Empowering Psychiatric Inpatients to Vote: Perceptions of Voting and the Barriers Encountered.

Individuals with psychiatric illness believe that voting is important. However, these individuals have lower rates of voting when compared to the general population. A survey of psychiatrically hospitalized adult patients was conducted to assess perceptions of and barriers to voting in patients with psychiatric illness. Data from 113 surveys was analyzed. A majority of survey participants agreed that they cared about voting, that their vote made a difference, and that their vote was important. 74% of individuals reported previously experiencing at least one barrier when exercising their right to vote. The most commonly experienced barriers reported were not having enough information to make an informed choice, not knowing where to vote, not having transportation, and not being registered to vote. Individuals who encountered a higher number of barriers in the past had a higher chance of encountering barriers more often. In conclusion, a high percentage of individuals with mental illness severe enough to warrant hospitalization have experienced barriers to voting, with many experiencing multiple barriers. Reduction of these barriers is important, as voting and the resultant public policies can directly affect this population's mental health and access to both mental and physical healthcare services.

Promoting Health Equity Through Voter Support Activities for the Inpatient Psychiatric Population.

Individuals with mental illness often face barriers to voting. One of the primary barriers is not being registered to vote. This paper describes voter support activities (VSAs) provided to hospitalized adults on the acute inpatient psychiatric units at Pennsylvania Psychiatric Institute. During the six weeks preceding the 2020 general election, adult inpatients were offered six VSAs and an optional survey examining previous voting behaviors and barriers encountered to voting. VSAs included checking voter registration status and polling location, completing a paper or electronic voter registration application, and requesting a mail-in ballot. Of 189 patients approached, 119 individuals participated in the survey and 60 individuals utilized at least one VSA. This project demonstrates that VSAs are a welcome and feasible resource for psychiatrically hospitalized adults. Psychiatric providers can serve an important role in promoting access to voting-related activities for their patients.

Surrogate Alcohol or Nonbeverage Alcohol Consumption: The Surrogate Alcohol Questionnaire (SAQ).

BACKGROUND: Diagnosis and treatment of alcohol use disorders and their sequelae are common clinical questions for the consultation-liaison psychiatrist. At an urban, academic medical center, the authors consulted on several patients whose consumption of alcohol included nonbeverage forms of alcohol, (described in the literature as surrogate alcohols, nonbeverage alcohols, e.g., mouthwash). METHODS: The authors describe 4 patients who presented with surrogate alcohol consumption. The authors review the clinical issues and literature related to surrogate alcohol use. The authors describe the array of substances, which either contain ethanol, but are not intended for drinking, or which contain other intoxicating alcohols (e.g., methanol), that are consumed in lieu of traditional beverage alcohol. Furthermore, the authors discuss standard medical treatment interventions for ethanol and non-ethanol based alcohols. The authors propose a screening tool, the surrogate alcohol questionnaire, a tool to facilitate better recognition of surrogate alcohol use.

Changes in cerebral blood flow and anxiety associated with an 8-week mindfulness programme in women with breast cancer.

This study employed functional magnetic resonance imaging to evaluate changes in cerebral blood flow (CBF) associated with the Mindfulness-based Art Therapy (MBAT) programme and correlate such changes to stress and anxiety in women with breast cancer. Eighteen breast cancer patients were randomized to the MBAT or education control group. The patients received the diagnosis of breast cancer between 6 months and 3 years prior to enrollment and were not in active treatment. The age of participants ranged from 52 to 77 years. A voxel-based analysis was performed to assess differences at rest, during meditation and during a stress task. The anxiety sub-scale of the Symptoms Checklist-90-Revised was compared with changes in resting CBF before and after the programmes. Subjects in the MBAT arm demonstrated significant increases in CBF at rest and during meditation in multiple limbic regions, including the left insula, right amygdala, right hippocampus and bilateral caudate. Patients in the MBAT programme also had a significant correlation between increased CBF in the left caudate and decreased anxiety scores. In the MBAT group, responses to a stressful cue resulted in reduced activation of the posterior cingulate. The results demonstrate that the MBAT programme was associated with significant changes in CBF, which correlated with decreased anxiety over an 8-week period.

Measuring informed decision making about prostate cancer screening in primary care.

PURPOSE: To measure the extent of informed decision making (IDM) about prostate cancer screening in physician-patient encounters, describe the coding process, and assess the reliability of the IDM measure. METHODS: Audiorecoded encounters of 146 older adult men and their primary care physicians were obtained in a randomized controlled trial of mediated decision support related to prostate cancer screening. Each encounter was dual coded for the presence or absence of 9 elements that reflect several important dimensions of IDM, such as information sharing, patient empowerment, and engaging patients in preference clarification. An IDM-9 score (range = 0-9) was determined for each encounter by summing the number of elements that were coded as present. Estimates of coding reliability and internal consistency were calculated. RESULTS: Male patients tended to be white (59%), married (70%), and between the ages of 50 and 59 (70%). Physicians tended to be white (90%), male (74%), and have more than 10 years of practice experience (74%). IDM-9 scores ranged from 0 to 7.5 (mean [SD], 2.7 [2.1]). Reliability (0.90) and internal consistency (0.81) of the IDM-9 were both high. The IDM dimension observed most frequently was information sharing (74%), whereas the dimension least frequently observed was engagement in preference clarification (3.4%). CONCLUSIONS: In physician-patient encounters, the level of IDM concerning prostate cancer screening was low. The use of a dual-coding approach with audiorecorded encounters produced a measure of IDM that was reliable and internally consistent.

Mediated decision support in prostate cancer screening: a randomized controlled trial of decision counseling.

OBJECTIVE: This randomized trial was conducted to assess the impact of a mediated decision support intervention on primary care patient prostate cancer screening knowledge, decisional conflict, informed decision making (IDM), and screening. METHODS: Before a routine office visit, 313 male patients eligible for prostate cancer screening completed a baseline telephone survey and received a mailed brochure on prostate cancer screening. At the visit, participants were randomized to either an enhanced intervention (EI) or a standard intervention (SI) group. Before meeting with their physician, EI Group men had a nurse-led "decision counseling" session, while SI Group men completed a practice satisfaction survey. An endpoint survey was administered. Survey data, encounter audio-recordings, and chart audit data were used to assess study outcomes. RESULTS: Knowledge increased in the EI Group (mean difference of +0.8 on a 10-point scale, p=0.001), but decisional conflict did not change (mean difference of -0.02 on a 4-point scale, p=0.620). The EI Group had higher IDM (rate ratio=1.30, p=0.029) and lower screening (odds ratio=0.67, p=0.102). CONCLUSION: Nurse-mediated decision counseling increased participant prostate cancer screening knowledge, and influenced informed decision making and screening. PRACTICE IMPLICATIONS: Nurses trained in decision counseling can facilitate shared decision making about screening.

Physician staffing for the practice of psychosomatic medicine in general hospitals: a pilot study.

BACKGROUND: The treatment of psychiatric illnesses, prevalent in the general hospital, requires broadly trained providers with expertise at the interface of psychiatry and medicine. Since each hospital operates under different economic constraints, it is difficult to establish an appropriate ratio of such providers to patients. OBJECTIVE: The authors sought to determine the current staffing patterns and ratios of Psychosomatic Medicine practitioners in general hospitals, to better align manpower with clinical service and educational requirements on consultation-liaison psychiatry services. METHOD: Program directors of seven academic Psychosomatic Medicine (PM) programs in the Northeast were surveyed to establish current staffing patterns and patient volumes. Survey data were reviewed and analyzed along with data from the literature and The Academy of Psychosomatic Medicine (APM) fellowship directory. RESULTS: Staffing patterns varied widely, both in terms of the number and disciplines of staff providing care for medical and surgical inpatients. The ratio of initial consultations performed per hospital bed varied from 1.6 to 4.6. CONCLUSION: Although staffing patterns vary, below a minimum staffing level, there is likely to be significant human and financial cost. Efficient sizing of a PM staff must be accomplished in the context of a given institution's patient population, the experience of providers, the presence/absence and needs of trainees, and the financial constraints of the department and institution. National survey data are needed to provide benchmarks for both academic and nonacademic PM services.

Women at a dangerous intersection: diagnosis and treatment of depression and related disorders in patients with breast cancer.

Breast cancer is a relatively common diagnosis for American women and depressive symptoms occur in many women with breast cancer. Identification of women with breast cancer and concomitant depressive symptoms and mood disorders requires particular attention by heath care providers, and may be aided by the administration of a variety of diagnostic and/or screening tools. Insomnia is also a significant problem for women with breast cancer at various stages of diagnosis and treatment, including after remission. Although many studies on the treatment of depression in women with breast cancer have been done, and the data do point to the efficacy of several antidepressants in this population, there are no data to support the widely held hypothesis that treatment of depression in patients with breast cancer may positively affect morbidity and mortality. Breast cancer treatments may give rise to depressive symptoms and this should be considered in the approach to pharmacotherapy. Several psychotherapeutic modalities offer relief of the symptoms and syndromes of depression in breast cancer. Future research can answer the question of which approach is most appropriate for which patients, and whether therapy can improve a variety of health outcomes and survival for women with breast cancer.

Prostate cancer: issues in psychosomatic medicine.

Prostate cancer is now a chronic condition. Screening, diagnosis, and treatment pose specific psychosocial challenges for men diagnosed and surviving with prostate cancer. Depression, anxiety, and cognitive impairment lead to emotional distress and difficulty coping. Treatments for psychosocial distress are targeted at couples and individuals. Lifestyle modification may improve coping and quality-of-life indicators.

Psychiatrists for medically complex patients: bringing value at the physical health and mental health/substance-use disorder interface.

BACKGROUND: In their current configuration, traditional reactive consultation-liaison services see a small percentage of the general-hospital patients who could benefit from their care. These services are poorly reimbursed and bring limited value in terms of clinical improvement and reduction in health-service use. METHOD: The authors examine models of cross-disciplinary, integrated health services that have been shown to promote health and lower cost in medically-complex patients, those with complicated admixtures of physical, mental, social, and health-system difficulties. CONCLUSION: Psychiatrists who specialize in the treatment of medically-complex patients must now consider a transition from traditional consultation to proactive, value-added programs and bill for services from medical, rather than behavioral, insurance dollars, since the majority of health-enhancement and cost-savings from these programs occur in the medical sector. The authors provide the clinical and financial arguments for such program-creation and the steps that can be taken as psychiatrists for medically-complex patients move to the next generation of interdisciplinary service.

Psycho-oncology: review and update.

The field of psycho-oncology is moving forward rapidly, especially for a relatively new field. Cancer patients and survivors are willing to discuss their needs and interests relating to diagnosis and treatment. There are guidelines and algorithms for determining levels of distress in cancer patients in both inpatient and outpatient settings. The pharmacologic treatment of distress, particularly depression, has vastly improved. Randomized controlled trials are becoming available for patients in order to determine the efficacy of psychotropic drugs. Numerous interventions are available to help cancer patients move forward with their lives. Some of these interventions began in the 1980s and have progressed to the use of complementary and alternative medicine techniques as coping strategies for cancer. With the rapid expansion of the Internet, cancer survivors' thirst for information also has grown. Many resources are available to help guide cancer patients through the maze of the diagnosis and treatment of cancer.

Pearls: in evaluating patient capacity to make medical decisions.

Evaluations of patients' capacity to make medical decisions are among the most common and most complex consultations that psychiatrists are asked to perform. We describe tips that we have found to be helpful while performing capacity evaluations. We also share tips that should help the clinician make up his or her mind regarding the patient following capacity evaluations.

Preparing African-American men in community primary care practices to decide whether or not to have prostate cancer screening.

BACKGROUND: This study was a randomized trial to test the impact of an informed decision-making intervention on prostate cancer screening use. METHODS: The study population included 242 African-American men from three primary care practices who were 40-69 years of age and had no history of prostate cancer. Participants completed a baseline survey questionnaire and were randomly assigned either to a Standard Intervention (SI) group (N=121) or an Enhanced Intervention (EI) group (N=121). An informational booklet was mailed to both groups. EI group men were also offered a screening decision education session. Two outcomes were considered: (1) complete screening (i.e., having a digital rectal exam (DRE) and prostate specific antigen (PSA) testing), and (2) complete or partial screening (i.e., having a PSA test with or without DRE). An endpoint chart audit was performed six months after initial intervention contact. The data were analyzed via exact logistic regression. RESULTS: Overall, screening use was low among study participants. EI group men had a screening frequency two times greater than that of SI group men, but the difference was not statistically significant: 8% vs. 4 % (OR = 1.94) fo rcomplete screening, and 19% vs. 10% (OR = 2.08) for complete or partial screening. Multivariable analyses showed that being in the EI group and primary care practice were significant predictors of complete or partial screening (OR = 3.9 and OR = 5.64, respectively). CONCLUSION: Prostate cancer screening use may be influenced by exposure to decision education and the influence of screening-related primary care practice factors.

Psychosocial oncology: supportive care for the cancer patient.

Increasing attention is being paid to the emotional and psychosocial needs of cancer patients. As a result of huge advances in early detection and in treatment modalities, there now are millions of cancer survivors in the United States. There has been a realization that cancer survivors have distinct psychosocial needs. As cancer survivors live longer, reduction of psychological distress has been recognized as being an important part of having an improved quality of life. There have been numerous changes in the field of psychosocial oncology since it first began 25 years ago. Guidelines now exist for the definition of distress and decision trees are available for making the appropriate referrals. Advances in pharmacologic treatment for depression and anxiety have made it possible to decrease distress and increase coping in cancer patients undergoing treatment as well as in cancer survivors. Numerous individual and group therapies have demonstrated effectiveness in improving mood and quality of life in cancer patients and those at high risk for developing cancer. Due to the forthright efforts of cancer patients, there are now many organizations and list serves (e-mailing lists) that cancer survivors can turn to for help before, during, and after cancer treatment. Finally, with the rapid expansion of the internet not only are there websites available as resources, but also the creation of interactive online support is becoming a reality. One of the most important issues in providing supportive care to cancer patients in the future is to meet the individual needs of patients and provide the type of psychological therapy that will work best for them.

Behaviors used by men to protect themselves against prostate cancer.

This paper reports on behaviors men use to protect themselves against prostate cancer. Data were collected via a telephone or mailed survey from 353 men enrolled in two studies of prostate cancer screening. Respondents reported behaviors they used to protect themselves against prostate cancer, and responses were coded as conventional care, self-care, or nothing. Men who reported using both conventional care and self-care were categorized as conventional care users. Polytomous logistic regression was conducted to evaluate the association between sociodemographic background, prior prostate screening, and cognitive, affective, and social support and influence factors with protective behavior type. The distribution of protective behaviors was as follows: conventional care, 63%; self-care only, 19%; and nothing, 18%. In multivariable analyses, higher education level was found to be positively associated with conventional care use. Perceived salience and coherence of prostate cancer screening was positively associated with conventional care use among men in one of the two studies. Low concern about screening was positively associated with self-care use, as was mailed survey completion. This study presents self-report data regarding prostate cancer protection behaviors. Most men in the study reported using some type of prostate cancer protective behavior. Decision-making about whether or not to take protective action and what type of behavior to use may be influenced by socioeconomic background, cognitive perceptions related to behavioral options, and concern about risk.