Depression, anxiety and delirium in palliative care

Depression, anxiety and delirium are ordinary syndromes in palliative care. In May 2013, the fifth edition of the Diagnostical and Statistical Manual of Mental Disorders has been issued, and a few variations have been added to these diagnoses. In this article, we present the last modifications, and the particularities of these syndromes in palliative care. For the Major Depressive Disorder, the symptoms of anorexia or hyperphagia sleep disorders and sexual disorders are less important in palliative care because of their aspecificity. The treatment includes a pharmacological one, and psychotherapy. This last one is more convenient, because the treatment needs a few days to be efficient, a time that could miss in case of imminent death. On the contrary, psychotherapy can be use very simply, without any side effects. Anxiety is very common in palliative care, but it is very often treated as a symptom, and less as a part of a syndrome, as an anxiety disorder. Now, the treatment is not only benzodiazepine, but also includes antidepressants, and psychotherapy. This is in favor of collaboration between palliative doctors and psychiatrist, to improve the care in case of anxiety. Finally, delirium is often considered as a psychiatric disease, when etiologies are often else. A few authors propose to take care of it thinking of two particular dimensions: reversibility and hypo/hyperactivity. Authors insist on the necessity for every people who work in palliative care to know well psychiatric semiology, and eventually to learn a few psychotherapic techniques. (C) 2014 Elsevier Masson SAS. All rights reserved.