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Acute psychotic presentation in syphilis-the great imitator is backIn the late 19th and the early 20th century, general paresis of the insane, as it was known historically, or neurosyphilis was a common cause of new-onset psychosis. Symptomatic neurosyphilis was reported in 10-20% patients with syphilis (Singh & Romanowski 1999). The widespread use of penicillin resulted in a marked reduction in syphilis (Kim 1965). Towards the end of the 20th century, syphilis was considered a rare disease and its relevance in clinical training and practice in general, and in neuropsychiatric settings in particular, diminished (Ropper 2019). Unfortunately, there has been a global resurgence of syphilis over the past decade. In England, between 2010 and 2019, the number of newly diagnosed syphilis patients increased from 2646 to 7982 (Mitchell et al. 2020). A similar increase from 45844 to 115045 was observed in the USA between 2010 and 2018 (Centers for Disease Control and Prevention 2019). Despite these increasing numbers, the clinical interest in syphilis, known for its protean manifestations earning the name of the 'great imitator', remains low.
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Do thinking styles play a role in whether people pathologise their pornography use?The concept of pornography addiction remains controversial and as such there are no diagnostic criteria. Despite this, individuals present to services with self-perceived problematic pornography use. Current treatment generally focuses on the pornography use, yet people's relationship with pornography is complex, and other factors may be relevant for therapy. Drawing on cognitive theory literature, this study explored whether thinking styles, influenced how people evaluate their pornography use. Self-reported (n = 265) “pornography addicts”, “somewhat pornography addicts”, and “non-addicts” were compared on their perceived effects of their pornography use, cognitive distortions, impact of religious beliefs, social desirability, and shame, within the values theory framework. Findings showed that groups differed significantly in their propensity for cognitive distortions, reported effects of their pornography use, the impact of their religious beliefs, and time spent viewing pornography. Significant differences were not found for the shame scales or social desirability. Regression analysis demonstrated that thinking styles mediated the relationship between time spent viewing pornography and the overall perceived negative impact of pornography. In light of this study's findings, thinking styles should be a focus in future research and treatment as it may help to reduce cognitive dissonance and engender agency. © 2017 College of Sexual and Relationship Therapists
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Are psychiatrists guilty of 'ageism' when it comes to taking a sexual history?Examined the attitudes and perceived current clinical practice of psychiatrists with regard to taking a sexual history and management of sexual dysfunction of patients. A questionnaire with two case vignettes describing an elderly male complaining of low mood (the other vignette described a middle-aged man with the same complaint) and questions regarding taking a sexual history and management of sexual dysfunction was sent to old age and general consultant psychiatrists. Results found that general and old age consultant psychiatrists take a sexual history more frequently of middle-aged men than of elderly men. There are no statistically significant differences between the two groups of psychiatrists in their psychiatric assessment regarding taking sexual history and the management of sexual dysfunction in elderly men. Middle-aged men with sexual dysfunction are referred to a specialized clinic, while elderly men are referred to a community psychiatric nurse. These findings indicate that taking a sexual history is often omitted in the psychiatric assessment of elderly men. Elderly men with sexual dysfunction do not receive appropriate referral and treatment. Human sexuality and particularly aged sexuality is an area that requires more attention in psychiatric training. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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Review of 'Reeling in the years - Gay men's perspectives on age and ageism'Reviews the book "Reeling in the Years--Gay Men's Perspectives on Age and Ageism," by Tim Bergling (2004). The book adds a welcome perspective, and a critical as well as frank contribution to the slowly, albeit gradually evolving amount of gerontological literature in the area of aging and homosexuality. The author skilfully and occasionally humorously, but always painstakingly honestly, illustrates the gay community's attitudes toward age and the rites of passage associated with certain age groups. The book explores the gay experience through young, middle-aged, and elderly viewpoints, including relationships, dating younger men, dating older men, the internet, sex, drugs, alcohol, HIV/AIDS, fitness, cosmetic surgery, retirement, bereavement, harassment, and discrimination. Overall, the book offers an engaging read, not only about age specifically, but about gay culture in general. (PsycINFO Database Record (c) 2016 APA, all rights reserved)
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Sexuality and ageingAcross the globe, both in developed and developing countries, the population is rapidly ageing. In the fields of sexual and relationship therapy and sexual health, ageing has not been an issue of priority. Too often, ageing is thought of as a process that relates to problems, deficits, and taboos, and less to pleasure, change, growth, and diversity. it is treated as a separate life stage and not a process throughout the lifecycle. Sexuality and sexual health are important parts of the lives of older people, as they have a significant impact on quality of life, psychological well-being and physical health, as well as social and family life. This book brings together contributions from those currently writing on and researching ageing as it relates, in a therapeutic context, to gender identity, to sex and sexuality, and to intimate relationships. This book was originally published as a special issue of Sexual and Relationship Therapy.
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HIV prevention advice for people with serious mental illnessBackground: People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. Objectives: To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. Search methods: We searched the Cochrane Schizophrenia Group's Trials Register (24 January 2012; 4 July 2016). Selection criteria: We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. Data collection and analysis: Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. Main results: We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. Authors' conclusions: Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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HIV prevention advice for people with serious mental illnessBACKGROUND: People with serious mental illness have rates of Human Immuno-deficiency Virus (HIV) infection higher than expected in the general population for the same demographic area. Despite this elevated prevalence, UK national strategies around sexual health and HIV prevention do not state that people with serious mental illness are a high risk group. However, a significant proportion in this group are sexually active and engage in HIV-risk behaviours including having multiple sexual partners, infrequent use of condoms and trading sex for money or drugs. Therefore we propose the provision of HIV prevention advice could enhance the physical and social well being of this population. OBJECTIVES: To assess the effects of HIV prevention advice in reducing morbidity, mortality and preserving the quality of life in people with serious mental illness. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Trials Register (24 January, 2012), which is based on regular searches of CINAHL, BIOSIS, AMED, EMBASE, PubMed, MEDLINE, PsycINFO, and registries of clinical trials. There is no language, date, document type, or publication status limitations for inclusion of records in the register. SELECTION CRITERIA: We planned to include all randomised controlled trials focusing on HIV prevention advice versus standard care or comparing HIV prevention advice with other more focused methods of delivering care or information for people with serious mental illness. DATA COLLECTION AND ANALYSIS: Review authors (NW, AC, AA, GT) independently screened search results and did not identify any studies that fulfilled the review's criteria. MAIN RESULTS: We did not identify any randomised studies that evaluated advice regarding HIV for people with serious mental illness. The excluded studies illustrate that randomisation of packages of care relevant to both people with serious mental illness and HIV risk are possible. AUTHORS' CONCLUSIONS: Policy makers, clinicians, researchers and service users need to collaborate to produce guidance on how best to provide advice for people with serious mental illness in preventing the spread of HIV infection. It is entirely feasible that this could be within the context of a well-designed simple large randomised study.
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Mental health pharmacists views on shared decision-making for antipsychotics in serious mental illnessBackground People diagnosed with serious mental illnesses (SMIs) such as schizophrenia and bipolar affective disorder are frequently treated with antipsychotics. National guidance advises the use of shared decision-making (SDM) in antipsychotic prescribing. There is currently little data on the opinions of health professionals on the role of SDM. Objective To explore the views and experiences of UK mental health pharmacists regarding the use of SDM in antipsychotic prescribing in people diagnosed with SMI. Setting The study was conducted by interviewing secondary care mental health pharmacists in the UK to obtain qualitative data. Methods Semi-structured interviews were recorded. An inductive thematic analysis was conducted using the method of constant comparison. Main outcome measure Themes evolving from mental health pharmacists on SDM in relation to antipsychotic prescribing in people with SMI. Results Thirteen mental health pharmacists were interviewed. SDM was perceived to be linked to positive clinical outcomes including adherence, service user satisfaction and improved therapeutic relations. Despite more prescribers and service users supporting SDM, it was not seen as being practised as widely as it could be; this was attributed to a number of barriers, most predominantly issues surrounding service user's lacking capacity to engage in SDM and time pressures on clinical staff. The need for greater effort to work around the issues, engage service users and adopt a more inter-professional approach was conveyed. Conclusion The mental health pharmacists support SDM for antipsychotic prescribing, believing that it improves outcomes. However, barriers are seen to limit implementation. More research is needed into overcoming the barriers and measuring the benefits of SDM, along with exploring a more inter-professional approach to SDM.;
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The relationships between induced abortion, attitudes towards sexuality and sexual problemsThis study aimed to investigate whether abortion is associated with (i) changes in attitudes and feelings towards sexual matters (erotophobia-erotophilia), (ii) sexual problems, and (iii) whether erotophobia-erotophilia and sexual problems are associated. Ninety-eight women having a first-trimester abortion were investigated together with a comparison sample of 51 non-pregnant women. Standardised questionnaires assessing sexual problems and attitudes and feelings towards sexual matters were completed by the study sample (prior to and 2 months after abortion) and the non-pregnant comparison sample. The findings indicated that attitudes and feelings towards sexual matters were similar in the study and comparison sample, and were more positive 2 months after the abortion than prior to it. More sexual problems were experienced following the discovery of the pregnancy than prior to the pregnancy or in the 2 months after abortion. Levels of sexual problems reported by the study sample prior to pregnancy and by the comparison sample were similar. Erotophobia-erotophilia and sexual problems were moderately correlated in the study sample. In conclusion, becoming pregnant did not appear to affect erotophobia-erotophilia, but having the abortion was followed by more positive attitudes and feelings towards sexual matters. Becoming pregnant had short-term negative effects on sexual relationships but these were not sustained following abortion. © British Association for Sexual and Relationship Therapy.
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The Edinburgh cohort of HIV-positive drug users: The effects of depressed mood and drug use upon neuropsychological functionThe effect of the human immunodeficiency virus (HIV) on cognitive function drug users is subject to the effects of drug use and depression. The current study tested the effect of these potential confounders in 244 HIV-positive drug users (147 asymptomatic, 97 symptomatic) and 42 confirmed HIV-negative drug users. No difference was found between HIV-positive and HIV-negative groups for measures of drug use, negative mood, or verbal IQ. Symptomatic HIV-positive patients were significantly more impaired on measures of non-verbal performance intelligence and memory than HIV-negative or HIV-positive asymptomatic patients. Structural modelling of the data suggested associations between falling CD4 count and impaired non-verbal performance; low mood, greater benzodiazepine use and poorer memory; and higher opiate use and slight impairment on non-verbal performance. Drug use and low mood did not act upon low CD4 count to affect non-verbal cognitive performance. Our results suggest cognitive impairment in HIV-positive drug users attributable to HIV illness can be detected, and that concurrent drug use and mood are not major confounders, provided such factors are recognized to begin with. © 1996 The British Psychological Society.
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Exchange, deceit, risk and harm: The consequences for women of receiving injections from other drug usersAims: To explore the consequences for women of being injected with illicit drugs. Methods: In-depth interviews with 45 women injecting drug users who have been injected by other people. Findings: Women's reliance on others to administer injections meant they had less control over their drug use. Exchanging drugs as currency for being injected was common and women had little choice but to provide the injector with drugs. Being injected by others often caused the recipient physical harm. Previous experience of deception and harm meant women became more knowledgeable about their injector's intentions and subsequently tried to reduce future damage when being injected. Women appeared to be confused about the risks associated with being injected and the perceived risks were often complex and polarized. Understanding the context and nature of being injected is important for services when working with injection recipients. Conclusions: This work uncovered ideas about a complex area and highlights the importance for those working with drug users to pay attention to this. Increased training and awareness for drug-service staff about factors influencing being injected and the potential associated risks is recommended. Reinforcing current harm-reduction messages and providing related advice to injection recipients is also important. In improving the knowledge and awareness about being injected, women recipients may gain increased choice and agency in the injection process.