ABSTRACT
Life-threatening illness creates an uncertain future that causes anxiety which may increase as the illness progresses. Anxiety in turn makes it more difficult for the patient to cope with suffering. In advanced disease, anxiety is often associated with depression. The Hospital Anxiety and Depression scale is a sensitive and specific tool for generalised anxiety which can also help in identifying accompanying depression. The differentiating feature is that patients may deny any severe anxiety, although sometimes anxiety is part of the drug effect. A single drug alone is an unusual cause unless higher doses are being used, or the patient is very young or elderly. The risk is much greater when two or more at-risk drugs are used together and this risk can be reduced by avoiding combinations of drugs with this effect. Pain that is not worsened by movement can make some patients restless, mainly as a distractive behaviour.
