bluuebunny/crossref_metadata_2025 huggingface dataset:
Gastrointestinal disease in the older population
Authors: Carrión Silvia , Clavé Pere
Published: December 2017

Gastrointestinal (GI) symptoms and disorders are common, affecting over a third of people aged 65+. Clinical management is often complicated by co-existing cognitive and mood disorders, multimorbidity, polypharmacy, and frailty. The prevalence of oropharyngeal and upper oesophageal motility disorders, gastrointestinal motility, and immunity alterations, colonic adenomas, and GI tract cancers increase with age. Many GI functions are preserved in healthy older age, but may be altered by environmental/lifestyle exposures including drugs and toxic habits and frailty. This chapter complements others which deal with some of the common GI related issues affecting older people: epidemiology of malnutrition; anorexia of ageing; oral health and disease; malabsorption; faecal incontinence and constipation.
Endocrinology of ageing
Authors: McKee Alexis , Morley John E.
Published: December 2017

Attempts to stave off ageing through a search for the fountain of eternal youth date back to biblical stories where the Garden of Eden was said to contain the river of immortality. Ageing is a multifaceted process with physiological, psychological, and societal impact. Life expectancy continues to increase globally. Thus it is relevant for physicians to discern between physiological and pathological hormonal changes associated with ageing. Diagnosing endocrine disorders in older people is challenging because the symptoms of endocrine disease often imitate normal physiological changes with ageing and because of the effect of polypharmacy on hormone levels. This chapter will serve as a guide for the diagnosis and treatment of endocrine disorders in this population.
Why, when, and where do older people die?
Authors: Prsic Elizabeth H. , Teno Joan M.
Published: December 2017

The demographics of death among older persons have changed markedly over the past century. Individuals are living longer, but gains in life expectancy differ significantly between low-, middle-, and high-income countries. While individuals would previously succumb to infectious disease after a brief illness, older persons often suffer long periods of morbidity at the end of life in the setting of chronic, non-communicable diseases. With increased care needs at the end of life, older persons are more likely to die in an institutional setting, despite preferences for death at home. While site of death has been proposed as a quality metric, it captures only one aspect of the trajectory of end-of-life care. This chapter explores various aspects of death among older persons, and places the subject in a larger geographic, medical, and socioeconomic context.
Prognostication and recognition of dying
Authors: Forte Viviana , Gambassi Giovanni
Published: December 2017

Prognosis is the science of evaluating what is like to happen in term of health outcomes (recovery, death, disability) related to a patient’s condition (cancer, chronic disease, accident). Estimating the likelihood of a life-threatening illness becomes crucial, especially among older people. It allows us to balance the benefits and burdens of diagnostic tests and treatments, to plan with the patient and family by their values, and to take care of physical, psychological, and social suffering when the disease is incurable. Validated prognostication tools are available for cancer, chronic conditions, and advanced dementia to help decision-making in the terminal phase of illness. Recognition of dying and care during the last days/hours of life should be a core competency of every physician. When a patient is actively dying, common signs tend to be present and if symptoms are not well controlled, the dying process may be prolonged and the patient may suffer unnecessarily.
Optimizing cognition in older adults: lifestyle factors, neuroplasticity, and cognitive reserve
Authors: Berardi Nicoletta , Sale Alessandro , Maffei Lamberto
Published: December 2017

Cognitive decline with age shows strong interindividual variance. Several epidemiological studies have shown that some of the factors associated with maintaining a good cognitive performance with age are lifestyle factors, such as practising physical activity and being engaged in cognively stimulating activities, which are potentially modifiable even in old age. In parallel, studies in animal models have shown that physical exercise and environmental stimulation result in better cognitive performance, potentiation of neural plasticity, neuroprotection. More recently, intervention studies in humans begin to show that training based on cognitive or physical activity enhance cognitive performance in older adults. At the core of lifestyle effects on cognitive ageing is neural plasticity and the action of multiple molecular factors which translate physical and cognitive activity into adaptive and protective changes in the brain, allowing elders to better face ageing-related cognitive changes.
Introduction to medical mycology
Authors: Warnock David W.
Published: December 2017

The pattern of fungal diseases has changed with the emergence of new pathogens and the resurgence of old ones. Many factors have contributed to this, including medical progress, environmental changes, and the development of drug resistance. The impact of these diseases on human health is not widely recognized, largely because of the many gaps in epidemiological surveillance data. Access to affordable diagnostics and antifungal drugs are critical issues in the developing world. New approaches to prevention and control will be needed if we are to reduce the substantial global burden of ill health and death due to fungal diseases.
Fungal taxonomy and nomenclature
Authors: Borman Andrew M.
Published: December 2017

This chapter summarizes historical and modern approaches to fungal taxonomy, the current taxonomic standing of medically important fungi, and the implications for fungal nomenclature following the recent Amsterdam Declaration on Fungal Nomenclature, which prohibits dual nomenclature. Fungi comprise an entire kingdom, containing an estimated 1–10 million species. Traditionally, fungal identification was based on examination of morphological and phenotypic features, including the type of sexual spores they form, and method of formation, and structural features of their asexual spores. Thus, many fungi have been described and named independently several times based on either their sexual or asexual stages, resulting in a single genetic entity having multiple names. Recent molecular approaches to fungal identification have led to profound changes in fungal nomenclature and taxonomy. Certain phyla have now been disbanded, cryptic species have been identified via molecular approaches, and long-recognized species have been transferred to new genera based on genotypic comparisons.
Fungal genetics
Authors: Dyer Paul S. , Munro Carol A , Bradshaw Rosie E.
Published: December 2017

Fungi have been long used as model organisms to investigate genetic and cellular processes. An overview is provided of how fungi function at a genetic level, including ploidy, gene structure, and gene flow by sexual and asexual processes. The tools used to study fungal genetics are then described, such techniques having widespread applications in medical mycology research. Classical genetic analysis includes the use of gene mapping by sexual crossing and tetrad analysis, and forward genetic experimentation based on mutagenesis, for which various mutant screening approaches are described. Molecular genetic analysis includes gene manipulation by transformation; different methods for gene knockout and targeting, and their application for forward and reverse genetic approaches, are outlined. Finally, molecular genetic methods used to study gene expression and function are reviewed, including use of inducible or constitutive overexpression, real-time PCR, cellular localization of gene products by fluorescent tagging, and detection of protein–protein interactions.
Fungal genomics and transcriptomics
Authors: Munro Carol A. , Wilson Duncan
Published: December 2017

The advent of whole-genome sequencing has resulted in a range of platforms for large-scale analysis of the DNA (genomics), RNA (transcriptomics), protein (proteomics), and metabolite (metabolomics) content of cells. These inclusive ‘omics’ approaches have allowed for unparalleled insights into fungal biology. In this chapter we will discuss how genomics and transcriptomics have been used to broaden our understanding of the biology of human pathogenic fungi and their interactions with their hosts.
Aspergillus species
Authors: Smith Stephanie J. , Manuel Rohini J. , Kibbler Christopher C.
Published: December 2017

There are more than 200 Aspergillus species, with over 30 known to be human pathogens. The fungus is also commercially important. Aspergillus niger is the source of enzymes such as amylases, lipases, and proteases and is used to produce the majority of the world’s citric acid. Diseases caused by Aspergillus species can vary widely, from superficial colonization to invasive and allergic disease. Mortality from invasive disease remains high, despite an increase in the number of antifungals available for therapy. Azole resistance is increasing, especially in Europe, and appears to be related to the use of azoles for agriculture.
Other yeasts
Authors: Linton Chris , Howell Susan
Published: December 2017

The yeasts described in this chapter are, in general, rare causes of serious human infection. Many are commonly found in the environment or as human commensals. The chapter provides a very brief summary of the following six yeast genera: Malassezia, Rhodotorula, Saccharomyces, Saprochaete, Sporobolomyces, and Trichosporon. Current taxonomy and significant species are also discussed although many fungal taxonomic groups are being re-evaluated in the light of DNA sequencing data, resulting in the renaming of some species and the regrouping of others. Pathogenicity, epidemiology, and clinical aspects are included, and treatment options are discussed. However, as infections caused by these yeasts are uncommon, there is sometimes a lack of supporting data. Culture and identification methods are also summarized, details of which will be presented in other chapters
Endemic dimorphic fungi
Authors: Restrepo Angela , Gónzalez Angel A. , Gómez Beatriz L.
Published: December 2017

Endemic dimorphic infections are acquired by inhalation of fungal spores which undergo a thermal transition to a yeast-like phase in the host. The causative organisms are geographically restricted and are isolated from the environment; likewise, the infections are associated with people living in, or visiting, these endemic regions. The clinical presentations range from asymptomatic to chronic, and disseminated, depending on the host immune status and other risk factors. The infections and their causative agents are: histoplasmosis (Histoplasma capsulatum), paracoccidioidomycosis (Paracoccidioides brasiliensis/lutzii), blastomycosis (Blastomyces dermatitidis/gilchristii), coccidioidomycosis (Coccidioides immitis/posadasii), talaromycosis (previously penicilliosis; Talaromyces [Penicillium] marneffei), and emmonsiosis (Emmonsia species). Diagnosis relies on microscopy and culture, histology, and immunological detection. Owing to their infectious nature, all of these organisms must be handled using biosafety level-3 containment. Treatment is based around azole administration, usually itraconazole, with amphotericin B for the more severe forms or for the most at risk patients.
Fungal disease in cystic fibrosis and chronic respiratory disorders
Authors: Kosmidis Chris , Denning David W. , Muldoon Eavan G.
Published: December 2017

A range of fungal disease syndromes affect patients with chronic respiratory diseases and cystic fibrosis (CF). Invasive aspergillosis is increasingly recognized in seriously ill patients with chronic obstructive pulmonary disease, especially after high-dose steroids. Chronic pulmonary aspergillosis affects patients with pre-existing cavities or bullae, such as those with previous tuberculosis or atypical mycobacterial disease, bullous emphysema, sarcoidosis, pneumothorax, or treated lung cancer. In addition, fungi have become one of the most important trigger agents for asthma, and allergic bronchopulmonary aspergillosis may complicate up to 3.5% of cases of asthma and up to 15% of cases of CF, starting in childhood. CF patients are commonly colonized with fungal organisms, although the impact of such colonization on outcome is not clear. Aspergillus is the most common mould isolated from CF patients. Distinguishing between colonization and infection remains challenging. Candida is thought to be of no clinical significance; however, it has been associated with decline in lung function.
Antifungal treatment guidelines
Authors: Cottom Laura , Jones Brian L.
Published: December 2017

The management of invasive fungal infection remains challenging. Given the ever-expanding body of published data and advances to scientific knowledge and technology, clinical guidance plays a greater role in supporting clinicians in making patient-centred treatment decisions, and it is essential that the guidance has been subject to rigorous scrutiny to ensure that the recommendations are based upon sound evidence. Numerous guidelines on the treatment of invasive fungal infection are available; however, differences in their recommendations exist. The relative paucity of high-quality trials is a likely contributing factor, and analysis and interpretation of clinical data have also led to conflicting conclusions. The differences in guideline remit and methodology often make direct comparison of guidance impractical. The chapter aims to present and evaluate the main recommendations set out in the Infectious Diseases Society of America (IDSA) and European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines.
Men in White Coats
Authors: Szmukler George
Published: December 2017

The book examines medical treatment under coercion and its justifications. Psychiatry springs to mind as most associated with coercion. Here, the fundamental criteria governing detention and involuntary treatment have remained fundamentally unchanged for over two centuries—first, the person has a ‘mental disorder’, largely undefined; and second, there is a risk of significant harm to the person or to others. Major problems attach to these criteria allowing a large degree of arbitrariness in the use of compulsion. Furthermore, when set against the huge shift over the past 50 years from ‘paternalism’ to patient ‘autonomy’ in general medicine, it becomes clear that conventional mental health law discriminates against people with ‘mental disorders’. Involuntary treatment is governed by entirely different principles. Patient ‘autonomy’ is not accorded the same respect in mental health care, while the ‘protection of others’ justification, based on ‘risk’ not offences, constitutes a discriminatory form of preventive detention reserved for people with ‘mental disorders’. A solution is proposed—a generic law, applicable across all medical specialties and settings. This ‘Fusion Law’ draws on the strengths of both ‘capacity-based’ and civil commitment models. The relationships of ‘capacity’ and ‘best interests’ to a person’s ‘beliefs and values’ (or ‘will and preferences’) are elucidated in order to examine the ‘Fusion Law’ against the standards set by the United Nations Convention on the Rights of Persons with Disabilities. ‘Coercion’ short of compulsion is then considered, as are the implications of the ‘Fusion Law’ for the forensic domain, general hospital practice, involuntary outpatient treatment, and ‘advance directives’.
The conventional grounds for involuntary treatment are highly problematic
Authors: Szmukler George
Published: December 2017

Substantial problems attach to both of the fundamental criteria that need to be met for involuntary treatment in conventional mental health legislation—the presence of a ‘mental disorder’ and a risk of harm to self or others. The boundaries of ‘mental disorder’ are of necessity loosely drawn, with substantial blurring at the edges and contested views about where these should lie. ‘Values’—for example, when does ‘sadness’ become a ‘depressive illness’—play a significant role in determining when a diagnosis of a ‘disorder’ is warranted. Precision in the assessment of ‘risk’ is poor, especially for those infrequent or rare harms that we are most concerned to prevent. In general psychiatric practice, the prediction of suicide or serious acts of violence to others is of severely limited value. Even with ‘state-of-the-art’ risk assessment measures, ‘false positives’ overwhelm ‘true positives’. Significant costs attach to an emphasis on risk assessment.
Where does this take us?
Authors: Szmukler George
Published: December 2017

The final chapter summarizes the arguments leading to the conclusion that conventional mental health law is discriminatory and that action is now required to remedy this unacceptable situation. The reasons for a ‘Fusion Law’ are reviewed. What prospects the future might hold for reform are considered. Two major currents in mental health policy that are in conflict are noted—the empowerment of, and giving a ‘voice’ to, persons with mental illness, on the one hand; and, the attempts to reduce ‘risk’, especially to others, on the other. The prospects for mental health law reform will depend on which will be the stronger. The UN Convention on the Rights of Persons with Disabilities as well as the introduction of capacity-based criteria in recent mental health laws in some countries offer promise. The passing of a generic, fusion-based law in Northern Ireland in 2016 is especially noteworthy.
Neuroimaging and Geriatric Forensic Psychiatry
Authors: Glen Tannahill , Simpson Joseph , Lamar Melissa , Wambach Denene M. , Wortzel Hal S.
Published: December 2017

Advances in structural and functional neuroimaging have resulted in significant clinical utility, especially in geriatric neuropsychiatry. However, in the absence of clinical correlation with cognitive, behavioral, and emotional impairment and functional disability, neuroimaging evidence is not sufficient for diagnosis of neurodegenerative conditions. This is especially true in the medicolegal environment. This chapter summarizes recent developments in neuroimaging for the most common geriatric neuropsychiatric conditions, including Alzheimer’s disease, vascular dementia, and frontotemporal dementia, and describes limitations in applying those findings to single-subject clinical formulations in the forensic arena. Applications of neuroimaging in the medicolegal geriatric setting are explored.
Assessment and Counseling of Older Drivers
Authors: Meuser Thomas M. , Carr David B.
Published: December 2017

Driving a motor vehicle is an important instrumental activity of daily living and thus a target for health-related assessment and assistance. Most older drivers self-regulate in response to changes in medical and functional status. A minority may not recognize the impact of such changes on driving (e.g., in dementia) and so may continue driving when no longer safe to do so, despite warning signs. When evaluating driver fitness, clinicians must weigh individual rights of autonomy and choice against objective findings of deficits and broader safety considerations. Driver evaluation requires a sensitive, individualized approach that also takes daily-life mobility into account. This chapter discusses driver fitness evaluation in the context of patient-centered care and resources to support patients in the transition in mobility from driving to not driving.
Neurostimulation Therapies, Side Effects, Risks, and Benefits
Authors: Gad Heba , Bateman Daniel , Holtzheimer Paul E.
Published: December 2017

Neurostimulation therapies are an alternative for non-responders to pharmacological or psychotherapy management, as well as when first-line treatments are contraindicated for treatment of neuropsychiatric disorders in the elderly. Brain stimulation treatments for neuropsychiatric disorders include the following FDA approved treatments for major depressive disorder: electroconvulsive therapy (ECT), which remains one of the most effective therapies for several neuropsychiatric disorders; repetitive transcranial magnetic stimulation (rTMS); and vagus nerve stimulation (VNS). Deep brain stimulation (DBS);magnetic seizure therapy (MST); transcranial direct-current stimulation (tDCS); and direct cortical stimulation (DCS) are not currently FDA approved. These techniques are reviewed in this chapter with special attention to their application in older adults. Medicolegal issues of informed consent and substituted decisions for procedures are also discussed.
Medical Legal Issues in Psychiatric Home Care and Telemental Health
Authors: Kohn Robert , Sheeran Thomas , Duni-Briggs Suzanne
Published: December 2017

Many elderly persons who reside in the community have the same degree of physical disability as those in nursing homes. Issues regarding autonomy and appropriateness of living independently, confidentiality, limitation of services provided, refusal of treatment, and physician safety often need to be addressed in home visits. Telemental health may help bridge the provider gap and is evolving as a service and field. Telemental health can take a variety of forms, including in-home monitoring, Internet and telephone psychotherapy, and videoconferencing. In telemental health there are ethical and forensic issues beyond those encountered in the home visit that clinicians may encounter. This chapter addresses these and medical-legal issues related to telemental health, including licensing and credentialing, malpractice and standard of care, informed consent, confidentiality, and the patient–physician relationship. Standards and guidelines have been established for telemedicine, including home healthcare and video-based online mental health services. These guidelines involve administrative core, technical core, clinical core, and implementation standards.
Evaluation of Elderly Persons in the Criminal Justice System
Authors: Frierson Richard L. , Srinivasan Shilpa
Published: December 2017

The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral symptoms can impair a defendant’s understanding of the legal system or their ability to work effectively with an attorney in the preparation of a defense. Therefore, assessments of capacity to stand trial may require special attention to the mental health conditions and symptoms more commonly seen in elderly persons, and the evaluation process may require modification to accurately assess this population and to rule out malingering. Unique challenges are also encountered in the evaluation of elderly defendants for criminal responsibility and in presentencing evaluations. This chapter provides an overview of these challenges and strategies to promote accurate evaluation of the elderly defendant.
The Elderly Sex Offender
Authors: Stewart Hannah , Fedoroff J. Paul
Published: December 2017

This chapter reviews the topic of problematic sexual behaviors committed by elderly men and women. Given the dearth of research done on problematic sexual behaviors in older people, references in this chapter include studies involving people as young as 55. Age-relevant findings regarding criminal sex offenses committed by elderly sex offenders and recidivism are considered along with aspects of this population that are similar to and different from younger men and women. Important ethical and sexual boundaries and their implications are discussed. Patterns of sexual offenses committed by elderly offenders against children are reviewed. Specific risk factors, particularly the role of cognitive impairment and psychiatric illness, are identified and described. Approaches to assessment and treatment are also presented. The chapter concludes with suggestions for future research.
Sociopathy, Antisocial Personality, and Directed Aggression in the Geriatric Population
Authors: Zurek Olivia , Stanton Laura , Kohn Robert
Published: December 2017

Elderly persons are not often thought of as being associated with criminal activity. Among the elderly for both genders, however, the percentage of persons arrested in the United States for violent crimes increased significantly from 1995 to 2013, this increase being due to more aggravated assault arrests. Epidemiological studies on antisocial personality disorder and FBI crime statistics provide an understanding of sociopathy and directed aggression in the geriatric population. This chapter addresses the risk factors for violent behavior among elderly persons and provides U.S. crime data for persons age 65 and older, presented by type of crime and by gender and race of perpetrators. The act of homicide among elderly persons is given particular attention. The chapter also discusses the role of dementia in crimes committed by elderly persons, as a sizable proportion of persons with dementia take part in criminal activity, particularly theft, although rates differ according to type of neurocognitive disorder.
Violence and Aggression in the Elderly
Authors: Surti Ghulam Mustafa , Stanton Laura , Kohn Robert
Published: December 2017

In nursing homes, aggression is seen in almost 32% of residents. Often, there are medical causes associated with delirium to account for such aggressive behaviors. This chapter discusses the incidence of and issues related to resident-to-staff and resident-to-resident aggression involving patients with major neurocognitive disorders in long-term care settings. Often such aggression results in physical injuries to staff. Resident-to-staff aggression most commonly occurs during direct caregiving. Resident-to-resident assault is not uncommon and has been categorized into 13 major subtypes. Use of physical restraint and pharmacological interventions in response to agitation and aggression in nursing homes carries liability due to risk of injury. The chapter also addresses sexuality of elderly nursing home residents, federal regulations mandating the allowance of expression of sexual needs of residents, and barriers that can impede expression of sexuality by residents. The chapter concludes with a discussion of elder-to-caregiver aggression in the community, including violent behavior toward family and caregivers employed by home healthcare agencies.
Cultural Issues in Geriatric Forensic Psychiatry
Authors: Lee Bandy X. , Lee Grace
Published: December 2017

Cultural competence is an essential skill for the geriatric forensic psychiatrist. Much of psychiatry and the law is “culture-bound,” favoring individual-centered analyses over consideration of social and cultural context. While this has worked reasonably well for relatively homogeneous, dominant cultures within Western (i.e., North American or European) societies, it is growing less viable as populations grow more pluralistic with widely variable means of organizing the world and their place in it. Furthermore, not only does culture shape meaning and significance for the individual, it determines the causes, manifestations, and final course of many major psychiatric disorders. Therefore, in order properly to assess a person’s state of mind in competency or criminal responsibility cases, to evaluate the likelihood of restorability, to explain mitigating factors, or to gauge the appropriateness of treatment programs, cultural considerations must come into play. This chapter discusses the elements of cultural competence and its practice, through case vignettes, and how this can translate into choice and resilience for the client, especially the elderly individual.
The Evolving Role of Psychiatry in Physician-Assisted Dying and Euthanasia
Authors: Wilkins James M. , Malin Maureen A. , Kohn Robert
Published: December 2017

Physician-assisted dying and euthanasia are last-resort options for patients with unbearable suffering. In the United States, physician-assisted dying is legal in a few states and reserved for individuals with terminal medical illness. Elderly patients are disproportionately represented among those who seek physician-assisted dying and euthanasia. Psychiatric referrals are rarely made and are not mandatory in the evaluation for physician-assisted dying or euthanasia. These practices raise issues regarding capacity and mental illness, such as depression and major neurocognitive disorders, as psychiatric evaluations appear to be underutilized. A crucial issue in the mental health assessment is whether decision-making capacity can be reliably assessed in the presence of mental illness, as up to 25% of individuals seeking physician-assisted dying may have depression. Psychiatrists are uniquely equipped to participate in the palliation of suffering, particularly emotional suffering, which is often present in those seeking physician-assisted dying and euthanasia. This chapter discusses the psychiatrist’s role in the evolving issue of assisted dying and euthanasia.
The Aging Physician and Other Professionals
Authors: Price Marilyn , Meyer Donald J.
Published: December 2017

Capacity to practice ones’ profession safely and effectively may become an issue as physicians or other professionals age. While this chapter will focus primarily on the psychiatric assessment of the aging physician, impairment due to illness in persons employed in other healthcare positions, the military, aviation, the judicial system, and law enforcement present similar public safety concerns. The assessment of a physician is used as a model for the evaluation of these other professionals. The role of the state physician’s health committees and physician competency committees in arranging for assessment, support, and monitoring of the impaired aging physician is discussed. Also discussed are mandatory screening and reporting regarding fitness for duty.
Segregation, Stigma, and Stratification: A Biosocial Model
Authors: Massey Douglas S. , Wagner Brandon
Published: December 2017

This chapter reviews research on segregation’s effect in generating concentrated poverty and stigma, and it explores the biological consequences of exposure to these conditions for health and socioeconomic status. High levels of segregation interact with high levels of poverty to produce concentrated poverty for African Americans and Hispanics in many metropolitan areas. In addition to objective circumstances of deprivation, the concentration of poverty also brings about the stigmatization of the segregated group. The differential exposure of Blacks and Hispanics to concentrated neighborhood disadvantage and its correlates, in turn, functions to shorten telomeres, increase allostatic load, and alter gene expression in deleterious ways. In so doing, it compromises health and cognitive ability, the two critical components of human capital formation, thus systematically undermining the socioeconomic prospects of African Americans and Hispanics in today’s post-industrial, information economy.
When Stigma Is Concealable: The Costs and Benefits for Health
Authors: Quinn Diane M.
Published: December 2017

Research on the effects of concealing a stigmatized identity on health outcomes is remarkably mixed, with results showing both health costs and benefits to concealing. This chapter reviews the literature and presents a framework for conceptualizing the moderators and mediators of the concealment–health relationship. It is proposed that people who reveal their stigmatized identity within supportive environments reap health benefits, whereas those living in more hostile environments benefit by greater concealment. However, if concealment leads to greater cognitive burden, then negative health outcomes can occur. If people do disclose their stigmatized identity, the confidants they choose, the level of social support received, and the negativity of the reactions will all influence the relationship between disclosure and health outcomes. Future research is needed to clarify which variables are most important for health and to examine differences between identity types and environments.
The Negative and Bidirectional Effects of Weight Stigma on Health
Authors: Major Brenda , Tomiyama Janet , Hunger Jeffrey M.
Published: December 2017

This chapter introduces a model describing the mechanisms by which weight stigma can lead to poorer health outcomes among people who are or who perceive themselves to be overweight. It is proposed that enacted weight stigma (discrimination) directly impairs the health of heavier weight individuals by changing the social and material aspects of their lives in ways that are detrimental to health. It is also proposed that perceived weight stigma can lead to social identity threat, which in turn can indirectly impair health by increasing stress and negative emotions, physiological reactivity, calorie intake, and stigma-avoidance behaviors. Finally, it is proposed that weight stigma is bidirectional, in that experiencing weight stigma leads to weight gain or inhibits weight loss through increased eating and other biobehavioral mechanisms, which in turn lead to further stigmatization. Implications for health and recommendations for future research are discussed.
Stigma, Social Identity Threat, and Health
Authors: Major Brenda , Schmader Toni
Published: December 2017

This chapter provides an overview of social identity threat theory and research and discusses its implications for health. The chapter defines social identity threat as the situationally triggered concern that one is at risk of being stigmatized and provides a conceptual model of its antecedents and consequences. Social identity threat stems from mere awareness of the cultural representations that associate a self-relevant social identity with undesirable characteristics, coupled with situational cues that bring these self-relevant cultural biases to mind, and personal characteristics that moderate one’s susceptibility to such experiences. Social identity threat can lead to involuntary psychological and physiological processes that when experienced repeatedly can have detrimental consequences for health. This chapter describes strategies that people use to cope with social identity threat and discusses their implications for health, in addition to providing a description of psychological interventions that can attenuate the negative effects of social identity threat.
Interpersonal Discrimination and Physical Health
Authors: Richman Laura Smart , Pascoe Elizabeth A. , Lattanner Micah
Published: December 2017

Interpersonal discrimination contributes to health inequalities for disadvantaged groups across numerous stigmatized identities. This effect has been found using cross-sectional, prospective, and experimental designs. Interpersonal discrimination has been associated with poor health across a wide range of mental health outcomes, including greater rates of depression, psychological distress, anxiety, and negative well-being, and also physical health outcomes such as hypertension, diabetes, respiratory problems, self-reported ill health, low birth weight, and cardiovascular disease. This chapter examines the relationship between interpersonal discrimination and health. It first reviews the literature, focusing on current best measurement practices, and then provides support for the theoretical model of the pathways by which interpersonal discrimination impacts health outcomes. The chapter then presents an updated meta-analysis that further supports the model and expands on types of discrimination and outcomes. It concludes with a discussion of directions for future research.
Experimental Research Design in the Study of Electoral Systems
Authors: Tucker Joshua A. , Duell Dominik
Published: December 2017

Understanding the effects of electoral systems is of great importance to both scholars and practitioners, and experimental research can be a valuable tool in pursuit of this goal. However, scholars need to think carefully about how to utilize experimental research, especially because the variation in electoral systems in which we are most interested—at the national level—is often impossible or unethical to manipulate. To inform how experiments and related methods of causal inference are then still able to facilitate investigations into the roots and consequences of electoral systems, we situate experimental research within a broader account of research design in the study of electoral systems, summarize existing experimental work, and discuss future avenues. We call for carefully crafting experimental tests in the laboratory and for using “naturally” occurring variation in existing institutions at lower levels of the electoral system.
Dewey and Bioethics
Authors: Hester D. Micah
Published: December 2017

The professional field of bioethics arose in the late 20th century, but many of its substantive characteristics were anticipated, even guided, by pragmatism in general and John Dewey specifically. Bioethics speaks to conditions of wellness and affliction, and these conditions occur within human experience and differ for each human being. Dewey’s moral philosophy is grounded on contextual experience—or “soft” particularism—in order to develop and identify ethical norms. This is brought into stark relief when he discusses healthcare and the practice of physicians, where Dewey implores us to remember that “health” is not a concept to be understood abstractly but must be seen within the context of living individuals. Physicians, in turn, are reminded that their own practices must not focus narrowly on basic science and simple mechanics, but must be “artistic,” using those sciences “to furnish . . . tools of inquiry into the individual case.”
Dewey and Pragmatist Feminist Philosophy
Authors: Heldke Lisa
Published: December 2017

John Dewey’s record as a feminist and an advocate of women is mixed. He valued women intellectual associates whose influences he acknowledged, but did not develop theoretical articulations of the reasons for women’s subordination and marginalization. Given his mixed record, this chapter asks, how useful is Dewey’s work as a resource for feminist philosophy? It begins with a survey of the intellectual influences that connect Dewey with a set of women family members, colleagues, and students. It then discusses Dewey’s influence on the work of late twentieth- and early twenty-first-century pragmatist feminist philosophers. Dewey’s influence has been strongest in the fields of feminist epistemology, philosophy of education, and social and political philosophy. Although pragmatist feminist philosophy remains a small field within feminist philosophy, this chapter argues that its conceptual resources could be put to further good use, particularly in feminist metaphysics, epistemology, and value theory.
The National Security Process
Authors: Schake Kori
Published: December 2017

Removing the friction of competing perspectives and bureaucratic interests by the various agencies of government (along with their supporters in the Congress and beneficiaries among businesses, interest groups, and the public) that would foster “unity of effort” and the ability to prioritize activity, budget accordingly, carry out policies crisply, and convey a consistent message by our government is chimerical. The interagency system cannot be structured to maximum efficiency in the United States. Efficiency is radically beside the point, because the purpose of the structure is to maximize consensus on the activity to be undertaken. The politics cannot be leached out of policymaking—nor should they be—because politics give policymaking its legitimacy.
U.S. National Security in the Western Hemisphere
Authors: Ashby Paul
Published: December 2017

This chapter contends that the Western Hemisphere is not only key to the development of U.S. national security but also remains of great importance today. Quite simply, U.S. national security interests grew firstly within their own “neighborhood,” and those interests continue to be both important and complex into the present day. Crucially, this is where national security threats come into direct contact with the U.S. homeland. Understanding this history and these interactive dynamics is important to the analysis of contemporary national security questions in the Western Hemisphere. The chapter focuses on key issues that are deeply intertwined: economics and trade; democracy, development, and human rights; drugs and transnational threats; and homeland security and homeland defense.
Epilogue
Authors: Eizenstat Stuart
Published: December 2017

A president is called to shape a foreign policy that both reflects America’s deepest values and serves its geopolitical interests. In doing so, a president has a range of options that can be used. However, these tools are not ends in themselves, but are undertaken to achieve certain goals. In this regard, there are five lessons that can serve as useful guideposts for those who are called to assist the president in this task. These include understanding that the tools of power are most effective when simultaneously employed; that multilateral action is usually more effective than unilateral action. In addition, while the executive branch has the lead on foreign policy, Congress and the states are also actors. When either of these groups lead they should grant the president flexibility in order to ensure that the policy continues to accomplish U.S. goals. The military tool of power while powerful frequently has serious constraint imposed upon it. It may also be more effective when used flexibly—e.g., the creation of NATO to deter the Soviet Union. Finally, policymaking is messy. Actions do not always result in the hoped-for outcome.
Critiques and Integrations of Phenomenology
Authors: Leoni Federico
Published: December 2017

Phenomenology played a central role in twentieth-century philosophy. But, from the second half of the century, many alternative philosophical movements emerged. Despite their radical criticism of phenomenology, they regularly touched upon themes that had been originally propounded by phenomenology itself. This is true of Jacques Derrida, Michel Foucault, and Gilles Deleuze. At the basis of their approaches, there is the need for a new version of the transcendental, the idea of an impure transcendental, and the intuition of a non-transcendental structure of the transcendental, which they all name “difference.” Phenomenology could draw useful insights from these perspectives: e.g., a more continuous view of the range of psychopathological experiences; a more exact comprehension of the different temporal and spatial structures of psychopathological worlds, as the internal possibilities and infinitesimal variations of the transcendental; and a more critical way of thinking through the structure of institutions and the normativity that dominates them.
Ludwig Binswanger
Authors: Hoffmann Klaus , Knorr Roman
Published: December 2017

The article presents Ludwig Binswanger’s approaches to psychoanalysis, psychiatry, and philosophy. His clinical practice in his sanatorium in Kreuzlingen, Switzerland close to the border to Germany was essentially determined by psychoanalysis and an individualized multiprofessional approach. Sigmund Freud supported this view—the published letters between him and Binswanger are important contributions of psychoanalytic and psychiatric history. In addition, Binswanger regarded philosophy as an essential foundation of psychiatry and psychoanalysis. He knew many psychiatrists, psychoanalysts, philosophers, and poets personally and exchanged many letters with them. First, he followed the phenomenological approach of Edmund Husserl and Martin Heidegger, later he was more identified with Martin Buber’s dialogical philosophy which he developed further. The article goes deeper into Binswanger’s central concepts and shows how important they became in the contemporary discussion where neurobiological, psychoanalytic, and sociological research shows new ways for psychiatric and psychotherapeutic practice.
R. D. Laing
Authors: Beveridge Allan
Published: December 2017

This chapter examines the early work of R. D. Laing, in particular his first book, The Divided Self (1960a), in which he sought to understand schizoid states and schizophrenia in terms of existential philosophy and phenomenology. He contrasted his approach which he characterized as an “existential-phenomenological construction” with the standard, disease model approach as exemplified by Emil Kraepelin. Laing contends that the patient’s behavior can be seen either as “signs” of disease, or as “expressive of his existence.” If we see the patient’s behavior as signs of disease, then he is the passive victim of a pathological process. However, if we see him from Laing’s existential perspective, then he is fully autonomous: he possesses agency of his actions. This is a key concept in Laing’s existentialist approach. This chapter goes on to consider in more detail how Laing drew on existential and phenomenological theory to explain disturbed mental states.
Phenomenology and the Cognitive Sciences
Authors: Gallagher Shaun
Published: December 2017

Phenomenology and cognitive science reviews the relationship between first- and second-person phenomenological descriptions of experience, and third-person cognitive explanations in the context of psychopathology. Taking schizophrenic symptoms of delusions of control and thought insertion as examples, this chapter addresses the question of whether we should take phenomenological reports in clinical settings at face value or interpret them informed by wider context and/or scientific background. The chapter also looks at how phenomenological analysis can contribute to empirical studies of the experiences of agency and ownership, and to the development of cognitive theory that seeks to explain delusional disorders of such experiences. It is argued that the interpretation of patients’ phenomenological reports can motivate empirical experiments that seek to identify processes that might contribute to explaining anomalous or alien experience and that communication between phenomenology, cognitive science, and psychiatry involves a multi-directional mutual enlightenment.
Phenomenology, Naturalism, and the Neurosciences
Authors: Aragona Massimiliano
Published: December 2017

Phenomenology, naturalism, and the neuro-sciences: their relationship poses several challenges. Current techniques to study brain functioning (e.g. refined neuroimaging devices) promise to reshape research programs in both cognitive sciences and psychopathology. But should naturalization of psychopathological research dismiss phenomenology, or should phenomenology be integrated with neuroscientific research? Is this an enrichment through interdisciplinary dialogue or a covert form of reductionism? After surveying the several meanings of phenomenology, naturalism, and the neurosciences, the chapter discusses the way current cognitive neurosciences operate, focusing on their key techniques, possibilities, and limitations. The neurophenomenological movement is then analyzed, showing that there are differences between the various proposals of naturalization of phenomenology. Neurophenomenology is discussed not only in opposition to Husserl’s original stance, but also in its proper role within the sciences of mind. Finally, the persistence within neurophenomenology of some reductionism is highlighted, suggesting the need for a more comprehensive hermeneutics within phenomenological psychopathology.