Medical attitudes towards transgender patients.

BACKGROUND/AIMS: Those identifying as transgender make up a significant and growing number of individuals. They face discrimination in healthcare and have been known to have adverse physical and mental health outcomes because of stigma. A study was carried out to ascertain how doctors perceive and interact with their transgender patients. METHODS: The attitudes of doctors, working in mental and physical healthcare settings in a borough in south-east England, towards transgender patients were evaluated by administering a standardised questionnaire. RESULTS: The response rate was 22%. Most doctors who responded had encountered a transgender patient, but consultants were more likely to identify and interact with them comfortably, used their preferred pronouns, and knew about policies relating to their care than trainee doctors. CONCLUSIONS: These findings add to the growing data regarding the perceptions about transgender patients in healthcare settings.

Self-Amputation in Two Non-Psychotic Patients.

Self-amputation, the extreme form of self-mutilation, is uncommon. The vast majority of cases are associated with psychosis, with a small number being assigned the controversial diagnosis of body identity integrity disorder. In this article, we report two cases of non-psychotic self-amputation and their similarities with a view to highlighting the risk factors and formulating an appropriate management plan.

Alcohol misuse among elderly psychiatric patients: a pilot study.

The aim of this pilot study was to ascertain the frequency of alcohol misuse among the elderly (> 65) psychiatric referrals. Consecutive referrals to a suburban elderly psychiatric team were screened for alcohol misuse by using the CAGE questionnaire as a part of psychiatric assessment. Gamma-glutanyl transpeptidase (GGT) was measured in those showing evidence of alcohol misuse. Frequency of alcohol misuse in the elderly was found to be low. Alcohol misuse was associated with raised GGT, depression, being divorced/ widowed and living alone.

Substitution therapy for heroin addiction.

Substitution treatment for heroin addiction, defined here as maintenance prescribing of opioid agonist drugs to opioid dependent subjects, has increased in the last decade. The recent history of substitution treatment in five countries--Canada, the U.K., Australia, Israel, and France--is reviewed. In all five countries, the critical issues around substitution treatment are similar. The first key issue concerns the balance between making treatment accessible and attractive, and minimizing diversion to the black market. The second issue concerns the role of primary health care in delivering MMT. In general, there has been increasing involvement of primary health care, with training and support for practitioners. However, there remains uncertainty and official ambivalence over whether treatment should be restricted to specialist clinics and practitioners, or available through primary care. Most importantly, underlying these issues is the problem of stigma being associated with both addiction, and with substitution treatment. The underlying problem that treatment is often at odds with community values places enormous strains on substitution treatment, and makes the treatment system vulnerable to shifting community support and abrupt, politically-driven changes in policy.