Psychiatric symptom management in terminal care.

During the terminal phase of illness, many geriatric patients develop psychiatric complications that subsequently have profound effects on their quality of life. Effective treatment requires the skills of a physician who is experienced in the recognition, assessment, and management of psychiatric complications of terminal care. Specialized knowledge is required, because even the most common psychiatric symptoms (anxiety, depression, and cognitive disorder) may be difficult to diagnose and treat. Recognition and management are complicated by the fact that these symptoms can arise as a consequence of other symptoms, for example, as a direct result of the disease and its treatment, or as a reflection of underlying psychosocial issues. In many instances, the use of pharmacologic agents, either alone or in combination with psychotherapeutic interventions, provides reasonable control of psychiatric symptoms. Here, too, specialized knowledge is required in order to know which regimens are likely to yield the most benefits with the least risk of toxicity. Fortunately, a considerable body of knowledge has accumulated over the last few years regarding the management of psychiatric symptoms in terminal care. The challenge for the future is to make sure that this information is applied in the routine clinical care of the terminally ill geriatric patient.