TAILIEUCHUNG - Ebook ABC of palliative care (2E): Part 2
(BQ) Part 2 book “ABC of palliative care” has contents: Depression, anxiety, and confusion, palliative care for children, chronic non-malignant disease, complementary therapies, community palliative care, bereavement, the carers, and other contents. | 28/6/06 11:31 AM Page 36 9 Depression, anxiety, and confusion Mari Lloyd-Williams Despite many advances in the palliation and management of the symptoms of advanced cancer, the assessment and management of psychological and psychiatric symptoms are still poor. A common misapprehension is to assume that depression and anxiety represent understandable reactions to incurable illness. When cure is not possible, the analytical approach we adopt to physical and psychological signs and symptoms is often forgotten. This error of approach and the lack of diagnostic importance given to major and minor symptoms of depression result in underdiagnosis and undertreatment of psychiatric disorder. Psychological adjustment reactions after diagnosis or relapse often include fear, sadness, perplexity, and anger. These usually resolve within a few weeks with the help of the patient’s own personal resources, family support, and professional care. However, 10–20% of patients will develop formal psychiatric disorders that require specific evaluation and management in addition to general support. Losses and threats of major illness ● ● ● ● ● ● ● ● It is important to recognise psychiatric disorders because, if untreated, they add to the suffering of patients and their friends and relatives Causes Depression and anxiety are usually reactions to the losses and threats of the medical illness. Other risk factors often contribute. Confusion usually reflects an organic mental disorder from one or more causes, often worsened by bewilderment and distress, discomfort or pain, and being in unfamiliar surroundings with unfamiliar carers. Elderly patients with impaired memory, hearing, or sight are especially at risk. Unfortunately, reversible causes of confusion are underdiagnosed, and this causes unnecessary distress in patients and families. Risk factors for anxiety and depression ● ● ● Clinical features ● ● ● Depression and anxiety These are broad terms that cover a continuum
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