BACKGROUND Minority patients with breast cancer are at risk for undertreatment of cancer-related pain. We evaluated the feasibility and efficacy of an automated pain intervention for improving pain and symptom management of underserved African American and Latina women with breast cancer. METHODS Sixty low-income African American and Latina women with breast cancer and cancer-related pain were enrolled in a pilot study of an automated, telephone-based interactive voice response (IVR) intervention. The intervention group patients were called twice per week by the IVR system and asked to rate the intensity of their pain and other symptoms. The patients’ oncologists received e-mail alerts if reported symptoms were moderate to severe. The patients also reported barriers to pain management and received education regarding any reported obstacles. RESULTS The proportion of women in both groups reporting moderate to severe pain decreased during the study, but the decrease was significantly greater for the intervention group. The IVR intervention was also associated with improvements in other cancer-related symptoms, including sleep disturbance and drowsiness. Although patient adherence to the IVR call schedule was good, the oncologists treating the patients rated the intervention as only somewhat useful for improving symptom management. CONCLUSIONS The IVR intervention reduced pain and symptom severity for underserved minority women with breast cancer. Additional research on technological approaches to symptom management is needed.

Environmental stressors such as mass disasters may contribute to an increased prevalence of depression within the population affected. We examined the prevalence of probable major depression and risk factors for depression in the 6-month period after the September 11, 2001, attacks on the World Trade Center among New York City (NYC) metropolitan residents. A total of 2700 persons who were representative of the NYC metropolitan area were included in this cross-sectional telephone survey. The prevalence of probable major depression in the 6 months after the attacks was 9.4%. Multivariate logistic regression covariates associated with the likelihood of probable major depression included being directly affected by the attacks, having a perievent panic attack, experiencing multiple life stressors, and having been exposed to previous traumatic events. Mass traumatic event exposure appears to be an independent environmental risk factor for depression in the postdisaster context; specific reactions such as perievent panic attacks may have prognostic value.

There is growing concern that the management of persons with psychiatric disabilities after disaster has been inadequate. Unfortunately, the literature is extremely limited, and empirical evidence on the best practices for addressing the needs of persons with psychiatric disabilities after disasters is sparse. A literature search of articles published in 3 widely used databases revealed only 12 articles on the topic. The 12 reviewed articles included persons with psychiatric disabilities after both natural disasters and acts of terrorism, both in close proximity to the disaster site and far away and in 3 different treatment modalities. All of the studies used clinically based samples. The available literature indicated that many persons with psychiatric disabilities demonstrate an ability to handle the stress of a disaster without decompensation from their primary illness. However, the literature also revealed that persons with severe mental illness (SMI) can experience posttraumatic stress disorder (PTSD), depression, anxiety, and illness exacerbation after disaster. There is evidence that persons with SMI can be resilient in the short term when they are enrolled in an assertive community treatment program prior to the disaster; however, the outcomes for people with severe mental illness in other treatment modalities are unclear. Well-designed studies with clinical and population-based samples on disaster reactions of persons with psychiatric disabilities are needed for disaster psychiatrists and emergency planners to develop empirically based treatment guidelines for this population.in the law as state and local governments, any department or other instrumentality of a state or local government, and certain transportation authorities. Emergency services, including state and local emergency operations, cannot legally discriminate against individuals with disabilities (Jones, 2005). One of the most important roles of local government is to protect its citizenry from harm, including helping people prepare for and respond to emergencies (Jones, 2005). Making local government emergency preparedness programs accessible to people with disabilities is a critical part of this responsibility and is also required by the ADA (Jones, 2005). Therefore, it is necessary for state and local governments to include adequate response and recovery plans for the psychiatrically disabled population in their emergency planning. The first step in developing proper disaster treatment and response protocols is a thorough assessment of the unique needs and responses of this population during times of disasters.One way to operationalize the term psychiatric disability is to use a benchmark of severity known as severe mental ill-

No abstract

Acute intermittent porphyria (AIP) is an autosomal dominant genetic defect in heme synthesis. Patients with this illness can have episodic life-threatening attacks characterized by abdominal pain, neurological deficits, and psychiatric symptoms. Feigning this illness has not been reported in the English language literature to date. Here, we report on a patient who presented to the hospital with an acute attack of porphyria requesting opiates. Diligent assessment of extensive prior treatment records revealed thirteen negative tests for AIP.