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Book Reviews   |    
Handbook of Psychiatry in Palliative Medicine
Reviewed by Mary Ellen G. Foti, M.D.
Psychiatric Services 2001; doi: 10.1176/appi.ps.52.8.1112
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edited by Harvey Max Chochinov, M.D., Ph.D., and William Breitbart, M.D.; New York, Oxford University Press, 2000, 435 pages, $79.50

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Emotional pain and suffering are nearly universal among dying patients. However, although psychiatric morbidity at the end of life is treatable or remediable, it is often unrecognized and untreated. Barriers to the identification and treatment of psychiatric complications at the end of life include therapeutic "nihilism," an acceptance that these are "normal" reactions, and lack of competence and confidence among clinicians in assessment and treatment.

Psychiatric morbidity among terminally ill patients is quite common, with some estimates of delirium approaching 80 percent and depression 50 percent. Recent research efforts repeatedly underscore the central importance of addressing psychiatric and psychosocial issues to optimize care of the terminally ill. These issues include problems such as depression, anxiety, suicidal ideation, delirium, eating disorders, fatigue, grief, loss, and bereavement as well as questions regarding capacity to make decisions and overall quality of life.

As a psychiatrist-researcher in end-of-life care, I was excited to be able to review the Handbook of Psychiatry in Palliative Medicine, the first comprehensive psychiatric palliative care textbook. The text expertly addresses the assessment and treatment of each of the problems listed above. It also provides theoretical and practical assistance in psychiatric palliative care for children, families, and staff.

The volume editors, Dr. Chochinov and Dr. Breitbart, are internationally known leaders in the identification and treatment of psychiatric complications at the end of life. Through past publications, presentations, and participation in policy making, they have drawn the attention of palliative care practitioners to the importance of these issues. With this volume they have provided the field with an expert how-to compendium.

The Handbook of Psychiatry in Palliative Medicine combines their work with that of 43 other internationally known contributors. The book has 28 chapters divided into seven parts covering psychiatric complications of terminal illness; symptom management; psychotherapeutic intervention and palliative care; pediatric palliative care; family and staff issues; ethical and spiritual issues; and research issues.

Because psychiatric morbidity at the end of life is widespread and causes treatable suffering, addressing psychiatric complications of terminal illness is a critical component of comprehensive end-of-life care. All providers of palliative care—psychiatrists, psychologists, mental health counselors, oncologists, hospice workers, and so on—will find this text both practical and thought provoking. It is a landmark publication.

Dr. Foti is associate professor of psychiatry at the University of Massachusetts Medical School in Worcester.

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