Know-how and guidance regarding palliative care from the viewpoint of a psychiatrist

Abstract

The mental symptoms of cancer patients (anxiety, depression, delirium, etc.) are greatly affected by the environment and physical symptoms of the patient The condition of the patient immediately after receiving the "bad news" (i.e. being told of their condition) is characterized by numbness, and communication becomes difficult Under these circumstances, spending time listening to the patient's worries or giving advice makes the patient feel as if their condition is someone else's problem that he or she perceives as a dream. However, correct understanding of their situation can help to gradually become closer to the patient's perspective. Furthermore, in cases of the simultaneous occurrence of depression and physical symptoms caused by cancer (pain, general fatigue, etc.), the alleviation of physical suffering should be prioritized. Alleviating physical suffering alone often leads to a reduction in the severity or complete disappearance of depression. However, depression does not always improve by antidepressants or psychotherapy alone. Likewise, the causes of the mental symptoms of delirium are mostly derived from the environmental condition or physical symptoms, and therefore, these must be treated and improved first. Prescribing antianxiety or sedative drugs should be avoided. As described above, one can say that adequately understanding and prioritizing the treatment and improvement of the environment and physical symptoms of the patient are important points in the palliative care of the mental symptoms of cancer patients. © 2011 The Japan Lung Cancer Society.