bluuebunny/crossref_metadata_2025 huggingface dataset:
The Assessment of Psychopathy and Response Styles in Sex Offenders
Authors: Gottfried Emily D. , Vitacco Michael J. , Rosner Richard , Gay Jeremy G.
Published: January 2022

Evaluating sexually based offenses requires nuanced knowledge in many different areas of assessment. Prominent among these areas are response styles, psychopathy, and the potential interplay between these two constructs. This chapter takes an in-depth look at the relationship between psychopathy and sexual offending behavior, and how clinicians must be cognizant of response styles when evaluating individuals accused of sex offenses. This chapter provides specific information on the use of the Psychopathy Checklist—Revised (PCL-R), Psychopathy Personality Inventory (PPI) instruments, the polygraph, and the penile plethysmography (PPG) in ensuring that evaluations of sexual offending risk are comprehensive. To that end, this chapter concludes with a series of recommendations so that clinicians can be knowledgeable about the benefits and limitations of methodologies used to evaluate psychopathy and response styles.
Forensic Evaluations of Juvenile Sex Offenders
Authors: Scott Charles L. , Campbell Jorien
Published: January 2022

Juvenile sex offenders (JSOs) are a heterogenous group and require skilled assessments to address several forensic questions the court may pose. This chapter outlines a stepwise process for the forensic evaluation of JSOs in the court process, with a review of specialized evaluations such as risk assessment of sexual and general violence, waiver to adult court, waiver of Miranda rights, competency to stand trial, and criminal responsibility. The forensic evaluator should be familiar with both legal and ethical standards governing the practice of forensic evaluations and the appropriate methodology to conduct evidence-based assessments.
Manifestations of Sexual Sadism
Authors: Hucker Stephen J. , Bradford John M. , Levin Giovana , Moulden Heather
Published: January 2022

Sexual sadism covers a wide range of behaviors including consenting sexual activity of a sadistic type with a consenting partner usually a masochist. It also involves criminal behavior often with extreme violence leading to sadistic sexually motivated homicides. This chapter covers the many clinical presentations of sexual sadism. It also reviews the history of sadistic behavior described in the seminal book “Psychopathia Sexualis” written by Richard von Krafft-Ebing.
Sexual Predator Laws and Their History
Authors: Brodsky Daniel J.
Published: January 2022

This chapter describes sexual predator laws, comparing and contrasting the historical and contemporary attempts in the United States and Canada to address the risk created by individuals who engage in behaviors broadly characterized as sexually deviant. It considers the rationale for sentencing and the earliest attempts to bring “treatment” into the criminal dispositional formula for sex offenders. The chapter also looks at the impact that the choice of societal response has on risk assessment and evaluation in the two systems, including the assessment and commitment of juvenile offenders. It then discusses the current US practice of civil commitment for a person deemed to be a sexually violent predator, beginning with the US Supreme Court decision in Kansas v. Hendricks. The chapter compares and contrasts this practice with the Canadian approach of designating an offender as a dangerous offender or a long-term offender under the criminal law.
Commentary
Authors: Berlin Fred S.
Published: January 2022

This commentary highlights some of the more critical issues and remaining challenges within the field of sexual offending. These include the issues of heterogeneity, safety and justice, civil commitment, actuarials, the prevention of sex offenses, mandatory reporting and child pornography, the treatment of paraphilic disorder, and public education. This book provides useful information with respect to persons who need treatment in relationship to sexual offending behaviors, but who unfortunately are all too often not considered to be deserving of it. It presents useful information to those concerned about public health and public safety, and it raises important issues relevant to criminal justice and what that means. As the book documents, the issue of sexual offending produces significant but often solvable challenges, with successful treatment providing the opportunity to make a positive difference in the lives of many.
Chronic fatigue syndrome
Authors: Gluckman Stephen J.
Published: January 2022

This chapter investigates chronic fatigue syndrome (CFS), a syndrome of subjective complaints most prominently featuring profound and prolonged physical exhaustion. Numerous infections have been proposed as etiologies for CFS, but evidence that the syndrome is not associated with any specific infectious agent is of three main types. First, there is no single infectious agent that is detectable in all cases of CFS; the disorder can occur in the absence of the most common agents, such as Epstein–Barr virus (EBV). Second, the development of the same syndrome occurs during convalescence after infections with non-overlapping geographic distribution. Third, attempts to treat CFS with anti-infectives have been uniformly disappointing. CFS is a clinical diagnosis that depends almost entirely on the history and the patient’s report of symptoms. At present, the pathophysiology of CFS is not sufficiently understood to inform specific therapy. Consequently, specific medical or psychiatric therapy is indicated only when there is an alternate or coexisting diagnosis.
Human and animal bites
Authors: Goldstein Ellie J. C. , Abrahamian Fredrick M.
Published: January 2022

This chapter highlights human and animal bites, which are common injuries. Human bites are either occlusional, where the teeth bite directly into flesh, or clenched-fist (closed-fist) injuries (CFIs). Most occur during fights, and the patient typically has a delayed presentation often resulting in infection. Patients may seek care at a hospital’s emergency department, primary care physician’s office, or with a specialist. The bacteriology of these wounds is diverse and comprises both aerobic and anaerobic organisms originating from the oral flora of biting animal, the victim’s skin flora, and occasionally environmental isolates. Pre-emptive antimicrobial therapy is often initiated for bite wounds that are extensive, located on the hands, associated with severe crush injury, presence of pre-existing edema, or have penetrated a joint or bony structure. However, closure of infected wounds is generally not recommended. Due to cosmetic and functional reasons, wounds to the head and neck and those overlying the joints may require primary closure. Major defects may require repair with subsequent surgeries.
Lice, scabies, and myiasis
Authors: Bernigaud Charlotte , Monsel Gentiane , Chosidow Olivier
Published: January 2022

This chapter discusses lice, scabies, and myiasis. Arthropod infestations of humans are most commonly caused by mites, head or body lice (pediculosis), pubic lice (pthiriasis), or fly larvae (myiasis). Although many mite species may feed on human tissue, scabies are the most common mites living on human hosts. All of these arthropods can cause irritation and inflammation of the skin, but fly larvae may penetrate more deeply into the body. Diagnosis of each of these parasitic problems is dependent on accurate identification of the infesting arthropod. Lice and scabies mites are readily transmitted between close contacts, whereas myiasis is not a contagious condition.
Superficial fungal infection of skin and nails
Authors: Koestenblatt Evelyn K. , Weinberg Jeffrey M.
Published: January 2022

This chapter investigates superficial fungal infection of skin and nails. The vast majority of fungal infections of the skin, hair, and nails are caused by the dermatophytes, and yeasts including Candida species and Malassezia furfur. The dermatophytes are organisms that are found in specific ecologic niches and consume the structural protein, keratin. Proper diagnosis of these conditions is essential as they can present in a similar fashion to nonfungal disease. Moreover, some fungi causing systemic infections may begin as cutaneous lesions. In most cases, potassium hydroxide (KOH) preparation, culture, and/or biopsy can provide a definitive diagnosis. Treatment of these conditions may include topical and/or systemic antifungal therapy.
Bronchitis
Authors: Poole Phillippa , Hobbs Mark
Published: January 2022

This chapter looks at bronchitis. Bronchial infections with viral and bacterial microorganisms cause considerable morbidity, as well as economic costs incurred through health care and loss of productivity. These infections affect all age groups. An important consideration is whether or not an individual has underlying chronic lung disease, as that alters the etiology, clinical presentation, laboratory findings, and indications for therapy. The chapter discusses acute infectious bronchitis in individuals without underlying chronic lung disease, before outlining approaches when an individual has an acute exacerbation of a chronic lung disease such as asthma, chronic obstructive pulmonary disease (COPD), or non-cystic fibrosis bronchiectasis.
Nosocomial pneumonia
Authors: Cunha Cheston B. , Cunha Burke A.
Published: January 2022

This chapter explores nosocomial pneumonia (NP), which may be defined as pneumonia that occurs after 5 or more days in hospital. NP is synonymous with hospital-acquired pneumonia (HAP). The subset of NP/ HAP patients on ventilators are referred to as ventilator-associated pneumonias (VAP). NP occurring early, i.e., less than 5 days after admission, actually represents incubating community-acquired pneumonia (CAP) that has become clinically manifest early after hospital admission. For this reason, the respiratory pathogens causing “early NP” are the usual CAP pathogens, e.g., Streptococcus pneumoniae. With true NP, the respiratory pathogens acquired in hospital are aerobic gram-negative bacilli (GNB). The most important, but not the most common, NP pathogen is Pseudomonas aeruginosa; some other GNB are also important NP pathogens, e.g., Klebsiella pneumoniae.
Mediastinitis
Authors: Karra Ravi , Kaye Keith S.
Published: January 2022

This chapter focuses on mediastinitis. The mediastinum is the space in the thorax between the lungs. It houses the heart, great vessels, esophagus, trachea, thymus, and lymph nodes. The connective tissues of the mediastinum are continuous with the long fascial planes of the head and neck, one reason why mediastinitis was primarily a complication of pharyngeal infections until the advent of thoracic surgery. By virtue of its deep position within the thorax, the mediastinum is a relatively protected organ space. There are four major portals of entry into the mediastinum: (1) direct inoculation of the mediastinum following sternotomy (i.e., postoperative mediastinitis [POM]); (2) spread along the long fascial planes of the neck (i.e., descending mediastinitis); (3) rupture of mediastinal structures, such as the esophagus; and (4) contiguous spread of infection from adjacent thoracic structures.
Food poisoning
Authors: Davis Carly R. , Pavia Andrew T.
Published: January 2022

This chapter investigates food poisoning. Initially, the diagnosis of specific food poisoning syndromes is suggested by the clinical presentation, the incubation period from exposure to onset of symptoms, and the food consumed. Symptoms include nausea and vomiting, diarrhea, abdominal cramps, and fever. A careful history of illness in meal companions may help point to the responsible food. Most food poisoning syndromes are self-limited, and for the majority of episodes, nonspecific supportive therapy is all that is required. Exceptions include botulism, listeriosis, some enteric infections in infants and compromised hosts, and some types of mushroom poisoning. The mainstay of treatment is fluid and electrolyte replacement to prevent and treat dehydration.
Abdominal abscess
Authors: Pharaon K. Shad , Trunkey Donald D.
Published: January 2022

This chapter addresses abdominal abscess, which often follows or complicates peritonitis. Abscesses can form within the peritoneal lining, usually days after an intraperitoneal infection. Intraperitoneal abscesses commonly follow a perforated appendix or diverticulum, but also occur after tubo-ovarian infection, recent surgery (particularly of the colon), pyogenic liver abscess after biliary tract disease, or splenic abscess from trauma. Patients can also develop retroperitoneal abscesses, such as a pancreatic abscess. Routine history, physical exam, and laboratory studies are the initial workup of suspected intra-abdominal infection. The cornerstones of treatment of an abscess are source control and antimicrobials. Source control requires taking measures to eliminate a source of infection, control ongoing contamination, and restore premorbid anatomy and function.
Splenic abscess
Authors: Dehority Walter , Howdieshell Thomas R.
Published: January 2022

This chapter describes splenic abscess. The diagnosis of splenic abscess is often overlooked because of its rarity and misleading clinical features as well as the presence of predisposing conditions that obscure its clinical presentation. Hence, it is not surprising that splenic abscess is often diagnosed during postmortem examinations, even in the era of antibiotics. Contributing factors to an apparent increase in the incidence of splenic abscess include advances in radiologic imaging, comfort with nonoperative management of blunt splenic trauma, and a greater number of patients who have cancer or are otherwise immunocompromised. There is no place for long-term medical management of a clinically overt splenic abscess. The mainstay of treatment consists of splenectomy and appropriate antibiotics.
Urethritis and dysuria
Authors: Pappas George , Bliziotis Ioannis A. , Falagas Matthew E.
Published: January 2022

This chapter highlights urethritis. The term urethritis refers to inflammation of the urethra, which can be attributed both to infectious and noninfectious processes. The urethral canal essentially represents the first site of the body to be exposed to a variety of sexually transmitted pathogens, and the interaction of these pathogens with the epithelial cells of the urethra gives rise to the syndrome’s symptoms. Dysuria refers to the experience of pain or burning sensation or discomfort in urination, and is a subjective symptom related to varying pathology of the urinary tract. The urethra being the terminal pathway of urine flow, its inflammation most often accounts for experience of dysuria. Antibiotic treatment of urethritis should always follow the diagnosis to prevent complications and further transmission of the pathogen.
Infection of native and prosthetic joints
Authors: Hasan Shahbaz , Smith James W.
Published: January 2022

This chapter describes infections of native and prosthetic joints. Infections of native joints generally occur in patients with predisposing factors such as trauma, underlying arthritis, immunosuppressive therapy, diabetes mellitus, malignancies, intravenous drug abuse, and other infections. Hematogenous spread of the organism through the highly vascular synovial space leads to an influx of polymorphonuclear leukocytes (PMLs) into the synovium and then to a release of enzymes that destroy the articular surface. Empiric antimicrobial therapy for suspected bacterial arthritis is started after obtaining appropriate fluid specimens for analysis and culture. The choice of antibiotics depends on the patient's age, risk factors, and results of the synovial fluid Gram stain. The antibiotics are modified after obtaining the culture results. Meanwhile, the object of successful management of prosthetic joint infections is 2-fold: eradication of infection and maintenance of functional integrity of the joint.
Aseptic meningitis
Authors: Meyers Burt R. , Restrepo Dalilah
Published: January 2022

This chapter evaluates aseptic meningitis syndrome, which is associated with symptoms, signs, and laboratory evidence of meningeal inflammation with spinal fluid findings that suggest a viral or noninfectious origin. Clinically, patients present with headache, nausea, meningismus, and photophobia, symptoms that are also common in patients with bacterial meningitis. A stiff neck, with or without a Brudzinski or Kernig sign, may be observed. Patients usually appear nontoxic but may have changes in mental status, including irritability. Other signs of possible viral infection may include pharyngitis, adenopathy, morbilliform rash, and evidence of systemic viral infection, including myalgia, fatigue, and anorexia. There are usually no signs of vascular instability, and the course is often self-limiting. Aseptic meningitis is a syndrome of multiple etiologies, both infectious and noninfectious. The etiologic diagnosis of aseptic meningitis is often complicated by the numerous possible causes and the lack of specific diagnostic tests.
Progressive multifocal leukoencephalopathy
Authors: Perrone Christopher M. , Berger Joseph R.
Published: January 2022

This chapter explores progressive multifocal leukoencephalopathy (PML). Until the advent of the AIDS pandemic, PML remained a vanishingly rare disorder seen almost exclusively in individuals with underlying immunosuppressive disorders. While the introduction of highly active antiretroviral therapy (HAART) led to a decline in AIDS-associated PML, AIDS is currently estimated to be the predisposing disorder for about 80% of all PML cases. However, development of immunosuppressive and immunomodulating therapies has led to a growing incidence of PML in patients with autoimmune disorders. To date, at least 50 drugs have been associated with PML, but the risk of PML with these drugs varies widely.
Opportunistic infections in HIV
Authors: Ogedegbe Anthony , Glesby Marshall
Published: January 2022

This chapter looks at the timely recognition and treatment of HIV-associated opportunistic infections (OIs), which remains an important skill for practicing physicians worldwide. It reviews the incidence of infections, which has fallen sharply since the advent of combination antiretroviral therapy, in which OIs remain the most serious threat to well-being and survival amongst HIV-infected individuals with advanced immunosuppression. It also mentions how morbidity from OIs is often the first indication of previously undiagnosed HIV infection despite improved access to global screening. The chapter offers a clinical overview of the most frequently encountered OIs, including its current concepts and approaches to management. It looks at CD4 cell count as an integral part of OI surveillance, prevention, and treatment.
Hospital-acquired fever
Authors: Seo Susan K. , Brown Arthur E.
Published: January 2022

This chapter focuses on fever as a common clinical problem in hospitalized patients. It explains the development of a fever in a hospitalized patient, which may be the clinical expression of a community-acquired infection that has completed its incubation period. It also highlights the possible causes of new-onset fever occurring at least 48 hours after hospital admission. The chapter discusses the nosocomial fever that occurs in 2% to 31% of medical inpatients due to infectious or noninfectious cause. It looks at the wide range of prevalence rates that has been attributed to differences in definition of fever, methods of temperature measurement, study population, and healthcare setting.
Tick-borne disease
Authors: Buckingham Steven C.
Published: January 2022

This chapter focuses on how ticks can transmit numerous bacterial, parasitic, and viral pathogens to humans, as well as how the secretions of some species can induce allergic reactions or cause paralysis. It provides a broad overview of tick-borne infections endemic to North America and discusses general principles regarding their epidemiology, therapy, and prevention. It looks at tick-borne infections that occur most often in the spring and summer, when ticks are most active, but are also reported in colder months. The chapter points out how patients are unaware of their recent tick exposure as tick bites are usually painless, ticks may attach in sites covered by hair or clothing, and ticks in their larval and nymphal stages are still capable of transmitting infection. It analyzes the geographic distributions of tick-borne infections that correspond to the distributions of their associated tick vectors.
Branhamella-Moraxella
Authors: Hodges Lisa S. , Bocchini Joseph A.
Published: January 2022

This chapter talks about Moraxella catarrhalis as an important etiologic agent of otitis media in children and bronchopulmonary infection in adults with chronic obstructive pulmonary disease (COPD) or impaired host defenses. It discusses Moraxella catarrhalis as a gram-negative unencapsulated diplococcus similar in morphology to the Neisseria. It also mentions Ghon and Pfeiffer, who described Moraxella catarrhalis as Micrococcus catarrhalis in 1902 and has since undergone several reclassifications. The chapter recounts how Moraxella catarrhalis was placed into the genus Branhamella based on fatty acid content and DNA homology. It examines how Moraxella catarrhalis is the most widely accepted nomenclature in the present.
Erysipelothrix
Authors: Hand W. Lee
Published: January 2022

This chapter deals with Erysipelothrix rhusiopathiae, which is a pleomorphic, non-spore-forming, gram-positive bacillus. It analyzes how E. rhusiopathiae causes both a self-limited soft-tissue infection and a serious systemic disease. It also investigates the spread and infection of E. rhusiopathiae of many domestic animals, such as sheep, cattle, horses, chickens, and dogs, as well as birds, fish, crustaceans, seals, and dolphins in some cases. This chapter examines the risk of infection of E. rhusiopathiae in humans due to occupational exposure, namely butchers, abattoir workers, fishermen, farmers, and veterinarians. It discusses the clinical spectrum of human infection that includes localized cutaneous infection, diffuse cutaneous disease, and systemic bloodstream infection.
HACEK
Authors: Chu Vivian H.
Published: January 2022

This chapter discusses HACEK, which is an acronym that describes a heterogeneous group of organisms that are identified as small gram-negative rods that are commonly present as part of normal oral–pharyngeal or respiratory flora. It explains HACEK as relatively fastidious microorganisms that have a predilection to infect heart valves. It also mentions Haemophilus species, Aggregatibacter species, Cardiobacterium hominis, Eikenella corrodens, and Kingella species as members of the HACEK group. This chapter emphasizes the HACEK's ability to cause a variety of other infections, such as endocarditis although, rarely. It examines human bites that can result in cellulitis or abscess formation resulting from HACEK organisms and various Haemophilus species, which can cause epiglottitis or brain abscesses.
Yersinia
Authors: Johnson Royce H. , Heidari Arash
Published: January 2022

This chapter deals with the genus Yersinia, which consists of 17 species; only three of which are consistently pathogenic for humans. Most famously, Y. pestis is the agent of plague, whereas Y. enterocolitica and Y. pseudotuberculosis are gastrointestinal pathogens. Y. pestis is an ancient organism that has largely existed as a rodent pathogen over the course of time, with only occasional human transmission since its divergence from Y. pseudotuberculosis 1,500 to 20,000 years ago. Alexandre Yersin first isolated Y. pestis in 1894. The chapter analyzes natural infections caused by Yersinia that occur most commonly through the bite of an infected flea and in which the majority of patients present with febrile lymphadenitis or bubonic plague.
Miscellaneous gram-positive organisms
Authors: Choudary Iqra , Schmitt Steven K. , Corales Roberto Baun
Published: January 2022

The pediococci are gram-positive bacteria that grow in pairs and tetrads and belong to the lactic acid bacteria group. They are used extensively in industry to ferment cheese and other dairy products, soy products, and alcoholic beverages, and they are normal inhabitants of the human gastrointestinal tract. Of the 13 species of pediococci, only Pediococcus acetolactic and P. pentosaceus are typically found in sugar-rich foods, and these have been identified as human pathogens. Recently, pediococci have been increasingly recognized as a cause of bacteremia, endocarditis, and pneumonitis in the immunocompromised host. The chapter discusses risk factors for Pediococcus infections that include prior antibiotic therapy, abdominal surgery, and gastric feeding. The chapter further discusses the testing, evaluation, and treatment of patients presenting with possible pediococcal disease.
Borreliosis
Authors: Cutler Sally J.
Published: January 2022

This chapter introduces the relapsing fever spirochetes, which comprise a number of different species transmitted by specific tick species, and classical relapsing fever species transmitted by rapid-feeding soft tick species. Borrelia miyamotoi is transmitted by hard tick vectors, with B. recurrentis as the notable exception since it is transmitted by clothing lice. The chapter describes main signs of fever caused by certain ticks; these are often accompanied by chills, headaches, arthralgia, myalgia, and tachycardia. Infection with B. duttonii has been associated with significant perinatal mortality in endemic regions such as Tanzania. B. miyamotoi manifests with fever often accompanied by thrombocytopenia and nonspecific influenza-like symptoms.
Rickettsial infections
Authors: Wald-Dickler Noah , Holtom Paul D.
Published: January 2022

This chapter describes Rickettsiaceae, small, aerobic, gram-negative coccobacilli that are obligate intracellular parasites of eukaryotic cells. It identifies three groups of Rickettsiae groups based on clinical presentation: the spotted fever group, the typhus group, and scrub typhus. It also covers Coxiella burnetii, the causal agent of Q Fever, which is covered in the γ‎-proteobacteria group, together with Legionella and Francisella tularensis. The chapter deals with rickettsial disease pathogenesis, which is characterized by systemic vasculitis whereby the organisms proliferate in vascular endothelial cells of host arterioles, capillaries, and veins. It analyzes organisms in Q fever that are acquired by inhalation of dust contaminated by birth fluids of domestic ungulates and proliferate in the lungs, causing inflammation and bacteremic seeding of other organs, particularly the liver.
Blastomycosis
Authors: McCarty Todd P. , Pappas Peter G.
Published: January 2022

This chapter covers blastomycosis, which is a systemic pyogranulomatous disease caused by the thermally dimorphic fungus Blastomyces dermatitidis. It mentions B. gilchristii, and B. helices as other pathogenic agents of blastomycosis. It also explains that blastomycosis is endemic to parts of the midwestern and south-central United States and Canada, but there have also been isolated reports of its occurrence in Africa, Asia, and Central and South America. The chapter reviews evidence that indicates that B. dermatitidis exists in warm moist soil enriched by organic debris, including decaying vegetation and wood and that infections occur through inhalation of aerosolized spores. It points out that primary infections from B. dermatitidis are usually asymptomatic or may result in a self-limited flu-like illness.
Miscellaneous (emerging) fungi and algae
Authors: Nnedu Obinna N. , Pankey George A.
Published: January 2022

This chapter provides an overview on nonendemic fungi and algae that cause disease among an increasing population of individuals at risk. It discusses how microorganisms, known as opportunistic agents, can cause disease when the patient suffers from some predisposing factor that has mechanically or immunologically decreased the capacity to resist infection. It also mentions how opportunistic agents can cause disease through an infecting agent that can survive and multiply at body temperature. The chapter identifies opportunistic fungal infections that are associated with predisposing factors, such as ketoacidosis, iron overload state, neutropenia, and defects in cell-mediated immunity. It considers microorganisms that are ubiquitous in nature but are uncommon causes of disease in humans.
Cytomegalovirus
Authors: El-Herte Rima I. , Meier Jeffrey L.
Published: January 2022

This chapter focuses on human cytomegalovirus (CMV), which is a member of the herpesvirus family that only replicates in humans. It traces the past and recent CMV infection that is marked by presence in serum of immunoglobulin G antibody (IgG) against CMV. It also looks at the proportion of people having CMV IgG that varies according to age, socioeconomic status, sexual activity/practice, and race/ethnicity. The chapter emphasizes on CMV as the leading infectious cause of birth defects and the most common non-genetic cause of sensorineural hearing loss. It cites pre-existing immunity to CMV in healthy people that does not fully protect from re-infection with a different CMV strain.
Epstein-Barr virus and other causes of the infectious mononucleosis syndrome
Authors: Meier Jeffrey L.
Published: January 2022

This chapter deals with the Epstein–Barr virus (EBV), which is a gammaherpesvirus that infects nearly everyone at some point during his or her lifetime. It explains that approximately 85 percent of non-Hispanic black and Mexican-American children and 52 percent of non-Hispanic white children had already acquired EBV by age 14 in the United States population from 2003 to 2010. It also talks about oropharyngeal epithelial cells as the source of infectious EBV in saliva, which can be transmitted through close oral contact with infectious saliva. The chapter emphasizes how deep kissing during sexual intimacy that ordinarily begins in adolescence and early adulthood increases EBV transmission risk. It reveals how EBV-seropositive donor blood products and tissues may transmit infection when EBV reactivates from latently infected B lymphocytes.
Herpes simplex 1 and 2
Authors: Whitley Richard J. , Alsulami Abdulsalam
Published: January 2022

This chapter introduces herpesviruses as large enveloped virions with an icosapentahedral nucleocapsid that consist of 162 capsomeres arranged around a double-stranded DNA core. It explores two antigenically distinct types of herpes simplex virus (HSV): HSV-1 and HSV-2. It also compares the homology that exists between the HSV-1 and HSV-2 genomes with most of the polypeptides specified by one viral type that is antigenically related to polypeptides of the other viral type. The chapter shows how the cutaneous HSV infection causes the ballooning of infected epithelial cells, with nuclear degeneration, loss of intact cellular membranes, and the formation of multinucleated giant cells. It cites cells that lyse and release clear fluid containing large quantities of virus, with subsequent accumulation of cellular debris and inflammatory cells between the epidermal and dermal layers.
Antifungal therapy
Authors: Farmakiotis Dimitrios , Rogers Ralph
Published: January 2022

This chapter examines the rapid growth of the patient population at risk for invasive fungal infections. It analyzes malignancies that lead to prolonged periods of neutropenia and recognized syndromes associated with the use of novel therapies, such as a variety of fungal infections in patients receiving tyrosine kinase inhibitors or endemic mycoses associated with tumor necrosis factor (TNF-α‎) inhibitors. It also looks at invasive fungal infections that are increasingly recognized in immunocompetent or “immunomodulated” individuals, such as the outbreak of Cryptococcus gatii infections in Northwestern United States and British Columbia. The chapter reviews recent advances in fungal pathogenesis and the development of potent, relatively nontoxic antifungal agents that have led to significantly improved outcomes. It emphasizes how the knowledge of clinical mycology and antifungal treatment basics is paramount across different specialties other than infectious diseases.
A Novel Approach to Risk Identification
Authors: Silveira José , Rockman Patricia
Published: January 2022

This chapter introduces a novel transdiagnostic approach to comprehensively identifying risks of harm and impairment while accommodating for the uncertainty and complexity intrinsic to clinical practice. The approach is described in detail. The importance of explicitly considering intentional versus unintentional harm is explained. Aspects of impaired functioning and critical symptoms that relate to risk identification are delineated. A list of critical domains of functioning is provided, and the rationale for their inclusion is discussed. Relevant functional impairments and critical symptoms are integrated into the approach. The importance of delineating gathered information according to categories of observed, reported, and suspected is explained. A real case is used to demonstrate the approach’s application to clinical care.
Forgiveness
Authors: Worthington Everett L.
Published: January 2022

Forgiveness is considered a virtue by most people, and in today’s often-contentious society it can promote better relationships, better physical and mental health, and often better spirituality. People rarely present seeking treatment for forgiveness. Rather, it often surfaces as people deal with depression, anxiety, stress-related disorders, interpersonal anger, unforgiveness, couple and family conflict, self-condemnation, guilt, shame, and hopelessness. Treating issues in forgiveness is not tied to a particular treatment approach. Psychodynamic psychotherapists will find it particularly useful in family-of-origin issues. Cognitive-behavioral psychotherapists can incorporate most treatment protocols within their schema. One of the best ways to treat forgiveness issues is to use evidence-based treatments as adjuncts to psychotherapy (i.e., psychoeducational groups, workbooks, engagement with a faith community) and use psychotherapy to handle unresolved issues arising from adjunctive treatment. In this chapter, assessment, treatment, relevance for engaging other community resources like faith communities, and ethical issues are addressed.
Defiance
Authors: Potter Nancy Nyquist
Published: January 2022

Defiance has been praised, blamed, and vilified. This makes sense if one understands defiance as a virtue with vices and an intermediate condition. Yet social conditions frequently associate negative interpretations with people who are oppressed, including people who have mental challenges and distresses, such that it turns out that defiant mentally ill people, especially people whose social locations implicate race, gender, ethnic and religious minorities are interpreted as having a vice and clamped down rather than being listened to and treated as possibly giving a legitimate and reasonable response to oppressive or unjust interactions or conditions. Defiance is sometimes a virtue for people with mental illnesses. Therefore, they should not automatically be assumed to be either mad or bad for being defiant. Sometimes defiant behavior is even a step toward flourishing. Clinicians too are sometimes rightfully defiant, even though norms and practices of psychiatry may consider such behavior to be blameworthy.
Pain Management
Authors: Hallenbeck James L.
Published: January 2022

This chapter examines pain management issues in palliative care. Pain is the most common complaint of terminally ill patients. It has been estimated that between 85% to 95% of pain syndromes can be adequately palliated using relatively simple techniques. Despite this, pain is often undertreated. The chapter discusses different types and classifications of pain and explains the factors that should be considered in pain management strategies. The author discusses approaches to pain assessment. Commonly used pain medications are described. Strategies for pain management with an emphasis on the use of opioids are also described.
Non-Pain Symptoms
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses the management of common non-pain symptoms in terminally and chronically ill patients. These symptoms include nausea and vomiting, constipation, bowel obstruction, dyspnea, and cachexia/anorexia/asthenia. A Darwinian approach to understanding pathophysiologies of symptoms is described, building on a common taxonomy of symptoms as first outlined in Chapter 3. The chapter explains principles of therapy and how best to tailor treatment, based on an understanding of the underlying pathophysiology for each of these symptoms. The chapter presents a particularly novel way of understanding the pathophysiology of dyspnea, which delineates different types of dyspnea and suggests a possible mechanism of action for the use of opioids in the treatment of dyspnea.
Burnout
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses burnout, an occupational hazard in health care that arises in response to chronic stress. It may affect clinicians and negatively impact patient care. Having a better understanding of burnout and developing a plan to manage it can go a long way in ameliorating its toxic effects. A general taxonomy of burnout is presented. This chapter explores common stressors giving rise to burnout. The author suggests that a better understanding of the components giving rise to burnout is a first step in addressing burnout. A mindfulness-based approach to dealing with burnout is presented. Compassion fatigue and its overlap with burnout is discussed. While burnout is ubiquitous in health care, features of burnout and compassion fatigue more specific to palliative care are discussed.
The Last 48 Hours
Authors: Hallenbeck James L.
Published: January 2022

This chapter discusses palliative care issues during active dying. This so-called terminal phase or active dying is characterized by a series of changes that affect the dying person, the family, and clinicians. The chapter explains how to assess and predict active dying, the signs and symptoms commonly present, and the role of the family in active dying. An approach to coaching of family members and loved ones is suggested. This approach parallels natural physiologic changes in the dying person, suggesting, for example, how best to nurture the patient when hunger and thirst are gone. It also provides a clinician checklist of things to review once active dying is identified.
Prejudice and Discrimination Related to Substance Use Problems
Authors: Chen Shu-Ping , Stuart Heather
Published: January 2022

This chapter provides an overview of stereotypes, prejudices, and discrimination associated with people experiencing substance use disorders as well as a discussion of contributors to the high level of stigma endorsement by the general population and healthcare professionals. Stigma influences how people with substance use disorders are viewed and treated and how they view themselves. These individuals have experienced stigma in its various forms, including social avoidance and exclusion, structural discrimination in healthcare systems and the broader society, internalized stigma, their own stigma toward treatment, and courtesy stigma toward family members. Stigma results in restricted resources and decreased access to healthcare and fosters health inequities among people with substance use disorders. Those who experience social rejection and internalized stigma show reduced help seeking and treatment compliance. This chapter discusses how the stigma associated with substance use shapes people’s lives and leads to adverse psychological, behavioral, and health outcomes.
Measuring Opioid-Related Stigma
Authors: Knaak Stephanie , Stuart Heather
Published: January 2022

Individuals who experience substance abuse, including opioid use, often experience significant stigma, prejudice, and discrimination. This chapter describes the nature of that stigma and the development of a scale for use with people who work in helping professions who may respond to or care for people with opioid use problems or who may be at risk of experiencing an overdose or poisoning. The various stages of the scale’s development are reported, and the potential uses of the scale for measuring stigma related to opioid use are highlighted. The scale may also be adapted to capture attitudes and behaviours toward people with other substance use problems or other target audiences; however, for any of these possible adaptions, additional qualitative research and psychometric testing would be required.
Stereotype and Social Distance Scales for Youth
Authors: Koller Michelle , Stuart Heather
Published: January 2022

Adolescents have become an important target for antistigma programming. Yet, there are few validated outcome measures that could be used to assess the effects of antistigma interventions targeting youth. This chapter describes the creation and validation of two scales to evaluate contact-based youth antistigma programs that were offered to middle and secondary school students. The chapter provides full psychometric details for individuals considering using these scales and documents the analytic steps taken to develop and test these novel instruments. This information may be helpful for individuals wishing to develop and test their own novel instruments for antistigma evaluation. We emphasize the importance of having clear conceptualizations, covering areas that are relevant to the program’s content, including people with lived experience, and conducting a careful and robust psychometric analysis before using scales to assess program effects.
Stigma Reduction for Healthcare Workers
Authors: Lauria-Horner Bianca
Published: January 2022

Stigma related to mental illness exists among healthcare providers and can have a significant toll on these workers, given the highly stressful nature of their employment. This chapter reports models that attempt to understand the factors associated with stigma and presents a process model for antistigma programs for healthcare professionals. A four-stage process is proposed, including the involvement of key stakeholders, utilizing evidence-based ingredients, the use of best practices in participatory learning, and culture change to maximize sustainability. The development, implementation, and dissemination of a program that builds on these core processes is described, and its positive results are detailed. The chapter concludes with recommendations for the further use and dissemination of this approach to stigma reduction for healthcare workers.
Seeds of Despair
Authors: Black Donald W.
Published: January 2022

This chapter examines suspected causes of antisocial personality disorder (ASPD). Bad parenting, defective genes, childhood trauma, poverty—these are but a few of the proposed causal factors in ASPD. Just as the diverse manifestations of ASPD may divert attention from the underlying disorder, focusing on a single cause risks overlooking the possibility that ASPD results from combinations of factors. Most of the debate about the causes of mental illness tends to swirl around the relative influence of nature versus nurture, or heredity versus environment. In this context, nature is generally construed as genetics and biology, whereas nurture refers to home and social environment plus early life experiences. Those favoring genetic theories for ASPD point to families in which patterns of misbehavior are repeated from generation to generation, suggesting a hereditary influence rooted in biology. Those favoring nurture see in the same families cycles of deprivation and abuse that lead to similar behavior in parents and children. In truth, the nature–nurture debate over ASPD and other conditions is largely spurious. In the end, the most satisfying theories of causation tread a middle ground between nature and nurture, drawing elements from both.
Power and Pretense
Authors: Black Donald W.
Published: January 2022

This chapter looks at antisocial persons who manage to make their way in society, often by suspicious means. Some antisocial persons manage to make their way through school and into the workforce, even becoming attorneys, businessmen, politicians, or other professionals. Those who hide their disorder beneath a veneer of success are sometimes described as high functioning, meaning that their antisocial personality disorder (ASPD) seems to have limited impact on their ability to get by in the world. This term has obvious limitations, as it may seem to elevate economic or career accomplishments over other potential symptoms like relationship problems, persistent lying, and a penchant for manipulation. Nevertheless, it reflects the fact that, in our society, money and status can effectively disguise ugly and destructive behaviors. Or, in some cases, they can lead to undeserved admiration, such as when people say the person accused of tax fraud is “smart” for taking advantage of the system. The chapter then considers the relationship between ASPD and narcissistic personality disorder, before looking at the problem of adult antisocial behavior.
Homelessness and mental health in Paraguay
Authors: Torales Julio , Gonzalez-Urbieta Israel
Published: January 2022

Homeless people constitute a vulnerable population in terms of mental health issues. Homelessness and inadequate housing are very prevalent conditions in Paraguay and this constitutes a major barrier for delivering healthcare, particularly in mental health, for this group. There are currently no public policy programmes aimed at meeting the specific needs of this group. Many steps can be taken to improve the mental health and the quality of life of these at-risk population. This chapter summarizes the current situation of homelessness in Paraguay, the barriers and the state of the access to mental health services for homeless people in the country. It also proposes various practical interventions that can constitute a way forward to enhance the living conditions of this vulnerable group of people.
Neurocognitive impairment in homeless persons
Authors: Sharma Neha , Brown Joshua D. , Summergrad Paul
Published: January 2022

Cognitive capability impacts individual functioning in every life domain such as social, emotional, academic, and occupational. Understanding the mechanism through which cognitive impairment can influence an individual’s susceptibility to homelessness is essential to providing effective services for improving health outcomes among this population. This chapter details the relationship between cognitive impairment and homelessness, with a focus on defining the clinical descriptions and diagnostic guidelines. It also discusses the bidirectional cause-and-effect association between homelessness and cognitive impairment, particularly reviewing disorders of cognition including schizophrenia, bipolar disorder, intellectual disability, autism spectrum disorder, childhood trauma, malnutrition, traumatic brain injury, and substance abuse. Lastly, this chapter uses the clinical correlations taken from available literature between homelessness and cognitive impairment to make recommendations on potential interventions that aim to address an individual’s cognitive skills as a relevant determinant of one’s functional capacity.
Nutrition and Dietary Recommendations
Authors: Faeh David
Published: January 2022

Along with exercise, diet is a highly important intervention to reduce the risk of cardiovascular disease. Indeed, diet affects both cardiovascular risk factors, such as blood pressure, lipids, and diabetes, but also has direct effects that are not fully clarified, for instance, through Mediterranean diet, that has been shown to reduce cardiovascular events. Mediterranean mainly consists of water, wine, coffee and tea, as well as fish, seafood and poultry, as well as salad and vegetables. In addition, the prevention of overweight and obesity is an essential part of dietary recommendations. Importantly, these recommendations have to be adhered to by the patients and individuals at risk, using questionnaires and intense follow-up.