The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Mar 2017
ReviewHormonal and Surgical Treatment Options for Transgender Women and Transfeminine Spectrum Persons.
Transgender women and other transfeminine spectrum people may pursue hormonal and/or surgical gender-affirming interventions. Hormone therapy includes androgen blockade and estrogen supplementation. Approaches to hormone treatment vary widely based on patient goals and physiology. ⋯ Many people are unable to obtain surgeries owing to prohibitive costs and long waiting lists. Hormonal and surgical therapies improve quality of life and mental health with minimal adverse effects. Ongoing research is needed to improve understanding about specific risks of hormone therapy and surgical outcomes.
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Psychiatr. Clin. North Am. · Dec 2016
ReviewMental Illness and Firearms: Legal Context and Clinical Approaches.
Gun violence and mental illness is a major area of media attention, especially because highly publicized mass shootings seem to have become more commonly reported in the press. Gun access also is undergoing a highly politicized debate in the United States. It is important for mental health practitioners to understand the background and context of laws related to firearms access, and to understand data related to risk of suicide and violence toward others caused by gun violence among persons with mental illness. In addition, clinically driven risk assessments with specific inquiry related to firearms can be important for identifying individuals for whom firearm-focused clinical risk mitigation may be warranted.
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The three widely known stalker classifications assist in categorizing stalkers, which allows for better management of violence risk. Although 80% of stalking is done by men, women also engage in stalking, and their violence risk should not be underestimated. ⋯ Clinicians can become a victim of stalking and may become victims of stalking by proxy, a special type of stalking behavior where the stalker involves other people or agencies to communicate with or track their victim. A careful stalking violence risk assessment is essential in the intervention and risk management process.
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Violence is common in the emergency department (ED). The ED setting has numerous environmental risk factors for violence, including poor staffing, lack of privacy, overcrowding, and ready availability of nonsecured equipment that can be used as weapons. Strategies can be taken to mitigate the risk of violence toward health care workers, including staff training, changes to the ED layout, appropriate use of security, and policy-level changes. Health care providers in the ED should be familiar with local case law and standards related to the duty to warn third parties when a violent threat is made by a patient.
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Primary sleep disorders include those not attributable to another medical or psychiatric condition: insomnia disorder, hypersomnolence disorder, narcolepsy, obstructive sleep apnea hypopnea syndrome, central sleep apnea syndrome, and the parasomnias. They are commonly encountered and are comorbid with many psychiatric disorders. It is important to recognize these disorders and be comfortable treating them or to know when to refer to a sleep disorders center and sleep specialist. Treatment of a comorbid sleep disorder can improve the overall quality of life, symptoms in mood disorders, and symptoms of excessive daytime sleepiness, and decrease cardiovascular morbidity and mortality.