Psychological distress and psychiatric comorbidities in palliative care

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.