Onkologie. 2025:19(3):124-130 | DOI: 10.36290/xon.2025.024

Anxiety, depression, and delirium in hospital palliative care - a brief overview

Tereza Foretová, Miroslav Žiaran
Komplexní onkologické centrum Pardubického kraje, Multiscan, s. r. o., Pardubická krajská nemocnice
Oddělení klinické a radiační onkologie, Nemocnice Pardubice

One of the fundamental objectives of palliative care is to ensure patient comfort and enhance quality of life in the context of incurable illness. While clinical attention has traditionally centred on the management of physical symptoms, the significance of psychological well-being should not be underestimated. Mental health constitutes an integral component of comprehensive palliative care, influencing the overall care trajectory. Anxiety, depression, and delirium represent the most prevalent psychiatric disorders encountered in palliative settings, each exerting a substantial impact on patients and their families. Despite their high prevalence, these conditions are frequently underdiagnosed or inadequately treated. This review aims to summarize current knowledge on the clinical features, prevalence, and diagnostic challenges associated with anxiety, depression, and delirium in palliative care as well as an overview of pharmacological and non-pharmacological treatment options. This article is intended as a concise resource for inpatient healthcare professionals engaged in palliative and supportive care. Given the scope of the topic, the aim is not to provide an exhaustive or detailed review.

Keywords: palliative care, anxiety, depression, delirium.

Accepted: June 26, 2025; Published: July 4, 2025  Show citation

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Foretová T, Žiaran M. Anxiety, depression, and delirium in hospital palliative care - a brief overview. Onkologie. 2025;19(3):124-130. doi: 10.36290/xon.2025.024.
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References

  1. . Atkin N, Vickerstaff V, Candy B. Worried to death': the assessment and management of anxiety in patients with advanced life-limiting disease, a national survey of palliative medicine physicians. BMC palliative care. 2017;16:1-10. Go to original source... Go to PubMed...
  2. . Kolva E, Rosenfeld B, Pessin H, et al. Anxiety in terminally ill cancer patients. J Pain Symptom Manage. 2011;42(5):691-701. doi: 10.1016/j.jpainsymman.2011.01.013. Epub 2011 May 12. PMID: 21565460; PMCID: PMC3179568. Go to original source... Go to PubMed...
  3. . Zweers D, de Graeff A, Duijn J, et al. Patients' Needs Regarding Anxiety Management in Palliative Cancer Care: A Qualitative Study in a Hospice Setting. Am J Hosp Palliat Care. 2019;36(11):947-954. doi: 10.1177/1049909119846844. Epub 2019 May 9. PMID: 31072110. Go to original source... Go to PubMed...
  4. . Trachsel M, Irwin SA, Chochinov HM, Anxiety and fear at the end of life. Therapeutische Umschau. Revue therapeutique. 2024;81(4):115-121.
  5. . Sláma O, Kabelka L, et al. Paliativní medicína pro praxi. Praha: Galén; 2022.
  6. . Salt S, Mulvaney CA, Preston NJ. Drug therapy for symptoms associated with anxiety in adult palliative care patients. Cochrane Database Syst Rev. 2017;5(5):CD004596. doi: 10.1002/14651858.CD004596.pub3. PMID: 28521070; PMCID: PMC6481598. Go to original source... Go to PubMed...
  7. . Davis EL, Deane FP, Lyons GCB, et al. Is Higher Acceptance Associated With Less Anticipatory Grief Among Patients in Palliative Care? J Pain Symptom Manage. 2017;54(1):120-125. doi: 10.1016/j.jpainsymman.2017.03.012. Epub 2017 May 4. PMID: 28479414. Go to original source... Go to PubMed...
  8. . Jacobsen JC, Zhang B, Block SD, et al. Distinguishing symptoms of grief and depression in a cohort of advanced cancer patients. Death Stud. 2010;34(3):257-273. doi: 10.1080/07481180903559303. PMID: 20953316; PMCID: PMC2953955. Go to original source... Go to PubMed...
  9. . Mugahl S, et al. Grief reaction and prolonged grief disorder. In: StatPearls [Internet]. StatPearls Publishing; 2023.
  10. . Nikolin S, Rodgers A, Schwaab A, et al. Ketamine for the treatment of major depression: a systematic review and meta-analysis. EClinicalMedicine. 2023;62:102127. doi: 10.1016/j.eclinm.2023.102127. PMID: 37593223; PMCID: PMC10430179. Go to original source... Go to PubMed...
  11. . Periyakoil VJ. Blue's Clues: Differentiating between Grief and Depression in Patients with Serious Life Limiting Illnesses (422). Journal of Pain and Symptom Management. 2010;39(2):399. Go to original source...
  12. . Perusinghe M, Chen KY, McDermott B. Evidence-Based Management of Depression in Palliative Care: A Systematic Review. J Palliat Med. 2021;24(5):767-781. doi: 10.1089/jpm.2020.0659. Epub 2021 Mar 15. PMID: 33720758. Go to original source... Go to PubMed...
  13. . Rayner L, Price A, Hotopf M, et al. The development of evidence-based European guidelines on the management of depression in palliative cancer care. Eur J Cancer. 2011;47(5):702-712. doi: 10.1016/j.ejca.2010.11.027. Epub 2011 Jan 4. PMID: 21211961. Go to original source... Go to PubMed...
  14. . Tašková I. Úzkostné poruchy a jejich léčba. Psychiatr. praxi. 2022;23(1):e17-27. Go to original source...
  15. . Vanderah TW, (ed.). Katzung's basic & clinical pharmacology. New York: McGraw Hill; 2024.
  16. . Grassi L, Caraceni A, Mitchell AJ, et al. Management of delirium in palliative care: a review. Curr Psychiatry Rep. 2015;17(3):550. doi: 10.1007/s11920-015-0550-8. PMID: 25663153. Go to original source... Go to PubMed...
  17. . Thom RP, Levy-Carrick NC, Bui M, et al. Delirium. Am J Psychiatry. 2019;176(10):785-793. doi: 10.1176/appi.ajp. 2018.18070893. PMID: 31569986. Go to original source... Go to PubMed...
  18. . Bianchi LA, Harris R, Fitzpatrick JM. Barriers to healthcare professionals recognizing and managing delirium in older adults during a hospital stay: A mixed-methods systematic review. J Adv Nurs. 2024;80(7):2672-2689. doi: 10.1111/jan.16018. Epub 2023 Dec 18. PMID: 38108154. Go to original source... Go to PubMed...
  19. . Portela Millinger F, Fellinger, M. Clinical characteristics and treatment of delirium in palliative care settings. Memo. 2021;14:48-52. https://doi.org/10.1007/s12254-020-00641-w. Go to original source...
  20. . Uhrová T, Klempíř J. Delirium - obecný úvod do problematiky. Neurol. praxi. 2011;12(5):304-306.
  21. . Bowman EML, Cunningham EL, Page VJ, et al. Phenotypes and subphenotypes of delirium: a review of current categorisations and suggestions for progression. Crit Care. 2021;25(1):334. doi: 10.1186/s13054-021-03752-w. PMID: 34526093; PMCID: PMC8441952. Go to original source... Go to PubMed...
  22. . Francis J, Young GB. Diagnosis of delirium and confusional states. UpToDate: Waltham, MA; 2012.
  23. . Ramirez CT, Verma RK. Early Palliative Care Improves Patient and Caregiver Quality of Life. Clin J Oncol Nurs. 2024;28(5):496-501. doi: 10.1188/24.CJON.496-501. PMID: 39324717. Go to original source... Go to PubMed...
  24. . Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi: 10.1056/NEJMoa1000678. PMID: 20818875. Go to original source... Go to PubMed...
  25. . Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013 Summer;13(2):214-23. PMID: 23789008; PMCID: PMC3684331.
  26. . Wensel TM, Powe KW, Cates ME. Pregabalin for the treatment of generalized anxiety disorder. Annals of Pharmacotherapy. 2012;46(3):424-429. Go to original source... Go to PubMed...
  27. . Citrome L. A review of the pharmacology, efficacy and tolerability of recently approved and upcoming oral antipsychotics: an evidence-based medicine approach. CNS Drugs. 2013;27(11): 879-911. doi: 10.1007/s40263-013-0105-7. PMID: 24062193. Go to original source... Go to PubMed...
  28. . Faraone SV. The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev. 2018;87:255-270. doi: 10.1016/j.neubiorev.2018.02.001. Epub 2018 Feb 8. PMID: 29428394; PMCID: PMC8063758. Go to original source... Go to PubMed...
  29. . Mücke M, Mochamat M, Cuhls H, et al. Pharmacological treatments for fatigue associated with palliative care: executive summary of a Cochrane Collaboration systematic review. J Cachexia Sarcopenia Muscle. 2016;7(1):23-27. doi: 10.1002/jcsm.12101. Epub 2016 Feb 10. PMID: 27066315; PMCID: PMC4799864. Go to original source... Go to PubMed...
  30. . Bachu A, Kotapati P, Kainth T et al. Use of Methylphenidate for Hypoactive Delirium: A Comprehensive Systematic Review. Psychoactives. 2023;2(4):337-345. Go to original source...
  31. . Krutská A, Kouba M. Fenomény blízké smrti : Vymezení pojmů, přehled literatury a zkušenosti z domácího hospice Cesta domů. PAL.MED.CZ. 2023;4(3):28-33. Available from: https://www.palmed.cz/pm/article/view/170.




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