bluuebunny/crossref_metadata_2025 huggingface dataset:
(008) Chronic High Fat Diet Decreases Vaginal Smooth Muscle Tone but does not Affect Pelvic Floor Skeletal Muscle in Mice
Authors: Burleson L , Odom M , Amorese A , Spangenburg E , Hannan J
Published: June 2023

Introduction

Pelvic organ prolapse (POP) is a disease that affects the physical and mental health of women, as well as their quality of life. POP, regardless of severity, can be a direct cause of female sexual dysfunction (FSD) by producing pain during intercourse or a general reluctance to engage in sexual activity. The largest risk factors for POP include parity, obesity, and advanced age. Obesity, a modifiable risk factor, is believed to increase intra-abdominal pressure and weaken the pelvic floor muscles and fascia. Studies have shown that obesity and a high fat diet (HFD) can weaken skeletal muscle by increasing collagen deposition and inducing muscle apoptosis.

Objectives

There is paucity in the literature of animal studies that have specifically investigated the effect of obesity on the support structures of the pelvic floor and how it contributes to POP. The objective of this study is to examine the structure and function of the vagina and pelvic floor in female mice fed a chronic HFD.

Methods

Adult female C57/Blk6N mice (10 weeks, n=32) were fed a control (10% kcal fat) or HFD (45% kcal fat) for 24 weeks. Ex vivo external vaginal sphincter contraction to increasing concentrations of adrenergic agonist norepinephrine and relaxation to nitric oxide donor DEA NONOate and electric field stimulation (EFS) was measured. Iliococcygeus (IC) muscles of the pelvic floor were isolated and set to optimal length and tetanic contractions were performed at increasing frequencies to asses absolute and specific force. Fatigue was measured following repetitive stimulations over 5 minutes. IC muscle fiber types were characterized with anti-myosin antibodies and cross-sectional area (CSA) of each fiber type was measured.

Results

Vaginal sphincter adrenergic-mediated contraction was a significantly decreased in HFD-fed mice (Fig 1A; p<0.05). The vaginal sphincter smooth muscle relaxation in response to a nitric oxide donor was greater in the HFD mice (Fig 1B; p<0.05). Neurogenic-mediated EFS vaginal relaxations were also enhanced in the HFD mice (p<0.05). Surprisingly, chronic HFD did not impact iliococcygeus muscle specific force, absolute force, or muscle fatigue (Fig 1C). Furthermore, HFD did not affect the CSA or population of type I, IIa, IIX, or IIb iliococcygeus muscle fibers.

Conclusions

HFD-induced obesity in mice leads to pelvic floor weakness by enhancing relaxation and decreasing tone of the vaginal smooth muscle. Interestingly, the function and composition of pelvic skeletal muscle was unaffected by HFD. As the vagina serves as a primary support structure to the pelvic organs, lack in muscle contractility and increase in relaxation following HFD suggests that obesity-induced POP may play a direct role in FSD.

Disclosure
(015) STOMP: Sexual function Trial of Overactive bladder: Medication versus PTNS
Authors: Polland A , Hamner J , Arunachalam D , Dwarica D , Gupta A , Pennycuff J
Published: June 2023

Introduction

Female sexual dysfunction affects approximately 45% of women, and an even greater percentage of those with overactive bladder (OAB). Sexual function, measured by the Female Sexual Function Index (FSFI), has been shown to improve with treatment of OAB. To date, no study has compared the effects of percutaneous tibial nerve stimulation (PTNS) versus medication (anticholinergics (ACH) or beta-agonists (BAG)) on sexual function.

Objectives

The objective of this study was to compare the effect of PTNS and medical therapy (MT) with ACH or BAG on female sexual function.

Methods

This was a prospective multi-center cohort study. Sample sizes of 63 per group were calculated to be necessary to detect a clinically relevant difference in the primary end point, FSFI. Sexually-active women with OAB completed the Overactive Bladder questionnaire (OAB-q), FSFI, Beck Depression Inventory and a visual analog pain scale prior to and after 12 weeks of therapy.

Results

175 patients were recruited and 104 completed follow up (58/108 ACH, 31/49 BAG, 13/18 PTNS). The PTNS group had lower overall FSFI (p=0.04), worse pain (p=0.01) and decreased lubrication (p=0.006) compared to the BAG and ACH groups. After treatment there were no significant differences between the groups in overall or sub-domain FSFI scores. There were within-group FSFI differences from pre- to post-treatment, with a worsening of arousal in the ACH group (p=0.046) and an improvement in overall FSFI (p=0.04) and pain (p=0.04) with BAG. After treatment, postmenopausal women in the BAG group had significantly better overall FSFI (p=0.01), desire (p=0.003), arousal (p=0.009) and orgasm (p=0.01).

Conclusions

While both PTNS and MT improved OAB, ACH resulted in worsening of aspects of sexual function, such as arousal, while BAG improved overall sexual function and pain. Improvement in sexual function with treatment was pronounced in the sub-group of postmenopausal women. While further research in necessary, this study provides additional information about the comparative effects of OAB treatments on female sexual function, which may ultimately lead to better patient selection and outcomes.

Disclosure

No.
(016) The Effect of Phosphodiesterase-5-inhibitor on Female Sexual Function: A Systematic Review and Meta-analysis
Authors: Khashaba S , Bruce A , Krishan A , Ehsanullah S , Ndrika S , Khela A
Published: June 2023

Introduction

The link between the attainment of healthy sexual function and a high quality of life in women is well established. However, while the management of male sexual dysfunction has been afforded huge research and development, far less time and effort has been lent in the achievement of successful remedies for females experiencing sexual dysfunction. The use of oral phosphodiesterase type 5 (PDE5) inhibitors, such as Sildenafil, has been the mainstay of treatment for male sexual dysfunction for the last two decades. PDE5 inhibitors have been shown to initiate penile erection, through smooth muscle relaxation and the subsequent increase in intracellular cGMP levels. PDE5-containing cells, similar to those found in the penis, have also been confirmed within the clitoris. No previous pooled analysis has been performed, looking at the possible effect of PDE5 inhibitors on female sexual function, in a population comprising of heterosexual cisgender population.

Objectives

We aimed to perform a systematic review and meta-analysis of the best possible available studies, to evaluate the efficacy and safety of PDE5 inhibitors versus placebo when used in an exclusively female population.

Methods

We conducted a comprehensive search of electronic databases (MEDLINE, PubMed, EMBASE, CINAHL, CENTRAL, SCOPUS, Google Scholar, Web of Science, EBSCO Host, TRIP and Epistemonikos), identifying studies comparing the PDE5 inhibitors versus placebo, and the resultant effect on female sexual function. The Cochrane risk-of-bias tool for RCTs and the Newcastle-Ottawa scale for observational studies were used to assess the included studies. Random effects modelling was used to calculate pooled outcome data.

Results

Searches of electronic databases resulted in 67 articles, from which 13 randomised control trials (RCTs) met the eligibility criteria, enrolling a total of 1605 patients. The use of PDE5 inhibitor was associated with a significantly improved orgasm satisfaction (P=0.01), increased sexual arousal (P=0.02), increase in sexual satisfaction (P=0.007) when compared to placebo. The use of PDE5i was also found to have a significant association with the incidence of headaches (P<0.0001) and flushing (P<0.00001).

Conclusions

Our meta-analysis demonstrated that the use PDE5 inhibitor was associated with a significantly higher attainment of orgasm satisfaction, sexual arousal, and sexual satisfaction when administered to a solely female population, when compared with placebo. However, the use of PDE5 inhibitors was also associated with a significantly increased risk of headache and flushing. Further large-scale high-quality RCTs are required in order to further evaluate the potential role of PDE5i’s in women, particularly in those suffering from significant sexual dysfunction. These future studies should focus on a more homogenous patient group, with stricter definitions of inclusion criteria.

Disclosure
(024) Sexual, Psychological, Interpersonal Well-being and (Unmet) Supportive Care Needs of Couples After a Gynaecological Cancer Treatment
Authors: Dalex P , Aerts L
Published: June 2023

Introduction

Previous research has shown that gynecological cancer negatively affects the psychological and sexual well-being of patients. However, little is known on the impact of a gynecological cancer on the partner’s sexual, psychological and social function and on the supportive care needs of couples during and after the cancer treatment.

Objectives

To assess the sexual, psychological and relational functioning of women and their partners after a gynecological cancer treatment and to assess their (unmet) supportive care needs during and after treatment.

Methods

Patients treated for a gynecological cancer at the [blinded for review] between January 2012 and September 2019 and their partners completed self- reported questionnaires. Participants completed the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory II, the Female Sexual Function Inventory, the International Index of Erectile Function’s, the Sexual Distress Scale’s, the Couple Satisfaction Index’s, and the Dyadic Sexual Communication Scale. In addition, they completed a self-reported questionnaire on (unmet) supportive care needs during and after treatment.

Results

Sixteen couples participated in the study. Mean age was 59.5 (range 46-72) for women and 63 (range 50-76) for men. The mean duration since treatment was 3 years (range = 1-7).Thirty-eight percent of women and 23% of men reported moderate to high levels of anxiety whereas 18,75% of women and no men suffered from moderate to severe depression. Sixty percent of patients reported a sexual dysfunction and 40% reported significant sexual distress. Eighteen percent of men reported an erectile dysfunction and 33% reported a significant sexual distress. Whereas most couples were satisfied about their relationship, difficulties in sexual communication were expressed by most couples. Receiving psychological support, information and help with the changes in the sexual life were the most widely supported care needs of patients and partners during and after treatment. Although the highest domains of unmet needs during and after treatment for both partners were in the informational, relational and physical domain, more than 50% of couples reported unmet needs in the sexual domain.

Conclusions

Gynecological cancer and treatment negatively affects the psychological and sexual well-being of both the patient and her partner. Support during and after treatment should take aspects such as psychological and sexual distress and the partner perspective into account.

Disclosure

No.
(033) Exploring the Link Between Autoimmune Disorders and Painful Sex in Ova-Having Bodies
Authors: Washington K , Wyatt H
Published: June 2023

Introduction

Sexual pain in females is an increasingly relevant issue, presenting frequently in offices of couple and sex therapists alike. A study of 3,000 Americans ages 18 to 59 found that sexual dysfunction was more prevalent for women (43%) than men of the same age group (31%), and that the marker of poor health in females was directly related to sexual pain specifically (Laumann et al., 1999). A multitude of studies show a circular relationship amongst immune function, inflammation, and sexual activity. This circular relationship sometimes becomes a feedback loop from which sexual pain occurs (Lorenz et al., 2015). Additionally, an important overlap between research in autoimmunity and research around inflammation and sexual pain is the presence of adverse childhood experiences (ACE’s), identification of low socioeconomic status, and education status (Basson, 2012; Khandker, 2011), making this problem potentially relevant to the entire family system.

Objectives

1: To attain understanding of psychoneuroimmunology, autoimmunity, and pain with sex as separate key factors. 2: To begin tracing the bidirectional influences of mind-body interactions on both expression of autoimmunity and on pain with sex in ova-having bodies. 3: To conceptualize the proposed comorbidity of autoimmunity and pain with sex in ova-having bodies and why it is important to systemic therapists.

Methods

The presenters examine and review existing data and literature from the fields of psychology, medicine, psychoneuroimmunology, and sex therapy.

Results

Current research supports a connection between chronic stress and its effect on the immune system, and chronic stress’ effect on those possessing ovarian reproductive systems during sexual activity. The presenters noticed a tendency of comorbid diagnosis of autoimmune disease in many ova-having individuals who present to therapy with the experience of pain during sexual intercourse.

Conclusions

Given that autoimmune disorders and pain with sex are prominent issues in ova-having persons, this literature provides a new option in clinical considerations when a client with the comorbid diagnosis of autoimmune disorder and sexual pain comes in for treatment. Knowing that an overlap in diagnosis exists, this research informs and encourages clinicians to investigate the comorbidity of pain with sex if autoimmune disorder is present and vice versa. Therapists can better assist with the emotional and cognitive aspects of autoimmune disorders and pain with sex. Both diagnoses are correlated to anxiety, depression, perfectionism, and high/chronic stress levels. Whether to help heal preventively or to aid the client in emotions and stress after the diagnosis has been made, the therapist is key to aiding the client’s cognitive and emotional aspects of diagnosis.

Disclosure

No.
(057) Retrospective Cohort Study: Associations Between Gynecology Provider Level and Female Sexual Dysfunction Screening Rates during Annual Exams
Authors: Berry W , Capbarat E , Rosenberg S , Walker T , Keegan E , Carter-Brooks C
Published: June 2023

Introduction

Female sexual dysfunction (FSD) is a broad term that encompasses personal distress from various aspects of intercourse including desire, arousal, orgasm, or pain. Various studies report a high prevalence of 10-20% in women, FSD screening rates are low in the United States.

Objectives

The objectives of this study are to determine if provider type or provider level of training affect rate of FSD screening at annual well-woman visits, and to compare rates of FSD screening compared to other screening including depression, cervical cancer, and breast cancer.

Methods

We performed a retrospective cohort study chart review of patients from our outpatient gynecology office who underwent a well-woman annual visit. Women were eligible if at least 18 years of age, new patients, sexually active now or in the past, were seen by a provider in our gynecology department (attending, resident, midwife, or nurse practitioner), and used English as a primary language. Charts were identified within the gynecology department between 11/1/2017 and 1/31/2020 by looking up visits with CPT codes 99385, 99386, and 99387, as well as GC modifiers to identify resident-level providers. The attending-level physician, nurse practitioner, and certified nursing midwife visits were matched to resident-level visits by CPT code and similar date of service. The primary outcome is comparative rates of FSD screening by resident-level providers versus attending-level providers. Secondary outcomes including comparative rates of FSD screening amongst other provider types, and comparison of FSD screening versus depression, cervical cancer, and breast cancer screening. Outcomes will be analyzed using Chi-square testing (if more than 5 patients are screened for FSD from each provider-type) or Fisher’s exact test (if no more than 5 patients are screened for FSD from any provider-type). Multivariable logistic regression modeling will be used to identified any associations between patient or provider demographics that may affect screening rates (patient age, race, insurance type, sex of provider, etc.)

Results

We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review.

Conclusions

We have approximately 400 total charts identified for review, which is ongoing and approximately 20% complete. We anticipate reporting results and conclusions after completion of chart review.

Disclosure

No.
(062) Do Polish Adolescents Sexual Minorities have Poorer Sleep? - Analysis from POLKA 18 Pilot Study
Authors: Szymuś K , Drejza M , Łopiński G , Barwińska J , Klein P , Majcherek E
Published: June 2023

Introduction

Sleep duration might be affected by many mental states that are a result of discrimination, lack of social acceptance and stressful lifestyle. Sexual minorities in unfriendly environments are at risk of the aforementioned conditions and significantly affect their sleep therefore interfere with their circadian rhythm, health outcomes and quality of life.

Objectives

This study aims to estimate the association between duration of sleep among Polish adolescent sexual minorities groups.

Methods

The data on the level of sleep were retrieved from POLKA 18 study, funded by ESC, which is a youth-led cross-sectional analytical study of Polish adolescents. A paper-based self-reported questionnaire, building up on the interdisciplinary model of holistic approaches in adolescent gynaecology, has been used to collect data from schools in five Polish regions. The questionnaires were distributed in the schools during the time of April-June 2019 by local research associates, who are medical students. The obtained data has been analysed using STATA 16.

Results

We received 650 results and included 632 in our final analysis. We have asked our respondents a question on which sexual orientation they identify with and 2.6% of them declared being attracted to people from the same sex, 4.27% declared as bisexual, 0.8% asexual. Overall, 41.3% of the respondents reported sleeping less than 6 hours a night. It seems that there is a strong association between the length of sleep and sexual orientation with LGBA youth being less likely to reach recommended 7 hours of sleep a night. 41.2% who identified as gay/lesbians and 40.7% who identified as bisexual reported having less than 7 hours of sleep duration in comparison to 60.2% of their heterosexual counterparts. (p<0.001).

Conclusions

American National Sleep Foundation recommends 7-9 hours of sleep for young adults aged 18-25 (National Sleep Foundation, 2015) and our study reports that youth identified as sexual minorities are less likely to reach the recommended hours of sleep in comparison to their heterosexual peers. Although ourstudy focused solely on the duration of sleep, other studies reported a higher prevalence of many other sleep disturbances, such as insomnia that has strong correlation with stress levels and mental health problems (Galinsky et al., 2018; Fricke et al., 2017; Chen et al., 2017). Moreover, other reports from Korea and China show that those who had shorter sleep duration were more likely to have depressive symptoms and suicidal tendencies (Li et al., 2017; Lee et al., 2017). In multiple studies, sexual minorities have reported more prevalence of mental health problems. Therefore, appropriate sleeping hygiene should be accounted as one of the important factors and strategies to improve mental health among adolescents, especially those identified as part of sexual minorities.

Disclosure

No.
Traumatic Experiences
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

Stressful and traumatic events and other difficult experiences can have long-lasting effects on mental health and well-being. While most people who suffer a very stressful event naturally recover over time, for others mental health difficulties continue. Some people may become “stuck” in the memory of the stressful event and report feeling haunted by it. This feeling of being trapped by the experience then leads many people to avoid thinking and talking about it and to avoid situations, people, or places that remind them of it. This can have a disastrous effect on daily life and mental health. In this chapter, readers are introduced to cases that will be followed throughout the Making Meaning of Difficult Experiences program and the steps of the program itself that are covered in more detail in the remaining chapters.
Why Approach Difficult Experiences?
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

This chapter covers why approaching and revisiting your memories of difficult experiences will help you emotionally process your experiences and move through them to the other side. Memory exposure and processing are a key component of prolonged exposure therapy for posttraumatic stress disorder (PTSD), an effective and flexible PTSD treatment. We use this component as the core of our approach in this book. This is a powerful way to learn that your memories of the event(s) are not the same as the event itself. Using this program, you learn that you can safely think about your experience and also learn how to talk with others who may have been through difficult experiences and can support them in processing those memories.
Self-Care
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

This chapter explores what you do—just for yourself—to take care of yourself. In this chapter, you are encouraged to consider what has worked for you in the past and also what new self-care strategies you may want to begin. The chapter begins with a self-assessment of what you are currently doing to take care of yourself and then consider whether and how you want to increase your self-care in your personal action plan. The Making Meaning of Difficult Experiences: Self-Guided Program walks the reader through eating, sleeping, exercise, alcohol use, drug use, and engagement in enjoyable activities and their role in self-care.
Closing the Book on Difficult Experiences
Authors: Rauch Sheila A.M. , Rothbaum Barbara Olasov
Published: June 2023

In the final chapter, we bring all of the pieces together from the Making Meaning of Difficult Experiences: Self-Guided Program. The chapter begins with summaries of the case studies and their recovery from difficult experiences and then summarizes each of the tools presented: memory exposure and processing, behavioral activation, social connection, and self-care. We consider posttraumatic growth and how approaching instead of avoiding difficult experiences provides a pathway toward resilience and growth from difficulty. In addition, some readers may feel that they want or need help to work through their difficult experiences. We present tips for how to connect with mental health resources and what types of resources may be most helpful.
Prologue
Authors: Kallivayalil Roy Abraham
Published: June 2023

There is a renewed interest in social psychiatry and its relevance to clinical practice today. Breakthroughs in neurosciences and psychopharmacological research to find an answer to mental health problems were believed to be imminent but has not really happened! Social psychiatry is primarily concerned with effects of the social environment on the mental health of the individual and vice versa. The COVID-19 pandemic has been a lesson on this. The origin of social medicine and social psychiatry can be traced to ancient Greek, Ayurvedic and Chinese medical practices. And the WHO has incorporated mental and social well-being in the definition of health in its constitution in 1948. There is an increasing need to focus on social determinants of mental health and on the biopsychosocial aspects of health and disease. The social aspects remain an essential component in understanding the genesis and management of psychiatric disorders but are often ignored due to too much emphasis on the biological domain. We need increased funding for research in psychosocial aspects—this is important not only in psychiatry but also in other fields of medicine. Health is often a dynamic balance between opportunities and limitations directly affected by social and environmental conditions. These basic premises underline the necessity and importance on the need for a comprehensive textbook of social psychiatry. This book is a creation of such a vision! There are 41 chapters in this book which comprehensively deal with all aspects of social psychiatry providing scientific and authoritative reference.
The Place of Adolescence in Social Psychiatry
Authors: Rothe Eugenio M.
Published: June 2023

This chapter discusses the historical and social construction of the concept of adolescence, the neurobiological changes that take place in this period of human development, the process of identity formation and transition to adulthood in adolescence, the newly conceptualized developmental category of emerging adulthood, the effects of poverty and social disadvantage on this stage of development, and the realities faced by adolescents in developing countries. The chapter also discusses the effects of the modern media, the effects of rejection and ostracism, and other risk factors and protective factors in adolescence and the need for a worldwide adolescent mental health policy.
Social Psychiatry
Authors: Cohen Carl I. , Doumlele Kyra
Published: June 2023

The world’s elderly population will double between 2015 and 2050 to 2 billion persons or about one-fifth of all people, and the reconfiguration of historical age distribution patterns will create enormous social and economic strains on societies and their ability to care for aging individuals. Moreover, globalization, modernization, and mass migration have especially affected older adults. Various micro and macro-level social and social-psychological theories of aging have been proffered to explain the processes that shape behavior and mental well-being. With respect to specific psychiatric disorders, cross-national studies have generally found lower incidence and prevalence rates of formal psychiatric disorders in older persons, although differences in psychiatric symptoms have been found less consistently. A variety of social variables have been found to affect rates of psychiatric disorders, but there are many inconsistencies that may reflect methodological differences across investigations.
Good Sport
Authors: Swartz Jacob
Published: June 2023

Sports, activities involving physical exertion and skill, have emerged prominent across most cultures and civilizations. Evolutionary psychology and anthropology indicate that sports and physical activity offer evolutionary benefits. Sports are an integral part of childhood, with an estimated 72% of middle schoolers regularly participating. Sports are embedded in current social and cultural life. While exercise alone can be enjoyable, participation in sports has added competition, whether the individual against self (“against the clock”) or against others, alone, or in teams. Sports have replicated real-life battle situations where winning became increasingly mental. Use of both mental and physical strengths occurs in competitive sports, not only for the competitors, but also for the observers, keen to gamble on their own skills at evaluating all the players. Sports and exercise are beneficial to mental health and in decreasing symptoms of depression and anxiety, and improving coping with stress. The benefits of sports for youth extend to social domains as well. Organized activities for young adolescents involved in sports, art, or music have been associated with healthier development, better health, and decreased sadness. Sports can also benefit psychosocial development for vulnerable populations such as those with developmental disorders. Young adolescent boys with developmental coordination disorder reported higher loneliness and lower self-esteem. As patients age, physical activity remains important to health. It is recommended that adults over 65 years old do at least 150 minutes of moderate aerobic activity a week.
Psychosexual Disorders
Authors: Manohar Shivananda , Tandon Abhinav , Rao Suman S. , Sathyanarayana Rao T. S.
Published: June 2023

Sexuality is the harmony between mind and body. Sexuality has many dimensions, which include biological, sociocultural, and psychological perspectives. Marriage, divorce, poverty, family system, and many other psychosocial factors influence the development and maintenance of sexuality. Though various classificatory systems have described sexuality in different lengths, none of them has been successful in catering to clinical needs. Though sexuality is a basic instinct, it has been neglected by clinicians as well as researchers. Normal sexual life significantly improves the quality of life of an individual. In this the chapter, the authors emphasize various dimensions of sexuality, particularly focusing on the social dimension.
Family Matters
Authors: Di Nicola Vincenzo , Song Suzan
Published: June 2023

This chapter addresses the role of the family in the mental, social, and relational well-being of migrants—immigrants, refugees, and displaced children, adolescents, and adults. Starting with a review of the ecosocial changes in a family after migration to new countries, cultures, and contexts, the chapter then discusses how clinicians can respond to the unique challenges for displaced families using a family-based approach. This requires a basic epistemological shift toward families and communities when dealing with migration and trauma. The key notion is that families are the crucible for socialization and belonging and crucial resources for the care, support, and healing of its members. The first challenge for clinicians with displaced persons is to add a sociocultural dimension to sensitize them to working with families across cultures, appreciating changing definitions of families, and understanding families in light of globalization and global mental health. The second challenge is to appreciate how family functioning is affected by disasters and conflicts leading to displacement, including migration and refugee status. These dislocations not only disrupt family functioning in the culture of origin (enculturation), but demand adaptation to other cultures (acculturation). Some of the clinical challenges for the clinician include family fragmentation and new family configurations, exposure to traumatic incidents, and differential effects of fragmentation and trauma across the domains of age (with unique challenges for refugee youth, elderly, and special needs), gender (with special sensitivity to how LGBTQ issues morph across culture), culture (including language, religion, and social class), and other aspects of identity.
Social Psychiatry
Authors: Gogineni Rama Rao , Joshi Prasad , Rostain Anthony
Published: June 2023

DSM-5 and ICD-11 define neurodevelopmental disorders (NDDs) as a group of conditions with onset in the developmental period, inducing deficits that produce impairments of functioning. NDDs comprise intellectual disability, communication disorders, autism spectrum disorders, attention-deficit/hyperactivity disorder, tic disorders, and specific learning disorders. NDDs affect multiple neurological systems and cause global changes to personal, social, and occupational functioning and overall developmental trajectory, including family interactions and social integration. Often these children struggle with comorbid mental illness, suicide, and aggression. Psychosocial, psychopharmacological, family, and educational interventions are essential for enhancement of functionality in the individuals, as well as their families. With proper diagnosis, treatments, and interventions, many of these youngsters can lead a much enhanced life.
A Social Psychological Perspective on Trauma and Trauma Disorders
Authors: Lyons Maryssa , Buhalo Daniel , Fallon April
Published: June 2023

The definition of trauma has existed in a shifting landscape. It can refer to a discrete bodily injury or an experience that produces psychological injury or pain. In the last few decades it has come to denote the event that occurs, not its impact. In common parlance, the term has evolved to mean any unpleasure. This chapter explores the nature of the changing definition of trauma and identification of traumatic disorders, the clinical phenomena associated with trauma, and how sociological and cultural forces have framed the understanding of and shaped the outcomes of these events for individuals and communities. It examines types of events, context surrounding the event, past experiences, previous generations’ experience, and cultural interpretations of similar events among those who experience it. Specifically, it focuses on social support and social identity as factors that exacerbate the experience but that can also be protective.
Social Psychiatry in Major Neurocognitive Disorders
Authors: Harlan Brian , Thornton Joseph E.
Published: June 2023

The social burden of dementing illnesses is immense and will continue to grow with an aging population barring major scientific breakthroughs. This chapter describes social aspects of progressive neurocognitive disease, focusing on frequent challenges encountered by families, communities, and clinicians. Uncertainties and delays in diagnoses delay developing care plans with family members. Clinicians must help the caregivers adapt to the current needs of the person with dementia and to develop contingency plans for future needs even in the context of uncertainty. Difficulties associated with various cultural differences, economic class, and barriers to access for dementia care and caregiver support are also addressed. Across cultures, denial of the role of dementia in disturbing behaviors is common, especially in family members. Helping the caregivers to look at the disturbing behaviors as symptoms of the illness rather than personal affronts will empower the caregivers to more effectively use available support services and intervention strategies.
Stigma
Authors: Rahmani Mariam , Ivbijaro Gabriel , Pumariega Andres J.
Published: June 2023

Stigma toward mental illness is rooted in history, neurobiology, and social hierarchy, and it is prevalent in all cultures. Stigma extends beyond the person who has a mental illness, to people associated with that person, resulting in dire consequences including the development of shame, social isolation, no treatment or under-treatment of treatable psychiatric illnesses, and health disparities, as well as discrimination. This chapter contributes definitions of stigma, a brief review of the neurobiology and sociocultural factors underlying stigma, types of stigma, and the adverse consequences of stigma, and suggests different approaches to addressing stigma at a personal and societal level.
Terrorism and Other Forms of Violent Extremism
Authors: Basu Debasish
Published: June 2023

Of the various kinds of violence and conflicts, terrorism and other forms violent extremism (VE) occupy a special place. The Global Terrorism Database contains nearly 200,000 terrorist incidents for the period 1970 to 2019. VE impacts not only the individual but also the society, economy, and ecology. The progression to VE can be tortuous, multiphasic, and unpredictable, with two concurrent pathways of cognitive and behavioral radicalization. Drivers of VE and terrorism include the structural/sociological context operating at a macro level to provide the “push” toward VE, and individual/psychological variables (including mental health issues) operating at the micro level as “personal” factors influencing radicalization. Most importantly, however, social psychology and psychiatry are best equipped to capture the confluence of these two levels at the “meso” level, where the conducive society and the vulnerable person meet, shape, and influence each other to generate the crucial “pull” toward radicalization to VE. Given the importance of the concept of social identity, social context, and socially facilitated meaning-making in the pathway to VE, mental health and social psychiatry have a central role to play to understand the origin, spread, consequences, and possible mitigation of terrorism and VE. Social psychiatry and socially oriented mental health professionals may contribute to the area of VE in the following ways: catering to the needs of those affected by terrorism and other VE; countering stigma; theoretical understanding and research; clinical, risk, and psychosocial assessment; prevention/countering of VE; advocacy; multi-sector coordination; community-based working; and a public health perspective.
The COVID-19 Pandemic
Authors: Pumariega Andres J. , Kastrup Marianne , Murthy R. Srinivasa
Published: June 2023

The global COVID pandemic has had very distinctly national and regional differences and responses, but clear implications for sociocultural and mental health factors within countries across the globe. This chapter examines these factors through an analysis of the impact and response of the pandemic in three national examples: the United States, the nations of the Scandinavian region, and the world’s most populous nation, India.
Social Psychiatry in Russia
Authors: Karpenko Olga A. , Kostyuk George P.
Published: June 2023

Social issues of psychiatry historically have been an important part of the Russian psychiatry, although the subject of “social psychiatry” still remains debatable. Acknowledgment of the importance of social factors in mental disorders determined the development of mental-health care in Russia since the end of 19th century and later in the Soviet Union and the Russian Federation. Creation of the community mental health clinics network, labor rehabilitation, and development of mental care legislation are important steps in the field of social psychiatry in Russia. In recent years the de-institutionalization of psychiatry and the development of the various types of day-care facilities can be regarded as part of the social psychiatry. Another remarkable tendency is the creation of interdisciplinary scientific and clinical collaborations in the field of mental health. This can help to stress the attention of society, policymakers, and academia on the importance of mental health problems, to reduce stigma, and to increase the awareness of mental health issues in society.
Glioblastoma
Authors: Lukas Rimas V.
Published: June 2023

Glioblastoma (GBM) is a term used to describe two histologically identical high-grade infiltrating gliomas: GBM isocitrate dehydrogenase (IDH) wildtype and GBM IDH mutated. GBM IDH wildtype follows a more aggressive natural history in comparison to GBM IDH mutated. In contemporary clinical practice both tumor types are treated similarly. Radiographic imaging often reveals heterogeneously enhancing tumors centered in subcortical white matter. A diagnosis is established with surgically obtained (biopsy or resection) tissue that histologically demonstrates an infiltrating astrocytic tumor with areas of either necrosis and/or endothelial proliferation. Of growing and greater importance are other molecular characteristics including methylation status of the methylguanine methyl transferase (MGMT) gene promoter. Extensive surgical resection is attempted as long as the benefits are deemed to outweigh the risks. This is followed by radiation with concurrent temozolomide chemotherapy followed by additional cycles of temozolomide and potentially tumor-treating fields. In the elderly population, intensity of treatment may be de-escalated. For progressive disease the optimal management is less clearly defined. It is anticipated that the management of GBM will continue to evolve as our collective understanding of the disease increases.
Tumors of the Pituitary Gland
Authors: Fong Reginald , Conger Andrew R.
Published: June 2023

Tumors of the pituitary gland account for approximately 10–15% of intracranial neoplasms, with an incidence ranging from 1 to 20 cases per 100,000 per year. Pituitary tumors represent a wide range of pathologies. The 2017 World Health Organization Classification of Tumors of Endocrine Organs lists 19 different pathologies originating from cell lines intrinsic to the pituitary gland. They require an understanding of endocrinology, genetics, and surgical options in order to manage them effectively. The majority of pituitary tumors are non-functional tumors; however, that does not preclude them from affecting the hypothalamic-pituitary axis due to mass effect. A full endocrine history and workup are required as a first step when a pituitary lesion is diagnosed. From there the management largely depends on the patient’s visual exam, physical exam, medical history, and comorbidities. Treatment options range from medical management, radiation therapy, and surgical resection, to chemotherapy. The majority of pituitary tumors are best managed by a multidisciplinary team that includes the combination of a neuro-endocrinologist, neurosurgeon, neuro-oncologist, and radiation oncologist. Craniopharyngiomas represent a unique pituitary lesion that are histologically and cytologically benign but can be locally aggressive and require surgical resection for cure. They are unique in the sense that some subtype expresses a gene that may prove to be a viable target for chemotherapy.
Primary Central Nervous System Lymphoma and Hematopoietic Neoplasms Affecting the Nervous System
Authors: Lim-Fat Mary Jane , Nayak Lakshmi
Published: June 2023

Primary central nervous system lymphoma (PCNSL) is a rare and aggressive variant of extranodal non-Hodgkin lymphoma involving compartments of the central nervous system, including the brain, leptomeninges, eyes, or spinal cord without evidence of systemic disease. PCNSL poses unique challenges to the neuro-oncologist in terms of clinical presentation, extent of disease evaluation, and treatment strategies. This chapter details the epidemiology, pathophysiology, differential diagnosis, investigations, management, and prognosis of PCNSL, with a focus on the most salient points for the neuro-oncologist. CNS involvement from other hematological malignancies will also be briefly discussed.
Tumors Affecting the Spinal Cord
Authors: Verla Terrence , Curley Kara L. , Neal Matthew T. , Ropper Alexander
Published: June 2023

This chapter provides an overview of intramedullary, intradural extramedullary, and extradural spinal tumors. The chapter reviews the epidemiology, pathophysiology, clinical manifestations, imaging, and management for each category of tumor. The most common types of intramedullary tumors are ependymoma, astrocytoma, and hemangioblastoma. The most common types of intradural, extramedullary tumors are meningioma, schwannoma, and neurofibroma. Extradural tumors are most commonly metastatic in nature. Primary bone tumors have diverse pathologies and make up the minority of extradural tumors.
Pediatric Low-Grade Glioma
Authors: Phadnis Sheetal , Nicolaides Theodore
Published: June 2023

Pediatric low-grade gliomas (PLGGs) are the most common subgroup of central nervous system (CNS) tumors in childhood. These tumors have a good prognosis, especially when they are completely resectable. Traditional cytotoxic chemotherapy and radiation therapy have proved to be effective in many unresectable cases, but careful attention to age of the patient and location of the tumor must be considered before embarking on a treatment plan. More recently, targeted therapy with either BRAF or MEK inhibitors has shown promising efficacy, and these agents are likely to play an increasing role in treatment of these patients moving forward.
Radiotherapy in Neuro-Oncology
Authors: Blau Molly Havard , Halasz Lia M.
Published: June 2023

This chapter provides an overview of radiation therapy specific to the central nervous system (CNS). The roles of each member of the planning and treatment teams are described, followed by a brief explanation of the radiobiologic effects of therapeutic radiation. The treatment modalities most commonly used for CNS tumors are described (e.g., photon, proton, and stereotactic radiation), highlighting common delivery systems. The chapter discusses treatment paradigms for specific diagnoses including high-grade gliomas (HGG), low-grade gliomas (LGG), brain metastases, benign brain tumors (meningioma, vestibular schwannoma, craniopharyngioma), and pediatric malignancies (medulloblastoma, ependymoma, diffuse pontine glioma). Radiation toxicity is discussed in the context of each diagnosis and treatment modality, as well as mitigation techniques to minimize the risk of radiation induced side effects.
Paraneoplastic Neurological Syndromes
Authors: Valencia-Sanchez Cristina , Mrugala Maciej M.
Published: June 2023

Paraneoplastic neurological syndromes (PNS) are immune-mediated disorders that occur as a result of autoimmune responses triggered by the ectopic expression of neuronal proteins in cancer cells. Patients typically present with subacute multifocal symptoms involving any area of the central and/or peripheral nervous systems. The neurologic disorder usually appears before the cancer has been identified. Recognition of the syndromes and antibody testing in serum and cerebrospinal fluid are essential for an early diagnosis and detection of an underlying malignancy. Each of these antibodies is predominantly associated with a different type of tumor, so the antibody detected is useful to guide diagnostic tests used to search for an underlying tumor. Treatment of these syndromes includes immunosuppressive therapies in conjunction with treatment of the tumor. The recent introduction of immune-checkpoint inhibitors into cancer treatment has revealed an increased incidence of neurological immune-related adverse effects that can manifest as PNS.
Neuro-Oncologic Emergencies
Authors: Hrachova Maya , Gritsch David , Gritsch Simon , Mrugala Maciej M.
Published: June 2023

Neuro-oncologic emergencies commonly arise in patients with brain tumors and systemic malignances, prompting expedited evaluation and management. Neurological complications are multifactorial in nature and stem from either direct tumor invasion or from underlying systemic processes. Status epilepticus, stroke, and metastatic spinal cord compression are the most common causes of morbidity due to the direct tumor effect. Inversely, adverse effects of chemotherapy (CAR-T), coagulopathy, pulmonary embolism, thrombocytopenia, and neutropenia are attributed to systemic involvement. Thus, it is essential to recognize signs and symptoms of neurological urgency in a timely manner to prevent serious and irreversible complications. This chapter reviews common neuro-oncological emergencies and provides a framework for their diagnostic workup and management.
Familial Syndromes in Neuro-Oncology
Authors: Dhamija Radhika , Hoxworth Joseph M. , Asthagiri Ashok R.
Published: June 2023

Familial cancer syndromes are caused by inherited mutations in tumor suppressor genes and are most commonly autosomal dominant in inheritance. Many of these syndromes increase the risk for central nervous system tumors. Early identification of these tumor syndromes is important to patient outcomes, and advances in genetic testing has made that possible. Common familial cancer syndromes associated with central nervous system tumors are neurofibromatosis types 1 and 2, Cowden syndrome, tuberous sclerosis complex, Li-Fraumeni syndrome, Turcot syndrome, Gorlin syndrome, and Von Hippel Lindau syndrome. This chapter discusses in detail the cardinal features of these syndromes with emphasis on neurological manifestations.