title: Psychiatric comorbidity among terminally ill patients in general practice in the Netherlands: a comparison between patients with cancer and heart failure.
abstract: BACKGROUND
  It is unclear whether psychiatric disorders are specifically related to the terminal phase of cancer, or independent of the underlying disease.
  
  
  OBJECTIVE
  To investigate the rate of psychiatric comorbidity and psychotropic drugs prescription in terminally  ill patients in the GP setting, comparing both patients with terminal cancer and heart failure.
  
  
  METHODS
  Retrospective cohort study using the Utrecht General Practitioner Research Network.
  
  
  METHODS
  Equally-sized groups of patients with terminal  cancer and heart failure were randomly selected from the database of four general practices over the years 2005-2009. Psychiatric comorbidities were determined using the International Classification for Primary Care (ICPC) codes and psychotropic drugs prescriptions using the Anatomical  Therapeutic Chemical (ATC) Classification System codes.
  
  
  RESULTS
  A total of 191 terminally ill patients were included in the study (111 with cancer and 80 with heart failure). The mean age for patients with terminal cancer (70.8 years, standard deviation [SD] = 12.8) was  15 years younger than that of patients with heart failure (85.6 years, SD = 9.2). Half of the terminally ill patients (50.3 %) were prescribed psychotropics, but only 13.6% of them had obtained a psychiatric diagnosis. There were no significant differences in prevalence of psychiatric disease  and psychotropic drug prescription between patients with terminal cancer and heart failure.
  
  
  CONCLUSIONS
  The results demonstrate a high use of psychotropic drugs in terminally ill patients, often in the absence of a formal diagnosis of a psychiatric disorder. The absence  of differences between patients with cancer and heart failure suggests that psychiatric diagnoses and increased psychotropic prescriptions are primarily related to the terminal stage of the disease and not to the background of cancer or heart failure.
authors: Faculty of Medicine, University Malaya, Department of Psychological Medicine, Lembah Pantai, Kuala Lumpur 50603, Malaysia. chong_guan1975@yahoo.co.uk
authors: Chong Guan
authors: CG
authors: Ng
authors: Ellen
authors: E
authors: Dijkstra
authors: Hugo
authors: H
authors: Smeets
authors: Marco P M
authors: MP
authors: Boks
authors: Niek J
authors: NJ
authors: de Wit
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology; D015331:Cohort Studies; D015897:Comorbidity; D004417:Dyspnea / Q000209:etiology; D005221:Fatigue / Q000209:etiology; D005260:Female; D058006:General Practice; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D009369:Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000523:psychology*; D009426:Netherlands / Q000453:epidemiology; D010146:Pain / Q000209:etiology; D015995:Prevalence; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D019452:Terminally Ill / Q000523:psychology / Q000706:statistics & numerical data*
chemical_list: D011619:Psychotropic Drugs