University of California, San Francisco, CA, USA.
Am Fam Physician. 2012 Aug 1;86(3):259-64.
Psychological distress is common in terminally ill persons and can be a source of great suffering. Grief is an adaptive, universal, and highly personalized response to the multiple losses that occur at the end of life. This response may be intense early on after a loss manifesting itself physically, emotionally, cognitively, behaviorally, and spiritually; however, the impact of grief on daily life generally decreases with time. Although pharmacologic interventions are not warranted for uncomplicated grief, physicians are encouraged to support patients by acknowledging their grief and encouraging the open expression of emotions. It is important for the physician to distinguish uncomplicated grief reactions from more disabling psychiatric disorders such as major depression. The symptoms of grief may overlap with those of major depression or a terminal illness or its treatment; however, grief is a distinct entity. Feelings of pervasive hopelessness, helplessness, worthlessness, guilt, lack of pleasure, and suicidal ideation are present in patients with depression, but not in those experiencing grief. Psychotherapy and antidepressant medications reduce symptoms of distress and improve quality of life for patients with depression. Physicians may consider psychostimulants, such as methylphenidate, for patients who have depression with a life expectancy of only days to weeks.
心理困扰在绝症患者中很常见，可能是极大痛苦的根源。悲伤是对生命末期发生的多种丧失的一种适应性、普遍性和高度个性化的反应。这种反应在失去后早期可能会强烈表现为身体、情感、认知、行为和精神上；然而，悲伤对日常生活的影响通常会随着时间的推移而减少。虽然对于单纯悲伤不需要药物干预，但医生鼓励通过承认患者的悲伤并鼓励他们开放地表达情感来支持患者。医生区分单纯悲伤反应和更具致残性的精神障碍（如重度抑郁症）很重要。悲伤的症状可能与重度抑郁症或绝症或其治疗的症状重叠；然而，悲伤是一个独特的实体。感到普遍的绝望、无助、无价值感、内疚、缺乏快感和自杀意念存在于患有抑郁症的患者中，但不存在于经历悲伤的患者中。心理治疗和抗抑郁药物可减轻抑郁患者的痛苦症状并提高生活质量。对于预计只有几天到几周寿命的患有抑郁症的患者，医生可以考虑使用苯丙胺类药物等精神兴奋剂。
