bluuebunny/crossref_metadata_2025 huggingface dataset:
Behavioural family interventions for the self-harming and suicidal adolescent
Authors: Henderson Anita , Litvin Roy
Published: January 2025

This chapter explores some of the behavioural interventions which a mental health nurse can draw on while advising a family whose child may be struggling with regulating their emotions, and using self-harming behaviours to cope. It discusses the possible impact of adverse childhood life events on the child’s ability to recognize and manage different emotions as they navigate relationships. It also addresses how a child could develop symptoms of borderline personality disorder, also known as emotionally unstable personality disorder, and what these may look like. The chapter explains the diagnostic criteria of this disorder and the behavioural patterns of borderline personality disorder as identified by Linehan in 1983. The chapter addresses the concept of dialectical behavioural therapy (DBT), the characteristics of emotional dysregulation, and the corresponding DBT skills and interventions used in a DBT programme. Utilizing a case study, the chapter draws on DBT techniques to support the mental health nurse in developing a crisis plan with the young person and their family.
Key skills in working with children and young people
Authors: Grealish Annmarie , Trainor Gemma
Published: January 2025

This chapter provides an overview of mental health difficulties among children and young people. Over the past decade there has been significant focus and debate on how to improve services for children and young people’s mental health services. This chapter has been created to assist clinicians in identifying skills and knowledge to recognise and treat common and complex mental health issues, understand how children and young people’s mental health services work and how to involve families/carers. It examines mental health in children and young people, and the key communication skills nurses can use to talk effectively to children and young people about their mental health. It then focuses on patient-reported outcome measures for children and young people to explore, define, and clarify their condition(s) or problem(s).
Key skills in working with people living with neurodevelopmental disorders
Authors: Sedgwick-Müller Jane
Published: January 2025

Mental health nurses (and other health and social care professionals) lack the knowledge and skills for working with service users with neurodevelopmental disorders, including the most prominent, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). This is a crucial access barrier for service users who need care and support. The functional impairments associated with ADHD and ASD can have long-term adverse effects on physical and mental health and socioeconomic outcomes. Enabling timely access to education, work, health, and social care services can optimize the well-being and quality of life for service users with ADHD and ASD. This chapter offers an informed understanding of the knowledge and skills required for working with ADHD and ASD based on lived experience, evidence, and specialist mental health nursing practice. The term ‘service users’ is used to refer to the person with ADHD and/or ASD, their family members, and caregivers.
Working with people with substance misuse problems
Authors: Callaghan Patrick , Sutcliffe Adam
Published: January 2025

Substance misuse is a growing and serious public health problem that continues to affect individuals, communities, and families. This chapter introduces some of the basic issues relevant to the development of nursing skills and approaches in working with people living with substance misuse. The chapter describes key mental health nursing skills on assessment, care planning, and evidence-based interventions that can help mental health nurses enable people living with substance misuse problems to effect lasting change in their behaviour so that they may recover from their problems or manage them in a way that does not overwhelm them, thereby allowing them to lead satisfying lives.
Why Is Chronic Opioid Therapy Not Working for My Patient’s Pain?
Authors: Carroll C. Patrick
Published: January 2025

This chapter suggests an approach to managing the complex effects of chronic opioid therapy (COT). Opioids generate ambiguity, conflict, and anxiety for both patients and clinicians deciding on their chronic use for chronic sickle cell disease (SCD) pain. While COT can be effective for chronic non-cancer pain like SCD pain, the short-term benefits of opioids often may not be sustained long-term. COT often fails to produce clinically significant benefit or may not outperform other interventions. COT is qualitatively more risky than other pharmacological interventions for pain because opioids are associated with tolerance, physical dependence, paradoxical hyperalgesia, risk of overdose, and misuse. However, for many of these same reasons, COT is also qualitatively more difficult to discontinue than most interventions. This chapter discusses the literature on COT for chronic pain. It recommends a set of parameters clinicians treating chronic SCD pain can use to develop a strategy to manage the risk of COT, while simultaneously assessing success or failure of COT and managing COT failure.
How Do I Manage My Patient with Severe Pain from Acute, Recurrent Priapism?
Authors: Azbell Roberta C. G. , Kang Caroline M. , Desai Payal C.
Published: January 2025

This chapter teaches clinicians how to confidently take a priapism-focused history and physical, counsel patients on when to seek emergency care, identify possible preventative therapies, and understand the importance of diagnosing this painful complication in their patients with sickle cell disease (SCD). It discusses when to suspect priapism and reviews key history and physical examination findings required for diagnosis. Priapism is an underdiagnosed yet highly morbid complication of SCD. It is defined as a persistent erection that is unrelated to sexual stimulation and if left untreated, can cause permanent penile tissue damage and erectile dysfunction. The acute management of priapism involves prompt emergency evaluation and intracavernosal injection of sympathomimetic agents such as phenylephrine. This chapter also discusses additional management options for refractory cases of priapism. While there are no preventative therapies that have been shown to be effective in large trials, this chapter reviews the potential preventative options that have been reported successfully in smaller studies. It points to future directions and ongoing clinical trials.
The Role of the Epigenome in Brain Development, Function, and Disease
Authors: Akbarian Schahram , Fullard John F. , Girdhar Kiran , Roussos Panos
Published: January 2025

Psychiatric disorders have a substantial genetic component. In recent years, genome-wide association studies have identified hundreds of loci associated with increased risk for disease, including schizophrenia, bipolar disorder, and depression. The majority of these loci reside within noncoding regions of the genome, often contain many candidate variants, and are thought to exert their effects by disrupting the function of DNA elements required for the optimal spatiotemporal regulation of gene expression. The epigenome encompasses the regulatory mechanisms governing the organization and function of the genome and is highly dynamic, displaying developmental and cell-type-specific differences. This chapter discusses the means by which analysis of the epigenome in diverse human brain cells can be used to better understand brain development and function and to pinpoint causal disease variants as well as their mechanisms of action, with the potential to identify novel therapeutic targets.
Methods for In Vivo Gene Manipulation
Authors: Monteggia Lisa M. , Xu Wei
Published: January 2025

Selective targeting and controlling diverse types of brain cells and their molecular processes are essential to understand brain function, elucidate the pathogenesis of mental disorders, and develop novel therapeutics for these disorders. Techniques regulating gene expression, including altering endogenous genes and introducing exogenous genes, are ways to achieve these goals. This chapter provides an overview of genetic manipulations in models systems, including the traditional transgene, knockout and knockin techniques, and the recently developed CRIPSR-Cas9 systems. It then discusses viral vectors, a collection of nanoscale vehicles that deliver genetic materials into infected cells. Each of these vectors exhibits special properties, such as infection selectivity or directional spreading along neuronal pathways, and provides versatile tools for targeting and regulating cells of interest. Thus, genetics and viral vectors offer powerful technology to delineate, monitor, and control brain circuitry to understand and potentially treat mental disorders.
Glial-Immune Mechanisms of Schizophrenia
Authors: Teymouri Kowsar , Ebrahimi Mahbod , Pouget Jennie G. , Kennedy James L.
Published: January 2025

This chapter reviews the emerging body of genetic and immunological evidence that provides support for immune disturbances in schizophrenia. Genome-wide association studies have identified 287 gene loci associated with schizophrenia, including several genes that appear to have dual roles based on their expression in both the central nervous system and immune cells. In addition, studies have shown correlations between increased peripheral inflammatory markers and schizophrenia risk, suggesting the involvement of inflammation. Moreover, the complement system is implicated in schizophrenia given that two genes, complement component 4 (C4) and CUB and SUSHI Multiple Domains 1 (CSMD1), may modulate schizophrenia risk via synaptic pruning. Positron emission tomography studies have further shown that microglial activation may be important for overpruning of synapses in schizophrenia. Overall, findings from immunogenetic studies in particular have identified potential pathogenic mechanisms such as C4 and CSMD1 as potential therapeutic targets for novel drug development in schizophrenia.
Translational Models for Psychosis
Authors: Corlett Philip R.
Published: January 2025

Computational approaches to explaining psychiatric illnesses are undergoing a renaissance. This chapter will describe computational approaches to psychotic symptoms. The approach can connect levels of explanation—from epidemiology down to circuit neuroscience. It suggests that delusions are driven by inappropriate prediction errors and hallucinations are driven by overweighted prior beliefs. Volatility processing may unite the two. When the world is perceived to be changing unpredictably an organism has two options—learn quickly to pre-empt the changes or ignore that signals that change is afoot. These may underwrite delusions and hallucinations respectively and each may be implemented in independent neural circuits. Furthermore, the social content of delusions and hallucinations demands explanation. Computational psychiatrists appeal either to a domain specific problem with social cognition or a domain general issue with inference. Future work will continue to refine the hypothesis space, ideally leading to a deeper understanding and better treatments for psychosis.
Novel Treatments for Schizophrenia
Authors: Paul Steven M. , Breier Alan
Published: January 2025

Antipsychotic drugs (APDs) have been available to treat patients with schizophrenia for more than 70 years. All currently available APDs share the common mechanism of antagonizing or blocking dopamine D2 receptors. Given the inadequate outcomes for patients with schizophrenia and the limitations of current APDs, new treatments with novel mechanisms are desperately needed. Progress to find novel therapies for schizophrenia has been slow, in part because its etiology and pathophysiology are still poorly understood. This chapter reviews potential novel APDs and their respective therapeutic targets, with a focus on compounds and targets for which recent clinical studies have yielded encouraging results, unambiguously negative results that have proven informative, or novel compounds that are currently under active investigation. With the prospect of several novel mechanistically distinct APDs on the horizon, such drugs used alone or in combination may result in markedly improved functional outcomes for patients living with schizophrenia.
Diagnostic Concepts and Epidemiology of Bipolar Disorder
Authors: Merikangas Kathleen R. , Stapp Emma K.
Published: January 2025

This chapter summarizes the magnitude, impact, comorbidity, and consequences of bipolar disorder. The aggregate lifetime prevalence rate of bipolar I disorder is approximately 1%, but as many as 5% or 6% of adults may manifest the broader spectrum of bipolar disorder. The onset of bipolar disorder occurs before age 30 years in nearly all of those who experience this condition. Comorbidity is pervasive among both adolescents and adults with bipolar disorder in the general population, suggesting disturbances in multiple systems of emotion, cognition, and behavior. Consequences of bipolar disorder include the development of comorbid medical and mental disorders, including substance use disorders. The occupational, economic, and social consequences are associated with substantial disability. The increased mortality from medical conditions, particularly cardiovascular disease and suicide, is particularly striking.
Molecular Neuroimaging in Substance Use Disorders
Authors: London Edythe D. , Robertson Chelsea L. , Prins Terry J.
Published: January 2025

This chapter describes the molecular neuroimaging techniques of positron emission tomography and single-photon emission tomography and the findings obtained in studies of chronic drug misuse and the behavioral states that perpetuate it. A deficit in the dopamine system, involving dopamine D2-type receptor availability, is common among drug use disorders. Studies of stimulant use disorders provide evidence for an imbalance between D2- and D1-type receptors, with links to impulsivity and cognitive deficits. Also common across addictions is a role of the orbitofrontal cortex in craving. More limited studies of serotonin and opioid systems show abnormalities in alcohol and stimulant use disorders that vary with duration of abstinence. Human molecular neuroimaging studies of opioid system markers, other than the μ-opioid receptor, and of other neurochemical and neuromodulatory systems are lacking. The field can benefit from large studies with standardization of methodology and from development of new radiolabeled probes for understudied systems.
Cellular and Molecular Mechanisms of Substance Use Disorders
Authors: Reissner Kathryn J.
Published: January 2025

Drug use results in both acute and long-lasting cellular adaptations in the brain. Preclinical animal models allow for investigation of cellular and molecular responses to drugs in the brain, as well as cellular correlates that drive drug taking and seeking. This chapter offers a historical perspective on studies investigating the cellular consequences of drug use and the cellular mechanisms driving drug-related behaviors in animal models. Focus in placed on both short-term consequences of acute drug exposure (“social use”) and longer lasting consequences of chronic rodent self-administration. Advancements in methodologies for optical imaging and sequencing of transcriptional responses in individual cells has further advanced the understanding of the mechanisms driving responses to drug exposure. Moreover, accumulating evidence indicates that neural responses to drug exposure vary in males and females, underscoring the importance of investigating sex-specific candidate treatment mechanisms for more effective intervention strategies.
Brain Development and the Risk for Substance Use, Misuse, and Substance Use Disorders
Authors: Ruiz Sonia G. , Casey B. J. , Baskin-Sommers Arielle
Published: January 2025

Adolescence is a developmental period associated with increased substance use and misuse. Typical neurodevelopmental changes in cognitive control, reward, and stress-related circuitry contribute to the vulnerability for substance use and misuse during adolescence. Specifically, an imbalance in regulation of reward and stress responsivity by cortical control circuitry is exaggerated during adolescence and appears to be associated with the eventual onset and maintenance of substance use disorders. Additional risk factors exacerbate this imbalance, including the influence of peers, early life adversity, family history of substance use disorders, pre- and postnatal substance exposure, and variations in personality traits such as impulsivity and sensation seeking. Interventions that bridge the gap between the neurodevelopmental science and intervention science have great potential for reducing the burden associated with adolescent substance use and misuse.
Genetics of Alzheimer’s Disease, Parkinson’s Disease, and Lewy Body Dementia
Authors: Renton Alan E. , Fulton-Howard Brian , Andrews Shea J. , Marcora Edoardo , Goate Alison M.
Published: January 2025

Genetic risk factors and pathogenic mechanisms underlying neurodegenerative diseases are being identified at unprecedented resolution, but larger and more diverse studies are needed. Increasing representation of non-European ancestry populations in neurodegenerative illness studies will enhance understanding of disease etiology and ameliorate health disparities. The genetic architecture of the neurodegenerative disorders Alzheimer’s disease (AD), Parkinson’s disease (PD), and Lewy body dementia (LBD) is primarily polygenic or oligogenic. Genetic, neuropathological, and clinical evidence suggests these disorders represent a PD–LBD–AD spectrum. AD, PD, and LBD risk alleles mediate their effects via cell type–specific pathogenic mechanisms. AD genetics converge on microglial or macrophage efferocytosis. PD and LBD genetics implicate endolysosome dysfunction potentially in neurons. Large-scale studies integrating genetics, omics, and the environment in diverse global populations will elucidate neurodegenerative disease pathogenic mechanisms and ultimately yield therapeutic interventions for equitable distribution worldwide.
Neuroimaging and Fluid Biomarkers of Alzheimer’s Disease
Authors: Gordon Brian A. , Schindler Suzanne
Published: January 2025

Alzheimer’s disease (AD) is a neurological disease defined by amyloid plaques and neurofibrillary tau tangles. This neuropathology can accumulate for a decade or more before the onset of dementia, and many cognitively normal older adults have some degree of AD pathology. The presence and progression of pathology can be measured using neuroimaging or fluid biomarkers obtained from the cerebrospinal fluid or blood. Imaging and biofluid measures provide complementary information, and each technique has its own strengths and limitations in terms of cost, invasiveness, and sensitivity to pathology. In addition to the core measures of amyloid and tau, there is an increasing repertoire of downstream markers of inflammation, synaptic dysfunction, hypometabolism, and cell death. Together, these biomarkers provide insights into the neurobiology of AD, play an important role in confirming the clinical diagnosis of symptomatic AD, and are increasingly integral parts of clinical trials and the development of effective treatments.
Diagnosis and Epidemiology of Pediatric Psychiatric Disorders
Authors: Janecka Magdalena , Briasouli Artemis , Khachadourian Vahe , Reichenberg Abraham
Published: January 2025

Pediatric psychiatric disorders are collectively very common, placing considerable burden on the affected individuals and their families, as well as health care and education systems. This chapter addresses the prevalence, life course trajectory, and heritability of five major pediatric psychiatric disorders: intellectual development disorder, autism spectrum disorder, attention-deficit/hyperactivity disorder, obsessive–compulsive disorder, and tic disorders. The chapter presents the evidence for (a) their comorbidity with each other, and frequent co-occurrence among members of the same family; (b) continuity between these clinical constructs and the behavioral traits that underlie them; and (c) lower fecundity associated with these disorders. The chapter discusses the impact of these observations for inferring the etiology of pediatric psychiatric disorders and their risk architecture. It then discusses future directions for improved prevention and treatments.
Current Treatments for Pediatric Psychiatric Disorders
Authors: Siper Paige M. , Trelles M. Pilar , Kufert Yael , Grice Dorothy E.
Published: January 2025

Child psychiatry is a specialized discipline. The child psychiatry patient must be considered within the context of their current psychiatric signs and symptoms, psychosocial history, developmental stage, family structure, and any medical or neurological factors. The clinician should conduct a comprehensive assessment, including collateral sources, in order to consolidate a sound working diagnosis and treatment plan. Compared to adult psychiatry, the depth and breadth of research regarding medication and psychosocial treatments in youth are limited; however, evidence-based treatments, both pharmacological and psychotherapeutic, continue to emerge for many childhood-onset psychiatric disorders. Psychopharmacology is considered the first-line approach for attention-deficit/hyperactivity disorder, bipolar disorder, and psychotic illnesses, and it is also indicated for moderate to severe presentations of depressive and anxiety disorders, obsessive–compulsive disorder (OCD), and Tourette disorder. Specialized psychotherapies are first-line treatments for autism and mild to moderate depressive and anxiety disorders, OCD, and Tourette disorder.
Computational Psychiatry and the Bayesian Brain
Authors: Friston Karl J. , Gu Xiaosi
Published: January 2025

Computational psychiatry is a burgeoning field that uses formal models of brain function to characterize the mechanisms of psychopathology, with the hope that these mechanistic views can generate objective and predictive targets for treatment and intervention. This chapter introduces relevant key concepts and rationale relevant for computational psychiatry. It focuses on the Bayesian brain framework as an example to demonstrate how computational theories and models can account for false beliefs observed across many mental disorders. This framework is also compared with other formal theories of the brain. Specifically, the chapter reviews findings on delusions in schizophrenia as an example of false sensory inference; it also uses false interoceptive and interpersonal inference in autism to demonstrate the impact of faulty inference during neurodevelopment. The chapter concludes by summarizing the status quo of the field and noting future directions of research.
Psychedelic Drugs as Treatment Agents
Authors: Yehuda Rachel , Lepow Lauren A. , Bonnano Philip A. , Zaretsky Tamar Glatman , Antonio Josimar Hernandez , Jagodnik Kathleen M.
Published: January 2025

Psychedelics are compounds that alter consciousness. Currently, most psychedelic substances are federally illegal in the United States; however, the U.S. Food and Drug Administration has designated three psychedelic-assisted psychotherapy treatments as breakthrough therapies. Treatment with psychedelic drugs involves administering a medication only once or a few times to facilitate a psychotherapeutic process. Extrapharmacologic factors of treatment are central to the design of these trials. Recent clinical research has found large effect sizes with no serious adverse events reported. Although the basic psychopharmacology profiles of these drugs have been characterized, and neuroscientific and psychotherapeutic frameworks have been proposed, the mechanisms of action for these treatments are under active investigation. The observed durable and transdiagnostic psychiatric effects are likely partially related to their robust induction of neuroplasticity. This chapter describes the state of psychiatric research involving the two major classes of psychedelic compounds—tryptamines and phenethylamines—and their psychotherapeutic context.
Prologue
Authors: Inui Thomas S.
Published: January 2025

Becoming a medical professional and developing medical professionalism are dynamic activities that involve more than merely acquiring and expertly applying medical knowledge; they require reflection on the part of the learner – as well as the teacher – to consider how, what, where, and when one acquires and applies their medical knowledge and expertise. One way to engage in the kind of reflection needed toward becoming a medical professional is through writing personal narratives or analyzing others’ narratives in self-reflection exercises. In this prologue, readers delve into what it means to be a medical professional and to cultivate medical professionalism, as well as consider and analyze a personal narrative of the author. Readers are then challenged to consider their own narratives and how they have contributed to their moral development and sense of professionalism and professional values.
Assessment of Professionalism
Authors: Kachur Elizabeth Krajic
Published: January 2025

Professionalism has become a priority concern in healthcare professions education. Yet it is difficult to assess this competency in a valid, reliable, feasible, and fair fashion. Professional standards and behaviors are influenced by many factors, some are explicit (e.g., laws, policies), others more difficult to identify (e.g., culture, role models). This chapter provides a framework to assist educational programs with creating a comprehensive and fair assessment plan. A modified Miller’s pyramid helps organize the different types of assessment formats from knowledge-focused quizzes to reflection-focused portfolios and essays that explore the formation of professional identities. Each offers advantages and challenges that can help educators select the assessment tool that best fits their needs and resources. Although the assessment of professionalism is still an emerging field, it has become clear that programs need to develop a “system of assessments” to optimize the capture of a learner’s true level of professionalism.
Lifestyle Medicine in Patient Care
Authors: Fagundes Christopher P. , Merlo Gia , Rippe James M.
Published: January 2025

The biopsychosocial model assumes good health is determined by biological, psychological, and social factors that interact to promote health and disease. Lifestyle medicine is an evidence-based lifestyle therapeutic intervention—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection—as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat and often reverse chronic disease. Chronic diseases are developed, prevented, managed, and treated through a complex array of biological, psychological, and social influences. The behaviors, social connections, and emotions that characterize people’s lives shape their quality of life and physical health.
The Professionalism and Ethics of Medical Mission Work
Authors: Essig Rachael , Angelos Peter
Published: January 2025

Professionalism is grounded in the ethics of a given vocation. Professional conundrums can feel insurmountable even in the most regular of environments. Medical professionals entering the international setting to practice must be equipped with the knowledge of how to traverse these potentially perplexing professional quandaries. Global medicine is a fast-growing area of medical practice with medical trainees stating increased interest in participation in international venues. While international destinations provide excellent opportunities to gain diverse medical knowledge and nurture cultural sensitivity, there are many challenges that arise with minimal education on navigating them. Adding a new situation and occasionally culture and language makes ethical challenges absolute enigmas. This chapter uses a case-based approach to establish a framework for navigating new challenges in various different settings.
Professionalism in Engagement and Patient/Family Communication
Authors: Pferdehirt Ryan , Carter Brian S.
Published: January 2025

Professional conduct by physicians can be challenging when communicating with patients and families. Professional codes of ethics and oaths, such as the Hippocratic oath, have been a foundation for defining professionalism, yet in modern times they may be considered of limited value. A cornerstone of professionalism is meaningful communication that employs the principle of autonomy and the virtues of humility, veracity, and trust to attain true engagement. These tenets are fundamental across all professional encounters but unique differences between adult and pediatric patients require attention. For adults, professional engagement means embracing a shared decision-making model where physicians acknowledge the difference in their repository of medical knowledge and skill and the power dynamic it contributes to and the intentional and deliberate work needed to create a more shared balance. In pediatrics, professionalism is apparent when physicians act in an empathic manner with the child and parent(s) and demonstrate care. This chapter explores the value of integrating humility, empathy, and veracity into communication with patients and families and how this serves to demonstrate professionalism and build trust.
Medical Leadership, Professionalism, and Vulnerable Populations
Authors: Ghosh S. Monty
Published: January 2025

Background: Health, housing, and homelessness are intricately intertwined, and approaches to the care of this population require an enhanced understanding of the intersectionality of health, social services, justice systems, and policy. This chapter examines how best to approach and integrate multisystems care to provide support for vulnerable populations, as well as examine how professional development could be structured to enhance care for this population. Also examined are trauma informed care and harm reduction, as well as how trauma-informed leadership can be helpful at an organizational and systems-based level. Last, some practical tips in working with those experiencing extreme vulnerabilities are examined.
Should Physicians or Health Organizations Be Environmentally Active?
Authors: Macpherson Cheryl C. , Budrie Leon , Inui Thomas S.
Published: January 2025

Physicians and healthcare organizations today regularly encounter patients whose health is directly or indirectly impacted by climate change. Growing numbers are taking steps to mitigate health impacts of climate change by exploring, advocating for, and implementing environmentally sustainable policies and practices in their workplaces. Scientific consensus highlights the need for healthcare organizations, physicians, and the global healthcare industry to implement environmental sustainability measures and move toward carbon neutrality rapidly and comprehensively. It is essential to limit and best manage the health impacts of climate change on patients and communities in the coming decade. While healthcare organizations and physicians are responding, bioethics and medical ethics literature offers relatively little insight into such questions. This chapter describes successful examples of physician advocacy for and implementation of environmentally sustainable practices in medicine and healthcare, discusses how their advocacy for and implementation of environmentally sustainable practices fulfills the responsibility to promote and protect individual and public health, and considers what medical educators and licensing bodies are doing to prepare the next generations of physicians destined to contend with the growing consequences of climate change for health and healthcare.
Cancer and the Social Self
Authors: Ciaralli Spencier
Published: January 2025

Cancer survivorship and other health identities have implications for core aspects of the self, such as self-esteem and the continuity of the self through and after the illness experience. Research has shown that life-threatening illnesses such as cancer can affect one’s sense of self by placing strain on and eroding performance of important roles that are central to other core identities (e.g., spouse, parent, or career-related roles). Perceptions of stigma may also develop and affect survivors’ illness disclosure, and this may erode available social support. Other linkages between illness identities and the self may be through body image satisfaction and sexuality and intimacy. This chapter provides a conceptual framework for examining these issues and presents foundational and recent research on these topics, along with research findings from the Cancer Survivors Research Program (CSRP) research program, including survivors’ narratives.
Methadone Versus Fentanyl for Nociceptive Cancer Pain
Authors: Borris Joshua , Israel Sydney Taylor
Published: January 2025

Radiation mucositis is a painful complication arising from targeted radiotherapy used to treat head and neck cancers. It can cause both neuropathic and nociceptive pain, which has been found to be responsive to opioids. Methadone, as an N-methyl-D-aspartate receptor antagonist, mu opioid agonist, and weak selective norepinephrine reuptake inhibitor, has the pharmacologic advantage of treating both nociceptive and neuropathic pain, compared to fentanyl. However, it is less known as to whether methadone has comparable efficacy for nociceptive pain relief compared to fentanyl. In this open-label, randomized noninferiority study, 82 patients were randomized to receive either methadone or fentanyl for management of nociceptive pain caused by radiation mucositis. Through documentation of daily pain ratings, pain interference, and use of breakthrough opioid doses, the authors determined that methadone was noninferior to fentanyl for treating nociceptive cancer pain.
Epidemiology of Amyotrophic Lateral Sclerosis and Effect of Riluzole on Disease Course
Authors: Costantino Ryan C.
Published: January 2025

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with limited treatment options and a median survival of 24–48 months. This study calculated the incidence and prevalence of ALS and explored the effect of riluzole exposure on survival. Results showed that riluzole had a positive effect on survival for approximately 6 months after diagnosis and that shorter riluzole treatments may be preferred as they were associated with longer survival times. Riluzole appears to confer a survival benefit of ~2–3 months in patients with ALS, although use beyond 18 months should be questioned based on data that showed untreated patients had better survival thereafter.
Topical Lorazepam, Diphenhydramine, and Haloperidol for Nausea in Cancer Patients
Authors: McPherson Mary Lynn
Published: January 2025

Nausea and vomiting are symptoms that commonly accompany a diagnosis of cancer, and the oral route of antinausea administration often is not feasible. Many hospice and palliative care practitioners advocate for the use of topically applied multidrug cocktails, such as ABH (Ativan, Benadryl, Haldol) gel. This study evaluated the efficacy of ABH gel applied to the palmar aspect of the wrist, compared with a placebo gel, in a cross-over, randomized, double-blind trial. The results showed no statistically significant difference between the 2 treatments; the placebo gel was determined to be noninferior to the active comparator. Topical ABH gel should not be recommended as a treatment option for nausea in cancer patients.
Gabapentin for Uremic Itching
Authors: Mis Lydia
Published: January 2025

Dermatologic complications are a disturbing complication associated with chronic kidney disease. Unfortunately, uremic pruritus is not alleviated with dialysis and therefore, patients my suffer from anxiety, depression, and sleep loss. Many small clinical trials have been published that show efficacy for the relief of uremic pruritus in dialysis patients. By pooling data across several published clinical trials, the true benefit of gabapentin can be evaluated, and a more accurate representation of the adverse effects can be reported for this patient population. Clinical efficacy was defined as a ≥ 50% reduction in pruritus scores and was evaluated for all studies in the review. This meta-analysis showed that gabapentin significantly decreased the severity of uremic pruritus as compared to placebo with a higher, but not significant increase in adverse drug effects.
Corticosteroids for Cancer-Related Pain, Fatigue, and Anorexia
Authors: Paice Judith A.
Published: January 2025

Corticosteroids are often considered essential agents in cancer symptom management, and current cancer pain clinical practice guidelines all include corticosteroids as part of multimodal therapy. However, few studies exist regarding efficacy, dosing, routes, and safety. This randomized controlled trial compared oral methylprednisolone 16 mg twice daily (approximately equal to dexamethasone 4 mg twice daily) to placebo over 7 days. There were no statistically significant differences in analgesia between groups, although differences were noted in reports of fatigue and appetite. Patients reported increased satisfaction in the methylprednisolone group.
Perioperative Pregabalin for Prevention of Postmastectomy Pain Syndrome
Authors: Pathak Ravi , Quest Tammie E.
Published: January 2025

This study assesses the role of pregabalin in the prevention of postmastectomy pain syndrome (PMPS). Chronic PMPS affects 20%–40% of breast cancer patients undergoing surgery. This has the potential to negatively affect the quality of life of this patient population with chronic postsurgical pain. The study is a randomized controlled trial of 200 patients with breast cancer who received pregabalin or placebo for 1 week at the time of elective breast surgery. The incidence of PMPS was significantly lower in the pregabalin group (P < .001, relative risk: 0.26, 95% CI: 0.12–0.56). In addition, this study demonstrated that the use of perioperative pregabalin significantly lowered the incidence of neuropathic pain measured by the Grading System for Neuropathic Pain and pain intensity measured by a visual analog scale at 4, 12, and 24 weeks. Therefore, the use of perioperative oral pregabalin could reduce the frequency of PMPS.
Morphine for Chronic Breathlessness
Authors: Rohlfing Anne , Widera Eric
Published: January 2025

Data is limited for long-acting opioids in the management of chronic, severe breathlessness, although it remains a common and distressing symptom for patients with serious illness. This chapter explores a multicenter, randomized, double-blinded trial comparing 1 week of low-dose sustained-release morphine versus placebo for patients with chronic, moderate to severe breathlessness. While no effect was found on breathlessness scores, overall the low dose was well tolerated without serious adverse consequences. Furthermore, the use of immediate-release opioids as needed in both the control and intervention groups, as well the inclusion of patients with moderate dyspnea, potentially contributed to the lack of effect on breathlessness in this trial.
Hyoscine Butylbromide for the Management of Death Rattle
Authors: Schack Elizabeth , Capano Elizabeth
Published: January 2025

This study by Mercadante et al. introduces a new paradigm of treating death rattle with anticholinergics prophylactically. The investigators suggest that providers invoke the rationale of the anticholinergic’s mechanism of action with the intent of maximizing its efficacy and preemptively treating the death rattle, one of the most distressing signs of dying. The investigators randomize actively dying patients from 2 Italian hospice locations into 2 study groups. Group 1 includes the patients designated to receive the traditional use of an anticholinergic, in this case hyoscine butylbromide (HB), once they are actively showing signs of death rattle. Group 1 patients who do not have death rattle symptoms do not receive HB. In Group 2, the patients receive HB prophylactically. The results of the study show that the prophylactic use of HB is an efficient practice in the prevention of death rattle. In addition, the study confirms that the late administration of HB reveals a limited response, confirming previous studies using anticholinergics for the same purpose.
Management of Intractable Hiccups
Authors: Mehta Ambereen K. , Wu David S.
Published: January 2025

This small, double-blind, randomized, controlled, crossover study suggested that baclofen reduced the severity of hiccup periods but did not decrease the actual number of hiccups. This study is significantly limited by its small participant number. Also, the underlying cause of hiccups is not reported, which limits generalizability. A paucity of strong evidence exists to guide treatment decisions for intractable hiccups.
Headache
Authors: Kernick David , Goadsby Peter J.
Published: January 2025

This is a practical resource dealing with the diagnosis and management of common and rare headache types. It is edited by a general practitioner and an academic neurologist and will be of value to all those who work in headache at all clinical levels. The book is published under the auspices of the British Association for the Study of Headache (BASH), an organization of practitioners and scientists whose aim is to reduce the burden of headache through education and research.
Severe headache of sudden onset
Authors: Weatherby Stuart
Published: January 2025

Headache of a sudden onset—and particularly when severe, as in the case of thunderclap headache—can indicate a serious underlying problem which requires urgent intervention. This chapter describes headaches that can present suddenly, their diagnosis, and their management. The focus is on vascular headaches and in particular subarachnoid haemorrhage.
Trigeminal autonomic cephalalgias, including cluster headache
Authors: Matharu Manjit
Published: January 2025

The trigeminal autonomic cephalalgias (TACs) are a group of primary headache disorders characterized by unilateral head pain that occurs in association with ipsilateral cranial autonomic features. They include cluster headache; paroxysmal hemicrania; short-lasting, unilateral, neuralgiform headache attacks (SUNHA); and hemicrania continua. This chapter describes the diagnosis, investigation, and management of these invariably disabling conditions.
Headache due to disorders of CSF pressure
Authors: Sinclair Alex , Mollan Susan
Published: January 2025

Headache is a feature of conditions where CSF pressure is too high or too low. This chapter describes the clinical features, investigation, and management of idiopathic intracranial hypertension and low pressure headache. Low pressure headaches are usually spontaneous or post lumbar puncture.
New daily persistent headache
Authors: Kernick David
Published: January 2025

New daily persistent headache (NDPH) is a poorly understood heterogeneous condition with a clearly remembered onset and pain becoming continual and unremitting within 24h and lasting at least 3 months. It covers a number of potential conditions, the diagnosis and management of which are covered in this chapter.
Building your psychotherapy skills
Authors: Rinaldi Matthew
Published: January 2025

Enactments are inevitable and tricky, but they are also insightful moments in psychodynamic psychotherapy. This chapter explores how the unconscious can enter into the room via an enactment and how a psychodynamic therapist may consider responding to these to most benefit the patient by pausing, drawing attention to the enactment, and then reflecting further in supervision. The spectrum of enactments is considered, as well as the difference between ‘acting in’ and ‘acting out’. The role of supervision is discussed as a third point from which to consider mutually unconscious experiences between the therapist and patient.
Building your psychotherapy skills
Authors: Rinaldi Matthew
Published: January 2025

Although countertransference is a cornerstone of psychodynamic psychotherapy, it can take time to learn how to recognize one’s own countertransference in-session. This chapter breaks down some of the barriers to trainees becoming attuned, empathic practitioners. By returning to the basics of affect recognition, and particularly focusing on this at the start of a session, the trainee can become more attuned to the emotionally salient aspect of a session. This may include one of the common types of countertransference, including positive/negative, empathic, dystonic, sexualized, defensive countertransferences, or overidentification which are explained in greater detail. The underlying mechanisms of projection and projective identification are described. The initial stages of digesting the experience through reverie and containment are outlined.
Building your psychotherapy skills
Authors: Rinaldi Matthew
Published: January 2025

Progress in psychodynamic psychotherapy is complicated. In this chapter, it is compared and contrasted with the dose–response relationship and the more appropriate concepts of circumambulation and working through are offered. Parallels are drawn between anxiety changes over the course of a session and over the course of a year. It also explains how a trainee might manage crises in a therapy, in firstly a practically helpful, safe, and later psychodynamic way.
Building your psychotherapy skills
Authors: Rinaldi Matthew
Published: January 2025

This chapter outlines the importance of the ending in psychodynamic psychotherapy, especially the lessons that the patient can take away about how they say goodbye, experience abandonment, work through previous losses, and prepare for their next steps in recovery. There may be a temptation to change one’s therapeutic style, perhaps due to the patient’s acting out or regression. However, the more analytic and neutral one can remain, the more insight the patient will gain into how they say goodbye. The effect of the therapy can pervade into the writing of the discharge summary, which becomes its own process of grief for the therapy and suggestions are given on how to approach this piece of writing.
A Stuart Musician’s Conversion to Catholicism: Richard Dering and the Venerable English College, Rome
Authors: Mailes Alana , Whitehead Maurice
Published: January 2025

The English organist and composer Richard Dering (c.1580–1630) is recognized today for his key role in the transmission of Italian musical styles to Seicento Britain. His early seventeenth-century travels and contacts made throughout the Italian peninsula led him to work in the Low Countries before he eventually returned to England as a prominent Stuart court musician. This article presents several new archival findings on Dering’s transnational musical career, conversion to Catholicism, and sojourn in Italy, where he was employed for his musical services at the Venerable English College in Rome. There, covertly monitored by English diplomatic agents, Dering composed music and became ensconced within the city’s English and Welsh Catholic community. We consider the possible liturgical functions of Dering’s Latin motet repertories at the college and elsewhere in early modern Rome. Our re-examination of his social and familial connections also reveals the likely source of Dering’s later patronage in Brussels.