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La Presse Médicale
Volume 44, n° 4P1
pages 442-455 (avril 2015)
Doi : 10.1016/j.lpm.2015.02.002
Les troubles psychiatriques en soins palliatifs et en fin de vie
Psychiatric disorders in palliative care and at the end of life
 

Michel Reich
 Centre Oscar-Lambret, équipe de psycho-oncologie, 3, rue Frédéric-Combemale, BP307, 59020 Lille, France 

Points essentiels

Les patients confrontés à des pathologies organiques à un stade avancé dit palliatif peuvent avoir une détresse psychologique, parfois annonciatrice de troubles psychiatriques avérés.

Certains symptômes fréquents et compréhensibles tels qu’un état de tristesse, une agitation modérée, une anxiété, ou plus inquiétants comme des hallucinations, un délire ou des idéations suicidaires doivent alerter le clinicien qui ne doit pas les minimiser en les attribuant de façon réactionnelle aux conséquences de l’évolution de la maladie physique ou aux effets secondaires des traitements.

Les données de la littérature concernant les troubles psychiatriques en soins palliatifs sont croissantes et peuvent guider les cliniciens dans leur rôle de dépistage et de prise en charge précoce et efficace de ces troubles (troubles anxieux, confusion mentale et troubles dépressifs).

La survenue de symptômes annonciateurs de troubles psychiatriques peut altérer la qualité de vie et impacter le pronostic de patients déjà fragilisés par le contexte d’une maladie physique évolutive.

Le clinicien devra être attentif à tout symptôme psychiatrique prodromique et ne pas hésiter à traiter et, si nécessaire, orienter vers un professionnel du soin psychique.

The full text of this article is available in PDF format.
Key points

Patients confronted to advanced organic diseases at a palliative stage can present psychological distress that might announce the occurrence of genuine psychiatric disorders.

Some frequent and comprehensible symptoms such as sadness, mild agitation, anxiety or more disturbing such as hallucinations, delusions or suicidal ideations must alert the clinician who should not minimize them by attributing them in a reactive way to the consequences of the evolution of physical disease or treatment's side effects.

Literature data regarding psychiatric disorders (mainly anxiety disorders, delirium and depressive disorders) in palliative care are emerging and can guide clinicians in their role to detect them and providing early and efficient management.

Occurrence of warning symptoms of psychiatric disorders can impaired quality of life and impact the prognosis of patients already weakened by the context of an advanced physical disease.

The clinician will have to be careful to any psychiatric prodromic symptom and not hesitate to treat and to refer if necessary to a heath mental professional.

The full text of this article is available in PDF format.


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