60 research outputs found
Cancer and severe mental illness: Biâdirectional problems and potential solutions
ObjectiveGiven the reported increased rates of physical morbidity and higher mortality rates among people with severe mental illness (SMI) (schizophrenia and severe mood disorders), with a life expectancy shorter of 15â20âyears with respect to the general population, the aim of this paper was to call attention to the problem of cancer in SMI.MethodsWe conducted a narrative review of the most significant papers published in the areas of cancer screening, incidence, mortality and palliative care in SMI.ResultsData from the literature confirm disparities in screening (eg, mammography; papâsmear test; colorectal cancer screening) and prevention (eg, clinical breast examination; smoking cessation). The incidence of cancer was found to be variable with a portion of the studies reporting a higher prevalence while others a similar or a lower prevalence of cancer compared to the general population. A lower percentage of patients with SMI received proper cancer treatment resulting in survival after cancer diagnosis significantly worse than people without SMI. Likewise, endâofâlife care has been shown to be lacking with poorer levels of physical, psychological and spiritual care.ConclusionsThe problems of stigma and discrimination, poorer dignity, poorer health behavior, lack of integration in healthâcare services for people with SMI needs to be addressed and solved in cancer care. Psychoâoncology has a very specific and mandatory role in integrating the recommendation of the World Health Organization to improve the links between oncology and mental health settings for more specific psychoâoncology programs addressed for this vulnerable segment of the population.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/163408/2/pon5534.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/163408/1/pon5534_am.pd
Managing Anxiety and Depression During Treatment
Here, we review the prevalence and treatment of anxiety and depression among patients with breast cancer. Cancerârelated symptoms include similarities to responses to traumatic stress. Wellâdeveloped screening devices for identifying and tracking psychiatric comorbidity are discussed. Basic principles of psychopharmacology, and individual and group psychotherapy are presented. Finally, effects of effective treatment of anxiety and depression on quality of life and overall survival are reviewed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/110604/1/tbj12355.pd
The risk and the course of cancer among people with Severe Mental Illness
The paucity of data regarding patients with Serious Mental Illness (SMI) and cancer is alarming given the fact that people with SMI, especially schizophrenia, bipolar disorders and severe depressive disorders, have in general poorer access to physical health care and higher morbidity and mortality because of physical illnesses. The aims of this review were to examine the current evidence from existing literature on the risk of developing cancer and its course among people with SMI. Equivocal results emerge regarding the risk of developing some kind of cancer among people with SMI, with contrasting data on a possible higher, similar or lower risk in comparison with the general population. In contrast, a series of studies have pointed out that patients with SMI who develop cancer are less likely to receive standard levels of cancer care, both in terms of screening, diagnosis and treatment. Also, the mortality for cancer has been confirmed to be higher than the general population. A global sensitization about these problems is mandatory in an era in which community psychiatry has been developed in all countries and that policies of prevention, treatment, follow up, and palliative care should regard all the segments of the population, including people with SMI, through an interdisciplinary approach
Clinical Implications of Cancer Related Inflammation and Depression: A Critical Review
Neuropsychiatric symptoms are problematic in cancer settings. In addition to poor quality of life, depression is associated with worsened survival. Patients who develop depression that responds to treatment have the same cancer-related survival as those patients who never had depression. Although depression in patients with cancer is common, it is often unrecognized, untreated, or at best, undertreated. There remains untapped potential for underlying cancer-related biology associated with depression to help clinicians correctly identify depressed cancer patients and orchestrate appropriate treatments to address cancer-related depression. Biologically, inflammation has been most vigorously described in its association with depression in otherwise healthy patients and to a significant extent in patients with medical illness. This association is especially relevant to patients with cancer since so many aspects of cancer induce inflammation. In addition to cancer itself, its treatments (e.g., surgery, radiation, chemotherapy, and systemic therapies) and associated factors (e.g., smoking, obesity, aging) are all associated with increased inflammation that can drive immunological changes in the brain followed by depression. This critical review investigates the relationship between depression and cancer-related inflammation. It investigates several hypotheses that support these relationships in cancer patients. Special attention is given to the data that support certain inflammatory markers specific to both cancer and depression, the neurobiological mechanisms by which inflammation can impact neurotransmitters and neurocircuits in the brain, and the data addressing interventions that reduce inflammation and depression in cancer patients, and future directions
The Relevance of Transference during Medication Management: A Case of Erotized Transference
Forces existing in psychiatry may diminish the importance of psychotherapy training as psychiatrists are increasingly given the task of medication management. Psychotherapeutic relationships can be created in medication management settings, however, and the neglect of concepts such as transference could have deleterious consequences. The authors describe the case of a man with a traumatic brain injury referred for medication management who developed an erotized transference toward his female resident-physician. This case illustrates the concept that an understanding of transference is relevant to the setting of medication managemen
Internet interventions for improving psychological wellâbeing in psychoâoncology: review and recommendations
Objective Too few cancer patients and survivors receive evidenceâbased interventions for mental health symptoms. This review examines the potential for Internet interventions to help fill treatment gaps in psychosocial oncology and presents evidence regarding the likely utility of Internet interventions for cancer patients. Methods The authors examined available literature regarding Internet interventions tailored to cancer patients' mental health needs and reviewed elements of Internet interventions for mental health relevant to advancing psychoâoncology Internet intervention research. Results Few rigorous studies focusing on mental health of cancer patients have been conducted online. A growing body of evidence supports the efficacy, accessibility, and acceptability of mental health Internet interventions for a variety of general and medical patient populations. The authors present recommendations and guidelines to assist researchers in developing, testing, and disseminating Internet interventions for cancer patients and survivors, to manage and improve their mental health. Issues unique to Internet interventionsâincluding intervention structure, customization, provider interaction, and privacy and confidentiality issuesâare discussed. These guidelines are offered as a step toward establishing a set of âbest practicesâ for Internet interventions in psychoâoncology and to generate further discussion regarding the goals of such interventions and their place in cancer care. Conclusions Internet interventions have the potential to fill an important gap in quality cancer care by augmenting limited available mental health services. These interventions should be developed in a manner consistent with best practices and must be empirically tested and validated. Copyright © 2011 John Wiley & Sons, Ltd.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93546/1/pon1993.pd
Carbamazepine-Associated Hyponatremia
Four cases of CBZ-induced or exacerbated hyponatremia are described in middle-aged to elderly females. Two cases are remarkable in that the pretreatment sodium levels demonstrate hyponatremia. A return to prior sodium levels was observed upon the discontinuation of carbamazepine therapy. No definitive conclusions can be drawn from these case reports; however, similarities in the cases can be examined as follows: (1) all four women have medical problems, in particular two patients had pre-existing hyponatremia; (2) all four patients were using concurrent medications; (3) all four women presented psychotic. A literature review examines risk factors, pharmacological mechanism, and the time course for CBZ-induced hyponatremia
Promoting medical studentsâ reflection on competencies to advance a global health equities curriculum
Abstract
Background
The move to frame medical education in terms of competencies â the extent to which trainees âcan doâ a professional responsibility - is congruent with calls for accountability in medical education. However, the focus on competencies might be a poor fit with curricula intended to prepare students for responsibilities not emphasized in traditional medical education. This study examines an innovative approach to the use of potential competency expectations related to advancing global health equity to promote studentsâ reflections and to inform curriculum development.
Methods
In 2012, 32 medical students were admitted into a newly developed Global Health and Disparities (GHD) Path of Excellence. The GHD program takes the form of mentored co-curricular activities built around defined competencies related to professional development and leadership skills intended to ameliorate health disparities in medically underserved settings, both domestically and globally. Students reviewed the GHD competencies from two perspectives: a) their ability to perform the identified competencies that they perceived themselves as holding as they began the GHD program and b) the extent to which they perceived that their future career would require these responsibilities. For both sets of assessments the response scale ranged from âStrongly Disagreeâ to âStrongly Agree.â Wilcoxonâs paired T-tests compared individual studentsâ ordinal rating of their current level of ability to their perceived need for competence that they anticipated their careers would require. Statistical significance was set at pâ<â.01.
Results
Studentsâ ratings ranged from âstrongly disagreeâ to âstrongly agreeâ that they could perform the defined GHD-related competencies. However, on most competencies, at least 50Â % of students indicated that the stated competencies were beyond their present ability level. For each competency, the results of Wilcoxon paired T-tests indicate â at statistically significant levels - that students perceive more need in their careers for GHD-program defined competencies than they currently possess.
Conclusion
This study suggests congruence between student and program perceptions of the scope of practice required for GHD. Students report the need for enhanced skill levels in the careers they anticipate. This approach to formulating and reflecting on competencies will guide the programâs design of learning experiences aligned with studentsâ career goals.http://deepblue.lib.umich.edu/bitstream/2027.42/109541/1/12909_2013_Article_919.pd
Screening for Depression, Sleep-Related Disturbances, and Anxiety in Patients with Adenocarcinoma of the Pancreas: A Preliminary Study
Purpose. Screening for depression, sleep-related disturbances, and anxiety in patients with diagnosed adenocarcinoma of the pancreas. Materials and Methods. Patients were evaluated at initial consultation and subsequent visits at the multidisciplinary pancreatic cancer clinic at our University Cancer Center. Cross-sectional and longitudinal psychosocial distress was assessed utilizing Personal Health Questionnaire 9 (PHQ9) to screen for depression and monitor symptoms, the Penn State Worry Questionnaire (PSWQ) for generalized anxiety, and the University of Michigan Sleep Questionnaire to monitor sleep symptoms. Results. Twenty-two patients diagnosed with pancreatic cancer participated during the 6-month pilot study with longitudinal followup for thirteen patients. In this study, mild-to-moderate depressive symptoms, anxiety, and potential sleep problems were common. The main finding of the study was 23% of the patients who were part of this pilot project screened positive for moderately severe major depressive symptoms, likely anxiety disorder or a potential sleep disorder during the study. One patient screened positive for moderately severe depressive symptoms in longitudinal followup. Conclusions. Depression, anxiety, and sleep problems are evident in patients with pancreatic cancer. Prospective, longitudinal studies, with larger groups of patients, are needed to determine if these comorbid symptoms impact outcome and clinical course
Approaches to suicide prevention: Ideas and models presented by Japanese and international early career psychiatrists
Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146308/1/pcn12737.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/146308/2/pcn12737_am.pd
- âŠ