Sociodemographic,Clinical, and Psychiatric Characteristics of Transsexuals from Spain

The aim of this study was to examine the characteristics of transsexuals from Spain. A total of 252 consecutive applicants for sex reassignment were evaluated using a standardized semistructured clinical interview and the Mini International Neuropsychiatric Interview (Spanish Version 5.0.0) to record demographic, clinical, and psychiatric data. Transsexualism was diagnosed in 230 patients, with a male to female (MF)/female to male (FM) ratio of 2.2:1. Transsexual patients frequently had low employment status, lived with their parents, and mainly had a sexual orientation toward same-sex partners. The most frequent psychiatric diagnoses were adjustment disorder and social phobia in both groups, and alcohol and substance-related disorders in the MF group. MF transsexuals were older than FM transexuals when requesting sex reassignment, but did not differ in age when starting hormonal therapy (often on their own); fewer MFs were in employment requiring high educational qualification, more were non-Spanish natives, and more had previous and current histories of alcohol and substance abuse or dependence. The basic characteristics of transsexuals from Spain were similar to those of other European countries, except for the higher proportion of patients living with their parents and the higher proportion of MFs who reported same-sex sexual orientation compared with previous studies.     

The comparative psychopathology of anorexia nervosa: Obsessive-compulsive disorder or phobia?

The current study investigates the similarities and differences between anorexic restricters, anorexic bulimics, female obsessives, agoraphobics, social phobics, and specific phobics. Measures of psychopathology were self-ratings of adjustment, the IPAT, FSS, MPI, and LOI. Results indicated that persons suffering from anorexia nervosa and bulimia nervosa were more similar to obsessives than to phobics with respect to obsessional personality traits and neuroticism. Additional research is needed in the examination of the central preoccupation in order to understand the differentiation of the various disorders and to what extent anorexia nervosa is a nosological entity.     

Clinical testing of hygienic criteria for assessing working conditions

Occupational morbidity in railway transport is discussed. The rates of occupational morbidity are compared with that due to temporary working incapacity. There were no direct correlations between the incidence of major nosological entities of occupational diseases, the magnitude and rate of influence of industrial factors, which provides evidence for their further testing and correction.     

Transsexualism and anatomic sex ratio reversal in Poland

Transsexualism has been described in numerous papers as a condition appearing, on the average, four times as often with somatic males than with somatic females. Against this background we consider the situation in Poland, where, during three consecutive observation cycles over 6 years, the results obtained were reversed. Among our transsexuals the ratio was 5.5:1, with the majority being somatic females.     

Sexual activity and temperament in polish transsexuals

Two groups of 23 female-to-male and 14 male-to-female transsexuals were compared to a representative sample of Polish controls along following dimensions: (i) temperamental features including reactivity and mobility of nervous processes, as measured by Strelau's Temperament Inventory; and (ii) patterns of sexual activity, measured with Dulko's Questionnaire for Measurement of Transsexualism. Transsexuals were found to resemble respective controls on temperamental dimensions according to their sense of gender identity and not their somatic sex. Male-to-female transsexuals were more similar to control females than to control males and the reverse was true for female-to-male subjects. With respect to forms of sexual activity, transsexuals, particularly the female-to-male, were found to have a relatively versatile erotic life. Both groups experienced more dreams with erotic content than respective controls. However, they also manifested fewer successes at satisfying their erotic needs.     

COVID-19 vaccine uptake in mental healthcare users: Czech nationwide register study

BackgroundThe excessive covid-related mortality of psychiatric patients was reduced by vaccination. The vaccine uptake in patients diagnosed with different mental health disorders is, however, not fully described.AimsA nationwide, record-based retrospective cross-sectional study examines the effect of substance use, psychotic, affective, anxiety, and personality disorders on COVID-19 vaccination rates in August and December 2021. Further, it quantifies the effect of receiving mental healthcare on vaccine uptake.MethodsThe COVID-19 vaccine rates of mental healthcare users in August and December 2021 were examined using logistic regression models adjusted for sex and age on a sample of 7,235,690 adult inhabitants of the Czech Republic. The probability of vaccine uptake in the week following mental healthcare appointment or hospitalization on any day in the fall 2021 was compared to the general probability of getting vaccinated during that week.ResultsThe vaccination rate in August 2021 was related to history of hospitalization due to substance use (OR = 0.71), personality (OR = 0.87), psychotic (OR = 0.92), and anxiety (OR = 1.15) disorders, while mood disorders had no effect (OR = 1.00). Compared to general population, mental healthcare users were undervaccinated in August but not in December 2021. Vaccine uptake was low in those with history of psychiatric hospitalizations but higher in those utilizing inpatient or outpatient mental healthcare recently, predominantly for affective disorders. Increased vaccine uptake was observed following utilization of mental healthcare as well as in those with repeated psychiatric hospitalizations.ConclusionsThe vaccination rates of mental healthcare users relative to general population largely differ across nosological categories and during the vaccination campaign. Psychiatrists were successful in promoting vaccination against COVID-19.     

Gender differences in compensatory behaviors, weight and shape salience, and drive for thinness

Gender differences in compensatory behaviors, weight and shape salience, and drive for thinness have rarely been examined in nonclinical samples. The present study examines gender differences in a sample of 1111 male and 1510 female twins responding to a questionnaire on eating attitudes and behaviors. Logistic regression using generalized estimating equations (GEE) tested the extent to which gender could be predicted from compensatory behaviors, weight and shape salience, and drive for thinness. The results indicated that use of compensatory behaviors predicted female gender for all except exercise and "other," where no gender differences were found. Greater importance of weight and shape also predicted female gender, as did drive for thinness. Findings with respect to exercise use and "other" compensatory behaviors have nosological implications for the eating disorders, especially as regards eating disorders in males. These findings suggest that both the nature and function of compensatory behaviors may differ by gender.     

Risk factors in the development of hemoblastoses in the population of the Tomsk Region

The Tomsk Region belongs to the areas of Siberia and the Far East which show a higher risk for hemoblastoses in the population. Chronic leukemia are prevalent in the structure of oncohematologic morbidity in the Tomsk Region as compared with other areas of Siberia and the Far East. There is a relationship of technogenic environmental pollution to the incidence of some nosological entities of hemoblastoses in the Region. Measures for environmental improvement are gaining in significant importance in the cancer-combating system.     

The 24-hour secretory pattern of LH and the response to LHRH in transsexual men

Ten separate aspects of hypothalamic and pituitary function were studied in 13 male-to-female transsexuals and compared to the results of 7 heterosexual adult men. In 4 of 5 transsexuals, the 24-hour mean serum concentration of LH, the LH pulse frequency or amplitude, or the apparent half-life of disappearance of serum LH were greater than the 95% confidence limit of normal men. The maximum concentration of LH or FSH following the administration of 100 µg LHRH, the area under the response curve of LH or FSH following LHRH, or both were significantly greater than normal in 5 of 13 male-to-female transsexuals. The response of LH following the administration of LHRH was repeated in 3 subjects during estrogen therapy, and in one there was a paradoxical increase in the response of LH. Transsexualism may be associated with a neuroendocrine defect in the hypothalamus or pituitary that is characterized by high-frequency, high-amplitude pulsatile secretion of pituitary LH.Supported in part by NIH Grants 1-K04-HD-00153 and 5-M01-RR-00633 and by USPHS Grant AM-06912.Deceased.     

Medically unexplained physical symptoms in medical practice: a psychiatric perspective

Clusters of medically unexplained physical symptoms have been referred to in the literature by many different labels, including somatization, symptom-based conditions, and functional somatic syndromes, among many others. The traditional medical perspective has been to classify and study these symptoms and functional syndromes separately. In psychiatry, current taxonomies (Diagnostic and Statistical Manual of Mental Disorder, 4th edition, and The International Statistical Classification of Diseases and Related Health Problems, 10th revision) classify these syndromes together under the rubric of somatoform disorders. In this article we approach medically unexplained physical symptoms from a psychiatric perspective and discuss the common features that unite multiple unexplained symptoms or functional somatic syndromes as a class. Included in this article is a discussion of nosological issues, clinical assessment, how these syndromes are viewed within the various medical specialties, and clinical management and treatment.     

Anorexia nervosa and schizophrenia: A case study

A case is presented in which a male patient developed anorexia nervosa and schizophrenia independently. The nosological issues involved are discussed in relation to existing diagnostic systems.     

The specificity of organization of the consultative-and-diagnostic service for the adult population in a big city

The volume and structure of the diagnostic services and of the medical aid appealability were analyzed for the Eastern Administrative District of Moscow by the example of a stage-2 diagnostic-and-consultative center. The analysis was made on the basis of 80233 receipts of patients for the period of January-April 2003. Three types of patients' flow were defined with respect to the purpose of visit: consultative aid (CA, 17.3%), consultative-and-diagnostic aid (CDA, 16.2%) and diagnostics (D, 66.5%). Differences are shown in the structure of appealability by the classes of diseases (nosological forms of diseases) and according to groups of patients. Consultations are mostly provided in cases of diseases of the endocrine system (20.9%), digestive system (20.2%) blood-circulation system (18.0%) and urogenital system (14.6%). Patients with urogenital disease (31.1%) and with blood-circulation lesions (13.5%) were found to be predominant in the CDA group. The structure of appealability is defined for the classes of diseases, their nosological forms and for medical specialties. It is pointed out that 52.1% of patients visited their general practitioners. Patients visited most often the doctors of the below specialties: oncology--16.1%, endocrinology and cardiology 12.3%, general practitioner--11.5% and gastroenterology--78%. The rate of visits was evaluated for the classes of diseases and medical fields; the estimated distribution of appealability was estimated with respect to the rate of visits. The structure of diagnostic examinations was analyzed by types, purpose, and classes of diseases (nosological forms).     

Issues in diagnosis and treatment of transsexualism

Transsexualism involves incongruity between anatomy and gender identity in biological normal persons. The literature in this area indicates controversy in diagnosis and treatment. Current guidelines for assessment and treatment selection are critically reviewed. Outcome data suggest that sex reassignment surgery is variably effective and potentially deleterious. Child and adult interventions may be more viable than previously assumed. Recommendations for research include systematic follow-up, longitudinal studies of gender-deviant children, and studies of psychopathology. Until rigorous outcome data are available, return to a conservative position on sex reassignment, using highly exclusive diagnostic guidelines and restrictive selection criteria, is advocated.     

Interim report of the DSM-IV Subcommittee on Gender Identity Disorders

This article summarizes the discussions and recommendations of the DSM-IV Subcommittee on Gender Identity Disorders, a subcommittee of the Child Psychiatry Work Group, regarding diagnostic issues. The issues reviewed include placement in the nomenclature, the concept of a spectrum of gender dysphoria rather than discrete levels of symptomatology, criticisms of current diagnostic criteria, subtyping by sexual orientation, and proposed changes in diagnostic criteria for the current DSM-III-R diagnoses of Gender Identity Disorder of Childhood, Transsexualism, and Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type.The views expressed in this article are those of the authors and do not represent the official positions of the DSM-IV Task Force of the American Psychiatric Association.     

The Ekbom symptom in schizophrenic psychoses

In connection with their schizophrenic cases, the authors analyse the nosological and psychodynamical characteristics of the phenomenon described by Ekbom. They emphasize the interaction between the psychotic process and object losses, which can be observed in the formation of secondary symptoms.     

"Folie a deux hallucinatoire"--a new case of induced hallucinatory psychosis. A new entity?]

The authors in their case report show a case of induced hallucinatory psychosis induced in a wife of a patient with alcoholic hallucinosis. They deal with the nosological position of "folie a deux hallucinatoire" (induced hallucinatory psychosis) and integrate the consequences of the case to the general psychopathological theory of hallucinations.     

Knowledge of and Attitude Toward Transsexualism Among College Students

Transsexualism is characterized by, among other things, an aspiration for sex reassignment surgery. The aim of this review was to determine the extend of the knowledge and the approach of Lodz college students toward transsexualism and to find out what rights students would grant to transsexual persons. The questionnaire studies were carried out in a group of 300 students. The studied group consisted of 51% of men and 49% of women with the median age of 23.2 ± 1.1 years. About 53.6% of questionnaired students gave correct answer to the question of the definition of transsexualism. Most of questionnaired students think that transsexuals should have the possibility of legal change of name (67%) or undergoing hormonal therapy (70%) and surgical treatment (63.5%). Most of respondents were against the refunding hormonal therapy (63.4%) and surgical treatment (65.6%) from social insurance. The knowledge of students from Lodz universities about transsexualism is comparable with that of their foreign counterparts. Student’s attitude toward legal and surgical sex change in transsexuals is positive. Female students show greater understanding of transsexual needs than male students.     

Study of population needs of orthodontic care

The prevalence of dental diseases in the population subject to orthodontic treatment is analyzed. High incidence of the main nosological entities, requiring orthodontic treatment, and the morbidity time course in different age groups are shown. Population need in orthodontic care is evaluated. Coefficients for evaluation of consumption of orthodontic care are estimated and the possibility of using these coefficients in practical public health is discussed.     

Slowly progressive aphasia without dementia

Slowly progressive aphasia without dementia is a rare disease, first described in 1982. Since then the existence of a nosological entity bearing that name is disputed. Case histories of two patients are described, with emphasis on clinical presentation and the importance of early diagnosis and neuropsychological evaluation. It is concluded that slowly progressive aphasia is a sign caused by a neurodegenerative cerebral disorder starting in the dominant hemisphere, ultimately accompanied by symptoms of generalised dementia.     

Development of male gender identity/role and a sexual orientation towards women in a 46,XY subject with an incomplete form of the androgen insensitivity syndrome

Transsexualism and homosexuality have been theorized to originate in the male from insufficient androgenization of the brain. For verification of this hypothesis clinical science must rely on subjects with an abnormal prenatal/perinatal endocrine history. A case of a 33-year-old 46,XY subject with an incomplete form of androgen insensitivity syndrome (AIS) is presented. In adulthood the only genital sign of masculinization is a clitoris of 4 cm; the vagina is normal size. The diagnosis AIS was verified by androgen receptor studies. At birth there was confusion as to the sex of the newborn. Originally, the subject was assigned to the male sex, but this decision was reversed 5 days after birth and the subject was reared as a girl. At age 30 the subject applied for gender reassignment treatment to the male sex. Upon psychological evaluation the gender identity was unambiguously male and the sexual orientation was exclusively towards women. The estrogen feedback effect on LH, regarded by some as a marker of the sexual differentiation of the neuroendocrinium was negative before orchiectomy but positive after orchiectomy. Our observation demonstrates that in 46,XY subjects a male gender identity and a sexual orientation towards women can develop with a strikingly lower-than-normal level of biological action of androgens.