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Guy Tsjoen - One of the best experts on this subject based on the ideXlab platform.
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endocrine treatment of gender dysphoric gender incongruent persons an endocrine society clinical practice guideline
The Journal of Clinical Endocrinology and Metabolism, 2017Co-Authors: Wylie C Hembree, Peggy T Cohenkettenis, L J G Gooren, Sabine E Hannema, Walter J Meyer, Hassan M Murad, Stephen M Rosenthal, Joshua D Safer, Vin Tangpricha, Guy TsjoenAbstract:Objective To update the "Endocrine Treatment of Transsexual Persons: An Endocrine Society Clinical Practice Guideline," published by the Endocrine Society in 2009. Participants The participants include an Endocrine Society-appointed task force of nine experts, a methodologist, and a medical writer. Evidence This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The task force commissioned two systematic reviews and used the best available evidence from other published systematic reviews and individual studies. Consensus process Group meetings, conference calls, and e-mail communications enabled consensus. Endocrine Society committees, members and cosponsoring organizations reviewed and commented on preliminary drafts of the guidelines. Conclusion Gender affirmation is multidisciplinary treatment in which endocrinologists play an important role. Gender-dysphoric/gender-incongruent persons seek and/or are referred to endocrinologists to develop the physical characteristics of the affirmed gender. They require a safe and effective hormone regimen that will (1) suppress endogenous sex hormone secretion determined by the person's genetic/gonadal sex and (2) maintain sex hormone levels within the normal range for the person's affirmed gender. Hormone treatment is not recommended for prepubertal gender-dysphoric/gender-incongruent persons. Those clinicians who recommend gender-affirming endocrine treatments-appropriately trained diagnosing clinicians (required), a Mental Health provider for adolescents (required) and Mental Health professional for adults (recommended)-should be knowledgeable about the diagnostic criteria and criteria for gender-affirming treatment, have sufficient training and experience in assessing psychopathology, and be willing to participate in the ongoing care throughout the endocrine transition. We recommend treating gender-dysphoric/gender-incongruent adolescents who have entered puberty at Tanner Stage G2/B2 by suppression with gonadotropin-releasing hormone agonists. Clinicians may add gender-affirming hormones after a multidisciplinary team has confirmed the persistence of gender dysphoria/gender incongruence and sufficient Mental capacity to give informed consent to this partially irreversible treatment. Most adolescents have this capacity by age 16 years old. We recognize that there may be compelling reasons to initiate sex hormone treatment prior to age 16 years, although there is minimal published experience treating prior to 13.5 to 14 years of age. For the care of peripubertal youths and older adolescents, we recommend that an expert multidisciplinary team comprised of medical professionals and Mental Health professionals manage this treatment. The treating physician must confirm the criteria for treatment used by the referring Mental Health Practitioner and collaborate with them in decisions about gender-affirming surgery in older adolescents. For adult gender-dysphoric/gender-incongruent persons, the treating clinicians (collectively) should have expertise in transgender-specific diagnostic criteria, Mental Health, primary care, hormone treatment, and surgery, as needed by the patient. We suggest maintaining physiologic levels of gender-appropriate hormones and monitoring for known risks and complications. When high doses of sex steroids are required to suppress endogenous sex steroids and/or in advanced age, clinicians may consider surgically removing natal gonads along with reducing sex steroid treatment. Clinicians should monitor both transgender males (female to male) and transgender females (male to female) for reproductive organ cancer risk when surgical removal is incomplete. Additionally, clinicians should persistently monitor adverse effects of sex steroids. For gender-affirming surgeries in adults, the treating physician must collaborate with and confirm the criteria for treatment used by the referring physician. Clinicians should avoid harming individuals (via hormone treatment) who have conditions other than gender dysphoria/gender incongruence and who may not benefit from the physical changes associated with this treatment.
Penny Bee - One of the best experts on this subject based on the ideXlab platform.
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low intensity interventions for obsessive compulsive disorder ocd a qualitative study of Mental Health Practitioner experiences
BMC Psychiatry, 2017Co-Authors: Judith Gellatly, Karina Lovell, Rebecca Pedley, Christine Molloy, Jennifer Butler, Penny BeeAbstract:Obsessive-compulsive disorder (OCD) is a debilitating Mental Health disorder that can substantially impact upon quality of life and everyday functioning. Guidelines recommend pharmacological and psychological treatments, using a cognitive behaviour therapy approach (CBT) including exposure and response prevention, but access has generally been poor. Low intensity psychological interventions have been advocated. The evidence base for these interventions is emerging but there is a paucity of information regarding Practitioners’ perceptions and experiences of supporting individuals with OCD using this approach. Qualitative interviews were undertaken with psychological wellbeing Practitioners (PWPs) (n = 20) delivering low intensity psychological interventions for adults with OCD within the context of a large pragmatic effectiveness trial. Interviews explored the feasibility and acceptability of delivering two interventions; guided self-help and supported computerised cognitive behaviour therapy (cCBT), within Improving Access to Psychological Therapies (IAPT) services in NHS Trusts. Interviews were recorded with consent, transcribed and analysed using thematic analysis. PWPs acknowledged the benefits of low intensity psychological interventions for individuals experiencing OCD symptoms on an individual and population level. Offering low intensity support provided was perceived to have the opportunity to overcome existing service barriers to access treatment, improve patient choice and flexibility. Professional and service relevant issues were also recognised including self-beliefs about supporting people with OCD and personal training needs. Challenges to implementation were recognised in relation to Practitioner resistance and intervention delivery technical complications. This study has provided insight into the implementation of new low intensity approaches to the management of OCD within existing Mental Health services. Benefits from a Practitioner, service and patient perspective are identified and potential challenges highlighted. Current Controlled Trials: ISRCTN73535163 . Date of registration: 5 April 2011.
William J Worden - One of the best experts on this subject based on the ideXlab platform.
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tasks and mediators of mourning a guideline for the Mental Health Practitioner
in Session: Psychotherapy in Practice, 1996Co-Authors: William J WordenAbstract:Clinicians who work with bereaved individuals around grief issues need a way to understand the process of mourning. Generally, the mourning process can be conceptualized as involving either stages, phases, or tasks. In this article the author selects the task model and outlines the tasks of mourning as well as identifying 6 mediators of mourning that influence both the grief experience and duration of the bereavement course. This model is useful for working with both complicated and uncomplicated bereavement. © 1996 John Wiley & Sons, Inc.
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grief counselling and grief therapy a handbook for the Mental Health Practitioner
1991Co-Authors: William J WordenAbstract:Preface. Introduction. Attachment, Loss, and the Tasks of Mourning. Attachment Theory. Is Grief a Disease? Is Mourning Necessary? The Four Tasks of Mourning. When is Mourning Finished? Normal Grief Reactions: Uncomplicated Mourning. Manifestations of Normal Grief. Grief and Depression. Determinants of Grief. The Mourning Process. Grief Counselling: Facilitating Uncomplicated Grief. Goals of Grief Counseling. Who Does Grief Counseling? When to Do Grief Counseling. Where Should Grief Counseling Be Done? Who Receives Grief Counseling? Identifying the At-risk Bereaved. Counseling Principles and Procedures. Useful Techniques. The Use of Medication. Grief Counseling in Groups. Facilitating Grief Through Funeral Ritual. Effectiveness of Grief Counseling. Abnormal Grief Reactions: Complicated Mourning. Why People Fail to Grieve. How Grief Goes Wrong. Diagnosing Complicated Grief. Grief Therapy: Resolving Pathological Grief. Goals and Setting for Grief Therapy. Procedures for Grief Therapy. Special Considerations for Grief Therapy. Techniques and Timing. Evaluating Results. Grieving Special Types of Losses. Suicide. Sudden Death. Sudden Infant Death (SIDS). Miscarriages. Still Births. Abortion. Anticipatory Grief. AIDS. Grief and Family Systems. Death of a Child. Children Whose Parents Die. Intervention Approaches. Grief and the Elderly. Family versus Individual Needs. The Counseler's Own Grief. Stress and Burnout. Training for Grief Counseling. Bibliography. Index.
Paul Henderson - One of the best experts on this subject based on the ideXlab platform.
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Mental Health Practitioner experiences of engaging with service users in community Mental Health settings a systematic review and thematic synthesis of qualitative evidence
Journal of Psychiatric and Mental Health Nursing, 2020Co-Authors: Paul Henderson, Naomi Ruth Fisher, Judith Ball, William SellwoodAbstract:WHAT IS KNOWN ON THE SUBJECT?: Engagement is regarded as important and beneficial for service users and Mental Health services A universal definition of engagement is not yet fully agreed upon. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Based upon their experience, Mental Health staff use varied engagement approaches to fit with the changeable and unique needs of people who use services (service users). Mental Health staff demonstrate qualities such as persistence and adaptability to successfully engage with service users. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Irrespective of professional background, the role of community Mental Health staff is not restricted to any single approach. Practical help and social support are as seen as important as clinical treatment to establish successful engagement. Little is known about the engagement experiences of Mental Health staff working in early intervention settings as most studies in this review focused on the perspectives of staff based in assertive outreach or community Mental Health teams. There is a need to further understand staff experiences of engagement with service users in early intervention settings. Role descriptions and expectations of community Mental Health workers should account for the wide-ranging flexible approach required in order to deliver appropriate interventions. This may involve a focus on engagement in training programmes. ABSTRACT: Introduction Effective Mental Health care is dependent on engaging service users, but some individuals do not actively attend appointments, and may stop engaging with Mental Health services. Quantitative studies reveal some salient factors that seem to predict engagement, but these studies miss the nuances of good clinical practice in this area. A number of qualitative studies of Health professionals' experiences and understanding of effective engagement have been published. Aim This review aimed to systematically identify, evaluate and synthesize results from these studies with a view to informing effective practice in this area. Methods Electronic databases MEDLINE, EMBASE, CINAHL, PsychINFO and AMED were searched (PROSPERO systematic review protocol registry (www.crd.york.ac.uk/prospero/; ID CRD42017083976). Of 799 records, ten papers met the inclusion criteria. All papers were subjected to quality appraisal based on the CASP checklist and data systematically extracted. A thematic synthesis of included studies examining Mental Health Practitioners' experiences of engagement in community Mental Health settings was conducted. Results Mental Health Practitioners see engaging service users as depending upon complex, multi-dimensional phenomena which should include individualized person-centred approaches as well as practical, social and clinical support. Mental Health Practitioners demonstrate qualities such as determination and adaptability to establish and maintain engagement with service users. Implications for practice As a core aspect of nurse education, registered Mental Health nurses and other professionals would benefit from systematic guidance regarding engagement strategies. Most studies in this review focused on assertive outreach or community Mental Health teams, more clarification is needed of Practitioner's engagement experiences in early intervention settings.
Meir Steiner - One of the best experts on this subject based on the ideXlab platform.
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approach to premenstrual dysphoria for the Mental Health Practitioner
Psychiatric Clinics of North America, 2010Co-Authors: Simone N Vigod, Benicio N Frey, Claudio N Soares, Meir SteinerAbstract:SUMMARY Premenstrual mood symptoms are common and a small but significant proportion ofwomenexperiencerecurrentpremenstrualmoodsymptomsthataresevereenoughtocause substantial social and occupational dysfunction. There is convincing evidencefor important roles for biological and sociocultural variables in the development ofpremenstrual mood symptoms. There are several effective treatments, used aloneor in combination, that have been found to ameliorate psychological symptoms asso-ciated with the menstrual cycle. Further interdisciplinary research into risk factors forPMDD, and the interaction between them, will provide a more complete under-standing of the cause of this disorder, and ultimately guide future developments intreatment. REFERENCES 1. Delaney J, Lupton MJ, Toth E. The curse: a cultural history of menstruation. NewYork: E.P. Dutton; 1976.2. Chrisler JC, Johnston-Robledo I. Raging hormones? Feminist perspectives onpremenstrual syndrome and postpartum depression. In: Ballou M, Brown LS,editors. Rethinking Mental Health and disorder: feminist perspectives. NewYork: Guilford Press; 2002. p. 174–97.3. American Psychiatric Association. Diagnostic and statistical manual of Mentaldisorders. Text revision (DSM-IV-TR). Fourth edition. Washington, DC: AmericanPsychiatric Association; 2000. p. 771–4.4. American College of Obstetricians and Gynecologists. Premenstrual syndrome.Patient Education Pamphlet, by the American College of Obstetriciansand Gynecologists; 2003. Available at: www.acog.org/publications/patient_education/bp057.cfm. Accessed February 16, 2010.5. Wittchen HU, Becker E, Lieb R, et al. Prevalence, incidence and stability ofpremenstrual dysphoric disorder in the community. Psychol Med 2002;32:119–32.6. Steiner M, Macdougall M, Brown E. The premenstrual symptoms screening tool(PSST) for clinicians. Arch Womens Ment Health 2003;6(3):203–9.7. Takeda T, Tasaka K, Sakata M, et al. Prevalence of premenstrual syndrome andpremenstrual dysphoric disorder in Japanese women. Arch Womens MentHealth 2006;9(4):209–12.8. Cohen LS, Soares CN, Otto MW, et al. Prevalence and predictors of premen-strual dysphoric disorder (PMDD) in older premenopausal women. The HarvardStudy of Moods and Cycles. J Affect Disord 2002;70:125–32.9. Rivera-Tovar AD, Frank E. Late luteal phase dysphoric disorder in youngwomen. Am J Psychiatry 1990;147:1634–6.10. Banerjee N, Roy KK, Takkar D. Premenstrual dysphoric disorder—a study fromIndia. Int J Fertil Womens Med 2000;45:342–4.