Ruth M. Lamdan

Psychological adjustment among African American breast cancer patients: One-year follow-up results of a randomized psychoeducational group intervention.

The effectiveness of support group interventions for cancer patients has been established among White patients but has been virtually unstudied among minority patients. The current study represents the 1st randomized support group intervention targeted to African American women with breast cancer. Participants (N = 73) with nonmetastatic breast cancer were randomly assigned to an 8-week group intervention or an assessment-only control condition At 12 months, the intervention resulted in improved mood as well as improved general and cancer-specific psychological functioning among women with greater baseline distress or lower income. Subsequent research is needed to address effective methods of enrolling and following women with fewer psychosocial and financial resources, as they were the most likely to benefit from this particular intervention.

Optimism, Social Support, and Adjustment in African American Women with Breast Cancer

Past studies show that optimism and social support are associated with better adjustment following breast cancer treatment. Most studies have examined these relationships in predominantly non-Hispanic White samples. The present study included 77 African American women treated for nonmetastatic breast cancer. Women completed measures of optimism, social support, and adjustment within 10-months of surgical treatment. In contrast to past studies, social support did not mediate the relationship between optimism and adjustment in this sample. Instead, social support was a moderator of the optimism-adjustment relationship, as it buffered the negative impact of low optimism on psychological distress, well-being, and psychosocial functioning. Women with high levels of social support experienced better adjustment even when optimism was low. In contrast, among women with high levels of optimism, increasing social support did not provide an added benefit. These data suggest that perceived social support is an important resource for women with low optimism.

The role of patient-provider communication for black women making decisions about breast cancer treatment.

Objective: Recent reports suggest that Black breast cancer patients receive adjuvant therapies less often than their White counterparts; however, few studies have examined the self‐reported experiences of Black breast cancer patients making treatment decisions. This study examined cultural beliefs and healthcare factors that impacted Black womens treatment decisions.

What, Why, and How of Consultation-Liaison Psychiatry: An Analysis of the Consultation Process in the 1990s at Five Urban Teaching Hospitals

There is controversy about the role and function of a consultation-liaison (C-L) psychiatrist, as reflected in the ongoing debate about what to call ourselves. To clarify the essential elements of our function, the authors analyzed the process and content of the entire consultation experience from the time of initial consultation to the time of discharge in 50 patients across 5 urban teaching hospitals. The common components of the C-L process, in this pilot study, were identified to be facilitative, consensus-seeking, and interpretative. Implications of these findings for the C-L psychiatrists role in the general hospital are discussed.

The Chief Resident for Education: Description of a Novel Academic Teaching Position

Received December 13, 2007; revised October 23, 2008; accepted November 3, 2008. Drs. Ning and Lamdan are affiliated with the Department of Psychiatry and Behavioral Science at Temple University, School of Medicine in Philadelphia; Dr. Gottlieb is affiliated with the Department of Psychiatry at Drexel University College of Medicine in Philadelphia. Address correspondence to Ruth M. Lamdan, Temple University, School of Medicine, Psychiatry and Behavioral Science, TUH-Episcopal Campus, 100 E. Lehigh Ave., Philadelphia, PA 19125; rlamdan@temple.edu (e-mail). Copyright 2009 Academic Psychiatry “An academical system without the personal influence of teachers upon pupils is an Arctic winter.” Attributed to Sir William Osler

Caregiver Status: A Potential Risk Factor for Extreme Self-Neglect

BACKGROUND Family caregivers are known to be at risk for physical illness and emotional distress caused by the extreme demands of the caregiving task. OBJECTIVE The authors present the case of a middle-aged, well-educated woman with advanced endometrial cancer, the symptoms of which she had ignored over an extended period of time because of her family obligations. METHOD The patient was treated with systemic chemotherapy and was evaluated for depression and subsequent delirium. RESULTS The patient was informed about her poor prognosis and was transferred to a skilled nursing facility. DISCUSSION The authors conclude that the caretaking responsibility, along with a low-grade depression, contributed to her delayed presentation and treatment.

Funding for Consultation-Liaison Services in Public Sector-Managed Care Plans:The Experience of the Consultation-Liaison Association of Philadelphia

Recently, the Commonwealth of Pennsylvania initiated plans to implement a mandated behavioral health carve-out program for Medicaid-eligible persons. The Consultation-Liaison Association of Philadelphia (CLAP) discovered that there was no provision for the coverage of psychiatric services for patients with concomitant medical illness. As a result, the authors responded by initiating a series of actions aimed at ensuring inclusion of such services as part of mental health services to be delivered. CLAP developed a brief position paper that includes a description of the need for such services, the types of services typically delivered, the impact of psychiatric input in the medical setting on costs and other outcomes, and a specific set of recommendations. These efforts have lead to the inclusion of consultation-liaison services in the new plan. A description of recent changes in Medicaid, including expansion of managed care plans, the status of mental health carve outs, and the possibility for inclusion of psychiatric consultations for the medically ill within these plans, is detailed.

Supervising the Supervisors: A Case-Based Group Forum for Faculty Development

ObjectiveFaculty development has increasingly become a focus in medical education. Many models are employed around the United States. The authors present a group model process developed to train new educators to teach our medical students.MethodsThe authors met monthly with a diverse faculty over the past 4 years and interacted in a nonhierarchal manner. The authors reviewed the literature, supervised one another, and developed a participatory method of solving educational and administrative problems.ResultsWhat emerged was a “case-based,” collaborative group format to develop an educational philosophy address challenging supervisory problems, develop tangible educational materials and “products” and promote academic careers.ConclusionThe authors propose this model for faculty development.