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Mental Healthcare: Time to End the Stigma

Mental Healthcare: Time to End the Stigma

It was with great sadness that we all saw the tragic news of Robin Williams’ suicide. For years, mental health has been a taboo topic. While the passing of this great actor is horrifying, we are only aware of it because of his stardom. How many others have met a tragic fate like his, but we just do not hear about it because they are ordinary people? It affects all ages, all races, and socioeconomic statuses. It is not a phenomena located to the U.S. but all across the globe. True that many people have trouble gaining access to mental healthcare sources, often for insurance coverage reasons or lack of available providers. But more often, help isn’t pursued because of the stigma attached to mental health diagnoses. All too often patients are embarrassed to admit they have a mental health problem. Yet, diseases such as anxiety and depression are very prevalent in our society. These conditions are chronic medical problems, just like diabetes and hypertension. But patients are often made to feel that these diseases are just in their head and that they can just “get over it.” This does not just happen in our general society, but when they seek medical help as well. Patients do not understand that even physical pain can be an underlying sign of depression. And many feel that their healthcare providers brush it off as “just depression.” So, rather than face these stigmas and embarrassments, many choose to deny or hide their illnesses. They are left untreated, which allows tragedies like suicide to occur. How can mental healthcare stigmas be ended? 1. More...
The Effects of Creative Art Therapy in Cancer

The Effects of Creative Art Therapy in Cancer

Many patients with cancer report using at least one complementary and alternative medicine (CAM) therapy. Various CAM therapies appear to improve the psychological symptoms that are commonly linked to cancer and its treatment, including disease-related fatigue, pain, and symptoms of anxiety and depression. Creative arts therapies (CATs)—which include drama therapy, writing therapy, music therapy, dance and movement therapy, and various forms of art therapy—have received less attention than other CAM therapies. Current clinical research on CATs has expanded from largely observational science to a wider, cross-disciplinary approach. Previous reviews have suggested that CATs may be useful adjuvant therapies to improve cancer- and treatment-related symptoms during and after treatment. To date, however, there has been no systematic review of randomized clinical trials (RCTs) examining the effects of CAT on psychological symptoms among cancer patients. A Comprehensive Review In JAMA Internal Medicine, my colleagues and I had a systematic review and meta-analysis published that used results from RCTs to evaluate the effect of CAT exposure on psychological symptoms and quality of life (QOL) in patients with cancer. In our review, we included 27 RCTs that involved more than 1,500 study participants. Our findings showed that CATs significantly reduced anxiety, depression, and pain and increased QOL after treatment. Pain appeared to remain significantly lower for patients using CAT when assessed at follow-up. Exposure to CAT did not appear to significantly reduce symptoms of fatigue after treatment or during follow-up, but these data are more difficult to interpret because the effects may be modality dependent. More specifically, reductions in anxiety were strongest in RCTs that had a non-CAT therapist administer the intervention as...
Managing Psychosocial Distress in ICD Recipients

Managing Psychosocial Distress in ICD Recipients

Implantable cardioverter defibrillators (ICDs) have been shown to prevent life-threatening ventricular arrhythmias, but recipients can sometimes have dramatic experiences resulting from care. Each month, about 10,000 Americans have ICDs implanted to restore normal heart rhythm and prevent sudden cardiac death. “Many people who experience cardiac arrhythmias are surprised to learn of their potentially life-threatening condition,” explains Sandra B. Dunbar, RN, DSN, FAAN, FAHA. “Patients and their family are often forced into critical medical decision making and required to confront and cope with their condition. They need to be educated on their treatment options and adjust to the fact that they need an ICD.” Studies have shown that ICDs can significantly improve survival and quality of life (QOL), but the underlying arrhythmia and its treatment may be accompanied by adverse psychological responses. “These responses may be underappreciated in some cases and warrant greater attention by healthcare providers,” says Dunbar. “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” Psychological outcomes are an important component of QOL and reflect an aspect of the costs and benefits beyond simply living longer.” “Focusing on ways to optimize psychological outcomes for those who are considering or receiving an ICD is paramount.” In an issue of Circulation, Dunbar and colleagues at the American Heart Association (AHA) had a scientific statement published that provides an evidence-based comprehensive review of psychosocial considerations and QOL for people who receive ICDs. The statement also describes the concerns and educational needs of ICD patients and their families and outlines evidence supporting interventions for improving educational and psychological outcomes for these patients....
The Impact of Psychological Distress on Atrial Fibrillation

The Impact of Psychological Distress on Atrial Fibrillation

Atrial fibrillation (AF) is the most common arrhythmia in adults and is rapidly reaching epidemic proportions in the United States. Recent studies have suggested that treatment of AF correlates with enhanced overall quality of life. According to current guidelines, the choice of management strategy for AF should be guided by the symptomatic status of patients due to AF. Despite the emphasis being placed on relief of AF symptoms, several smaller investigations have suggested that psychological distress may be linked with patient-reported AF symptom severity. Some analyses have shown that patients with AF have a high prevalence of anxiety and depression. It’s possible that depression and anxiety may be more important than the number or duration of AF episodes in predicting AF symptom severity. These conditions may also be important predictors of worsened outcomes in patients with AF. Few studies, however, have investigated the association between anxiety and depression and severity of symptoms that patients attribute to AF. Intriguing New Data on Patients with Atrial Fibrillation To determine whether psychological distress is an important factor in patient-reported AF symptom severity, my colleagues and I performed a study—published in the Journal of Cardiovascular Electrophysiology—that examined the issue in greater detail. A cohort of 300 outpatients with stable AF was screened for symptoms of anxiety, depression, and somatization disorder. They also completed questionnaires that assessed general health and well-being, specifically measuring disease-specific AF symptom severity. Overall, patients in the study with worsened severity of depression, anxiety, or somatization disorder symptoms had an increase in AF symptom severity regardless of the AF severity scale used (see Figure). In addition, greater severity of depression...

Surgical Catastrophes and Anesthesiology

Most anesthesiologists will experience at least one perioperative catastrophe over the course of their careers. These events may have a profound and lasting emotional impact on anesthesiologists and may affect their ability to provide patient care in the aftermath of the incident (see article from guest blogger, Skeptical Scalpel, Complications & Collateral Damage). In an effort to more closely examine the impact of perioperative catastrophes on anesthesiologists, my colleagues and I conducted a survey that was published in Anesthesia & Analgesia. We sent a questionnaire to 1,200 randomly selected members of the American Society of Anesthesiologists who were practicing in the United States. Among the 659 anesthesiologists who completed the survey, 84% had been involved in at least one unanticipated death or serious injury of a perioperative patient during their career. Catastrophic Events Have a Lasting Impact When we asked anesthesiologists to recall their most memorable catastrophic event, more than 70% reported that they experienced guilt and anxiety and reliving the event. Most felt personally responsible for the death or injury, even if they considered the event to be unpreventable. The vast majority (88%) required time to recover emotionally from the catastrophe, and 19% acknowledged having never fully recovered. Another 12% even considered changing careers in the aftermath of the catastrophe. In addition, about two-thirds of the anesthesiologists reported feeling that their ability to care for patients was compromised in the first 4 hours after the event. However, nearly all respondents reported that they carried on with their usual work schedule after the incident occurred. In fact, only 7% were given time off. Our results clearly demonstrate that surgical...
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