The dense granules of platelets contain many molecules. Which of the following is found in dense granules?

Regarding a normal secondary follicle in a lymph node:

Which of the following statements is true regarding monoclonal B-cell lymphocytosis (MBL)?

It is proposed that spirituality and psychiatry, commonly held to be separate concerns, are in fact deeply entangled and inseparable. Meaning-making, an important concern of spirituality, is important to human well-being and needs to be taken more seriously by psychiatry. The damage done by historical antagonisms between psychiatry and religion needs to be undone by affirmation of spiritual concerns within psychiatric practice and by closer partnerships between psychiatry and faith communities. Professional boundaries need to be understood not as protecting psychiatry as secular space (which many religious patients find hostile to their spiritual concerns) but as protecting safe therapeutic space within which psychological recovery and spiritual growth may occur. Psychiatrists need to develop an interest in clinical theology, as a way of understanding the ordinary theological concerns of patients (including their ‘atheologies’). Psychiatry needs to be more spiritually attentive – to shed light on what patients desire spiritually and psychologically – rather than focussing only on the metaphorical shadows of psychopathology. Psychiatry needs to keep spirituality in mind.

A 55-year-old Caucasian woman presents for evaluation of fatigue. The patient states that her symptoms have been present for approximately 8 months and reports two episodes of cellulitis over the last year. Physical examination reveals mild splenomegaly; no skin lesions, lymphadenopathy, or other abnormalities are identified. Review of a complete blood count and peripheral blood smear shows absolute neutropenia, normocytic, normochromic anemia, and mild absolute lymphocytosis composed of numerous large lymphocytes with abundant cytoplasm and prominent red-pink granules. Which of the following is the most likely diagnosis?

Trans and non-binary people face many barriers to accessing healthcare. There is also a lack of research and guidance focusing on the health of transgender and non-binary people. Many clinicians also do not feel confident in their knowledge of specialist care for trans and non-binary people. As part of gender-affirming care, trans and non-binary people may start gender-affirming hormone therapy to provide masculinising or feminising changes that are more congruent with their gender identity. This has shown to a positive impact on the mental health and quality of life of trans and non-binary people. Over the life course, trans and non-binary people may also access other hormonal medications such as contraceptives and hormone replacement therapy for menopause. There are unique considerations for prescribing these medications for trans and non-binary people, especially if they are on gender-affirming hormones. In this chapter, we summarise evidence around the care for trans and non-binary people with specific considerations for the intersection between gender-affirming hormones, mental health, and sexual and reproductive healthcare.

The following are features of normal erythropoiesis except.

In this chapter, we examine the experiences of neurodivergent autistic people and attention deficit hyperactivity disorder (ADHD) individuals around menstruation and the life transition of menopause. The chapter is informed by personal insights from neurodivergent individuals with first-hand encounters of menstrual and menopausal challenges, our ‘experts by experience’. In doing so, we aim to inform and empower clinicians to appropriately support these patients with their menstrual and menopausal health. We begin by discussing what autism and ADHD are, the features of these conditions, and why they are particularly relevant and important in regard to health needs and for healthcare, and the shared interpersonal-environmental and intrapersonal factors of autistic people and ADHD individuals (ADHDers). We then individually consider autistic and ADHD experiences of menstruation and menopause with narrative from our experts by experience. Based on this information, we provide point-by-point advice for health professionals supporting neurodivergent people with menstruation and menopause health.

Psychiatrists have responded nationally and internationally to the growing scientific evidence on spirituality and psychiatry and to concerns about bad professional practice, by developing good practice guidelines/policies and by way of continuing professional development initiatives (special interest groups, conferences, etc.). Professional boundaries have historically been understood as keeping psychiatry, as a secular concern, separate from patients’ spiritual and religious concerns. However, as earlier chapters demonstrated, this is unrealistic in light of the entanglements of spirituality and psychiatry, and unlikely to be helpful for many patients. It does not address the importance of religion to patients worldwide or the transition in Western countries from a secular to a post-secular age. The Jungian concept of temenos is taken up as a way of understanding boundaries as protecting safe therapeutic spaces for psychological and spiritual transformation. Boundaries in clinical practice are thus created not to keep the psychological and spiritual domains separate but to protect a safe psychological and spiritual space within which positive therapeutic change may occur.

Sexual and reproductive health needs are often overlooked in psychiatric care; people with severe mental illness are at risk of unintended pregnancy and may struggle to access sexual health services. The link between psychological symptoms and contraceptive use is complex and the impact of hormonal contraceptives on mental health is poorly understood. There can be interactions between hormonal contraceptives and psychotropic medication, and where psychotropics with potential teratogenic effects are considered, good contraceptive counselling is imperative. The chapter explores mechanisms, risks and benefits of different types of contraceptives and explores their use beyond pregnancy prevention, including alternative therapeutic indications. Contraception choices are considered in specific groups including perimenopause, trans and non-binary people, and other marginalised groups. We aim to empower mental health professionals to engage collaboratively with their patients in discussing contraception as part of assessment and formulation. Where relevant, we encourage consideration of how contraceptive choices may interact with mental health conditions and influence management plans

Broader debates about possible ways of addressing the tensions between science and theology/religion have not often been applied to psychiatry, and yet it is to a large extent scientific research on spirituality and mental health over recent decades that has generated current interest in the importance of spirituality to psychiatry. The four models of relationship between science and religion, developed by Ian Barbour – conflict, independence, dialogue and integration – each have their correlates in the literature on spirituality and psychiatry. However, in clinical practice it is the ‘ordinary’ theology of patients that assumes greater importance than the formal, or academic, theology of philosophical debate. As an example of the importance of a kind of ordinary theology which has been subjected to scientific research, the concept of God images is explored. It is proposed that, in the course of assessment and treatment, a kind of ‘clinical theology’ is needed, in which psychiatrists take into account inner representations of God and other ordinary theological beliefs which inform understanding of a patient’s illness and spirituality.