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Even with guideline-conform treatment in specialized outpatient clinics and intensive treatment programs, some patients suffering from severe and enduring anorexia nervosa do not achieve a satisfying level of mental health and quality of life. As this patient group is associated with a high mortality, a palliative stage of anorexia nervosa is postulated. In these cases, treatment decisions should factor in not only a prolongation of life but also quality of life, especially when compulsory treatment is considered. In doubtful cases, a palliative care physician and the clinical ethics committee should be consulted.

Background The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. Objective This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. Material and methods The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. Results Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. Conclusion The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.

People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.

Even with guideline-conform treatment in specialized outpatient clinics and intensive treatment programs, some patients suffering from severe and enduring anorexia nervosa do not achieve a satisfying level of mental health and quality of life. As this patient group is associated with a high mortality, a palliative stage of anorexia nervosa is postulated. In these cases, treatment decisions should factor in not only a prolongation of life but also quality of life, especially when compulsory treatment is considered. In doubtful cases, a palliative care physician and the clinical ethics committee should be consulted.

Background The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. Objective This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. Material and methods The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. Results Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. Conclusion The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

Even with guideline-conform treatment in specialized outpatient clinics and intensive treatment programs, some patients suffering from severe and enduring anorexia nervosa do not achieve a satisfying level of mental health and quality of life. As this patient group is associated with a high mortality, a palliative stage of anorexia nervosa is postulated. In these cases, treatment decisions should factor in not only a prolongation of life but also quality of life, especially when compulsory treatment is considered. In doubtful cases, a palliative care physician and the clinical ethics committee should be consulted.

Background The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. Objective This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. Material and methods The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. Results Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. Conclusion The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

Background The aim of palliative care is to optimize the quality of life of patients with incurable advanced diseases. Adequate psychotherapeutic and psychiatric care is essential in this context. Objective This article presents the recommendations of the S3 guideline on palliative care for patients with incurable cancer with regard to psychotherapeutic and psychiatric contents. Material and methods The guideline was developed under the leadership of the German Society for Palliative Medicine (DGP) within the methodological framework of the German Guideline Program in Oncology. Systematic literature reviews were carried out to identify relevant publications in the databases Medline, Cochrane Library, PsycInfo and Embase. Based on the publications included and clinical experience, representatives of 61 professional associations developed and agreed on evidence-based and consensus-based recommendations. Results Out of the total of 15 chapters in the guidelines, four have a special reference to psychiatry or psychotherapy; they cover the topics depression, anxiety, delirium in the dying phase and dealing with the desire to die. These chapters contain a total of 71 recommendations, almost one third of which are evidence-based. In view of the regularly undetected psychological symptoms in patients with incurable cancer, an early assessment is recommended. Optimal control of physical symptoms and support in social and existential matters are general measures that should be provided in addition to non-pharmacological and pharmacological procedures. Conclusion The guideline on palliative care deals with important mental issues that should be considered by all disciplines and professions. The need for research in palliative care remains high.

People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.

Even with guideline-conform treatment in specialized outpatient clinics and intensive treatment programs, some patients suffering from severe and enduring anorexia nervosa do not achieve a satisfying level of mental health and quality of life. As this patient group is associated with a high mortality, a palliative stage of anorexia nervosa is postulated. In these cases, treatment decisions should factor in not only a prolongation of life but also quality of life, especially when compulsory treatment is considered. In doubtful cases, a palliative care physician and the clinical ethics committee should be consulted.

People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.

Menschen mit schweren psychiatrischen Erkrankungen und einer zusätzlichen onkologischen Erkrankungen stellen die Behandler im palliativen Setting vor große Herausforderungen. Verhaltensweisen erscheinen oft unverständlich oder befremdlich. Depressiver Rückzug oder wahnhaftes Erleben im Rahmen einer chronischen Psychose kann beängstigend wirken. Der vorliegende Artikel skizziert die epidemiologischen Daten sowie die Besonderheiten im Erleben dieser Personengruppe. Im Anschluss an ausgewählte Kasuistiken aus psychologischer Sicht werden Gedanken zu den Aufgaben des Psychiaters im palliativen Setting vorgestellt. = People with severe psychiatric illnesses and an additional oncological illness represent great challenges to therapists in the palliative setting. Behavior patterns often appear incomprehensible or disconcerting. Depressive withdrawal or delusion in the context of a chronic psychosis can be frightening. This article outlines the epidemiological data as well as the particularities in the experience of this group of people. Following selected case studies from a psychological perspective, thoughts on the tasks of the psychiatrist in the palliative setting are presented.

ObjectiveDesires for hastened death (DHD; wish to hasten death is also in use) are prevalent in terminally ill patients. Studies show that health professionals (HP) are often underprepared when presented with DHD. HPs in specialized palliative care (SPC-HP) often encounter DHD. This study aimed to identify SPC-HP responses to DHD in daily practice and their corresponding functions. MethodsNarrative interviews were conducted with 19 SPC-HPs at four German University Hospitals. Transcripts were analyzed using the documentary method. An inventory of established responses to DHD was compiled, and their corresponding functions in the context of the patient-SPC-HP interaction were reconstructed. ResultsTwelve response categories and six corresponding functions were identified. On the patient level, responses categorized as symptom control, exploring the reasons and generating perspective, reorientation, and hope were particularly used to ease the patient's burden. On the interaction level, creating a relationship was fundamental. On the SPC-HP level, various methods served the functions self-protection and showed professional expertise. ConclusionsProfound personal and professional development is necessary to respond to the inherent challenges presented by DHD. Establishing helpful relationships with patients is essential regardless of SPC-HP specialization. SPC-HPs should maximize their skills in establishing and maintaining relationships as well as strengthening their own resilience, possibly in specific training courses. Copyright (c) 2015 John Wiley & Sons, Ltd.

ObjectiveDesires for hastened death (DHD; wish to hasten death is also in use) are prevalent in terminally ill patients. Studies show that health professionals (HP) are often underprepared when presented with DHD. HPs in specialized palliative care (SPC-HP) often encounter DHD. This study aimed to identify SPC-HP responses to DHD in daily practice and their corresponding functions. MethodsNarrative interviews were conducted with 19 SPC-HPs at four German University Hospitals. Transcripts were analyzed using the documentary method. An inventory of established responses to DHD was compiled, and their corresponding functions in the context of the patient-SPC-HP interaction were reconstructed. ResultsTwelve response categories and six corresponding functions were identified. On the patient level, responses categorized as symptom control, exploring the reasons and generating perspective, reorientation, and hope were particularly used to ease the patient's burden. On the interaction level, creating a relationship was fundamental. On the SPC-HP level, various methods served the functions self-protection and showed professional expertise. ConclusionsProfound personal and professional development is necessary to respond to the inherent challenges presented by DHD. Establishing helpful relationships with patients is essential regardless of SPC-HP specialization. SPC-HPs should maximize their skills in establishing and maintaining relationships as well as strengthening their own resilience, possibly in specific training courses. Copyright (c) 2015 John Wiley & Sons, Ltd.