Cancer is the leading cause of disease-related death for adolescents and young adults (AYAs) in the United States. Parents of AYAs with life-threatening illnesses have expressed the desire to talk to their children about end of life (EOL) care, yet, like caregivers of adult patients, struggle to initiate this conversation. Building Evidence for Effective Palliative/End of Life Care for Teens with Cancer is a longitudinal, randomized, controlled, single-blinded clinical trial aimed at evaluating the efficacy of FAmily CEntered disease-specific advance care planning (ACP) for teens with cancer (FACE-TC). A total of 130 dyads (260 subjects) composed of AYAs 14–20 years old with cancer and their family decision maker (>18 years old) will be recruited from pediatric oncology programs at Akron Children’s Hospital and St. Jude Children’s Research Hospital. Dyads will be randomized to either the FACE-TC intervention or Treatment as Usual (TAU) control. FACE-TC intervention dyads will complete three 60-minute ACP sessions held at weekly intervals. Follow-up data will be collected at 3, 6, 12, and 18 months post-intervention by a blinded research assistant (RA). The effects of FACE-TC on patient-family congruence in treatment preferences, quality of life (QOL), and advance directive completion will be analyzed. FACE-TC is an evidenced-based and patient-centered intervention that considers QOL and EOL care according to the AYA’s representation of illness. The family is involved in the ACP process to facilitate shared decision making, increase understanding of the AYA’s preferences, and make a commitment to honor the AYA’s wishes.

Objectives: To describe the prevalence of psychiatric morbidity and the treatment needs of new committals to Irish prisons.Methods: A population survey of 615 prisoners representing 7.9% of male committals to Irish prisons in the year of survey, 313 remands (9.6% of total remand committals) and 302 sentenced committals (6.4% of total sentenced committals). The main outcome measures were ICD-10 diagnoses of mental disorder based on interviews using SADS-L and prison medical records.Results: Current prevalence rates of any psychotic illness were 3.8% (remand) and 0.3% (sentenced), six month prevalence rate 5.1% (remand) and 2.6% (sentenced) and lifetime rate 9.3% (remand) and 6.6% (sentenced). Schizophrenia and drug/organic psychoses were the most common psychoses. Major depressive disorder had a current prevalence of 4.5% (remand) and 4.6% (sentenced), a six month prevalence of 4.8% (remand) and 6.0% (sentenced), and a lifetime prevalence of 8.6% (remand) and 15.9% (sentenced). Sixty-point-six per cent of the sample had a current substance misuse problem.Conclusions: There is significant psychiatric morbidity in committal prisoners.

Objectives: To estimate the prevalence of psychiatric morbidity, substance misuse problems and related health and social problems among women prisoners newly committed and a cross-section remanded and sentenced in the Irish prison population. In 2002 women represented 10.7% (1043) of all persons committed to the Irish Prison system, and 3.3% (104) of the daily average number of persons in custody. We surveyed psychiatric morbidity in these two groups to assess the need for psychiatric services for women prisoners, and to compare Irish morbidity with an international average.Method: We interviewed 94 newly committed women prisoners within 72 hours of committal, representing approximately 9% of female committals per year. We also interviewed a cross sectional sample of 92 women, representing approximately 90% of all women in custody. Mental illness and substance misuse was measured using the SADS-L, SODQ and a structured interview.Results: Five (5.4%) of the committal and 5 (5.4%) of the cross-sectional sample had a psychotic illness within the previous six months. 8 (8.5%) of the committals and 15 (16.3%) of the women in the cross-sectional sample had a major depressive disorder in the last six months. 8 (8.6%) committals and 14 (15.2%) in the cross-sectional sample had an anxiety disorder within the last six months. 61 (65.6%) of the women interviewed at committal and 61 (65.2%) of the cross-sectional sample had a substance misuse problem in the last six months.Conclusions: There is a high prevalence of mental illness and substance misuse problems amongst women newly committed to prison and in a cross section of those remanded or sentenced in prison in Ireland. We found evidence of a cycle of deprivation and institutionalisation. These findings highlight the need for the integration of community and forensic psychiatric services, and for ongoing collaboration with drug services.

Objectives: To estimate the psychiatric service requirements for the remand population.Method: We interviewed 232 (42.6%) men, a representative sample of men on remand, using the SADS-L, SODQ and a structured demographic interview.Results: We found high rates of psychiatric morbidity in our sample. The six month prevalence of psychosis was 7.6%, almost twice the rate in a recent international meta-analysis. Major depressive disorder was present in 10.1% (six month prevalence). Substance misuse problems were also common but there was no significant difference between rates of substance misuse in psychotic and nonpsychotic prisoners. A total of 31.2% had a lifetime history of any mental illness (excluding substance misuse, adjustment disorder and personality disorder).Conclusions: The high levels of psychiatric morbidity detected in our sample indicate a substantial unmet need for mental health services and addiction treatment services for the mentally ill in Irish prisons.

AbstractBackground and purposeThe Fear-Avoidance Model of Chronic Pain proposed by Vlaeyen and Linton states individuals enter a cycle of chronic pain due to predisposing psychological factors, such as negative affectivity, negative appraisal or anxiety sensitivity. They do not, however, address the closely related concept of anxious rumination. Although Vlaeyen and Linton suggest cognitive-behavioral treatment methods for chronic pain patients who exhibit pain-related fear, they do not consider mindfulness treatments. This cross-sectional study investigated the relationship between chronic musculoskeletal pain (CMP), ruminative anxiety and mindfulness to determine if (1) ruminative anxiety is a risk factor for developing chronic pain and (2) mindfulness is a potential treatment for breaking the cycle of chronic pain.MethodsMiddle-aged adults ages 35-50 years (N = 201) with self-reported CMP were recruited online. Participants completed standardized questionnaires assessing elements of chronic pain, anxiety, and mindfulness.ResultsRuminative anxiety was positively correlated with pain catastrophizing, pain-related fear and avoidance, pain interference, and pain severity but negatively correlated with mindfulness. High ruminative anxiety level predicted significantly higher elements of chronic pain and significantly lower level of mindfulness. Mindfulness significantly predicted variance (R2) in chronic pain and anxiety outcomes. Pain severity, ruminative anxiety, pain catastrophizing, pain-related fear and avoidance, and mindfulness significantly predicted 70.0% of the variance in pain interference, with pain severity, ruminative anxiety and mindfulness being unique predictors.ConclusionsThe present study provides insight into the strength and direction of the relationships between ruminative anxiety, mindfulness and chronic pain in a CMP population, demonstrating the unique associations between specific mindfulness factors and chronic pain elements.ImplicationsIt is possible that ruminative anxiety and mindfulness should be added into the Fear-Avoidance Model of Chronic Pain, with ruminative anxiety as a psychological vulnerability and mindfulness as an effective treatment strategy that breaks the cycle of chronic pain. This updated Fear-Avoidance Model should be explored further to determine the specific mechanism of mindfulness on chronic pain and anxiety and which of the five facets of mindfulness are most important to clinical improvements. This could help clinicians develop individualized mindfulness treatment plans for chronic pain patients.