Up to 80% of patients in palliative care suffer from neurological and/or psychiatric symptoms. For many of those symptoms, there are effective treatment options which should be known to the treating physician. The following article reviews clinical, etiological and diagnostic aspects as well as treatment options. For this, a systematic literature search is combined with clinical experience. Pure motor restlessness often is caused by aggravated physical symptoms. Delirium paradoxically often is reversible, even in the palliative setting, but may also be irreversible and a sign of impending death. Fear and depression must not be overlooked as they may effectively be treated. Suicidal ideation may be dealt with without transfer to a psychiatric ward. Physician assisted suicide is critically discussed.