Glioblastoma multiforme (GBM) is an aggressive primary brain tumor associated with poor prognosis, rapid functional decline, and psychological distress. An updated review of the literature is lacking, despite that patients with GBM appear to be among the highest risk for suicide among cancer patients. This review summarizes up-to-date evidence of suicide risk factors, screening approaches, and suicide mitigation strategies in patients with GBM. Suicide risk is the highest in the first year following GBM diagnosis. It is also associated with older age, male gender, and tumor-related factors such as supratentorial location. Other factors such as neurocognitive decline and poor functional status may also contribute. Evidence emerging from broader oncology populations suggests that demoralization and existential distress may be factors, though these have not been studied in GBM cohorts. Treatment-related psychiatric adverse effects from corticosteroids, anti-epileptic drugs, chemotherapy, and radiotherapy may also influence psychiatric illness and mediate suicide risk. Screening tools such as the Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale, and Colombia-Suicide Severity Rating Scale have been effectively used to screen for suicide in conjunction with clinical interviewing in GBM patients. Evidence-based suicide reduction interventions include psychotherapy, safety planning, lethal means restriction, and caregiver support. GBM is a diagnosis that is associated with higher rates of suicide than almost all other cancers, and the extant literature identifies demographic and tumor features that are associated with suicide in this population. Effective interventions exist to identify and support these patients. Future studies should systematically measure risk factors identified in broader oncology populations to identify additional GBM-specific risk factors for suicide.

Cancer advances are not distributed equitably among many segments of the population. Specifically, individuals with serious mental illness (SMI) face compounded disparities in cancer detection, treatment, and survival. SMI, characterized by conditions such as schizophrenia, bipolar disorder, and severe major depression, is associated with significant functional impairment and a two-to-three-decade reduction in life expectancy. Patients with SMI encounter unique challenges when navigating cancer care, including fragmented care pathways, less access to cancer therapeutics, limited psychosocial support, stigma, heightened vulnerability to diagnostic overshadowing where symptoms are attributed to their psychiatric rather than a medical or oncologic condition, and underrepresentation in therapeutic clinical trials. This review explores the intersection of SMI and cancer care starting with the conceptual background and its importance related to cancer outcomes and the delivery of ethical care to highlight unmet needs and a multitude of barriers. The paper proposes practical recommendations to improve cancer care for individuals with SMI who develop cancer including adopting the collaborative care model, enhancing psychosocial and psychiatric integration in oncology settings, and addressing biases inherent in clinician training. Interventions targeting individual, interpersonal, health system, and policy levels are essential to comprehensively mitigating disparities and developing durable cancer delivery strategies. Equitable cancer care for patients with SMI is both a moral imperative and a cornerstone of advancing social justice in oncology. Thus, there is a critical need to prioritize the translation of research advances, to close the gap in cancer outcomes and mortality, and to improve patient outcomes and wellbeing.

Patients with Serious Mental Illness (SMI) are reported to be at higher risk for somatic disorders (e.g. cardiovascular and metabolic diseases) and higher mortality, compared to the general population, because of the consequences of SMI including psychotropic medication side effects, sedentary and unhealthy lifestyle, difficult access to physical health care. The aim of this review was to examine the current evidence regarding oncology, focusing on the problem of cancer among patients with SMI. Compared to the general population, individuals with SMI showed a lower rate of screening for cancer, suboptimal standard cancer treatment, delayed treatment, and higher mortality from cancer. Several factors, including those related to the patient, the health-care system, and the social context, are involved in these negative outcomes. It is therefore necessary to raise awareness and alert clinicians in oncology settings to the challenging problem of cancer among patients with SMI, a marginalized and vulnerable segment of the population that can be at risk for not receiving proper cancer prevention and care. Evidence supports the mandatory need for an interdisciplinary approach involving psychiatry and mental health services.

Non-pharmacological techniques designed to reduce anxiety, pain, and healthcare utilization have shown effectiveness in pediatric and non-surgical adult populations; however, their application has not been widely evaluated among adult surgical patients. This study randomized opioid-naive adults undergoing first-time, elective cardiac surgery to receive either targeted interventions from a trained “comfort coach” or usual care. The primary outcome assessed was healthcare utilization, specifically measured as the number of days at home within the first 30 days post-surgery. Secondary outcomes included postoperative opioid use and patient-reported outcomes, collected via validated surveys. Additionally, 50 participants in the intervention group completed semi-structured qualitative interviews to explore their experience and acceptability of the intervention. Among the 160 randomized subjects (COACH: n = 77; USUAL CARE: n = 79), three did not undergo surgery and one was excluded for dementia, leaving 156 participants with a mean age of 63 years, 33% of whom were female. The primary outcome was not statistically different between groups, with the COACH group averaging 22.8 ± 4.4 days at home and the USUAL CARE group 22.0 ± 4.5 days (p = 0.26). Both groups exhibited similar decreases in anxiety and depression from preoperative clinic to 90-days postoperatively, and discharge pain scores averaged below 3/10. Notably, opioid prescriptions were larger than patient-reported consumption (p < 0.001). Qualitative analysis revealed the comfort coach intervention was highly valued, with participants identifying positive themes regarding the role and impact of the coach. These findings suggest that a comfort coach is a valued, novel healthcare role for cardiac surgery patients, and further research should prioritize comprehensive patient-reported outcomes.

Over the last 20 years, dignity and dignity-conserving care have become the center of investigation, in many areas of medicine, including palliative care, oncology, neurology, geriatrics, and psychiatry. We summarized peer-reviewed literature and examined the definition, conceptualization of dignity, potential problems, and suggested interventions. We performed a review utilizing several databases, including the most relevant studies in full journal articles, investigating the problems of dignity in medicine. It emerged that dignity is a multifactorial construct and that dignity-preserving care should be at the center of the health organization. Dignity should be also regularly assessed through the tools currently available in clinical practice. Among dignity intervention, besides dignity models of care, dignity intervention, such as dignity therapy (DT), life review and reminiscence therapy, have a role in maintaining both the extrinsic (preserved when health care professionals treat the patient with respect, meeting physical and emotional needs, honors the patient’s wishes, and makes attempts to maintain privacy and confidentiality) and intrinsic dignity (preserved when the patient has appropriate self-esteem, is able to exercise autonomy and has a sense of hope and meaning). Unified trends across diverse medical contexts highlight the need for a holistic, patient-centered approach in healthcare settings. Challenges compromising dignity are pervasive, underscoring the importance of interventions and systematic efforts to address these issues. Future research and interventions should prioritize the multifaceted nature of dignity, striving to create healthcare environments that foster compassion, respect, and dignity across all medical settings.

Trust is an essential component of medical care. Patients with cancer who are not able to trust a healthcare system, or its clinicians are not able to optimally reach survivorship. Patients who opt for no cancer treatment might not be exercising self-autonomy or expressing personal wishes but rather manifesting distrust or mistrust for cancer care delivery. In modern times, the systems of care that overlay advancing oncologic science and technology pride themselves on expediency and safety but run the risk of becoming transactional and impersonal. This chapter explores the history of trust in medicine, evidence of and potential reasons for its loss, what is truly meant by trust in medicine by evaluating its proper definition, the risk of trust commodification, and that restoration of trust must pay attention to relational components.

Cancer-related lymphedema (CRL) places an already vulnerable patient population at risk for the development and worsening of psychological distress. The purpose of this review is to highlight factors contributing to distress in lymphedema secondary to breast, head and neck, genitourinary cancers, and melanoma and discuss pertinent treatment considerations. Multiple factors contribute to distress in CRL, including changes in body image, sleep, sexuality, functional capacity, and social interaction. There is limited literature describing psychopharmacological considerations in CRL, though exercise, which may be used for the treatment of depression and anxiety, may also improve CRL. Psychiatrists, oncologists, physiatrists, palliative medicine physicians, and physical and occupational therapists should have an awareness and understanding of CRL. To effectively manage distress in these patients, it is crucial to be mindful of psychotropic side-effect profiles, emphasize non-pharmacologic modalities including psychotherapy and exercise, and ensure patients receive evidence-based treatments for CRL.

Through an overview of invasive lobular carcinoma (ILC), this review highlights the unique complexities the diagnosis and treatment of this disease represents, followed by psychological considerations for both patients and providers. Perspectives from members of the multidisciplinary treatment team are included. A cancer diagnosis can be difficult for patients and their families and can also have a significant impact on the treatment team. Prior work related specifically to ILC is limited. Each member of the multidisciplinary team faces unique challenges when treating patients with ILC. This can manifest in a variety of ways and recognizing the complexities specific to this diagnosis can be helpful when considering strategies to mitigate provider burn out and secondary injury. ILC is a variant of breast cancer with a distinct set of diagnostic and treatment challenges. Recognition of patient and provider challenges specific to this diagnosis is important for future research considerations and stress mitigation management strategies.

RIBA: Professor of Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, MI Marcia L. Verduin, MD, Book Editor Overall rating: 5 stars M.B.R. was formerly a series book editor with Dr Bhugra for Springer and Wiley. M.B.R. will be serving as a series book editor with Drs Dinesh Bhugra and Luigi Grassi for a new series for Springer Nature.

BACKGROUND:This epidemiological study described changes in the estimated prevalence of current pharmacological and/or psychotherapy-based treatment utilization among college students with depression only, anxiety only, or comorbid depression & anxiety.METHODS:A sample of 190,500 weighted responses was collected through the 2013-2019 Healthy Minds Study questionnaires. Annual prevalence estimates of depression only, anxiety only, or comorbid depression & anxiety were computed. Current use of therapy, pharmacological services, or dual treatment among students with depression and/or anxiety were examined via descriptive statistics.RESULTS:Estimated prevalence of college students who screened positive for depression only, anxiety only, and comorbid depression & anxiety escalated from 2013 to 2018-2019. When assessed individually, rates of currently using any psychiatric medication, participating in therapy, and engaging in concurrent medication & therapy services significantly rose among students with depression and/or anxiety. However, temporal trends in the current use of specific classes of psychiatric medications among young adults with depression only, anxiety only, or comorbid depression & anxiety differed by medication class.LIMITATIONS:This study was unable to assess psychiatric prescribing practices, depression or anxiety diagnoses, and prior mental health treatment.CONCLUSIONS:An increasing proportion of college students are reporting depression and/or anxiety symptoms as well as pharmacological and/or psychotherapy service utilization when comparing rates from 2013 to 2018-19. Although this may indicate increasing acceptability to disclose and seek treatment for problematic symptomology, continued surveillance of college populations is needed to identify students at risk for adverse psychiatric health outcomes, especially during the coronavirus disease 2019 pandemic.

These NCCN Guidelines for Distress Management discuss the identification and treatment of psychosocial problems in patients with cancer. All patients experience some level of distress associated with a cancer diagnosis and the effects of the disease and its treatment regardless of the stage of disease. Clinically significant levels of distress occur in a subset of patients, and identification and treatment of distress are of utmost importance. The NCCN Distress Management Panel meets at least annually to review comments from reviewers within their institutions, examine relevant new data from publications and abstracts, and reevaluate and update their recommendations. These NCCN Guidelines Insights describe updates to the NCCN Distress Thermometer (DT) and Problem List, and to the treatment algorithms for patients with trauma- and stressor-related disorders.

This chapter offers concrete ideas regarding how to manage the interface between mental/behavioural health and medical care, and a case example of an early screening tool for presymptomatic behaviour disorders in children and adolescents. It reviews the dilemmas encountered with integrated care, distinguish integrated care from collaborative care and note some examples of integrated care from low-income as well as higher-income countries. The chapter presents several examples of specific methods of communication, and a case-study of integration. The value of the model is to organize thinking about integrating medical and mental health care by understanding the needs of the clinic population. An additional way to meet the needs of the population the team is to serve is through conscious selection of the level of collaboration required for that population. The operational view clarifies how someone might function, and determines who does the care as well as when.

Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians’ deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients’ quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.

Purpose of Review Over the last 30 years, medical assistance in dying (MAiD) including euthanasia (EU) and physician-assisted death (or suicide, PAS) has become the center of a large debate, particularly when these practices have involved people with psychiatric illness, including resistant depression, schizophrenia, personality, or other severe psychiatric disorders. We performed a review utilizing several databases, and by including the most relevant studies in full journal articles investigating the problem of MAiD in patients with psychiatric disorders but not in physical terminal conditions (non-terminal, MAiD-NT). Recent Findings Literature has shown that a small percentage of people with psychiatric disorders died by MAiD-NT in comparison with patients with somatic diseases in terminal clinical conditions (e.g., cancer, AIDS). However, the problem in the field is complex and not solved yet as confirmed by the fact that only a few countries (e.g., the Netherlands, Belgium, Luxemburg) have legalized MAiD-NT for patients with psychiatric disorders, while most have maintained the practices accessible only to people with somatic disease in a terminal phase. Also, how to make objective the criterion of irremediability of a mental disorder; how to balance suicide prevention with assisted suicide; how to avoid the risk of progressively including in requests for MAiD-NT vulnerable segments of the population, such as minors, elderly, or people with dementia, in a productive-oriented society, are some of the critical points to be discussed. Summary The application of MAiD-NT in people with psychiatric disorders should be further explored to prevent end-of-life rights from contradicting the principles of recovery-oriented care.

Professor Emeritus and Chair Emeritus of Psychiatry, University of Maryland School of Medicine, Baltimore, Maryland. Send reprint requests to John Talbott, MD, Professor Emeritus and Chair Emeritus of Psychiatry, University of Maryland School of Medicine, 3908 North Charles Street, Unit 101, Baltimore, MD 21218. E-mail: [email protected].

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.