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Polycystic ovary syndrome (PCOS) is a common endocrine disorder amongst reproductive-aged women associated with cardiometabolic, reproductive and psychological abnormalities. Lifestyle modification, including a healthy diet, is considered first-line treatment for management of clinical symptoms. However, there is limited high-quality evidence to support one superior therapeutic dietary intervention for PCOS management that is beyond general population-based dietary guidelines. Adherence to a Mediterranean diet (MedDiet) has been shown to decrease cardiometabolic disease risk and attenuate depressive symptoms, particularly in patients with metabolic perturbations. This narrative review summarises the proposed biological mechanisms underpinning the potential therapeutic benefits of a MedDiet for the management of cardiometabolic, reproductive and psychological features related to PCOS. Observational evidence suggests an inverse relationship between MedDiet adherence and PCOS features, particularly insulin resistance and hyperandrogenemia. Although the exact mechanisms are complex and multifaceted, they are likely related to the anti-inflammatory potential of the dietary pattern. These mechanisms are underpinned by anti-inflammatory bioactive constituents present in the MedDiet, including carotenoids, polyphenols and n-3 polyunsaturated fatty acids (PUFAs). Synthesis of the available literature suggests the MedDiet could be a promising therapeutic dietary intervention to attenuate short and long-term symptoms associated with PCOS and may aid in reducing the longer-term risks associated with cardiometabolic diseases and reproductive and psychological dysfunction. Nevertheless, current evidence remains insufficient to inform clinical practice and well-designed clinical trials are needed. As such, we provide recommendations for the design and delivery of future MedDiet interventions in women with PCOS, including exploring the acceptability, and feasibility to enhance adherence.
This chapter considers the relevance of postcolonialism to the discipline of ‘international relations’ (IR). It argues that postcolonialism advances a powerful critique of traditional approaches to IR (see chapters on realism and liberalism) since it calls into question the discipline’s foundational ontological and epistemological assumptions. In particular, it challenges the dominant assumption that states are the basic units of IR and that we should examine the relations between these units in the context of an anarchical system. Postcolonialism refocuses our attention on the constitutive role played by colonialism in the creation of the modern world and sees international relations as hierarchical rather than anarchical. It sees academic disciplines such as IR – and Western rationalist, humanist and universalist modes of thinking in general – as complicit in reproducing colonial power relations and seeks normatively to resist practices of colonialism in its material and ideational forms, whether political, economic or cultural.
This chapter seeks to promote both awareness and understanding of anxiety-based conditions that many older people experience in acute settings and in evidence-based medical and psychosocial interventions that support recovery.
The chapter begins by exploring and identifying the conditions, difficulties, and circumstances that give rise to anxiety in hospitalised older people. This is followed by a description of common anxiety types, their symptomatic presentation, and ther causes. The chapter goes on to explore those evidence-based medical and psychosocial treatment interventions that promote recovery and adjustment
Starting off substantive engagement with Sun Tzu with a focus on calculation serves a positive purpose. It is a way of emphasizing to contemporary audiences that there is more to Sun Tzu than being tricky or unorthodox – the strands of his way of war that readers, at least Western ones, widely note and often lionize. In present usage, the umbrella term “calculation” is intended to serve as a flexible rubric capable of covering intendedly rational judgments of more than one kind, many intuitive, others more formally structured.
This chapter reflects on the psychological, physical consequences of sexual violence in and beyond Othello—in contemporary times. I argue that the white identity formation process, and allegiance to its ideals, inherently impedes racial equality; the process itself works to reiterate white superiority. This is evident as I apply the intraracial color-line mainly to readings of Iago, the play’s most visible and vocal white other. In conjunction with readings of Othello, I look back at the transatlantic slave trade and examine the trajectory of white violence that has led to Black silence and the de-victimization of Black boys and men, which is one of many reasons psychologists suggest Black males are not always heard, much like Othello, when it comes to their experiences with sexual and non-sexual violence. With historical examples in mind, I return to Shakespeare’s canon to reflect on how early modern texts amplify the “white voice.”
Edited by
Masum Khwaja, Imperial College of Science, Technology and Medicine, London,Peter Tyrer, Imperial College of Science, Technology and Medicine, London
Written by a multidisciplinary team of experienced clinicians, this chapter provides the reader with an initial outline of some of the complex psychological mechanisms which underlie or can give rise to violence, such as trauma, problems with attachment and failure to develop a capacity to mentalise, as well as pointers for a wider review of the literature. This is followed by an overview of the range of current evidence-based psychological interventions and therapies available for the prevention and management of violence. Importantly, whilst their approach may differ, they all make use of the therapeutic relationship as an agent for change. The interventions include anger management, positive behavioural support, mentalisation-based techniques, application of a psychoanalytic perspective, family or systemic therapy, help with work experience, education and addressing substance misuse. This chapter will be of interest to professionals in a variety of settings who would like to find out more about how they can make sense of and try to prevent and reduce violence, as well as to patients, carers and the wider public.
To summarize reports describing implementation and evaluation of Web-based psychosocial interventions for disaster-related distress with suggestions for future intervention and research, and to determine whether a systematic literature review on the topic is warranted.
Methods:
Systematic searches of Embase, PsycINFO, and MEDLINE were conducted. Duplicate entries were removed. Two rounds of inclusion/exclusion were conducted (abstract and full-text review). Relevant data were systematically charted by 2 reviewers.
Results:
The initial search identified 112 reports. Six reports, describing and evaluating 5 interventions, were included in a data analysis. Four of the 5 interventions were asynchronous and self-guided modular programs, with interactive components. The fifth was a short-term, online supportive group intervention. Studies utilized a variety of evaluation methods, and only 1 of 14 outcome measures used across the studies was utilized in more than 1 project.
Conclusions:
Several Web-based psychosocial interventions have been developed to target disaster-related distress, but few programs have been formally evaluated. A systematic review of the topic would not be recommended at this time due to heterogeneity in reported studies. Further research on factors impacting participation, generalizability, and methods of program delivery with consistent outcome measures is needed.
Refugees experience a greater rate of common mental disorders relative to most other populations, and there remains a need to address these needs. However, most refugees are hosted in low-and-middle-income countries, where there is a lack of resources and mental health providers who can deliver mainstream mental health services. This situation has led to the emergence of scalable mental health interventions that can deliver evidence-based programs to refugees in need. Many countries hosting refugees have implemented programs that train local lay providers in interventions that can be delivered at scale. This review provides a narrative overview of these scalable interventions and critiques the evidence for their efficacy. It is noted that there are limitations to currently available scalable interventions, and there is a need for greater attention to determining the longer-term benefits of interventions, addressing the mental health needs of refugees who do not respond to these interventions, assisting refugees with more severe psychological disorders, and understanding the specific mechanisms that underpin observed benefits of these interventions.
Autonomy is the concept of self-rule, or the ability to control our personal choices. This chapter starts with a discussion of the dubious practice of selling herbal weight-loss products and asks whether regulations should try to protect consumers from making bad choices or if buyers should be solely in control of their own decisions. Advertising can be a challenge to autonomy, especially if it misleads or manipulates by triggering unreflective psychological dynamics, and capitalism relies on consumers being informed and able to make voluntary choices. The challenges posed by internet commerce are also discussed. The morality of workplace restrictions on individuals is examined, as well as the challenges of intrusive psychological testing and reduced barriers between professional and private lives. Whistleblowing is also introduced as emblematic of the tension between individual values and loyalty to a company. The concluding case examines the Wells Fargo banking scandal where customers were unaware of accounts opened in their name and the firm coerced employees to act against their best moral judgment.
Mindful eating (ME) has been linked to improvement in binge eating disorder, but this approach in obesity management has shown conflicting results. Our aim was to assess the effect of ME associated with moderate energy restriction (MER) on weight loss in women with obesity. Metabolic parameters, dietary assessment, eating behaviour, depression, anxiety and stress were also evaluated. A total of 138 women with obesity were randomly assigned to three intervention groups: ME associated with MER (ME + MER), MER and ME, and they were followed up monthly for 6 months. ME + MER joined seven monthly mindfulness-based intervention group sessions each lasting 90 min and received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d). MER received an individualised food plan with MER (deficit of 2092 kJ/d - 500 kcal/d), and ME joined seven monthly mindfulness-based intervention group sessions each lasting 90 min. Seventy patients completed the intervention. Weight loss was significant, but no statistically significant difference was found between the groups. There was a greater reduction in uncontrolled eating in the ME group than in the MER group and a greater reduction in emotional eating in the ME group than in both the MER and the ME + MER groups. No statistically significant differences were found in the other variables evaluated between groups. The association between ME with energy restriction did not promote greater weight loss than ME or MER.
Extraordinary reproductive technologies are continuing to evolve for people needing medical assistance to have a child, which are replete with complex psychosocial issues. Optimal patient care involves the collaboration of numerous healthcare professionals (physicians, nurses, laboratory scientists, administrative staff, as well as counselors) working together to provide reproductive medical services. This chapter provides a biopsychosocial model for the medical and psychosocial assessment and treatment of individuals and couples seeking reproductive medical assistance. Beginning with an overview of infertility and reproductive physiology/pathophysiology, evaluation and treatment are discussed from a collaborative perspective of medical and psychosocial management. All aspects of reproductive medical care are presented from the lifestyle choices to assisted reproductive technologies including IVF, gamete donation and gestational surrogacy. The complex psychological challenges of patients dealing with significant medical conditions and the consequences of invasive medical procedures, coupled with treatment failures and loss are examined. In addition, a collaborative approach to decision-making in treatment and family building alternatives is discussed. The chapter also serves as a springboard to topics in the second edition of Fertility Counseling covering therapeutic approaches, assessment and preparation in assisted reproduction, addressing the needs of diverse of populations, practice issues, and special topics on pregnancy loss, reproductive trauma and resiliency, postpartum adjustment, and the pregnant therapist.
Complex regional pain syndrome (CRPS) is a chronic localized pain condition that can have a significant impact on the quality of life. It affects children and adolescents as well as adults, but is more common among adolescent girls.
Objectives
To present up-to-date clinical information regarding CRPS in pediatric population.
Methods
A review of recent literature.
Results
In contrast to adults, CRPS appears after an initial event that is typically a minor trauma and occurs more frequently in the lower extremity than in the upper extremity. This syndrome is characterized by spontaneous or stimuli-induced pain, which is disproportionate to the actual incident trauma/stimulus, in the presence of a wide variety of autonomic and motor disturbances. The exact mechanism of CRPS is unknown, although several different mechanisms have been suggested. In many cases, CRPS follows a relatively minor trauma, in some cases, no previous injury was recalled and there are psychological factors implicated. It has been found a high prevalence of anxiety and depression in patients with CRPS and it is considered stress has an important role in inducing or perpetuating CRPS. Standard care consists of a multidisciplinary approach with the implementation of intensive physical therapy in conjunction with psychological counseling; in some patients, pharmacological treatments may help to reduce pain.
Conclusions
A multidisciplinary approach with psychological and psychiatric counseling are needed for effective management of CRPS. Further research in targeting specific mechanisms involved in the pathophysiology of CRPS should lead to prevention of this condition.
Forensic mental health is the interface between mental disorder and the courts and embraces a wide range of risk and clinical need assessments related to medical, psychological and social therapies. This chapter describes the nature and purposes of forensic mental health assessments in different settings (community, prison, hospital) and at different stages in mentally disordered offenders’ pathways to recovery (assessments at court, inpatient treatment, imprisonment and transitions to the community). It sets out assessment aims and the methods used to address these; outlines the main forensic mental health diagnostic systems (DSM-V and ICD-10); and overviews the complementary uses of systematic file review, clinical interviews, behavioural observations, psychometric assessments, structured professional judgement tools and mental disorder diagnoses. It illustrates the interplay between all these issues with two composite case studies at two stages of the individual’s progress, namely at court and at the transition from secure care to the community.
1. Post-intensive care syndrome (PICS) affects between 40 and 60 per cent of critical illness survivors, and manifests as new impairments of cognitive, psychological and/or physical function.
2. Major risk factors for PICS include >72 hours of mechanical ventilation, prolonged ICU delirium, maternal/obstetric critical illness and baseline physical and mental health co-morbidities.
3. The typical service model of follow-up care includes a face-to-face outpatient review approximately 2–3 months following discharge home, with follow-up visits at 6 and 12 months where required.
4. Physical, cognitive, psychological and global clinical outcomes should be evaluated using domain-specific tools and assessments.
5. Critical care recovery clinics provide an important opportunity to reconnect with patients and ‘re-humanise’ the ICU care delivered.
The devastating effects of the current pandemic are profoundly affecting peoples’s physical and psychological health. Numerous studies on the effects of previous infectious outbreaks have been published. Similarly, an increasingly growing body of research on COVID-19 has been developed and released, reporting a substancial psychological impact of both the outbreak and the response, suggesting that the population may express high levels of psychological symptoms.
Objectives
This presentation aims to synthesize existent literature that reports on the effects of COVID-19 on psychological outcomes of the general population, groups with higher vulnerability and its associated risk factors.
Methods
Bibliographic research was made through scientific databases such as PubMed and EMBASE. No time limit was used. Pertinent articles were carefully reviewed for additional relevant citations.
Results
Generally, there is a higher prevalence of symptoms of adverse psychiatric outcomes among the public when compared to the prevalence before the pandemic. Psychological reactions to pandemics include maladaptive behaviours, emotional distress and symptoms of stress, anxiety, depression, and avoidance behaviors. The groups known to be at higher risk for mental health problems during the pandemic are: women, healthcare workers, people under 40 years old and with chronic diseases. Other risk factors are: frequent exposure to social media/news relating to COVID-19, poor economic status, lower education level, and unemployment.
Conclusions
The COVID-19 pandemic represents an unprecedented threat to mental health. In addition to flattening the curve of viral transmission, special attention needs to be paid to the challenges it poses to the mental health of the population at a global scale.
The coronavirus (COVID-19) pandemic causes healthcare professionals to suffer mental health problems such as psychological distress, anxiety, depression, denial and fear. However, studies are lacking related to Ethiopia and to Africa in general.
Aims
To study the mental health of healthcare professionals during the COVID-19 pandemic in Ethiopia.
Method
A hospital-based cross-sectional study was conducted at Jimma University Medical Center among 249 healthcare professionals. The data were collected using self-administered questionnaires between 22 and 28 March 2020. The psychological impact was assessed using the Impact of Event Scale – Revised (IES-R) and symptoms of insomnia were measured using the Insomnia Severity Index (ISI). Social support was evaluated using the three-item Oslo Social Support Scale. Data were analysed using logistic regression to examine mutually adjusted associations, expressed as adjusted odds ratios. The psychosocial status of the healthcare professionals was predicted using a classification tree model supported by the genetic search method.
Results
The prevalence of psychological distress among healthcare professionals was 78.3%. The mean IES-R score was 34.2 (s.d. = 19.4). The ISI score indicated that the prevalence of insomnia was 50.2%. Higher psychological distress was associated with younger age, having insomnia, not having a daily update on COVID-19, and feeling stigmatised and rejected in the neighbourhood because of hospital work.
Conclusions
This study indicates that, in Ethiopia, the prevalence of psychological distress among healthcare professionals is high and associated with specific sociodemographic risks.
Asthma is increasing in prevalence in school-aged children. Causes for it include psychological triggers such as anxiety, stress, and depression. Interventions that are derived from education and psychology appear promising for symptom reduction. These treatments include written emotional expression, relaxation and guided imagery, gratitude exercises, mindfulness, and yoga, amongst others. This chapter reviews the myriad causes and treatments for childhood asthma.
The first case of 2019-nCoV pneumonia infection occurred in Wuhan, Hubei Province, South China Seafood Market in December 2019. As a group with a high probability of infection, health workers are faced with a certain degree of psychological challenges in the process of facing the epidemic. This study attempts to evaluate the impact of 2019-nCoV outbreak on the psychological state of Chinese health workers and to explore the influencing factors. During the period from 31 January 2020 to 4 February 2020, the ‘Questionnaire Star’ electronic questionnaire system was used to collect data. The 2019-nCoV impact questionnaire and The Impact of Event Scale (IES) were used to check the psychological status of health workers in China. A total of 442 valid data were collected in this study. Seventy-four (16.7%) male and 368 (83.3%) female individuals participated in this study. The average score of high arousal dimension was 5.15 (s.d. = 4.71), and the median score was 4.0 (IQR 2.0, 7.0). The average score of IES was 15.26 (s.d. = 11.23), and the median score was 13.5 (IQR 7.0, 21.0). Multiple regression analysis showed that there were critical statistical differences in high arousal scores among different gender groups (male 3.0 vs. female 5.0, P = 0.075). Whether being quarantined had significant statistical differences of IES scores (being quarantined 16.0 vs. not being quarantined 13.0, P = 0.021). The overall impact of the 2019-nCoV outbreak on health workers is at a mild level. Chinese health workers have good psychological coping ability in the face of public health emergencies.