Depression, anxiety, and delirium

Abstract

The assessment and treatment of psychological disorders such as depression, anxiety, and delirium can prove challenging in paediatric palliative care (PPC). Clinicians face the difficulties of distinguishing among symptoms of disease progression, medical side effects, and ‘normal’ psychological distress; the roles of cognitive and emotional development; and the lack of standardized assessment measures. Because research in this area is limited, recommendations often are extrapolated from adult palliative care (PC), or paediatric psychiatric or psychological literature in populations without life-threatening conditions. Patient- and family-centred care require that we address these symptoms, which may not meet clear diagnostic criteria, but significantly impair quality of life (QOL). Careful history taking, active listening, and close observation are essential in unearthing psychological symptoms. Collaboration with mental health professionals is recommended whenever possible, to provide specialist assessment and inform non-pharmacological and psychopharmacological treatment. Clinicians must incorporate limited data with clinical judgement and consultation to guide interventions that best reduce suffering and improve quality of life.