Beyond clinical remission: The foundations and rationale of palliative psychiatry

In recent decades, despite therapeutic advancements, a significant percentage of patients with refractory mental disorders that show no significant clinical improvement continue to experience substantial psychological suffering and functional deterioration. Faced with this reality, the development of palliative psychiatry is proposed. This approach focuses on alleviating suffering and enhancing quality of life, extending beyond the pursuit of symptomatic remission. This model represents a paradigm shift from the conventional framework, which primarily focuses on symptom control and rehabilitation. Instead, palliative psychiatry offers an individualized intervention focused on harm reduction, compassionate accompaniment, symptom management, respect for autonomy, and psychosocial support. Potential beneficiaries include patients with a past medical history of multiple failed treatments, persistent suffering, and severe functional impairment, and those in contexts of therapeutic exhaustion or elevated iatrogenic risks. Palliative psychiatry presents significant ethical, educational, and clinical challenges. It should be understood not as an abandonment of care, but as an ethical and compassionate approach to addressing it. Despite its limitations and the nascent development of the field, palliative psychiatry offers a promising pathway to improve care for a population often overlooked by conventional biomedical models.