Advertisement

Psychological Symptoms

  • Gregory B. CrawfordEmail author
Reference work entry

Abstract

Psychological symptoms are highly prevalent in people requiring palliative care. They are much more challenging to elicit, and more controversy exists about what is normal and what might require intervention than physical symptoms. There are significant issues in determining what is normal and what is not. Sadness, distress, anxiety, and depression can coexist and require careful assessment.

Management of psychological symptoms and conditions can broadly be considered in terms of non-pharmacological and pharmacological therapies, “the talking and the drug therapies.” These are not mutually exclusive, and for people with limited energy, failing cognition, and limited time, some pragmatic decisions may be necessary. To be distressed and immobilized by emotion is not normal. Depression is not a normal part of dying. There should be discussion about the nature of psychological issues and conditions, explanation of common somatic symptoms, and a plan for intervention and support.

The burden on the carer, both professional and personal, in such situations should not be underestimated.

References

  1. Akizuki N, Akechi T, Nakanishi T, Yoshikawa E, Okamura M, Nakano T, Murakami Y, Uchitomi Y. Development of a brief screening interview for adjustment disorders and major depression in patients with cancer. Am Cancer Soc. 2003;97:2605–13.Google Scholar
  2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). 5th ed. Washington, DC: American Psychiatric Association; 2013.CrossRefGoogle Scholar
  3. Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. Br Med J. 2003;327:1144–6.CrossRefGoogle Scholar
  4. Barraclough JE. Psycho-oncology and the role of the psychiatrist in cancer patient care. Int J Psychiatry Clin Pract. 1997;1:189–95.PubMedCrossRefPubMedCentralGoogle Scholar
  5. Barraclough J. Cancer and emotion: a practical guide to psycho-oncology. Chichester: Wiley; 1999.Google Scholar
  6. Beck AT, Beck RW. Screening depressed patients in family practice. A rapid technic. Postgrad Med. 1972;52(6):81–5.PubMedCrossRefPubMedCentralGoogle Scholar
  7. Blazer DG, Kessler RC, McGonagle KA, Swartz MS. The prevalence and distribution of major depression in a national community sample: the National Comorbidity Survey. Am J Psychiatr. 1994;151:979–86.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Block SD. Assessing and managing depression in the terminally ill patient. Ann Intern Med. 2000;132:209–18.PubMedCrossRefPubMedCentralGoogle Scholar
  9. Breitbart W, Bruera E, Chochinov H, Lynch M. Neuropsychiatric syndromes and psychological symptoms with advanced cancer. J Pain Symptom Manag. 1995;10:131–41.CrossRefGoogle Scholar
  10. Bukberg J, Penman D, Holland JC. Depression in hospitalised cancer patients. Psychosom Med. 1984;46:199–212.PubMedCrossRefPubMedCentralGoogle Scholar
  11. Butow P, Price MA, Shaw JM, Turner J, Clayton JM, Grimison P, Rankin N, Kirsten L. Clinical pathway for the screening, assessment and management of anxiety and depression in adult cancer patients: Australian guidelines. Psychooncology. 2015;24(9):987–1001.PubMedCrossRefPubMedCentralGoogle Scholar
  12. Cambridge University Press. Cambridge dictionary: English dictionary. Cambridge: Cambridge University Press; 2018.Google Scholar
  13. CareSearch. Anxiety. 2017. Retrieved 25 Mar 2018, from https://www.caresearch.com.au/caresearch/tabid/225/Default.aspx.
  14. Cassidy S. Sharing the darkness. The spirituality of caring. New York: Maryknoll, Orbis Books; 1991.Google Scholar
  15. Chochinov HM. Dignity-conserving care – a new model for palliative care: helping the patient feel valued. J Am Med Assoc. 2002;287(17):2253–60.CrossRefGoogle Scholar
  16. Chochinov HM, Wilson KG, Enns M, Lander S. Prevalence of depression in the terminally ill: effects of diagnostic criteria and symptom threshold judgments. Am J Psychiatr. 1994;151:537–40.PubMedCrossRefPubMedCentralGoogle Scholar
  17. Chochinov HM, Wilson KG, Enns M, Lander S. Are you depressed? Screening for depression in the terminally ill. Am J Psychiatr. 1997;154:674–6.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Clayton JM, Hancock KM, Butow PN, Tattersall MH, Currow DC, Adler J, Aranda S, Auret K, Boyle F, Britton A, Chye R, Clark K, Davidson P, Davis JM, Girgis A, Graham S, Hardy J, Introna K, Kearsley J, Kerridge I, Kristjanson L, Martin P, McBride A, Meller A, Mitchell G, Moore A, Noble B, Olver I, Parker S, Peters M, Saul P, Stewart C, Swinburne L, Tobin B, Tuckwell K, Yates P. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers. Med J Aust. 2007;186(12 Suppl):S77, s79, s83–108PubMedPubMedCentralGoogle Scholar
  19. Cohen-Cole SA, Stoudemire A. Major depression and physical illness. Special considerations in diagnosis and biologic treatment. Psychiatr Clin N Am. 1987;10:1–17.CrossRefGoogle Scholar
  20. Coull G, Morris PG. The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: a systematic review. Psychol Med. 2011;41(11):2239–52.PubMedCrossRefPubMedCentralGoogle Scholar
  21. Crawford GB, Robinson JA. The geriatric depression scale in palliative care. Palliat Support Care. 2008;6(3):213–23.PubMedCrossRefPubMedCentralGoogle Scholar
  22. Dein S. The management of psychological distress in terminal illness. Prim Care Psychiatry. 2000;6:123–6.CrossRefGoogle Scholar
  23. Demmer C. A survey of complementary therapy services provided by hospices. J Palliat Med. 2004;7:510–6.PubMedCrossRefPubMedCentralGoogle Scholar
  24. Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CLM. The prevalence of psychiatric disorders among cancer patients. J Am Med Assoc. 1983;249: 751–7.CrossRefGoogle Scholar
  25. DiMatteo M, Lepper H, Croghan T. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160:2101–7.PubMedCrossRefPubMedCentralGoogle Scholar
  26. Dinan TG. The physical consequences of depressive illness. Br Med J. 1999;318:826.CrossRefGoogle Scholar
  27. Durkin I, Kearney M, O’Siorain L. Psychiatric disorder in a palliative care unit. Palliat Med. 2003;17:212–8.CrossRefGoogle Scholar
  28. Ellis GK, Robinson JA, Crawford GB. When symptoms of disease overlap with symptoms of depression. Aust Fam Physician. 2006;35:647–9.PubMedPubMedCentralGoogle Scholar
  29. Endicott J. Measurement of depression in patients with cancer. Cancer. 1984;53:2243–9.PubMedCrossRefPubMedCentralGoogle Scholar
  30. Ernst E. Massage therapy for cancer palliation and supportive care: a systematic review of randomised clinical trials. Support Care Cancer. 2009;17(4):333.PubMedCrossRefPubMedCentralGoogle Scholar
  31. Fredman L, Weissman MM, Leaf PJ, Bruce ML. Social functioning in community residents with depression and other psychiatric disorders: results of the New Haven epidemiologic catchment area study. J Affect Disord. 1988;15:103–12.PubMedCrossRefPubMedCentralGoogle Scholar
  32. Gallo JJ, Rabins PV. Depression without sadness: alternative presentations of depression in late life. Am Fam Physician. 1999;60:820–6.PubMedPubMedCentralGoogle Scholar
  33. Gilbody SM, House AO, Sheldon TA. Routinely administered questionnaires for depression and anxiety: systematic review. Br Med J. 2001;322:406–9.CrossRefGoogle Scholar
  34. Goldberg D, Huxley P. Common mental disorders. A biosocial model. London: Tavistock Publications Ltd.; 1992.Google Scholar
  35. Goldman LS, Nielsen NH, Champion HC. Awareness, diagnosis, and treatment of depression. J Gen Intern Med. 1999;14:569–80.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Goldney RD, Fisher LJ, Wilson DH, Cheok F. Major depression and its associated morbidity and quality of life in a random, representative Australian community sample. Aust N Z J Psychiatry. 2000;34:1022–9.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Goldney RD, Ruffin R, Fisher LJ, Wilson DH. Asthma symptoms associated with depression and lower quality of life: a population survey. Med J Aust. 2003;178:437–41.PubMedPubMedCentralGoogle Scholar
  38. Goldney RD, Phillips PJ, Fisher LJ, Wilson DH. Diabetes, depression, and quality of life. Diabetes Care. 2004;27:1066–70.PubMedCrossRefPubMedCentralGoogle Scholar
  39. Grassi L, Indelli M, Marzola M, Maestri A, Santini A, Piva E, Boccalon M. Depressive symptoms and quality of life in home-care-assisted cancer patients. J Pain Symptom Manag. 1996;12:300–7.CrossRefGoogle Scholar
  40. Grunfeld E, Coyle D, Whelan T, Clinch J, Reyno L, Earle CC, Willan A, Viola R, Coristine M, Janz T, Glossop R. Family caregiver burden: results of a longitudinal study of breast cancer patients and their principal caregivers. Can Med Assoc J. 2004;170: 1795–801.CrossRefGoogle Scholar
  41. Henderson S, Andrews G, Hall W. Australia’s mental health: an overview of the general population survey. Aust N Z J Psychiatry. 2000;34:197–205.PubMedCrossRefPubMedCentralGoogle Scholar
  42. Hickie IB, Davenport TA, Hadzi-Pavlovic D, Koschera A, Naismith SL, Scott EM, Wilhelm KA. Development of a simple screening tool for common mental disorders in general practice. Med J Aust. 2001;175:S10–7.PubMedPubMedCentralGoogle Scholar
  43. Hilliard R. The use of music therapy in meeting the multidimensional needs of hospice patients and families. J Palliat Care. 2001;17:161–6.PubMedPubMedCentralGoogle Scholar
  44. Hinton J. Which patients with terminal cancer are admitted from home care? Palliat Med. 1994;8:197–210.PubMedCrossRefPubMedCentralGoogle Scholar
  45. Holland JC, Korzun AH, Tross S, Silberfarb P, Perry M, Comis R, Osterr M. Comparative psychological disturbance in patients with pancreatic and gastric cancer. Am J Psychiatry. 1986;143:982–6.PubMedCrossRefPubMedCentralGoogle Scholar
  46. Hotopf M, Chidgey J, Addington-Hall J, Lan Ly K. Depression in advanced disease: a systematic review part 1. Prevalence and case finding. Palliat Med. 2002;16:81–97.PubMedCrossRefPubMedCentralGoogle Scholar
  47. Hudson PL, Schofield P, Kelly B, Hudson R, O’Connor M, Kristjanson LJ, Ashby M, Aranda S. Responding to desire to die statements from patients with advanced disease: recommendations for health professionals. Palliat Med. 2006;20(7):703–10.PubMedCrossRefPubMedCentralGoogle Scholar
  48. Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188:662–70.PubMedCrossRefPubMedCentralGoogle Scholar
  49. Kathol RG, Mutgi A, Williams J, Clamon G, Noyes R. Diagnosis of major depression in cancer patients according to four sets of criteria. Am J Psychiatr. 1990;147:1021–4.PubMedCrossRefPubMedCentralGoogle Scholar
  50. Kelly B, Burnett K, Pelusi D, Badger S, Varghese F, Robertson M. Factors associated with the wish to hasten death: a study of patients with terminal illness. Psychol Med. 2003;33:75–81.PubMedCrossRefPubMedCentralGoogle Scholar
  51. Kissane DW, Clarke DM, Street AF. Demoralization syndrome – a relevant psychiatric diagnosis for palliative care. J Palliat Care. 2001;17(1):12–21.PubMedCrossRefPubMedCentralGoogle Scholar
  52. Kramer JA. Use of the Hospital Anxiety and Depression Scale (HADS) in the assessment of depression in patients with inoperable lung cancer. Palliat Med. 1999;13:353–4.PubMedCrossRefPubMedCentralGoogle Scholar
  53. Krout R. The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Med. 2001;18(6):383–90.CrossRefGoogle Scholar
  54. Kübler-Ross E. On death and dying. New York: The Macmillan Company; 1969.Google Scholar
  55. Kyle G. Evaluating the effectiveness of aromatherapy in reducing levels of anxiety in palliative care patients: results of a pilot study. Complement Ther Clin Pract. 2006;12(2):148–55.PubMedCrossRefPubMedCentralGoogle Scholar
  56. Lin EHB, Katon W, von Korff M, Tang L, Williams JW, Kroenke K, Hunkeler E, Harpole L, Hegel M, Arean P, Hoffing M, Della Penna R, Langston C, Unutzer J. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. J Am Med Assoc. 2003;290:2428–34.CrossRefGoogle Scholar
  57. Lloyd-Williams M. The assessment of depression in palliative care patients. Eur J Palliat Care. 1999;6:150–3.Google Scholar
  58. Lloyd-Williams M. Screening for depression in palliative care patients: a review. Eur J Cancer Care. 2001;10:31–5.CrossRefGoogle Scholar
  59. Lloyd-Williams M, Payne S. A qualitative study of clinical nurse specialists’ views on depression in palliative care patients. Palliat Med. 2003;17:334–8.PubMedCrossRefPubMedCentralGoogle Scholar
  60. Lloyd-Williams M, Riddleston H. The stability of depression scores in patients who are receiving palliative care. J Pain Symptom Manag. 2002;24:593–7.CrossRefGoogle Scholar
  61. Lloyd-Williams M, Friedman T, Rudd N. A survey of antidepressant prescribing in the terminally ill. Palliat Med. 1999;13:243–8.PubMedCrossRefPubMedCentralGoogle Scholar
  62. Lloyd-Williams M, Dennis M, Taylor F, Baker I. Is asking patients in palliative care, “are you depressed?” appropriate? Prospective study. Br Med J. 2003a;327:372–3.CrossRefGoogle Scholar
  63. Lloyd-Williams M, Spiller J, Ward J. Which depression screening tools should be used in palliative care? Palliat Med. 2003b;17:40–3.PubMedCrossRefPubMedCentralGoogle Scholar
  64. Maguire P. Barriers to psychological care of the dying. Br Med J. 1985;291:1711–3.CrossRefGoogle Scholar
  65. Maguire P, Howell A. Improving the psychological care of cancer patients. In: House A, Mayou R, Mallinson C, editors. Psychiatric aspects of physical disease. London: Royal College of Physicians and Royal College of Psychiatrists; 1995.Google Scholar
  66. Marsh L, McDonald WM, Cummings J, Ravina B, NINDS/NIMH Work Group on depression and Parkinson’s Disease. Provisional diagnostic criteria for depression in Parkinson’s disease. Report of an NINDS/NIMH Work Group. Mov Disord. 2006;21:148–58.PubMedCrossRefPubMedCentralGoogle Scholar
  67. Marziali E, Alexander L. The power of the therapeutic relationship. Am J Orthopsychiatry. 1991;61(3): 383–91.PubMedCrossRefPubMedCentralGoogle Scholar
  68. 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;26:593–9.PubMedPubMedCentralGoogle Scholar
  69. McIntyre E. Staff ratings of elderly at day care centres: mental status, hypochondriasis, depression. Clin Gerontol. 1982;1:45–50.PubMedCrossRefPubMedCentralGoogle Scholar
  70. Meyer HAM, Sinnot C, Seed PT. Depressive symptoms in advanced cancer. Part 2. Depression over time; the role of the palliative care professional. Palliat Med. 2003;17:604–7.PubMedCrossRefPubMedCentralGoogle Scholar
  71. Murray CJL, Lopez AD. Evidence-based health policy – lessons from the global burden of disease study. Science. 1996;274:740–3.CrossRefPubMedPubMedCentralGoogle Scholar
  72. National Comprehensive Cancer Network. Distress management. Clinical practice guidelines. J Natl Compr Cancer Netw. 2003;1(3):344–74.CrossRefGoogle Scholar
  73. Ng F, Crawford GB, Chur-Hansen A. Palliative medicine practitioners’ views on the concept of depression in the palliative care setting. J Palliat Med. 2013;16(8):922–8.PubMedCrossRefPubMedCentralGoogle Scholar
  74. Ng F, Crawford GB, Chur-Hansen A. How do palliative medicine specialists conceptualize depression? Findings from a qualitative in-depth interview study. J Palliat Med. 2014;17(3):318–24.PubMedCrossRefPubMedCentralGoogle Scholar
  75. Ng F, Crawford GB, Chur-Hansen A. Depression means different things: A qualitative study of psychiatrists’ conceptualisation of depression in the palliative care setting. Palliative & Supportive Care 2015;13(5):1223–30PubMedCrossRefPubMedCentralGoogle Scholar
  76. Ouslander JG. Physical illness and depression in the elderly. J Am Geriatr Soc. 1982;30:593–9.PubMedCrossRefPubMedCentralGoogle Scholar
  77. Palliative Care Expert Group, Moulds R, Allardice J, Boughey M, Cairns W, Chye R, Crawford G, Dedigama M, Glaetzer K, Good P, Herbert A, Homewood M, Kelly B, Mitchell G, Ravenscroft P, Rogers I, Scholes S, Sweidan M, W. S. Therapeutic guidelines: palliative care. Melbourne: Therapeutic Guidelines Ltd.; 2016.Google Scholar
  78. Parker G, Fletcher K, Hadzi-Pavlovic D. Is context everything to the definition of clinical depression? A test of the Horwitz and Wakefield postulate. J Affect Disord. 2012;136(3):1034–8.PubMedCrossRefPubMedCentralGoogle Scholar
  79. Passik SD, Theobald DE. Managing addiction in advanced cancer patients: why bother? J Pain Symptom Manag. 2000;19(3):229–34.CrossRefGoogle Scholar
  80. 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;16:1594–600.PubMedCrossRefPubMedCentralGoogle Scholar
  81. Passik SD, Donaghy KB, Theobald DE, Lundberg JC, Holtsclaw E, Dugan WM. Oncology staff recognition of depressive symptoms on videotaped interviews of depressed cancer patients: implications for designing a training program. J Pain Symptom Manag. 2000;19:329–38.CrossRefGoogle Scholar
  82. Passik SD, Kirsh KL, Theobald D, Donaghy K, Holtsclaw E, Edgerton S, Dugan W. Use of a depression screening tool and a fluoxetine-based algorithm to improve the recognition and treatment of depression in cancer patients: a demonstration project. J Pain Symptom Manag. 2002;24:318–27.CrossRefGoogle Scholar
  83. Pautex S, Berger A, Chatelain C, Herrmann F, Zulian GB. Symptom assessment in elderly cancer patients receiving palliative care. Crit Rev Oncol Haematol. 2003;47:281–6.CrossRefGoogle Scholar
  84. Periyakoil, VJ. Is it grief or depression? Fast Facts #43. Palliative Care Network of Wisconsin, USA, 2015. Accessed at https://www.mypcnow.org/blank-rc5hu on 26 May 2018
  85. Peveler R, Carson A, Rodin G. Depression in medical patients. Br Med J. 2006;325:149–52.CrossRefGoogle Scholar
  86. Portnoy R, Thaler H, Kornblith J, McCarthy Lepore J, Friedlander-Klar E, Kiyasu E, Sobel K, Coyle N, Kemeny N, Norton L, Scher H. The memorial symptom assessment scale: an instrument for the evaluation of symptom prevalence, characteristics and distress. Eur J Cancer. 1994;30A:1326–36.CrossRefGoogle Scholar
  87. Rapp SR, Vrana S. Substituting nonsomatic symptoms in the diagnosis of depression in elderly male medical patients. Am J Psychiatr. 1989;146:1197–200.PubMedCrossRefPubMedCentralGoogle Scholar
  88. Razavi D, Delvaux N, Farvacques C, Robaye E. Screening for adjustment disorders and major depressive disorders in cancer in-patients. Br J Psychiatry. 1990;156:79–83.PubMedCrossRefPubMedCentralGoogle Scholar
  89. Robinson JA, Crawford GB. Identifying palliative care patients with symptoms of depression: an algorithm. Palliat Med. 2005;19:278–87.PubMedCrossRefPubMedCentralGoogle Scholar
  90. Ruo B, Rumsfeld JS, Hlatky MA, Liu H, Browner WS, Whooley MA. Depressive symptoms and health-related quality of life: the heart and soul study. J Am Med Assoc. 2003;290:215–21.CrossRefGoogle Scholar
  91. Smith EM, Gomm SA, Dickens CM. Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliat Med. 2003;17:509–13.PubMedCrossRefPubMedCentralGoogle Scholar
  92. Sorenson SB, Rutter CM, Aneshensel CS. Depression in the community: an investigation into age of onset. J Consult Clin Psychol. 1991;59:541–6.PubMedCrossRefPubMedCentralGoogle Scholar
  93. Spiegel D. Cancer and depression. Br J Psychiatry. 1996;168(Supplement 30):109–16.CrossRefGoogle Scholar
  94. Vida S, Des Rosiers P, Carrier L, Gauthier S. Prevalence of depression in Alzheimer’s disease and validity of research diagnostic criteria. J Geriatr Psychiatry Neurol. 1994;7:238–44.PubMedCrossRefPubMedCentralGoogle Scholar
  95. Weissman M, Bland RC, Canino GJ, Faravelli C, Greenwald S, Hwu H-G, Joyce PR, Karam EG, Lee C-K, Lellouch J, Lepine J-P, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen H-U, Yeh E-K. Cross-national epidemiology of major depression and bipolar disorder. J Am Med Assoc. 1996;276:293–9.CrossRefGoogle Scholar
  96. Wilhelm K, Mitchell P, Slade T, Brownbill S, Andrews G. Prevalence and correlates of DSM-IV major depression in an Australian national survey. J Affect Disord. 2003;75:155–62.PubMedCrossRefPubMedCentralGoogle Scholar
  97. Wilson KG, Chochinov HM, de Faye BJ, Breitbart W. Diagnosis and management of depression in palliative care. In: Handbook of psychiatry in palliative medicine. New York: Oxford University Press; 2000. p. 25–49.Google Scholar
  98. Wilson KG, Mikail SF, D’Eon JL, Minns JE. Alternative diagnostic criteria for major depressive disorder in patient’s with chronic pain. Pain. 2001;91:227–34.PubMedCrossRefPubMedCentralGoogle Scholar
  99. World Health Organization. The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization; 1993.Google Scholar
  100. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer V. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatric Res. 1982–1983;17:37–49.CrossRefGoogle Scholar
  101. Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8(2):67–74.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Northern Adelaide Palliative ServiceNorthern Adelaide Local Health NetworkAdelaideAustralia
  2. 2.Discipline of MedicineUniversity of AdelaideAdelaideAustralia

Personalised recommendations