Psychiatric disorder in a palliative care unit

Introduction: Studies have shown varying prevalence rates of psychiatric disorders in patients with terminal illness. On average it is expected that between 33 and 50% of this population will require psychological support. Despite this, up to 50% of psychiatric disorders remain unrecognized by medical and nursing personnel. The objectives of this study were to assess clinically the prevalence of psychiatric disorder occurring in the study population and to ascertain whether this disorder had been detected and treated prior to admission. Method: Following assessment of the patient, the presence or absence of a psychiatric diagnosis was determined according to the criteria laid down by the ICD-10 Diagnostic Criteria for Research. Results: One hundred and thirty-nine (62%) patients met ICD-10 diagnostic criteria for psychiatric disorder. Thirty-three (24%) patients had dual diagnoses. The commonest diagnoses were organic disorders followed by neurotic and stress-related disorders and depression (27%, 16% and 16%, respectively). One hundred and twenty-six (91%) patients with a psychiatric disorder had been symptomatic on admission. Of these, 35% were receiving incorrect or inadequate treatment. Conclusion: Almost two-thirds of the palliative care population studied had comorbid psychiatric illness. One-third of these disorders had not been identified or treated appropriately prior to admission. Future research needs to identify effective methods of detecting and diagnosing these disorders to enable early and efficient treatment programmes be initiated.