Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-05T09:21:18.953Z Has data issue: false hasContentIssue false
  • English
  • Français

Liaison psychiatry in palliative care

Published online by Cambridge University Press:  13 June 2014

Ann Payne ,
Michael J Kelleher ,
Yvonne Hayes  and
Tony O'Brien
Ann Payne
Affiliation:
Cork University Hospital, Wilton, Cork, Ireland
Michael J Kelleher
Affiliation:
St Michael's Hospital, Cork, Ireland
Yvonne Hayes
Affiliation:
Clonakilty, Cork, Ireland
Tony O'Brien
Affiliation:
Marymount Hospice, Cork, Ireland
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Psychiatric disorders are common and frequently undetected and under treated in the palliative care population. The aims of this pilot study were determine to: (1) the incidence of psychiatric co-morbidity; (2) the patient's current insight; (3) future fears regarding symptom control; and finally (4) the degree of satisfaction with their doctors level of communication, at the time of their diagnosis.

Methods: Over a six-month period, 100 consecutive hospice admissions were assessed by AP, within 72 hours of their arrival. This patient group all had advanced malignant disease. A semi-structured questionnaire was used as a guide (see Table 1) to interview. A full history, cognitive and Mental State Examination (MSE) were performed on each patient.

Results: Sixty-four patients were interviewed, 36 were excluded. Sixteen (25%) had a depressive illness, six (9%) had anxiety, 56 (88%) had full or partial insight into their illness. Only eight (12%) were unaware of the nature or implications of their disease. Of those who responded, 19 (30%) felt dissatisfied with how their doctors communicated their diagnosis. A significant proportion, 30 (47%) felt that eventually their symptoms would become out of control.

Conclusions: This was a pilot study by a psychiatrist at the bedside in the hospice setting. We found that by concentrating on psychological symptoms rather than the biological, a diagnosis of depression was possible even in these complex medical patients. However, recognition of treatable anxiety in this population is a challenge. Even though 30 (47%) felt that their most distressing symptoms would become out of control during the course of their illness, we found an incidence of anxiety of only six (9%). This suggests that our interview underestimates the true level of anxiety in these patients, and highlights the need for a low threshold for diagnosis and possibly an objective screening mechanism. Regarding the ‘breaking of bad news’, 19 (31%) of patients were dissatisfied and unhappy with this experience and there is clearly room for improvement in communicating a diagnosis of malignancy.

Keywords

DepressionAnxietyDyingHospiceSymptomsInsight
Type
Brief Report
Information
Irish Journal of Psychological Medicine , Volume 21 , Issue 1 , March 2004 , pp. 25 - 27
Copyright
Copyright © Cambridge University Press 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Durkin, I, Kearney, M, O'Siorain, L. Psychiatric Disorder in a Palliative Care Unit. Palliative Med 2003; 17: 212–218.CrossRefGoogle Scholar
2.Chochinov, HM, Wilson, KG, Enns, M, Lander, S. “Are you depressed?” Screening for depression in the terminally ill. Am J Psychiatry 1997; 154: 674–6.Google ScholarPubMed
3.Kissane, DW, Smith, GC. Consultation-Liaison Psychiatry in an Australian oncology unit. Aust NZ J Psychiatry 1996; 30: 397–404.CrossRefGoogle Scholar
4.Payne, S, Hillier, R, Langley-Evans, A, Roberts, T. Impact of witnessing death on hospice patients. Soc Sci Med 1996; 43(12): 1785–1794.CrossRefGoogle ScholarPubMed
5.Chochinov, HM. Psychiatry and Terminal Illness. Can J Psychiatry 2000; 45(2): 143–150.CrossRefGoogle ScholarPubMed