Hospice provides care with a palliative approach (management of symptoms) for patients in the last six months of life. Although palliative medicine can be provided at any point in a disease trajectory, the patient does not have to have a life expectancy of less than six months. The cornerstone of a good evaluation in a patient with a terminal illness is as always a thorough psychiatric evaluation based on DSM-IV criteria, with a high index of suspicion for depression and delirium. The first step in assessing and treating depression at the end of life should be ensuring that the patient has adequate pain control. The main stay of treatment for anxiety at the end of life is benzodiazepines. It is important to address and manage substance abuse in a patient with a terminal illness because it tends to worsen psychiatric conditions and make palliative care interventions less effective.