The Health Care Experience of a Transgender Woman: The Role of the Consultation-Liaison Psychiatrist in Advocacy Against Discrimination in the Hospital Setting.

INTRODUCTION: Transgender individuals are at increased risk for health disparities and commonly avoid seeking health care due to experiences of mistreatment, stigma and discrimination. METHODS: We discuss the case of a young transgender woman with no prior psychiatric history presenting with feelings of frustration in the context of repeated misgendering and misnaming on the medical floor. The primary care team described the patient as "agitated," prompting psychiatric consultation. DISCUSSION: We examine how stigma and discrimination impacts the provider-patient relationship for gender and racial minorities, while highlighting the role of the Consultation-Liaison (CL) psychiatrist in advocacy in the hospital setting. Misgendering, misnaming, and other forms of discrimination against gender minorities are harmful and further fuel health and health care disparities in this population. We propose several interventions to mitigate the negative outcomes of misgendering in the hospital setting. CONCLUSION: It is imperative to ensure a trans-affirmative environment for patients while keeping an open-ended, non-judgmental, and inclusive attitude in the clinical setting. Staff education, multidisciplinary and collaborative approach as well as open communication between team members should be implemented on a broad scale to reduce biased provider-patient interactions and their harmful consequences to transgender individuals.

The association of antidepressant monotherapy and weight change in a Middle Eastern psychiatric population.

Genetic and lifestyle factors influence weight changes secondary to antidepressants. However, the association between antidepressants and weight changes is seldom studied in Middle Eastern populations who have a unique genetic, lifestyle and dietary profile. This is a chart-based retrospective longitudinal study that describes the 6-month evolution of weight in outpatient Lebanese adults initiated on serotonin reuptake inhibitor (SRI) antidepressant monotherapy, with the exclusion of confounders with metabolic implications. A linear mixed model was used to estimate the association of weight with time. Demographic factors were tested for interaction with the model. The sample consisted of 200 antidepressant trials. After adjusting for baseline weight, age, and sex, weight did not change significantly from week 1 to week 4 (P = 0.530) but significantly increased by 0.15 kg/week from week 4 to week 24 (P < 0.05). Sex, baseline weight, alcohol use, tobacco use, and presence of metabolic condition(s) did not affect weight change (P > 0.05). The same changes were observed across all SRIs and diagnoses. Our results show that SRI monotherapy is associated with weight gain throughout the treatment course in a Middle Eastern population. We recommend judicious prescription of SRIs and clinical vigilance over weight throughout the course of treatment in these populations.

The Role of Epigenetics in Addiction: Clinical Overview and Recent Updates.

Addiction is an international public health problem. It is a polygenic disorder best understood by accounting for the interplay between genetic and environmental factors. A recent way of perceiving this interaction is through epigenetics, which help grasp the neurobiological changes that occur in addiction and explain its relapsing-remitting nature. It is now known that every cell has a different way of expressing its phenotype, despite a universal DNA sequence. This is particularly true in the central nervous system where environmental factors influence this expression. Three major epigenetic processes have been found to participate in the perpetuation of addiction by changing the state of the chromatin and the degree of gene transcription: histone acetylation and methylation, DNA methylation, and noncoding RNAs. In the animal model literature, substantial evidence exists about the role of these epigenetic changes in the different phases of substance use disorders. This book chapter is a non-systematic literature review of the recent publications tackling the topic of epigenetics in addiction. Even though this evidence remains scarce and relatively poorly systematized, it is a promising foundation for future research of molecules that target specific brain regions and their functions to address core behavioral changes seen in addiction.