Sexual dysfunction and commonly used drugs in neurology.

Sexual dysfunction is common in men and women with neurological diseases. Medications used in neurology can cause sexual dysfunction independently of the disease process and this may adversely affect patients' quality of life. This review focuses on medications commonly prescribed to neurological patients that may contribute to altered sexual function, and discusses how they may differ in men and women.

Ketamine-assisted meaning-centered psychotherapy for a patient with severe suicidal behavior.

There is a current debate in society as to whether depression can be a terminal illness. Meaning-centered psychotherapy (MCP) and psychedelic medicines have both been shown to treat existential distress in palliative care settings. We are reporting the case of a patient for whom MCP combined with ketamine was an effective treatment for his recurrent and severe depressive disorder with suicidal ideation. His complex assessment and management of suicide (CAMS) scores improved significantly with this treatment modality. Ketamine is generally well tolerated and can enhance treatment outcomes in patients undergoing MCP.

Women's Health in Times of Emergency: We Must Take Action.

Women have historically faced gendered patterns of disadvantage during times of emergency. Evidence demonstrates differences in gendered exposures and inequities during acute crises such as natural disasters and pandemics, including Covid-19, and longer-term emergencies such as climate change. These patterns, without intervention, may be perpetuated in future crises. Threats to women's health in times of emergency can arise from restricted access to health care, economic disadvantages, and harmful social norms. During crises, women face additional barriers to accessing maternal, contraceptive, and abortion care, likely exacerbating existing inequities in reproductive health outcomes. Gendered inequalities in financial and economic stability can become even more stark. Globally, women perform the majority of health care and unpaid caregiving work, but face barriers to affording costs of living and obtaining health insurance due to over-representation in low-wage jobs. Finally, gendered expectations of social roles contribute to increased vulnerabilities, such as displacement and poverty. Violence against women rises in times of emergency and pathways to escaping trauma can be limited. In addition to directly addressing women's unique barriers and providing support in times of emergency through bolstering health care access, economic, and social support systems, thoughtful solutions such as trauma-informed care, increasing the number of women in leadership roles, educational initiatives, and advocacy from health professionals are needed to protect and advance women's health.

Clinical Advances in Sex- and Gender-Informed Medicine to Improve the Health of All: A Review.

Importance: Biological sex and sociocultural gender represent major sources of diversity among patients, and recent research has shown the association of sex and gender with health. A growing body of literature describes widespread associations of sex and gender with cells, organs, and the manner in which individual patients interact with health care systems. Sex- and gender-informed medicine is a young paradigm of clinical practice and medical research founded on this literature that considers the association of sex and gender with each element of the disease process from risk, to presentation, to response to therapy. Observations: Characteristics that underlie sex and gender involve both endogenous and exogenous factors that change throughout the life course. This review details clinical examples with broad applicability that highlight sex and gender differences in the key domains of genetics, epigenomic modifiers, hormonal milieu, immune function, neurocognitive aging process, vascular health, response to therapeutics, and interaction with health care systems. These domains interact with one another in multidimensional associations, contributing to the diversity of the sex and gender spectra. Novel research has identified differences of clinical relevance with the potential to improve care for all patients. Conclusions and Relevance: Clinicians should consider incorporating sex and gender in their decision-making to practice precision medicine that integrates fundamental components of patient individuality. Recognizing the biological and environmental factors that affect the disease course is imperative to optimizing care for each patient. Research highlights the myriad ways sex and gender play a role in health and disease. However, these clinically relevant insights have yet to be systematically incorporated into care. The framework described in this review serves as a guide to help clinicians consider sex and gender as they practice precision medicine.