Investigating the outcome of the initial assessment at a national transgender health service: Time to review the process?

Background: Globally, there is a lack of a standardized assessment process prior to the initiation of gender affirming medical interventions and consequently there is a discrepancy in this process among different transgender health services.

Aim: The main objective of this study is to investigate the outcome of the initial assessment process at a national transgender health service.

Method: The outcome of people over the age of 17 years, assessed at a large national transgender health service in the United Kingdom during a 2-year period was categorized into: (1) recommendation for cross-sex hormone treatment, or (2) no recommendation for cross-sex hormone treatment. In addition, 200 case notes were reviewed in order to investigate the level of agreement between the two clinicians involved in the assessment process.

Results: During the study period, a total number of 617 people completed their assessment at the service. Following assessment 380 (61.6%) patients were recommended for cross-sex hormone treatment, leaving 237 (38.4%) patients who required a longer assessment period or were discharged. The factors associated with being recommended for cross-sex hormone treatment were having socially transitioned, not smoking, having initiated cross-sex hormones prior to assessment, being older, and assigned male at birth. Out of the 200 case notes reviewed, agreement between assessor 1 and 2 (3 months apart) was found in 88% (n = 176) of the cases.

Discussion: Although the results of the study may not be generalizable to other international centers, questioning the assessment process and the role of the assessors is important to ensure treatment is offered in a timely and efficient manner. The findings from this study suggest that the routine inclusion of two assessors needs to be reviewed.     

Effects of anxiety on task switching: Evidence from the mixed antisaccade task

According to the attentional control theory of anxiety (Eysenck, Derakshan, Santos, & Calvo, 2007), anxiety impairs performance on cognitive tasks that involve the shifting function of working memory. This hypothesis was tested using a mixed antisaccade paradigm, in which participants performed single-task and mixed-task versions of the paradigm. The single task involved the completion of separate blocks of anti- and prosaccade trials, whereas in the mixed task, participants completed anti- and prosaccade trials in a random order within blocks. Analysis of switch costs showed that high-anxious individuals did not exhibit the commonly reported paradoxical improvement in saccade latency, whereas low-anxious individuals did. The findings are discussed within the framework of attentional control theory.     

Repressive adaptation in a nonclinical sample: consistent and inconsistent reports of child psychosocial functioning across informants

Using multiple indicators (self-report, parent report, school grades, and disciplinary referrals), we compared the psychosocial functioning of children across Weinberger's (1990) and Weinberger, Schwartz, and Davidson's (1979) repressive adaptive style (RAS) groups. Participants included 134 children ages 10 to 13 years that were recruited from public schools and 117 of their caregivers. Relative to nonrepressors, we hypothesized repressors to evidence lower levels of self-reported distress but higher parent-reported distress on the Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992). Summary scores from the BASC self-report differed significantly between repressors and nonrepressors in the expected directions. No significant group differences in parent-reported distress or school functioning emerged. Consistent with Phipps (2005), results question the predominant assumption that the RAS is associated with risk of psychosocial difficulties in children.     

An informal online learning community for student mental health at university: a preliminary investigation

As a potential solution to increasing demands on mental health services at universities, this project seeks to develop an informal online learning community for mental health support and education. Students' use of the Internet and Information and Communication Technologies (ICT), especially to access health information, provides a supporting rationale for this project. The design for this study is grounded in the pedagogical principles of informal learning and the practices for building successful online communities. The student online mental health community has been implemented at the authors' university (University of Dublin, Trinity College) for one academic term and the initial analysis of its usage is positive. Features that are being positively evaluated are the role of the reader participant, disinhibition that arises from anonymity, online provision acting as a gateway to further support, and online provision reaching an audience who ordinarily do not use face-to-face services. At the same time, difficulties specific to this type of community have surfaced, including technical issues, implications of anonymity and user safety.     

Dexamethasone and stressor-magnitude regulation of stress-induced transcription of HPA axis secretagogues in the rat

Regulation of the production of hypothalamic-pituitary-adrenal (HPA) axis secretagogues, corticotropin-releasing hormone (CRH) and arginine vasopressin (AVP), may be differentially sensitive to the negative feedback effects of glucocorticoids. We chose to study this phenomenon by examining the ability of dexamethasone to influence CRH and AVP heteronuclear RNA (hnRNA) levels in an escapable/inescapable (ES/IS) foot-shock stress paradigm. On Day 1, adult male rats were subjected to either ES or IS foot-shock; on Day 2, saline or dexamethasone (100 microg/kg) was administered 2 h prior to the stressor. We found that ES/IS foot-shock stimulated similar robust increases in plasma adrenocorticotrophic hormone (ACTH) and corticosterone concentrations, and medial parvocellular division of the paraventricular nucleus (mpPVN) AVP and CRH hnRNA and c-fos mRNA levels in saline-treated ES/IS rats. Dexamethasone pretreatment suppressed ACTH and corticosterone levels similarly in IS and ES animals. Dexamethasone pretreatment also suppressed mpPVN CRH and AVP hnRNA levels at 30 min. However, by 120 min, the mpPVN AVP hnRNA levels in dexamethasone-treated rats were similar to those measured in the saline group. We also found that rats that received the most shocks on Day 1 had greater HPA axis activation on Day 2. We conclude that the magnitude of the foot-shock stressor, determined by learned and immediate cues, is important in determining the magnitude of the HPA response.     

Caregiver Involvement in the Intensive Mental Health Program: Influence on Changes in Child Functioning

We examined behavioral markers of caregiver involvement and the ways in which family participation was related to treatment outcomes in 47 elementary school children with SED enrolled in a school-based intensive mental health program. Measures of caregiver involvement included therapeutic home visits, attendance at therapeutic meetings, completion of ratings on the daily point sheet, and extra communications with the therapeutic team on the point sheet. Greater initial impairment was associated with greater caregiver involvement. Greater caregiver involvement was linked to improvement in child thought processes, increased ability to provide emotional and social supports for the child, and greater overall child functioning at discharge. Our findings also reflected increased therapists’ attempts to provide additional in-home services in cases where caregivers demonstrated a decline in their ability to provide for their children’s physical and material needs, or in which therapists discovered that the family functioning was more impaired than what was initially assessed. We provide a case study that exemplifies many of these findings.     

An Examination of the Psychometric Properties and Factor Structure of the Feelings of Stigmatization Questionnaire

As the experience of stigma and its psychological dimensions require careful measurement, the purpose of this study was to examine the psychometric properties and factor structure of the Feelings of Stigmatization Questionnaire (FSQ). A total of 170 participants with psoriasis and 124 with atopic dermatitis (AD) completed the FSQ. AD participants self-rated AD severity, while psoriasis severity was determined by a clinician. Confirmatory (CFA) and exploratory factor analytic (EFA) techniques were used to examine the factor structure of the FSQ. The FSQ total score was not related to age, age at onset, illness duration or psoriasis severity but it was negatively associated with AD severity (r = −.25, p < .01). The original six-factor structure of the FSQ was not replicated in our sample. Using EFA, a fixed three-factor solution proved the most stable, with the dimensions of feeling flawed, anticipation of rejection and secrecy, and positive attitudes towards skin disease being identified.     

Use of virtual reality distraction to reduce claustrophobia symptoms during a mock magnetic resonance imaging brain scan: a case report.

The present case series with two patients explored whether virtual reality (VR) distraction could reduce claustrophobia symptoms during a mock magnetic resonance imaging (MRI) brain scan. Two patients who met DSM-IV criteria for specific phobia, situational type (i.e., claustrophobia) reported high levels of anxiety during a mock 10-min MRI procedure with no VR, and asked to terminate the scan early. The patients were randomly assigned to receive either VR or music distraction for their second scan attempt. When immersed in an illusory three-dimensional (3D) virtual world named SnowWorld, patient 1 was able to complete a 10-min mock scan with low anxiety and reported an increase in self-efficacy afterwards. Patient 2 received "music only" distraction during her second scan but was still not able to complete a 10-min scan and asked to terminate her second scan early. These results suggest that immersive VR may prove effective at temporarily reducing claustrophobia symptoms during MRI scans and music may prove less effective.