physical symptoms of patients with terminal conditions. Over the years, medical and psychological discourse on end-of-life care has increasingly drawn attention to many of the distinct psychosocial challenges that patients confront, emphasizing the importance of integrating the physical and psychological aspects of care essential to improving quality of life. Addressing the multiplicity of psychological issues faced by patients can be daunting, especially when considered in the context of the limited time available before death ensues. This chapter will highlight the psychological needs of the terminal patient. An emphasis will be placed on subsyndromal, but nonetheless distressing, psychological states, as well as the assessment and management of psychiatric disorders frequently encountered within the context of palliative care. Although much of the data come from studies of patients with terminal cancer, many of the principles outlined herein are likely to apply to a broad spectrum of patients requiring end-of-life care.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Worden JW. Grief counseling and grief therapy – a handbook for the mental health practitioner. 4th ed. New York: Springer; 2009.

    Google Scholar 

  2. Meares RA. On saying goodbye before death. JAMA. 1981;246(11):1227–9.

    Article  PubMed  CAS  Google Scholar 

  3. Periyakoil VS, Kraemer HC, Noda A, Moos R, Hallenbeck J, Webster M, Yesavage JA. The development and initial validation of the Terminally Ill Grief or Depression Scale (TIGDS). Int J Methods Psychiatr Res. 2005;14(4):202–12.

    Article  PubMed  Google Scholar 

  4. Larson DB, Swyers JP, McCullough ME. Scientific research on spirituality and health. Rockville, MD: National Institute for Healthcare Research; 1997.

    Google Scholar 

  5. Koenig HG, Cohen HJ, Blazer DG, Pieper C, Meador KG, Shelp F, Goli V, DiPasquale B. Religious coping and depression among elderly, hospitalized medically ill men. Am J Psychiatry. 1992;149:1693–700.

    PubMed  CAS  Google Scholar 

  6. Nelson CJ, Rosenfeld B, Breitbart W, Galietta M. Spirituality, religion, and depression in the terminally ill. Psychosomatics. 2002;43:213–20.

    Article  PubMed  Google Scholar 

  7. Breitbart W, Rosenfeld B, Pessin H, Kaim M, Funesti-Esch J, Galietta M, Nelson CJ, Brescia R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA. 2000;284:2907–11.

    Article  PubMed  CAS  Google Scholar 

  8. McClain CS, Rosenfeld B, Breitbart W. Effect of spiritual well-being on end-of-life despair in terminally-ill cancer patients. Lancet. 2003;361:1603–7.

    Article  PubMed  Google Scholar 

  9. Baider L, Russak SM, Perry S, Kash K, Gronert M, Fox B, Holland J, Kaplan-Denour A. The role of religious and spiritual beliefs in coping with malignant melanoma: an Israeli sample. Psychooncology. 1999;8(1):27–35.

    Article  PubMed  CAS  Google Scholar 

  10. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D. Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy-spiritual well-being scale (FACIT-Sp). Ann Behav Med. 2002;24(1):49–58.

    Article  PubMed  Google Scholar 

  11. Holland J. Psychosocial distress in the patient with cancer. Standards of care and treatment guidelines. Oncology. 2000;15(4 Suppl 2):19–24.

    Google Scholar 

  12. Block SD. Psychological issues in end-of-life care. J Palliat Med. 2006;9(3):751–72.

    Article  PubMed  Google Scholar 

  13. Greer S, Watson M. Mental adjustment to cancer: its measurement and prognostic importance. Cancer Surv. 1987;6(3):439–53.

    PubMed  CAS  Google Scholar 

  14. Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer; 1984.

    Google Scholar 

  15. Park CL, Folkman S. Meaning in the context of stress and coping. Rev Gen Psychol. 1997;1:115–44.

    Article  Google Scholar 

  16. Parkes CM. What becomes of redundant world models? A contribution to the study of adaptation to change. Br J Med Psychol. 1975;48:131–7.

    Article  PubMed  CAS  Google Scholar 

  17. Baider L, Ever-Hadani P, Goldzweig G, Wygoda MR, Peretz T. Is perceived family support a relevant variable in psychological distress? A sample of prostate and breast cancer couples. J Psychosom Res. 2003;55:453–60.

    Article  PubMed  Google Scholar 

  18. National Consensus Project for Quality Palliative Care Consortium. National consensus project for quality palliative care: clinical practice guidelines for quality palliative care, executive summary. J Palliat Med. 2004;7(5):611–27.

    Article  Google Scholar 

  19. Edwards A, Pang N, Shiu V, Chan C. The understanding of spirituality and the potential role of spiritual care in end-of-life and palliative care: a meta-study of qualitative research. Palliat Med. 2010;24(8):753–70.

    Article  PubMed  CAS  Google Scholar 

  20. Fallowfield L, Ratcliffe D, Jenkins V, Saul J. Psychiatric morbidity and its recognition by doctors in patients with cancer. Br J Cancer. 2001;84(8):1011–5.

    Article  PubMed  CAS  Google Scholar 

  21. McDonald MV, Passik SD, Dugan W, Rosenfeld B, Theobald DE, Edgerton S. Nurses’ recognition of depression in their patients with cancer. Oncol Nurs Forum. 1999;26(3):593–9.

    PubMed  CAS  Google Scholar 

  22. Passik SD, Dugan W, McDonald MV, Rosenfeld B, Theobald DE, Edgerton S. Oncologists’ recognition of depression in their patients with cancer. J Clin Oncol. 1998;16(4):1594–600.

    PubMed  CAS  Google Scholar 

  23. Maguire P, Pitceathly C. Improving the psychological care of cancer patients and their relatives – the role of specialist nurses. J Psychosom Res. 2003;55:469–74.

    Article  PubMed  Google Scholar 

  24. Leo RJ. Clinical manual of pain management in psychiatry. Washington, DC: American Psychiatric Press; 2007.

    Google Scholar 

  25. Ryan H, Schofield P, Cockburn J, Butow P, Tattersall M, Turner J, Girgis A, Bandaranayake D, Bowman D. How to recognize and manage psychological distress in cancer patients. Eur J Cancer Care. 2005;14:7–15.

    Article  CAS  Google Scholar 

  26. Kelly B, McClement S, Chochinov HM. Measurement of psychological distress in palliative care. Palliat Med. 2006;20:779–89.

    Article  PubMed  Google Scholar 

  27. Carlson LE, Bultz BD. Cancer distress screening – needs, models, and methods. J Psychosom Res. 2003;55:403–9.

    Article  PubMed  Google Scholar 

  28. Breitbart W, Bruera E, Chochinov H, Lynch M. Neuropsychiatric syndromes and psychological symptoms in patients with advanced cancer. J Pain Symptom Manage. 1995;10(2):131–41.

    Article  PubMed  CAS  Google Scholar 

  29. Minagawa H, Uchitomi Y, Yamawaki S, Ishitani K. Psychiatric morbidity in terminally ill cancer patients. A prospective study. Cancer. 1996;78(5):1131–7.

    Article  PubMed  CAS  Google Scholar 

  30. Kadan-Lottick NS, Vanderwerker LC, Block SD, Zhang B, Prigerson HG. Psychiatric disorders and mental health service use in patients with advanced cancer: a report from the coping with cancer study. Cancer. 2005;104(12):2872–81.

    Article  PubMed  Google Scholar 

  31. Leonard M, Agar M, Mason C, Lawlor P. Delirium issues in palliative care settings. J Psychosom Res. 2008;65:289–98.

    Article  PubMed  Google Scholar 

  32. Mitchell AJ, Chan M, Bhatti H, Halton M, Grassi L, Johansen C, Meader N. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 2011;12:160–74.

    Article  PubMed  Google Scholar 

  33. Stark DP, House A. Anxiety in cancer patients. Br J Cancer. 2000;83:1261–7.

    Article  PubMed  CAS  Google Scholar 

  34. van’t Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: a meta-analytical review of 58 studies after 1980. Psychosom Med. 1997;59:280–93.

    PubMed  Google Scholar 

  35. Stark D, Kiely M, Smith A, Velikova G, House A, Selby P. Anxiety disorders in cancer patients: their nature, associations and relation to quality of life. J Clin Oncol. 2002;20(14):3137–48.

    Article  PubMed  CAS  Google Scholar 

  36. Wasteson E, Brenne E, Higginson IJ, Hotopf M, Lloyd-Williams M, Kaasa S, Loge JH. Depression assessment and classification in palliative cancer patients: a systematic literature review. Palliat Med. 2009;23(8):739–53.

    Article  PubMed  Google Scholar 

  37. Hopwood P, Stephens RJ. Depression in patients with lung cancer: prevalence and risk factors derived from quality-of-life data. J Clin Oncol. 2000;18:893–903.

    PubMed  CAS  Google Scholar 

  38. Sellick SM, Crooks DL. Depression and cancer: an appraisal of the literature for prevalence, detection, and practice guideline development for psychological interventions. Psychooncology. 1999;8(4):315–33.

    Article  PubMed  CAS  Google Scholar 

  39. Akechi T, Okuyama T, Onishi J, Morita T, Furukawa TA. Psychotherapy for depression among incurable cancer patients (Review). Cochrane Database Syst Rev. 2010;(11):CD005537. doi:10.1002/14651858.

  40. Miller K, Massie MJ. Depression and anxiety. Cancer J. 2006;12:388–97.

    Article  PubMed  CAS  Google Scholar 

  41. Stiefel F, Fainsinger R, Bruera E. Acute confusional states in patients with advanced cancer. J Pain Symptom Manage. 1992;7:94–8.

    Article  PubMed  CAS  Google Scholar 

  42. Kutner JS. Applying the evidence base to terminal care. J Palliat Med. 2005;8(5):1040–1.

    Article  PubMed  Google Scholar 

  43. Plonk WM, Arnold RM. Terminal care: the last weeks of life. J Palliat Med. 2005;8(5):1042–54.

    Article  PubMed  Google Scholar 

  44. Akechi T, Okuyama T, Sugawara Y, Nakano T, Shima Y, Uchitomi Y. Major depression, adjustment disorders, and post-traumatic stress disorder in terminally ill cancer patients: associated and predictive factors. J Clin Oncol. 2004;22(10):1957–65.

    Article  PubMed  Google Scholar 

  45. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. Text revision.

    Google Scholar 

  46. Cassel EJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;306(11):639–45.

    Article  PubMed  CAS  Google Scholar 

  47. Cherny NI, Coyle N, Foley KM. Suffering in the advanced cancer patient: a definition and taxonomy. J Palliat Care. 1994;10:57–70.

    PubMed  CAS  Google Scholar 

  48. Ridner SH. Psychological distress: concept analysis. J Adv Nurs. 2004;45(5):536–45.

    Article  PubMed  Google Scholar 

  49. Kearny M, Mount B. Spiritual care of the dying patient. In: Chochinov HM, Breitbart W, editors. Handbook of psychiatry in palliative medicine. New York: Oxford University Press; 2000. p. 357–73.

    Google Scholar 

  50. Kissane DW, Clarke DM, Street AF. Demoralization syndrome: a relevant psychiatric diagnosis for palliative care. J Palliat Care. 2001;17:12–21.

    PubMed  CAS  Google Scholar 

  51. Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM. The demoralization scale: a report of its development and preliminary validation. J Palliat Care. 2004;20(4):269–76.

    PubMed  Google Scholar 

  52. Clarke DM, Kissane DW, Trauer T, Smith GC. Demoralization, anhedonia and grief in patients with severe physical illness. World Psychiatry. 2005;4(2):96–105.

    PubMed  Google Scholar 

  53. Cavanaugh S, Clark DC, Gibbons RD. Diagnosing depression in the hospitalized medically ill. Psychosomatics. 1983;24:809–15.

    Article  PubMed  CAS  Google Scholar 

  54. Craven JL, Rodin GM, Johnson L, Kennedy SH. The diagnosis of major depression in renal dialysis patients. Psychosom Med. 1987;49(5):482–92.

    PubMed  CAS  Google Scholar 

  55. Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Predictors of depressive symptomatology of geriatric patients with lung cancer – a longitudinal analysis. Psychooncology. 2002;11:12–22.

    Article  PubMed  CAS  Google Scholar 

  56. Breitbart W, Rosenfeld BD, Passik SD. Interest in physician-assisted suicide among ambulatory HIV-infected patients. Am J Psychiatry. 1996;153(2):238–42.

    PubMed  CAS  Google Scholar 

  57. Chochinov HM, Wilson KG, Enns M, Lander S. Depression, hopelessness, and suicidal ideation in the terminally ill. Psychosomatics. 1998;39:366–70.

    Article  PubMed  CAS  Google Scholar 

  58. Onitilo AA, Nietert PJ, Egede LE. Effect of depression on all-cause mortality in adults with cancer and differential effects by cancer site. Gen Hosp Psychiatry. 2006;28:396–402.

    Article  PubMed  Google Scholar 

  59. Pinquart M, Duberstein PR. Depression and cancer mortality: a meta-analysis. Psychol Med. 2010;40:1797–810.

    Article  PubMed  CAS  Google Scholar 

  60. Satin JR, Linden W, Phillips MJ. Depression as a predictor of disease progression and mortality in cancer patients – a meta-analysis. Cancer. 2009;115:5349–61.

    Article  PubMed  CAS  Google Scholar 

  61. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM. Influence of psychological response on survival in breast cancer: a population-based cohort study. Lancet. 1999;354:1331–6.

    Article  PubMed  CAS  Google Scholar 

  62. Chochinov HM, Wilson KG, Enns M, Mowchun N, Lander S, Levitt M, Clinch JJ. Desire for death in the terminally ill. Am J Psychiatry. 1995;152(8):1185–91.

    PubMed  CAS  Google Scholar 

  63. Chochinov HM, Tataryn D, Clinch JJ, Dudgeon D. Will to live in the terminally ill. Lancet. 1999;354:816–9.

    PubMed  CAS  Google Scholar 

  64. Jones JM, Huggins MA, Rydall AC, Rodin GM. Symptomatic distress, hopelessness, and the desire for hastened death in hospitalized cancer patients. J Psychosom Res. 2003;55:411–8.

    Article  PubMed  Google Scholar 

  65. Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. Pain and desire for hastened death in terminally ill cancer patients. Cancer Nurs. 2005;28(4):318–24.

    Article  PubMed  Google Scholar 

  66. Mystakidou K, Parpa E, Katsouda E, Galanos A, Vlahos L. The role of physical and psychological symptoms in desire for death: a study of terminally ill cancer patients. Psychooncology. 2006;15:355–60.

    Article  PubMed  Google Scholar 

  67. Brown JH, Henteleff P, Barakat S, Rowe CJ. Is it normal for terminally ill patients to desire death? Am J Psychiatry. 1986;143:208–11.

    PubMed  CAS  Google Scholar 

  68. Breitbart W. Suicide in cancer patients. Oncology. 1987;1:49–55.

    PubMed  CAS  Google Scholar 

  69. Breitbart W. Identifying patients at risk for, and treatment of major psychiatric complications of cancer. Support Care Cancer. 1995;3(1):45–60.

    Article  PubMed  CAS  Google Scholar 

  70. Bolund C. Suicide and cancer: II. Medical and care factors in suicides by cancer patients in Sweden, 1973–1976. J Psychosoc Oncol. 1985;3(1):31–52.

    Article  Google Scholar 

  71. Filiberti A, Ripamonti C, Totis A, Ventafridda V, De Conno F, Contiero P, Tamburini M. Characteristics of terminal cancer patients who committed suicide during a home palliative care program. J Pain Symptom Manage. 2001;22(1):544–53.

    Article  PubMed  CAS  Google Scholar 

  72. Beck AT, Steer RA, Kovacs M, Garrison B. Hopelessness and eventual suicide: a ten-year prospective study of patients hospitalized with suicidal ideation. Am J Psychiatry. 1985;142:559–63.

    PubMed  CAS  Google Scholar 

  73. Cooper-Patrick L, Crum RM, Ford DE. Identifying suicidal ideation in general medical patients. JAMA. 1994;272:1757–62.

    Article  PubMed  CAS  Google Scholar 

  74. Radloff LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;3:385–401.

    Article  Google Scholar 

  75. Zigmond AS, Snaith RP. The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand. 1983;67:361–70.

    Article  PubMed  CAS  Google Scholar 

  76. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation; 1996.

    Google Scholar 

  77. Hotopf M, Chidgey J, Addington-Hall J, Ly KL. Depression in advanced disease: a systematic review Part 1. Prevalence and case finding. Palliat Med. 2002;16:81–97.

    Article  PubMed  CAS  Google Scholar 

  78. Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;126(3):335–48.

    Article  PubMed  Google Scholar 

  79. Lloyd-Williams M, Friedman T, Rudd N. An analysis of the validity of the Hospital Anxiety and Depression Scale as a screening tool in patients with advanced metastatic cancer. J Pain Symptom Manage. 2001;22:990–6.

    Article  PubMed  CAS  Google Scholar 

  80. Chochinov HM, Wilson KG, Enns M, Lander S. “Are you depressed?” Screening for depression in the terminally ill. Am J Psychiatry. 1997;154:674–6.

    PubMed  CAS  Google Scholar 

  81. Lloyd-Williams M, Spiller J, Ward J. Which depression screening tools should be used in palliative care? Palliat Med. 2003;17:40–3.

    Article  PubMed  Google Scholar 

  82. Rayner L, Price A, Hotopf M, Higginson IJ. The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer. 2011;47:702–12.

    Article  PubMed  Google Scholar 

  83. Massie MJ, Popkin MK. Depressive disorders. In: Holland JC, Rowland JH, editors. Psycho-oncology. New York: Oxford University Press; 1998. p. 518–40.

    Google Scholar 

  84. Rayner L, Price A, Evans A, Valsraj K, Hotopf M, Higginson IJ. Antidepressants for the treatment of depression in palliative care: systematic review and meta-analysis. Palliat Med. 2011;25(1):36–51.

    Article  PubMed  Google Scholar 

  85. Ly KL, Chidgey J, Addington-Hall J, Hotopf M. Depression in palliative care: a systematic review. Part 2. Treatment. Palliat Med. 2002;16:279–84.

    Article  PubMed  Google Scholar 

  86. Orr K, Taylor D. Psychostimulants in the treatment of depression. CNS Drugs. 2007;21(3):239–57.

    Article  PubMed  CAS  Google Scholar 

  87. Bruera E, Chadwick S, Brenneis C, Hanson J, MacDonald RN. Methylphenidate associated with narcotics for the treatment of cancer pain. Cancer Treat Rep. 1987;71(1):67–70.

    PubMed  CAS  Google Scholar 

  88. Reissig JE, Rybarczyk AM. Pharmacologic treatment of opioid-induced sedation in chronic pain. Ann Pharmacother. 2005;39(4):727–31.

    Article  PubMed  CAS  Google Scholar 

  89. Candy B, Jones L, Williams R, Tookman A, King M. Psychostimulants for depression. Cochrane Database Syst Rev. 2008;(2):CD006722.

    Google Scholar 

  90. Massie MJ, Holland JC, Straker N. Psychotherapeutic interventions. In: Holland JC, Rowland JH, editors. Handbook of psycho-oncology: psychological care of the patient with cancer. New York: Oxford University Press; 1989. p. 455–69.

    Google Scholar 

  91. Breitbart W, Jacobsen PB. Psychiatric symptom management in terminal care. Clin Geriatr Med. 1996;12:329–47.

    PubMed  CAS  Google Scholar 

  92. Noyes R, Holt CS, Massie MJ. Anxiety disorders. In: Holland JC, editor. Psycho-oncology. New York: Oxford University Press; 1998. p. 548–63.

    Google Scholar 

  93. Roth AJ, Breitbart W. Psychiatric emergencies in terminally ill cancer patients. Hematol Oncol Clin North Am. 1996;10(1):235–59.

    Article  PubMed  CAS  Google Scholar 

  94. Spencer R, Nilsson M, Wright A, Pirl W, Prigerson H. Anxiety disorders in advanced cancer patients correlates and predictors of end-of-life outcomes. Cancer. 2010;116:1810–9.

    Article  PubMed  Google Scholar 

  95. Wilson KG, Chochinov HM, Skirko MG, Allard P, Chary S, Gagnon PR, Macmillan K, De Luca M, O’Shea F, Kuhl D, Fainsinger RL, Clinch JJ. Depression and anxiety disorders in palliative cancer care. J Pain Symptom Manage. 2007;33(2):118–29.

    Article  PubMed  Google Scholar 

  96. Skarstein J, Aass N, Fossa SD, Skovlund E, Dahl AA. Anxiety and depression in cancer patients: relation between the Hospital Anxiety and Depression Scale and the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. J Psychosom Res. 2000;49:27–34.

    Article  PubMed  CAS  Google Scholar 

  97. Speilberger CD. Manual for the State-Trait Anxiety Inventory: STAI (Form Y). Palo Alto, CA: Consulting Psychologists Press; 1983.

    Google Scholar 

  98. Henderson M, MacGregor E, Sykes N, Hotopf M. The use of benzodiazepines in palliative care. Palliat Med. 2006;20:407–12.

    Article  PubMed  CAS  Google Scholar 

  99. Roth AJ, Massie MJ. Anxiety and its management in advanced cancer. Curr Opin Support Palliat Care. 2007;1:50–6.

    Article  PubMed  Google Scholar 

  100. Portenoy RK, Foley KM. Management of cancer pain. In: Holland JC, Rowland JH, editors. Handbook of psychooncology: psychological care of the patient with cancer. New York: Oxford University Press; 1989. p. 369–82.

    Google Scholar 

  101. Lawlor PG, Gagnon B, Mancini IL, Pereira JL, Hanson J, Suarez-Almazor ME, Bruera ED. Occurrence, causes, and outcome of delirium in patients with advanced cancer – a prospective study. Arch Intern Med. 2000;160:786–94.

    Article  PubMed  CAS  Google Scholar 

  102. Ostgathe C, Gaertner J, Voltz R. Cognitive failure in end of life. Curr Opin Support Palliat Care. 2008;2:187–91.

    Article  PubMed  Google Scholar 

  103. Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: the confusion assessment method. Ann Intern Med. 1990;113:941–8.

    PubMed  CAS  Google Scholar 

  104. Breitbart W, Rosenfeld B, Roth A, Smith MJ, Cohen K, Passik S. The memorial delirium assessment scale. J Pain Symptom Manage. 1997;13:128–37.

    Article  PubMed  CAS  Google Scholar 

  105. Ryan K, Leonard M, Guerin S, Donnelly S, Conroy M, Meagher D. Validation of the confusion assessment method in the palliative care setting. Palliat Med. 2009;23:40–5.

    Article  PubMed  CAS  Google Scholar 

  106. Rolfson DB, McElhaney JE, Jhangri GS, Rockwood K. Validity of the confusion assessment method in detecting post-operative delirium in the elderly. Int Psychogeriatr. 1999;11(4):431–8.

    Article  PubMed  CAS  Google Scholar 

  107. Wei LA, Fearing MA, Sternberg EJ, Inouye SK. The confusion assessment method (CAM): a systematic review of current usage. J Am Geriatr Soc. 2008;56(5):823–30.

    Article  PubMed  Google Scholar 

  108. Lawlor PG, Nekolaichuk C, Gagnon B, Mancini IL, Pereira JL, Bruera ED. Clinical utility, factor analysis, and further validation of the memorial delirium assessment scale in patients with advanced cancer: assessing delirium in advanced cancer. Cancer. 2000;88:2859–67.

    Article  PubMed  CAS  Google Scholar 

  109. Centeno C, Sanz A, Bruera E. Delirium in advanced cancer patients. Palliat Med. 2004;18:184–94.

    Article  PubMed  Google Scholar 

  110. Jackson KC, Lipman AG. Delirium in palliative care patients. J Pharm Care Pain Symptom Control. 1999;7(4):59–70.

    Article  Google Scholar 

  111. Bruera E, Miller J, McCallion J, Macmillan K, Krefting L, Hanson J. Cognitive failure in patients with terminal cancer: a prospective study. J Pain Symptom Manage. 1992;7(4):192–5.

    Article  PubMed  CAS  Google Scholar 

  112. Casarett DJ, Inouye SK. Diagnosis and management of delirium near the end of life. Ann Intern Med. 2001;135:32–40.

    PubMed  CAS  Google Scholar 

  113. Morita T, Tei Y, Tsunoda J, Inoue S, Chihara S. Underlying pathologies and their associations with clinical features in terminal delirium of cancer patients. J Pain Symptom Manage. 2001;22(6):997–1006.

    Article  PubMed  CAS  Google Scholar 

  114. Gagnon PR. Treatment of delirium in supportive and palliative care. Curr Opin Support Palliat Care. 2008;2:60–6.

    Article  PubMed  Google Scholar 

  115. Breitbart W, Tremblay A, Gibson C. An open trial of olanzapine for the treatment of delirium in hospitalized cancer patients. Psychosomatics. 2002;43:175–82.

    Article  PubMed  CAS  Google Scholar 

  116. Jackson KC, Lipman AG. Drug therapy for delirium in terminally ill adult patients (Review). Cochrane Database Syst Rev. 2009;(4):CD004770.

    Google Scholar 

  117. Lonergan E, Britton AM, Luxenberg J, Wyller T. Antipsychotics for delirium. Cochrane Database of Systematic Reviews. (2):CD005594, 2007.

    Google Scholar 

  118. Bottomley DM, Hanks GW. Subcutaneous midazolam infusion in palliative care. J Pain Symptom Manage. 1990;5(4):259–61.

    Article  PubMed  CAS  Google Scholar 

  119. Fainsinger R, Miller MJ, Bruera E, Hanson J, Maceachern T. Symptom control during the last week of life on a palliative care unit. J Palliat Care. 1991;7(1):5–11.

    Google Scholar 

  120. Mercadante S, De Conno F, Ripamonti C. Propofol in terminal care. J Pain Symptom Manage. 1995;10:639–42.

    Article  PubMed  CAS  Google Scholar 

  121. Bruera E, Bush SH, Willey J, Paraskevopoulos T, Li Z, Palmer JL, Cohen MZ, Sivesind D, Elsayem A. Impact of delirium and recall on the level of distress in patients with advanced cancer and their family caregivers. Cancer. 2009;115(9):2004–12.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, School of Medicine and Biomedical Sciences, State University of New York, Buffalo, NY, USA

    Raphael J. Leo M.A., M.D. & Maria Theresa Mariano M.D.

Authors
  1. Raphael J. Leo M.A., M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Theresa Mariano M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Raphael J. Leo M.A., M.D. .

Editor information

Editors and Affiliations

  1. Department of Anesthesiology, Yale University, New Haven, 06520, Connecticut, USA

    Nalini Vadivelu

  2. Citrus Road 278, River Ridge, 70123, Louisiana, USA

    Alan David Kaye

  3. Keck School of Medicine, Department of Anesthesiology, Pain Medic, of the University of Southern California, Los Angeles, 90035, California, USA

    Jack M. Berger

Appendices

Review Questions

  1. 1.

    Which of the following is the most common psychiatric disorder encountered in palliative care settings?

    1. (a)

      Adjustment disorder

    2. (b)

      Depression

    3. (c)

      Anxiety disorder

    4. (d)

      Delirium

  2. 2.

    What is the primary treatment for adjustment disorders in the palliative care setting?

    1. (a)

      Anxiolytics

    2. (b)

      Sedatives

    3. (c)

      Psychotherapy

    4. (d)

      Hypnotics

  3. 3.

    Psychostimulants may be a reasonable consideration for the treatment of a terminal cancer patient who is experiencing which of the following?

    1. (a)

      Generalized worry and apprehension, with episodic dyspnea and perceived palpitations

    2. (b)

      Depressive symptoms and incapacitating opioid-induced sedation

    3. (c)

      Depressive symptoms including insomnia, anorexia, and irritability

    4. (d)

      Alcohol withdrawal

  4. 4.

    Which of the following is the best assessment for diagnosis of an anxiety disorder in palliative care settings?

    1. (a)

      Clinical interview based on DSM criteria

    2. (b)

      Hospital Anxiety and Depression Scale

    3. (c)

      State Trait Anxiety Scale

    4. (d)

      Distress Thermometer

  5. 5.

    Each of the following factors is likely to bode favorably in terms of adapting to the challenges faced at the end-of-life except:

    1. (a)

      Having a spiritual framework

    2. (b)

      The perception that one has an accessible social support network

    3. (c)

      Believing that one’s illness and clinical course is uncontrollable and unpredictable

    4. (d)

      The perception that one has a repertoire of skills with which to manage stressors

Answers

  1. 1.

    Answer: (d). As high as 80% of terminally ill patients can experience delirium, especially in the weeks before death. Depression and adjustment disorders have a prevalence range of 13–22%, and 10–22%, respectively. Anxiety disorder is the fourth most common psychiatric comorbidity ranging from 7 to 13%.

  2. 2.

    Answer: (c). Psychotherapy is the primary treatment for adjustment disorders. Anxiolytics, sedatives-hypnotics can be used as an adjunct for patients who experience incapacitating symptoms that can impede their ability to participate in psychotherapy.

  3. 3.

    Answer: (b). Although there is insufficient evidence to recommend the use of psychostimulants in palliative care settings, these agents have been advocated for the rapid improvement of depressive symptoms. In addition, psychostimulants offer the potential benefit of reducing incapacitating opioid-induced sedation. The potential adverse effects, e.g., insomnia, anorexia, and heightened anxiety, would preclude their use in patients experiencing many of these symptoms. Psychostimulants would not be indicated for the treatment of alcohol withdrawal.

  4. 4.

    Answer: (a). The Hospital Anxiety and Depression Scale, State Trait Anxiety Scale, and Distress Thermometer are screening instruments. However, a clinical interview based on DSM criteria is the gold standard in diagnosing anxiety disorders in the palliative care setting.

  5. 5.

    Answer: (c). Terminal patients can successfully navigate the adaptational challenges posed in the advanced phases of illness. Among the factors listed here, inflexible and maladaptive beliefs, i.e., perceiving that one’s illness is uncontrollable and unpredictable, may bode poorly with regard to managing psychological distress.

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Leo, R.J., Mariano, M.T. (2013). Psychological Distress and Psychiatric Comorbidities in Palliative Care. In: Vadivelu, N., Kaye, A., Berger, J. (eds) Essentials of Palliative Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-5164-8_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-5164-8_3

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-5163-1

  • Online ISBN: 978-1-4614-5164-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation