bluuebunny/crossref_metadata_2025 huggingface dataset:
(010) A Novel Collaborative Protocol for Successful Management of PGAD/GPD Mediated by Tarlov Cyst-induced Radiculopathy of Sacral Spinal Nerve Roots in the Cauda Equina
Authors: Kim C , Blevins J , Komisaruk B , Uloko M , Goldstein S , Goldstein I
Published: June 2023

Introduction

In 2012, Komisaruk et al introduced the concept that neurologic-based women’s sexual health issues, genito-pelvic dysesthesia (GPD), could be caused by radiculopathy of sacral spinal nerve roots within the cauda equina. Over the last 4 years, to more effectively manage patients with suspected cauda equina pathology, a robust collaboration among sexual medicine, spine surgery and neurophysiology disciplines has been established.

Objectives

The aim of this study is to review the collaborative experience in managing patients with genito-pelvic dysesthesia.

Methods

We defined GPD in the broadest sense to include both unwanted, unrelenting, distressing arousal, pain and/or itching symptoms >6 mo (hyperfunction), and also persistent degrees of genital anesthesia leading to orgasmic dysfunction >6 mo (hypofunction). Charts from 2015 to 2019 of GPD patients presenting to our sexual medicine facility where neurogenital testing results were consistent with radiculopathy of sacral spinal nerve roots within the cauda equina were reviewed retrospectively. Lumbar and sacral MRIs were obtained and reviewed simultaneously in collaborative bi-monthly meetings and identified as having or not having treatable spinal abnormalities, subdivided into subtle or obvious. When appropriate, a transforaminal epidural spinal injection (TFESI) or caudal block with anesthetic agent and/or steroid was administered and the outcome measured by Patient Global Impression of Improvement (PGI-I). Those with clinically significant symptom reduction were considered for minimally invasive spine surgery (MISS).

Results

734 patients (586 women; 80%; mean age 47 +/− 24) met criteria for this retrospective chart review. 637 lumbar and/or sacral MRIs were reviewed. A total of 112 TFESI were performed, 90 of which showed positive responses with more than 60% improvement on PGI-I of 1,2. 57 surgeries were performed. 17 patients (71% women) with PGAD underwent MISS for herniated nucleus pulposus and or annular tear. 76% declared post-op clinical improvement with PGI-I 1,2,3 with mean follow-up of 12 months (4 - 30 months).

Conclusions

Cauda equina pathology can cause unwanted, unrelenting, distressing neurologic-based GPD from radiculopathy of sacral spinal nerve roots. In selected cases these GPDs may be reversed by MISS. There are management benefits from collaboration among sexual medicine, spine surgery and neurophysiology specialists.

Disclosure

No.
(021) Earlier Age of First Sexual Activity Predicts Women’s Higher Sexual Pleasure, but also Higher Sexual Shame
Authors: Bogen K , Jones H , Lorenz T
Published: June 2023

Introduction

Despite calls for greater focus on sex-positive frameworks for understanding adolescent sexuality (Harden, 2014), the majority of research on early puberty and sexual debut has primarily focused on negative outcomes such as body shame (McKenney & Bigler, 2016; Schooler et al., 2005), sexual or vulvar pain (Bergeron et al., 2011; Latthe et al., 2006), risk for STIs (Sandfort et al., 2008; Upchurch et al., 2004), and unwanted pregnancy (O’Donnell et al., 2001; Mosher & McNalley, 1991). However, some studies suggest that early puberty is also associated with positive outcomes such as higher sexual desire (Fortenberry, 2013) and greater intimacy in early sexual relationships (Kaltiala-Heino et al., 2003). Possibly, this contradiction arises as researchers have not often distinguished between the effects of puberty – and pubertal timing – on partnered vs. solitary sexual experiences.

Objectives

The current study was designed to improve providers’ understanding of women’s early sexual experiences and later sexual wellness. Specifically, we sought to clarify associations between early puberty and partnered vs. solitary sexual debut and add to the scant literature addressing the effects of early puberty on positive outcomes such as sexual pleasure and functioning.

Methods

92 women recruited from a large university in the Midwest (Mean age = 20.51, SD = 2.7) participated in an online survey about sexual wellness. We ran a series of Pearson correlations between women’s age at puberty, menses, first masturbation, first partnered sexual activity, and their adult levels of sexual shame, sexual pleasure, and sexual functioning.

Results

Early puberty was significantly correlated with higher reported sexual shame in adulthood, whereas early partnered sexual debut was significantly correlated with higher reported sexual pleasure in adulthood. Of note, early masturbation was significantly correlated with both higher sexual shame and higher sexual pleasure in adulthood. Correlations with overall sexual functioning were not significant.

Conclusions

Results suggest that the experiences of early puberty and early masturbation are each associated with increased sexual shame, and that these experiences may be particularly important targets for intervention to decrease sexual distress in adulthood. Moreover, although early partnered sexual debut has been largely stigmatized as a sexual health risk across sexual science literature, our findings suggest that earlier partnered sexual debut may enable women to experience greater sexual pleasure, perhaps as a result of earlier negotiation of their sexual desires and sexual communication (Sprecher et al., 2019). If replicated, these findings would suggest the need for targeted sexual education for patients experiencing early adolescence to prevent development of sexual shame in adulthood.

Disclosure

No.
(022) Measures of Sexual Functioning, Particularly Pain Functioning, are Imperfect Predictors of Women’s Sexual Pleasure
Authors: Jones H , Bogen K , Lorenz T
Published: June 2023

Introduction

There is a complex relationship between women’s sexual functioning and positive outcomes such as satisfaction or pleasure. Some studies indicate that lower physical pleasure mediates the association between sexual function and distress (Stephenson & Metson, 2015), suggesting these constructs are related but distinct. Moreover, different aspects of sexual dysfunction are differentially associated with distress: for example, women more commonly report low desire as distressing than orgasm dysfunction (Shifren, et al., 2008). Additionally, researchers have noted that sexual pain disorders differ from other sexual dysfunctions in both etiologic mechanisms and psychosocial outcomes (Binik et al., 2002). Given that the ultimate goal of sexual medicine treatments is to improve women’s sexual satisfaction and pleasure, what are the actual associations between different aspects of sexual function and women's wellbeing?

Objectives

To explore associations between sexual function, satisfaction and pleasure in healthy young women. In particular, we were interested in associations between pain and sexual pleasure.

Methods

Women at a large Midwest university completed an online survey about sexual wellness (N= 92; Mean age = 20.5, SD = 2.7), including well- validated indices of sexual pleasure (using the Female Sexual Subjectivity Inventory, FSSI) and sexual functioning (using the Female Sexual Function Index, FSFI). Analyses were conducted examining the relationships between sexual functioning, sexual satisfaction, sexual pleasure, and sexual pain.

Results

Although there was a significant relationship between higher sexual functioning and higher sexual pleasure, less than 20% of the total variance in sexual pleasure was explained by sexual functioning (R2 = 0.176). Similarly, while there was a positive relationship between sexual pleasure and sexual satisfaction, sexual satisfaction accounted for less than 30% of the total variance in pleasure (R2 = 0.266). Sexual pain was not significantly associated with sexual pleasure and accounted for only 2% of the variance in pleasure.

Conclusions

While sexual functioning, satisfaction and pleasure all had statistically significant associations, the overlap between these constructs was considerably smaller than typically assumed. Notably, there was no association between pain and pleasure, which further supports the conceptualization of sexual pain as distinct from other types of sexual dysfunction. When conceptualizing interventions that address women’s sexual pleasure, relying solely on self- reported sexual functioning or pain may miss important sources of pleasure such as intimacy, relationship satisfaction, or positive mood.

Disclosure

No.
(044) Sex Education: Including Simulation in CME Presentations
Authors: Phillips N , Bachmann G
Published: June 2023

Introduction

Lectures on female sexuality often include power point and video materials. However, perhaps the addition of simulation may enhance the educational experience.

Objectives

At a recent major presentation geared to the Ob/Gyn health team, the two authors were asked to present on taking a sexual history, with inclusion of sexual dysfunction. It was decided that simulation would be included to highlight strategies and interview skills related to the patient interaction and attendee responses would be evaluated.

Methods

By way of a virtual presentation, one of the authors presented the material that had to be covered in a standard power point presentation. However, before each point was presented, the two authors role-played a health care provider talking to a patient. The presenter, in her role as health care provider, first incorrectly asked the patient about her symptoms in what was an indirect and inattentive way, which was followed by a debriefing. Next, the presenter asked the patient in a more focused and responsive manner about her symptoms, and there was debriefing after this. This process was repeated throughout the presentation.

Results

The feedback from the presentation was overall positive. Comments from attendees noted that they could clearly understand, through the simulation the difference between correct sexual history taking and poor sexual history taking, and, as a result, would feel more comfortable in future patient interactions concerning sexual issues.

Conclusions

The use of simulation/role playing should be considered in all sexual health presentations.

Disclosure

No.
(046) Signalling the Vaginal Code: A Dual Role for Oxytocin in Sexual Partner Preference and Reproduction
Authors: Mac Cionnaith C , Gomez-Perales E , Ismail H , Pfaus J , Brake W
Published: June 2023

Introduction

In female rats, paced copulation induces a neuroendocrine response that is necessary for pregnancy. Paced copulation is also a strong sexual reinforcer that results in both conditioned place preference and conditioned sexual partner preference. Although the neuropeptide oxytocin (OT) controls partner preference formation in female prairie voles, it is not known whether OT regulates sexual preference formation in female rats.

Objectives

The current experiments tested whether (i) OT is necessary and sufficient to induce a sexual partner preference, and (ii) OT signalling affects the reproductive effects of pacing that are necessary for both pregnancy and partner preference. These experiments also tested whether peripheral or central OT signalling regulates these behaviours by using an antagonist that enters the CNS (Cligosiban, 5mg/kg; CLG) and one that does not (L-371,257, 1mg/kg; data collection in progress).

Methods

In the first experiment, Long-Evans female rats (n = 14) were injected I.P. with either saline, 20μg OT, 50μg OT, CLG, L-371,257, one minute before their first 30-min sexual experience with a male rat scented with almond. Four days later, the females were given a drug-free 30-min partner preference test in an open field with two males, one scented and the other unscented. The second experiment tested whether OT signalling augments the facilitation of estrous termination that is reliably induced with stimulation of the cervix (VCS). Long-Evans females (n = 12) were injected with either saline, 50μg OT, CLG, or L371,257, 1min prior to sham stimulation or 50 distributed VCSs administered with a lubricated glass rod. Twelve hr after VCS or sham females copulated with a male to assess sexual receptivity.

Results

In the first experiment, females treated with both doses of OT received the scented male’s ejaculation first and more often, but they did not solicit the scented male more often than the unscented male. CLG-treated females received the unscented male’s first ejaculation preferentially and solicited the unscented male more often. In the second experiment, females treated with OT showed decreased sexual receptivity regardless of the type of stimulation, suggesting that OT mimicked the effect of VCS. In contrast, estrous termination was attenuated in females given CLG and L371,257 with VCS, suggesting that central and peripheral OT receptors play a role in activating neuroendocrine responses induced by copulation.

Conclusions

Taken together, these data suggest that OT signalling regulates aspects of both reproduction and sexual reward in female rats, biasing their preferences to receive ejaculations preferentially from males that are associated with paced copulation and terminating their sexual receptivity faster, thus, increasing the likelihood of pregnancy and paternity.

Disclosure

No.
(047) Hope and Flourishing: The Effect of Hope on Psychological Flourishing in Participants with Chronic Pain
Authors: Marino Clyne L
Published: June 2023

Introduction

Patients living with chronic pain conditions, especially conditions for which there is no cure, may experience feelings of hopelessness and mental health challenges with the continuation of health issues. This study explored the relationship between hope for a cure to a condition and psychological flourishing, with exploratory variables such as age, whether participants were told that their chronic condition might be curable, and whether they believed their condition to be curable.

Objectives

The hypothesis was that participants with chronic pain who score high in hope, operationalized by the Herth Hope Index, would also score high in psychological flourishing, measured by Diener’s Psychological Flourishing Scale.

Methods

Participants were 116 females with chronic conditions including endometriosis and fibromyalgia between the ages of 18 and 50-years-old recruited online via Facebook to complete a Qualtrics survey.

Results

In the testing of exploratory variables, there was a significant correlation between participant belief that their pain was curable and participant scores on the Psychological Flourishing Scale, r=.203, N=101, p<0.05, two tails. A Pearson product-moment calculation explored the relationship between total scores on the Herth Hope Index (M=23.901, SD=4.072) and the Psychological Flourishing Scale (M=33.087, SD=11..372). This relationship was found to be statistically significant, r=.736, N=102, p<0.01, two tails, indicating a strong positive relationship between scores on the Herth Hope Index and scores on the Psychological Flourishing Scale. Higher belief that pain was curable was associated with higher scores on the Psychological Flourishing Scale. There was not, however, a significant correlation between being told that one’s condition is incurable or participant age and scores on the Psychological Flourishing Scale. A finding of note was that believing one’s condition to be incurable was distinct from and more significant than being told by a physician that a condition was incurable.

Conclusions

Further studies should include more diverse samples, or into other factors that might promote psychological flourishing in patients with chronic pain. In particular, future studies could investigate how the discussions clinicians may have with their patients in regard to outcomes for their health conditions could affect psychological outcomes for the patients. A better understanding of language that could be detrimental for the psychological flourishing of patients with chronic conditions would be important to inform best practices for clinician-patient interactions.

Disclosure

No.
(050) Vulvodynia Viewed From a Disease Prevention Framework: Insights From Patient Perspectives
Authors: Webber V , Miller M , Gustafson D , Bajzak K
Published: June 2023

Introduction

Persons with vulvodynia (a chronic vulvar pain condition) suffer many barriers to diagnosis and treatment, several of which may be exacerbated by the sociocultural and geographical context in which they live.

Objectives

We drew on the experiences of patients with vulvodynia who were living in small urban and rural communities to learn what they perceived as the major barriers to diagnosis and treatment as well as to probe for possible solutions.

Methods

For this qualitative case study, we conducted 3 focus groups with a total of 10 participants, drawn from patients seen at our academic tertiary referral center, with a goal of understanding their lived experience with vulvodynia. The patient dialogue was coded into themes and temporally grouped to illustrate struggles and victories in diagnosis and treatment.

Results

Participants confirmed that healthcare provider knowledge and attitudes as well as system challenges (specialist and allied healthcare provider availability) are major barriers to timely diagnosis. Of novel interest are other factors that exacerbate distress and delay diagnosis such as patients’ inadequate knowledge of sexual functioning and sociocultural messages regarding “normal” sexual activity. Our work suggests that a disease prevention framework that includes comprehensive sexual education before or at the onset of sexual activity may be of benefit in reducing the burden of vulvodynia when added to strategies to increase healthcare provider knowledge and improve access to effective treatments.

Conclusions

While healthcare provider knowledge and attitudes are often at the forefront of barriers to diagnosis, our study suggests that to minimize patient distress and expedite diagnosis, resources must also be directed to promoting comprehensive sexual health education.

Disclosure

No.
(056) The Decreased Sexual Desire Screener: What are we missing?
Authors: Harper L , Mahar E , Powers C
Published: June 2023

Introduction

The Decreased Sexual Desire Screener (DSDS) is a five-item self-report questionnaire used to assist clinicians in diagnosis of generalized acquired Hypoactive Sexual Desire Disorder (HSDD). While the first four items of this questionnaire assess whether the woman has decreased sexual desire that is causing her distress, the fifth item assists in identifying possible medical and psychological factors that could confound the diagnosis of HSDD (e.g., menopausal symptoms, pain, alcohol). The present study used baseline data from users of a mobile app (Rosy). The app was designed with the goal of improving women’s sexual function, particularly sexual desire, by providing evidence-based resources to users.

Objectives

To investigate what factors—beyond those listed in question five of the DSDS—may contribute to women’s low sexual desire, and to examine what percentage of women using the mobile app may qualify for HSDD.

Methods

Women downloaded Rosy through Apple’s App Store for iOS devices or Google Play for Android devices. App users completed the DSDS when they first opened the app. From February 2019 (the launch of the app) to early-November 2019, if women felt that a factor not listed in question five of the DSDS contributed to their current desire in sexual desire or interest, they were able to respond with “other” and then type in that factor. Because the format of this study did not allow for discussion of question five responses with the women, we did not consider this question when examining whether the woman may qualify for a diagnosis of HSDD; previous research found that eliminating question five increases the sensitivity from 83.6% to 88.4% and decreases the specificity from 87.8% to 77.5% (Clayton et al., 2009).

Results

Of the 2,178 women who had the option to type in factors they felt contributed to their low sexual desire that were not already listed in question five, 122 (5.6%) wrote a response. Considering these 122 women, 25.4% attributed their low sexual desire to body-image or self-image issues (e.g., weight gain, not feeling attractive), 8.2% to trauma (e.g., sexual trauma), 7.4% to children, and 5.7% to feeling like there is not enough time in the day. Furthermore, we found that 53.5% of the 8,497 app users who reported that they were referred to the app by a professional (i.e., clinician, physician, therapist) may qualify for HSDD versus 39.1% of the 8,750 users who reported finding the app through social media or word of mouth.

Conclusions

Using mobile app data, we explore what factors not listed in question five of the DSDS women believe are linked to their low sexual desire. We also found that the majority of users who reported professional referrals to the app may qualify for HSDD. This study highlights how data from mobile apps, such as Rosy, can be used to better understand HSDD and factors that may contribute to women’s low sexual desire.

Disclosure

Yes - Rosy Wellness, Inc.

Industry initiated, executed and funded study – Yes.
(060) Dyspareunia in Patients with Female Prostatitis
Authors: Parshin A
Published: June 2023

Introduction

Female prostatitis (skeneitis) remains a little-studied disease and is hidden in the literature under the guise of urethral syndrome.

Objectives

To assess dyspareunia in patients with female prostatitis.

Methods

From 2015 to 2019, 79 patients with female prostatitis were examined. The diagnosis was based on complaints, anamnesis, examination of patients in a gynecological chair and urethroscopy. The analysis of patients ' complaints was made. Patients with dyspareunia were asked to localize pain in the vagina.

Results

Dyspareunia was a complaint in 28 patients. Among 61 patients who had sexual activity, this was 46%. Of these, 9 (15%) patients localized pain during sexual intercourse along the anterior wall of the vagina. This localization seems logical, because the female prostate gland is located on the side of the anterior wall of the vagina.

Conclusions

Dyspareunia occurs in almost half of patients with female prostatitis. When asking complaints from patients, it is necessary to specify the localization of pain in the vagina. Dyspareunia along the anterior wall of the vagina is proposed to be considered a new specific symptom of female prostatitis.

Disclosure

No.
(066) STI Co-infection Among Pregnant Women with SARS-CoV-2
Authors: Needham K , Pope R
Published: June 2023

Introduction

Although information on COVID-19 infection during pregnancy is still limited, existing evidence does not support increased susceptibility to infection or increased risk of developing severe disease during pregnancy, and the occurrence of intrauterine transmission has not been proven conclusively. However, to our knowledge, there is even less information available on co-infection with sexually transmitted infections in pregnant patients with COVID-19. The prevalence of any curable STI (gonorrhea, chlamydia, trichomoniasis, or syphilis) during pregnancy is estimated to be 3.3% (95% CI 2.9-3.7).

Objectives

STIprevalence may be correlated with COVID-19 infection in pregnant women, since both are influenced by risk-taking behaviors (i.e. condom use, mask-wearing, handwashing, and social distancing). On the other hand, an upregulated immune response in the setting of COVID-19 infection may in fact provide immunological protection against co-infection with STI’s or Group B Streptococcus (GBS), a non-sexually transmitted infection with a prevalence of 17.9% (95% CI 16.2-19.7) in pregnant patients. Our goal was to further explore this relationship.

Methods

We conducted a chart review of 34 pregnant patients with COVID-19, specifically looking at the incidence of antenatal STI’s and GBS.

Results

The mean age of the participants was 28.9 (SD 5.7) years, the mean gestational age at infection was 33.9 (SD 7.3) weeks, and the mean gestational age at delivery was 37.2 (SD 4.4) weeks. 26.5% (n=9) of patients tested positive for an STI, including gonorrhea (n=3), chlamydia (n=3), HPV (n=3), and trichomoniasis (n=2). 23.5% (n=8) tested positive for GBS infection.

Conclusions

The increased incidence of STI’s among pregnant women with COVID-19 compared to the expected incidence for any pregnant woman may suggest increased risks to this particular population that are worth investigating further.

Disclosure

No.
How to Approach Difficult Experiences: Memory Exposure and Processing
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

In this chapter, readers walk through how to approach memories of difficult experiences. This chapter provides the specific worksheets and how to approach the memory, stay with the emotions associated with the memory, consider what the memory says about you as a person at the time of the difficult experience and now, and then do it again and again. Through repeatedly connecting with the memory and letting yourself feel the emotions, you can come to a different perspective on the experience and how you feel and think about it and yourself. The Making Meaning of Difficult Experiences: Self-Guided Program gives the structure to approach the memory and emerge on the other side in a better place.
Getting Active
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

In this chapter, you learn how to get up and reconnect with the world despite difficult experiences through an intervention called behavioral activation. Behavioral activation essentially means getting and staying active. Behavioral activation is a way to increase your activities and improve your mood. We need to take care of ourselves before we can take care of others. Part of this self-care is staying active and doing things that nourish our soul. When we are stressed or sad or recovering from a difficult situation, it is easy to put those activities aside, but then we aren’t functioning at our best. Examples of self-care activities are presented to help you choose how to get started, provide a structure to help you set goals for behavioral activation, and track your progress.
Percutaneous Trial of Spinal Cord Stimulation
Authors: Pritzlaff Scott G. , Kreis Paul G. , Fishman Scott M.
Published: June 2023

This chapter tackles the percutaneous trial of spinal cord stimulation (SCS). Anterograde lead placement for stimulation is largely utilized for treating pains in the low back, leg, neck, and arm. Fluoroscopic guidance helps overcome the difficulties of false loss of resistance (LOR) during the process of inserting temporary leads while placing epidural catheters. Guidewires are also utilized for lead manipulation and steering to establish a path for epidural space. The chapter expounds on the process of percutaneous trials, which includes lead manipulation, stimulation testing, and anchoring the lead externally. It covers the instructions on what patients need to do following the SCS procedure.
History of Social Psychiatry and Historical Aspects of the World Association of Social Psychiatry
Authors: Kallivayalil Roy Abraham , Kastrup Marianne , Gogineni Rama Rao , Di Nicola Vincenzo , Sharma Shridhar
Published: June 2023

Social psychiatry is a discipline that focuses on the social dimension of mental health, mental illness, and mental healthcare. Social psychiatry uses the concepts and methods of the social sciences, including psychology, sociology, and anthropology. In 1903 the term “social” was first linked to psychiatry. In 1911 psychiatric care outside the asylums was advocated. Dr. E. E. Southard of Harvard Medical School, in 1922, taught “social psychiatry,” which he termed “an art now during development by which the psychiatrist deals with social problems.” The First and Second World Wars advanced psychiatry, including social psychiatry. The tumultuous 1960s bought a myriad of advances, including family therapy, community psychiatry, and the biopsychosocial model. The World Association of Social Psychiatry (WASP) was founded in 1964 by Joshua Bierer of the United Kingdom. In 1976, the World Congress of Social Psychiatry was held for the first time in Opatija, Croatia. In 2001, the World Association of Social Psychiatry (WASP) was officially launched. WASP had a phenomenal growth, especially during the past decade. Currently WASP has 27 member societies representing all the continents. It is the beacon of promoting social psychiatry in etiology and the treatment of human wellness, and the prevention and treatment of mental suffering.
The Biopsychosocial Model of Health
Authors: Craig Tom K. J.
Published: June 2023

This chapter provides an update to the biopsychosocial model of health first described in detail by George Engel in the 1970s. He argued that abnormalities in biological mechanisms are not enough to explain the subjective experience of “illness” or to account for the variation in treatment response, course, and ultimate outcome of many conditions. Instead, psychological and social factors come to the fore, determining when and how people come to view themselves as unwell, influencing whether and when they enter and remain in treatment, as well as many other key aspects of the illness experience. The model has been heavily criticized in the light of advances in the understanding of biological mechanisms; opponents claim that the model is little more than a distraction from the real understanding of disease, or a convenient compromise to resolve ideological conflicts with the champions of psychology and sociology. What is missing, they imply, is any evidence for a truly causal psychosocial mechanism that interacts with biology at a fundamental level. In this light, the recent theoretical work of Derek Bolton and Gillett provides a way forward. This model and supporting evidence are described.
Social Psychiatry
Authors: Lolas Fernando , Rodríguez Eduardo
Published: June 2023

Every human being is born into a moral community. Ethics begins from the inner reflection of persons who orient their lives according to reason, belief, or utility. Social institutions have been established for regulating the practice of the professions. Psychiatry is a meta-text composed of different texts not easily compatible with each other. Written regulations, norms, and principles must be balanced against the major interests of all persons and institutions involved. If problems cannot be resolved, they can be dissolved in the common good of a democratic and egalitarian society. The ethical dimensions of social psychiatric practice will incorporate public health, international health and global health perspectives. Prima facie principles helpful in this field include autonomy, beneficence, non-maleficence, and justice. Cultural and structural factors may influence the relative weight of each principle in concrete cases. Methods of ethical reasoning applied to psychiatric practice from a social perspective should be comprehensive and should incorporate social, clinical, research, educational, and training aspects.
The Importance of Medical Professionalism in Social Psychiatry
Authors: Rothe Eugenio M.
Published: June 2023

The main goal of being a physician is to uphold the primacy of the patient (altruism), and a good-quality interaction and maintenance of the patient-doctor relationship form the core mission of the medical profession. Thus the new concept of medical professionalism recognizes that all healthcare occurs reciprocally, and that emotions play an important part of all human interactions and are connected to the curative effect of the doctor-patient relationship. This chapter discusses the erosion of medical professionalism in developing countries, the importance of restoring medical professionalism worldwide, and teaching it as an integral part of the medical school curriculum. It will also address cultural differences and the essential components in the practice of medical professionalism, as well as how practicing professionalism enriches both the physician and the patient and enhances the prestige of the medical profession.
Developing a Curriculum to Teach Social Psychiatry
Authors: Rothe Eugenio M. , Pumariega Andres J. , Gogineni Rama Rao
Published: June 2023

Very few residency-training programs provide a formal curriculum of social psychiatry that teaches residents about the social determinants of health and the evidence-based social treatment approaches to treat these problems. In many cases, trainees learn about social aspects of psychiatry through clinical exposure to patients, their families, and the community. Trainees need to be taught that social psychiatry is a paradigm that combines medical training with the perspectives of social anthropology, social psychology, cultural psychiatry, sociology, and other disciplines relating to the human condition in order to better understand and treat mental disorders. This chapter describes the necessary elements that should be included in psychiatry residency-training programs so that future psychiatrists can learn to treat patients from a complete biopsychosocial perspective.
Social Psychiatry
Authors: Moffic H. Steven
Published: June 2023

Psychiatrists face death in their clinical practice in many forms, and the psychology hereof is clearly important. It is part of the psychiatric profession to assess the risk of suicide, as well as homicide, as part of daily clinical work. Decisions related to these areas all have severe ethical and confidentiality implications. The chapter further describes some of the personal experiences of the author when faced with patient suicide. Despite many religious grieving rituals, workplace procedures on how to handle grief in employees are needed but lacking. Recently physician-assisted death has become a social issue of increasing concern. Though few psychiatrists support this procedure, they nevertheless play an important role in assessing the existence of clinical depression, or another psychiatric disorder, as a reason for the request. Society needs this clinical expertise also in the movement to prolong life. Recommendations are provided on pertinent issues related to death and dying, including countertransference, mourning, hastening death or prolonging life, epidemics, disasters, patient perspectives, relationship with other professions, and dealing with denial.
Social Psychiatry
Authors: Stotland Nada L. , Shrestha Angela Devi
Published: June 2023

Historically women have been excluded from positions of power and subjected to abuse of various kinds. Both religious and scientific reasons have been used to confine women to inferior roles in society. In many societies, a female newborn is viewed as a liability, and all through the reproductive phases of life women may experience these as defining and incapacitating them. Menstruation may limit activities and be considered shameful. Fertility may be linked to reproductive injustice, and access to abortion may be nonexistent or under massive attack, and sexual access to unwilling women is seen as an entitlement in many situations. Postpartum depression poses particular social challenges. In the family, women are still subject to oppression. It is also within the family that women are most at risk of psychological and physical abuse. Women entering professional careers may encounter considerable resistance, varying from mistrust to outright harassment. Women’s rights, though recognized in a few places, are under attack in others, and fundamentalist expressions of religion may restrict women’s roles and rights. The #MeToo movement did not resolve women’s challenges, and it is doubtful if abused women are better off than they were before #MeToo. This chapter provides a list of clinical and social applications to incorporate the impact of social realities into the practice of medicine including psychiatry. Social psychiatrists have an important role to examine all that affects a woman’s mental health in order to prevent misunderstandings and subsequent mismanagement.
Social Psychiatry
Authors: Pradhan Basant
Published: June 2023

Social cognitive neuroscience is an emerging discipline that bridges across several disciplines and includes the concepts of social brain and social psychiatry. Simply speaking, social brain is the biological substrate of what social psychiatry entails. Our sociality is the outcome of an intricate and multi-dimensional relationship between the size of the social brain, the richness as well as the selectivity of its neural networks and the behavioral complexities emanating from the bonded relationships that underpin our social coalitions. Although no specific brain area is specifically designated as the social brain, accumulating data from the neuroimaging and cognitive neuroscience research reveal that distinct neuronal networks do subserve our social functionings and also that the social information processing may actually be different non-social information processing. Our various social functioning and the related processes serve as the operational domains for both the social brain as well as social psychiatry. Their scopes are quite broad and range from epidemiological/anthropological research and an indistinct boundary with individual or group psychotherapy at one end, and quite precise brain mapping, genetic, neurochemical studies and targeted neuromodulation and integrative psychiatric interventions at the other end. This chapter embarks upon these fascinating aspects from social cognitive neuroscience, biological, developmental and spiritual perspectives and also discusses some therapeutic implications, both actual and potential.
Suicide and Sociocultural Considerations
Authors: Gaind K. Sonu
Published: June 2023

This chapter on suicide and sociocultural considerations reviews the complex phenomena related to suicide that must be understood by considering a person’s complete biopsychosocial and cultural experience, and societal context. While suicide in the medical model is traditionally considered to be linked to mental illnesses, sociocultural elements play significant roles in understanding suicide in the broader context. Societal responses to suicide and suicide attempts should not foster shame and blame; they likewise should not glorify or romanticize suicide. Suicide-prevention strategies benefit from integrated team approaches and need to be sensitive to local sociocultural environments. Careful consideration of sociocultural issues related to suicide is essential as assisted dying policies are being debated worldwide, and the medical profession has an obligation to contribute evidence-based policy guidance rather than simply ideologically driven positions. Total life suffering contributes to a person’s wish to die, and sociocultural suffering must be considered and addressed for suicide-prevention strategies to succeed.
Medical Illness in Psychiatry
Authors: Thornton Joseph E.
Published: June 2023

This chapter takes a three-step approach to medical illness in psychiatry. First it takes the practitioner’s point of view in relationship to the patient encounter for assessment. Then it takes a holistic view for clinical formulations and interventions with the patient. Third, it examines the ethics of care and where interventions for patients are directed toward their social framework. For the clinical encounter the author emphasizes the importance of a comprehensive systematic patient-centric assessment so that the diagnostic formulation is driven by the findings on the examination, avoiding premature diagnostic closure. The next sections help place the clinical findings into the social context of the patient’s developmental history and current cultural environment. Treatment interventions are tailored to assist the patient from their perspective. Finally, looking at social determinants of health, one recognizes that interventions to help patients must be directed at the social matrix, whether it is access to information for self-care or access to medical care. The current COVID-19 pandemic provides content for discussion on ethics and social psychiatry.
Child Maltreatment from a Sociocultural Perspective
Authors: Shapiro Michael
Published: June 2023

Child maltreatment occurs across the globe, in all nations, in all cultures. Consequences of child maltreatment include impaired lifelong physical and mental health; the global impact can lead to shortened life spans, a diminished workforce, increased healthcare costs, and ultimately slow the economic and social development of a society. There is sufficient evidence that links childhood maltreatment with the development of mental illness and physical illness, and maltreatment experienced as a child is a risk factor for being a perpetrator of child maltreatment as an adult. The best working definition of child maltreatment includes the context of contemporary community values and professional expertise of what is considered inappropriate and damaging, which are determined by social constructs and culture. This chapter presents a historical and current review of child maltreatment from a cultural perspective and foreshadows the global challenge that lays ahead.
The Mental Health of Prisoners
Authors: McLellan Angus , Molodynski Andrew
Published: June 2023

Prisons have for centuries been the backbone of penal systems internationally, with more than 90% of inmates being men. Incarceration rates differ significantly and are highest among underprivileged and minority groups. The United States has the highest overall incarceration rate. Mental health problems are more prevalent in prisons than outside, with increased rates of major depression and psychosis. Those with mental illness also have significant impairment in other areas of social functioning, and female prisoners have very high levels of mental illness. Substance misuse is a significant problem in prisons, and again prevalence is higher than in the general population. The first weeks of incarceration are especially risky as regards suicidal behavior. Certain groups require special attention, such as prisoners on remand, adolescents, women, older people, and LGBT+ prisoners. Evidence is emerging that interventions may reduce reoffending rates and improve the health of prisoners, but there is no consistency of approach within or between individual countries. Prison is still used primarily as punishment, with rehabilitation playing a smaller part or being absent altogether even though the United Nations states that prisoners should have the same access to healthcare as if they were in the general community.
Youth Violence
Authors: Rothe Eugenio M. , Ono Yoshiro , Pumariega Andres J.
Published: June 2023

Only a small proportion of acts of violence against children are reported and investigated, and few perpetrators are held to account. In terms of youth perpetrators, the scant data this chapter reviews the existing epidemiological iteterature and focuses on preventive interventions. However, there is increased international attention to violence perpetrated by youth and its various associated factors. This chapter reviews the literature on this important topic and focuses on preventive approaches.
Neuropathology Primer
Authors: Kulac Ibrahim , Pekmezci Melike
Published: June 2023

The neuropathology primer chapter summarizes the histomorphologic, molecular, and immunohistochemical features of the central nervous system (CNS) neoplasms and is largely based on the 2016 World Health Organization (WHO) classification of CNS tumors (significant impending changes are noted where appropriate). It provides a practical approach and reviews the main diagnostic and grading criteria for the most commonly encountered CNS tumors and some rare tumors with unique histologic or molecular features. Specifically, it summarizes the diagnostic criteria for diffuse glial neoplasms including oligodendroglioma, diffuse astrocytoma, and glioblastoma using an integrated approach combining histologic and molecular findings. It also reviews solid glial tumors such as pilocytic astrocytoma and pleomorphic xanthoastrocytoma; glioneuronal, neuronal, and ependymal neoplasms; meningiomas; non-meningothelial mesenchymal tumors; primary melanocytic neoplasms of CNS; embryonal tumors; and tumors of the sellar and pineal region. In addition, tumors arising from the peripheral nerve sheaths are summarized. The chapter includes numerous figures representing typical histologic examples for many tumor types.
Ependymoma
Authors: Alnahhas Iyad , Rayi Appaji , Slone Wayne , Kobalka Peter , Ong Shirley , Giglio Pierre , Puduvalli Vinay K.
Published: June 2023

Ependymomas are uncommon glial neoplasms whose biology and clinical characteristics are poorly understood and for which there are few effective treatment options. They occur predominantly in the pediatric as well as the adolescent and young-adult age groups and are seen mainly in the posterior fossa and spinal cord. They range in behavior from low-grade slow-growing tumors such as myxopapillary ependymomas to aggressive malignancies such as anaplastic ependymomas. Intense research in recent years has yielded novel insights into the biology and clinical behavior of these tumors, which has allowed development of several targeted therapeutic approaches. However, the modest efficacy of such studies to date have emphasized the complexity of these tumors and highlighted the need for continued preclinical and translational research to address their clinical impact. This chapter reviews the current state of the science of biology, pathophysiology, and classification of ependymomas and outlines the current recommendations for treatment of patients with these tumors.
Germ Cell Tumors
Authors: Takami Hirokazu
Published: June 2023

Intracranial germ cell tumors (GCTs) are rare central nervous system neoplasms predominantly occurring in pediatric and young adult patients. GCTs predominantly arise in the brain midline, most frequently at the pineal region. The WHO classification defines five histopathological GCT subtypes: germinoma, mature and immature teratoma, yolk sac tumor, choriocarcinoma, and embryonal carcinoma, which are divided into germinomas and non-germinomatous germ cell tumors (NGGCTs). Tumor markers include human chorionic gonadotropin (HCG) and alpha fetoprotein (AFP) in blood serum and cerebrospinal fluid, the elevation of which typically suggests choriocarcinoma and yolk sac tumor components, respectively. Cases with negative tumor markers are diagnosed based on histopathology on surgically obtained specimens. Most germinomas are highly chemo- and radiosensitive, with non-responders accounting for less than 10%. NGGCTs are frequently resistant to standard adjuvant therapies, and sometimes require more intensive treatment, such as myeloablative chemotherapy followed by autologous bone marrow stem cell transplantation or multiple surgical resections at recurrence. Surgical resection is reserved for mature teratoma, which is curable with resection alone, and for cases with poor response to induction chemotherapy. Although approximately 60% of GCTs harbor mutations in either MAPK or PI3K pathways, no targeted therapy has been registered to date. Overall survival at 10 years for germinoma and NGGCT is approximately 90–95% and 75–90%, respectively. Long-term survivors are at risk of secondary malignancy, cardiovascular disease, and cognitive decline due to therapeutic sequelae. Progress in treatment options will include targeted therapy, immunotherapy, and dose reduction of radiation.