Psychological causes of nausea and vomiting in palliative care

Anxiety is frequently accompanied by increasing sympathetic nervous system activity, causing physical symptoms including nausea and vomiting, tachycardia and sweating.

Anticipatory nausea occurs before the stimulus (eg chemotherapy). Nausea and vomiting can be precipitated by odours or sights linked to the stimulus (eg hospital), or even the thought of the stimulus (eg having chemotherapy). Minimise anticipatory nausea by giving adequate prophylactic antiemetic therapy before the first administration of the treatment likely to cause nausea and vomiting. Once established, anticipatory nausea and vomiting is difficult to prevent and treat.

Assist patients to understand the relationship between psychological distress and physical manifestations. Supportive responses and specific counselling techniques (eg desensitisation, relaxation) to address anxiety are usually helpful. Pharmacological treatment can block the physical manifestations of anxiety—see Anxiety and associated disorders in palliative care.