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Fears and inner restlessness in advanced illness

A serious illness can trigger emotional reactions which may express themselves as tension and inner restlessness. Fear of the future, unresolved  conflicts, loneliness or the question as to ‘why’ can be aggravated by concerns about the well being of the relatives. Physical symptoms such as trembling, sweating, a racing heart (tachycardia) or a rise in blood pressure (hypertension) can be an indicator of fears and mental distress.  In individual cases, such symptoms can even include vertigo, nausea and a general feeling of weakness.

Minor physical (somatic) symptoms can in this case often alleviated by creating a familiar atmosphere. The presence of relatives or friends, offering of personal gifts or listening to favourite music contribute to  the restoration of inner peace and relaxation. Other patients benefit more from being for themselves in this situation. Careful exploration of the patients needs and asking the patient openly about his preferences is the key point. Therfore, you (as a patient) can help the doctors and nurses a lot if you feel comfortable in sharing your need and sorrows with them. Under this circumstances, it will be more easy to help you best. Supportive chats with sensitive and specially trained personnel like clergy, medical doctors or psychologists are also often helpful. Furthermore, taking medication, in certain cases, may be indicated. 

Depression

Phases of depression can emerge during periods of illness and can alternate with periods of inner strength. However, whether a period of feeling ‘down’ is a depressive period or a temporary dysphoria and whether treatment with drugs is necessary, should be a joint decision between you and your doctor. Your subjective  perception and level of psychological strain play a central role in determining this.

Depression can manifest itself in many ways. Emotions ranging from sorrow and desperation to anger, and from paralysis to a sense of despair and hopelessness are all possible. The trigger for such reactions can be the conveyance of a cancer diagnosis, recurrence of disease, worsening of the condition or therapeutic  failures. In addition, the loss of bodily functions or social bonds and roles may also lead to painful psychological symptoms.  

Normally,  depressive phases are the result  of illness-related stress and serve as an intrinsic safety mechanism to cope with the prevailing situation. If this condition however, develops into a permanent  state, painful or sad emotions can be replaced by a sense of leaden paralysis. Typical in such a situation is a loss both of any interest in and zest for life. Moreover, concentration levels and the ability to remember may become affected to a varying degree. Sleep disorders, loss of appetite and thoughts of suicide are also possible. Almost always, these episodes are transient if the patient is well cared by an experienced team. Supportive chats with sensitive and specially trained personnel like clergy, medical doctors or psychologists are also often helpful. Furthermore, taking medication in certain cases, may be indicated.

Therapy

It can be extremely helpful if you talk about your feelings and reflect on your environment and personal situation.  Talking helps to sort out thought processes and to build trust with other people. This can be your relatives, doctors and nurses or other people drawn from your environment. A conversation with a member of the clergy or psychologist can also help you to face life.  In certain circumstances, medication (anti-depressants) may be used.  Such treatment will depend however on the severity and duration of the depressive episode and is no substitute for personalised care. The preferred substance in the clinical treatment of depression is the so called ‘selective  serotonin reuptake inhibitors’ (SSRI) and  tricyclic anti-depressants (TCA).Your doctors will always discuss the treatment options with you so you can make choice according to the different alternatives.

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