CMN 557-Unit 3
baby blues
50% of women who give birth 3-5 days after delivery Days to weeks No associated stressors no sociocultural influence no associated with h/o mood disorder no fly hx of mood do tearfulness; mood lability sleep disturbance sometimes no SI rarely any thoughts to harm baby no feelings of guilt, inadequacy
coprohilia
sexual pleasure associated with the desire to defecate on a partner, to be defecated on, or to eat feces (coprophagia)
Cause may be related to attitude toward sex in general and toward partner; may be related to fear of AIDS
what may be the cause of postcoidal dysphoria?
-Monitor H & H levels as testosterone can increase these levels -Routinely monitor liver function as testosterone is processed in the liver
what should you monitor for when taking testosterone?
Incidence unknown; more common in men; may occur in adulterous sex and contacts with prostitutes
when does postcoidal dysphoria often occur?
2% 3
Fetishism-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
6% 30
Frotteurism- Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
A. A marked incongruence between one's experience/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least two of the following: 1. A marked incongruence between one's experience/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics). 2. A strong desire to be rid of one's primary and/or secondary sex characteristics because of a marked incongruence with ones' experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics). 3. A strong desire for the primary and/or secondary sex characteristics of the other gender. 4. A strong desire to be of the other gender (or some alternative gender different from one's assigned gender). 5. A strong desire to be treated as the other gender (or some alternative gender different from one's assigned gender). 6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one's assigned gender). B. The condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning. Specify if: With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 congenital adrenal hyperplasia or 259.50 androgen insensitivity syndrome). Coding note: Code the disorder of sex development as well as gender dysphoria. Specify if: Posttransition: The individual has transitioned to full-time living in the desired gender (with or without legalization of gender change) and has undergone (or is preparing to have) at least one cross-sex medical procedure or treatment regimen-namely, regular cross-sex hormone treatment or gender reassignment surgery confirming the desired gender (e.g., penectomy, vaginoplasty in a natal male, mastectomy or phalloplasty in a natal female).
Gender Dysphoria in Adolescents and Adults
Gender identity is a person's sense of being female or male.
Gender identity
Klinefelter's syndrome
Genotype is XXY; male habitus present with small penis and rudimentary testes because of low androgen production; weak libido; usually assigned as male
Sexual identity
Gonads and secondary sex characteristics
e. All of the above
20.10 Which of the following substances have been associated with sexual dysfunction? A. Cocaine b. Trazodone c. Amoxapine d. Antihistamines e. All of the above
all of the above
20.11 In the most severe forms of paraphilia, A. persons never experience normal sexual behavior with partners B. the specific paraphilia imagery or activity is absolutely necessary for any sexual function C. the need for sexual behavior consumes so much money, time, concentration, and energy that persons describe themselves as out of control D. orgasm does not produce satiety in the same way it typically does for age mates E. all of the above
Sexual aversion disorder
20.12 Avoidance of genital sexual contact with a sexual partner
Hypoactive sexual desire disorder
20.13 Patient has few or no sexual thoughts or fantasies
Anorgasmia
20.14 Recurrent and persistent inhibition of female orgasm
Dyspareunia
20.15 Recurrent pain during intercourse
Vaginismus
20.16 Involuntary and persistent constrictions of the outer one-third of the vagina
C. Vaginal lubrication results from sympathetic stimulation
20.2 With regard to innervation of sex organs, all of the following are true except A. Penile tumescence occurs through the synergistic activity of parasympathetic and sympathetic pathways. B. Clitoral engorgement results from parasympathetic stimulation. C. Vaginal lubrication results from sympathetic stimulation. D. Sympathetic innervation is responsible for ejaculation. E. Sympathetic innervation facilitates the smooth muscle contraction of the vagina, urethra, and uterus during orgasm.
Gender identity
20.28 Sense of maleness or femaleness
Sexual orientation
20.29 The object of a person's sexual impulses
The answer is B
20.3 Which part of the brain is directly involved in sexual drive in mammals? A. Temporal lobe B. The limbic system C. Neo cortex D. Frontal lobe E. Parietal lobe
Sexual identity
20.30 Chromosomes
Sexual behavior
20.32 Desire and fantasies
Enzymatic defects in XY genotype (e.g., 5-[alpha]-redyctase deficiency, 17-hydroxysteroid deficiency)
20.33 Interruption in production of testosterone
Klinefelter's syndrome
20.34 Genotype is XXY
Virilizing adrenal hyperplasia (adrenogenital syndrome
20.35 Excess androgens in fetus with XX genotype
Androgen insensitivity syndrome (testicular feminization syndrome)
20.36 Absence of second female sex chromosome (XO)
Androgen insensitivity syndrome (testicular feminization syndrome)
20.37 Inability of tissues to respond to androgens
Hermaphroditism
20.38 Both testes and ovaries
all of the above
21.7 Girls with gender identity disorder in childhood A. regularly has male companions B. may refuse to urinate in a sitting position C. may assert that she has or will grow a penis D. may give up masculine behavior by adolescence E. all of the above
change in pitch of voice
21.8 In biological men undertaking estrogen hormone treatment, all of the following side effects are common except A. testicular atrophy B. change in pitch of voice C. diminished erectile capacity D. breast enlargement E. decrease in density of body hair
Moderately emetogenic
Doxorubicin Daunorubicin Cyclophosphamide Nitrosoureas Mitomycin-C Procarbazine
PP depression
-10% of women who give birth happens 3-6 months after delivery lasts months to years if untreated lack of support is a stressor strong association of sociocultural influences, h/o mood do, hx of family mood d/o, tearfulness and mood lability often present anhedonia nearly always a sleep disturbance sometimes SI often thoughts of harming the baby feelings of guilt and inadequacy are often present and excessive
Exhibitionism
-Almost 100% men expose to women to assert masculinity (showing penis) and watching victim reaction (fright, surprise, disgust). -Men feel castrated and impotent. -Wives of serve as substitute for the men's mother (excessive attachment during child).
Klinefelter's Syndrome
-An extra X chromosome is present (karyotype is XXY) -At birth, persons have normal male appearance -Excessive gynecomastia may occur in adolescence. -Testes small, usually no sperm production. -Inflicted are tall, and body habitus is eunuchoid. -Reports suggest a higher rate of gender dysphoria. -Men have a feminine fat distribution and lack development of secondary male sex characteristics. -Acromegaly is usually immediately recognizable by the large head and jaw -Not associated with intellectual disability
Nefazodone (Serzone), trazodone (Desyrel)
-Hypotension -Premature ventricular contractions
Tricyclic antidepressants
-Orthostatic hypotension -Delayed cardiac conduction, heart block -Type 1A antiarrhythmic effect -Ventricle arrhythmias in overdose -Tachycardia
Couvade which is related to pseudocyesis
-found in some cultures father of child undergoes simulated labor as if he was giving birth -normal phenomenon in some societies
telephone and computer scatiologia
-obscene phone calling and involves an unsuspecting partner. tension and arousal begin in anticipation of phoning; the recipient of the call listens while the telphoner verbally exposes his preoccupations or induces her to talk about sexual activity -persons with interactive computer networks will sometimes impulsively send pics of obscene nature.
C. According to the classic psychoanalytic model, paraphilias are caused by a failure to complete the process of genital adjustment.
20.5 Which of the following statements is true about paraphilias? A. Paraphilias are usually not distressing to the person with the disorder. B. Paraphilias are found equally among men and women. C. According to the classic psychoanalytic model, paraphilias are caused by a failure to complete the process of genital adjustment. D. With an early age of onset, paraphilias are associated with a good prognosis. E. Paraphilias such as pedophilia usually involve vaginal or anal penetration of the victim.
B. a nonsexual body part
20.6 The term partialism refers to fetishes involving A. a specific item of clothing B. a nonsexual body part C. a specific type of material D. a nonsexual behavior E. a specific food item
c. vaginal intercourse is considered the most appealing type of sexual experience by a large majority of men and women
20.7 Research has indicated that A. a majority of married people are unfaithful to their spouses B. the median number of sexual partners over a lifetime for men is six and for women two C. vaginal intercourse is considered the most appealing type of sexual experience by a large majority of men and women D. masturbation is more common among those 18 to 24 years old than among those 24 to 34 years old E. the percentage of single women reporting \"usually or always\" having an orgasm during intercourse is greater than the percentage of married women reporting this
E. all of the above
20.8 Measures used to help differentiate organically caused impotence from functional impotence include A. monitoring of nocturnal penile tumescence B. glucose tolerance tests C. follicle-stimulating hormone (FSH) determinations D. testosterone level tests E. all of the above
e. all of the above
20.9 Psychiatric interventions used to assist the paraphilia patient include A. dynamic psychotherapy B. external control C. cognitive behavioral therapy D. treatment of comorbid conditions E. all of the above
Girls with congenital virilizing adrenal hyperplasia are less interested in dolls.
21.1 Which of the following is true? A. Girls with congenital virilizing adrenal hyperplasia are less interested in dolls. B. Polycystic ovaries has not been considered as associated with transsexualism. C. Mothers, more than fathers, give negative responses to boys playing with dolls. D. Boys with gender identity disorders (GIDs) are more likely to be right-handed than control boys. E. Boys with GID generally tend to have more sisters than brothers.
uring hormonal treatments, both males and females need to be watched for hepatic dysfunction and thromboembolic phenomena.
21.10 Which of the following statements does not apply to the treatment of gender identity disorder? A. Adult patients generally enter psychotherapy to learn how to deal with their disorder, not to alter it. B. Before sex-reassignment surgery, patients must go through a trial of cross-gender living for at least 3 months. C. A one-to-one play relationship is used with boys in which adults' role model masculine behavior. E. Hormonal therapy is not required as a preceding event in sex-reassignment surgery. D. uring hormonal treatments, both males and females need to be watched for hepatic dysfunction and thromboembolic phenomena
Turner's syndrome
21.11 A 17-year-old girl presented to a clinic with primary amenorrhea and no development of secondary sex characteristics. She was short in stature and had a webbed neck.
True hermaphroditism
21.12 A baby was born with ambiguous external genitalia. Further evaluation revealed that both ovaries and testes were present.
Congenital virilizing adrenal hyperplasia
21.13 A baby was born with ambiguous external genitalia. Further evaluation revealed that ovaries, a vagina, and a uterus were normal and intact.
Androgen insensitivity syndrome
21.14 A buccal smear from a phenotypically female patient revealed that the patient was XY. A further workup revealed undescended testes.
Klinefelter's syndrome
21.15 A tall, thin man presented for infertility problems was found to be XXY
atypical female sex identification
21.2 In a patient with Turner's syndrome, all of the following are common findings except A. atypical female sex identification B. gonadal dysgenesis C. female genitalia D. small uterus E. dyspareunia
all of the above
21.3 Sex reassignment A. is often the best solution in treating gender dysphoria B. usually involves a full-time social transition to living in the desired gender before hormonal treatment C. includes daily doses of oral estrogen in persons born male D. may involve sex reassignment surgery E. all of the above
includes a sense of \"gender stability\
21.4 Gender constancy A. is a task of separation-individuation B. has no age-related stage-like sequence because it is inherent C. includes a sense of \"gender stability\" D. cannot be tested in the clinical situation E. none of the above
Genetic phenotype and potential for reproduction
21.5 In patients born with ambiguous genitalia, which of the following is the predominant factor by which assigned sex is determined? A. Wishes of the parents B. Genetic phenotype and potential for reproduction C. Extent of virilization D. Surgical team capabilities E. Wishes of the patient at the time of puberty
E. may say that his penis or testes are disgusting
21.6 A boy with gender identity disorder A. usually begins to display signs of the disorder after age 9 years B. experiences sexual excitement when he cross-dresses C. has boys as his preferred playmates D. is treated with testosterone E. may say that his penis or testes are disgusting
All of the above
21.9 True statements about the epidemiology of gender identity disorders include A. As many as five boys are referred for each girl referred. B. Among a sample of 4- to 5-year-old boys referred for a range of clinical problems, the reported desire to be the opposite sex was 15 percent. C. Most parents of children with gender identity disorder report that cross-gender behaviors were apparent before age 3 years. D. The prevalence rate of transsexualism is estimated to be about one case per 10,000 males. E. All of the above
B. bradycardia
27.1 All of the following are cardiovascular effects of tricyclic antidepressants in patients with heart disease except A. tachycardia B. bradycardia C. arrhythmias D. hypotension E. heart block
all of the above
27.10 In evaluating patients with complaints of chronic pain of whatever cause, the physician must be alert to A. use of over-the-counter medications B. alcohol dependence C. withdrawal symptoms during the evaluation D. an underlying medical illness E. all of the above
triggered by external factors such as cold weather and physical trauma
27.11 Psoriasis has been shown to be A. triggered by external factors such as cold weather and physical trauma B. rarely associated with personality disorders C. unaffected by such psychosocial interventions as meditation or relaxation D. associated with lower levels of anxiety and depression than in the general population E. none of the above
can cause seizures and dystonias
27.12 Dialysis dementia A. is a common occurrence B. can cause seizures and dystonias C. can occur after a patient's first dialysis treatment D. often leads to suicide E. all of the above
women who are having extramarital affairs
27.13 A decrease in T lymphocytes has been reported in all of the following except A. bereavement B. nonpsychotic inpatients C. medical students during final examinations D. women who are having extramarital affairs E. caretakers of patients with dementia of the Alzheimer's type
none of the above
27.14 A review of the impact of biobehavioral factors on adult cancer pain concluded that A. the relationship to affective states was major B. environmental influences were strong C. there was a consistent role of personality factors D. all of the above E. none of the above
B. The mortality rates and recurrence rates in patients with malignant melanoma have been shown to be greater in patients who did not receive a structured group intervention than in those who did.
27.15 True statements about the effects of psychosocial interventions in cancer outcomes and prognosis include A. There is no evidence that psychotherapy influences the outcome of metastatic breast cancer. B. The mortality rates and recurrence rates in patients with malignant melanoma have been shown to be greater in patients who did not receive a structured group intervention than in those who did. C. Group behavioral intervention in patients with breast cancer does not appear to have any effect on lymphocyte mitogen responses. D. A lack of social support and depression has not been shown to be linked to diminished immune responses in women with breast cancer. E. Hypothalamic-pituitary-adrenal axis hypoactivity induced by exposure of rats to stress is associated with increased tumor growth.
B. cisplatin
27.16 A highly emetogenic anticancer agent is A. bleomycin B. cisplatin C. doxorubicin D. vinblastine E. vincristine
resistance to entering psychotherapy
27.17 In the psychotherapeutic treatment of patients with psychosomatic disorders, the most difficult problem is patients' A. positive response to the interpretation of the physiological meaning of their symptoms B. overemphasis of the psychological component of their physiological symptoms C. erotic transference to the psychotherapist D. resistance to entering psychotherapy E. none of the above
E. all of the above
27.18 Antidepressants have been shown to be helpful in the treatment of A. glossodynia B. idiopathic pruritus C. urticaria D. vulvodynia E. all of the above
D. unlikely occurrence at night
27.19 Psychogenic pruritus differs from neurologic pruritus in that psychogenic pruritus is characterized by A. a chronic course B. a greater intensity C. accompanied pain in the same location D. unlikely occurrence at night E. insomnia
All of the above
27.2 True statements about research in psychocardiology include A. The most consistent psychological correlates of hypertension are inhibited anger expression and excessive anger expression. B. Stress leads to excess secretion of epinephrine, which increases cardiac contractility and conduction velocity. C. Cardiac surgery patients at greatest risk for complications are depressed and in denial about their anxiety. D. Mental stress leads to diminished cardiac perfusion. E. All of the above
E. Adverse effects of medication
27.20 Which of the following is the most common reason for a C-L psychiatrist to be consulted? A. Anxiety B. Depression C. Disorientation D. Sleep disorders E. Adverse effects of medication
Medication noncompliance
27.21 You are the C-L psychiatrist called to consult on a patient who is scheduled for a liver transplant. You learn the patient now needs a transplant after he was infected with hepatitis C because of promiscuous sexual activity. Which of the following is this patient at increased risk for? A. Adjustment disorder B. Major depression C. Medication noncompliance D. Organ rejection E. Suicide
D. Paranoid delusions
27.22 A 53-year-old male patient is found to have an occipital lobe tumor. He would be least likely to exhibit which of the following symptoms and complaints? A. Headache B. Homonymous hemianopsia C. Papilledema D. Paranoid delusions E. Visual hallucinations
D. Normal age-related sleep patterns
27.23 An 83-year-old woman presents with a chief complaint, \"It takes me up to 45 minutes to sleep after going to bed.\" The patient further states that she sometimes wakes up a few times in the night after falling asleep. She has no toxic habits, does not have obstructive sleep apnea, and does not feel unrefreshed upon waking. She reports that her energy level has decreased since her dog passed away 3 years ago, but she continues to see her friends every Sunday for bingo. What disorder does she most likely have? P.244 A. Alzheimer's dementia B. Major depressive disorder C. Normal bereavement D. Normal age-related sleep patterns E. None of the above
a. Conduction side effects
27.3 Antidepressants should be used cautiously in cardiac patients because of increased risk of which of the following? A. Conduction side effects B. Hypertension C. Noncompliance D. Suicide E. All of the above
E. 98 percent
27.4 Phantom limb occurs after leg amputation in what percentage of patients? A. 10 percent B. 50 percent C. 80 percent D. 90 percent E. 98 percent
B. Decreased contraction amplitude in the distal esophagus
27.5 Which of the following is not a physiological response of the gastrointestinal (GI) system to acute stress? A. Increased resting tone of the upper esophageal sphincter B. Decreased contraction amplitude in the distal esophagus C. Decreased antral motor activity in the stomach D. Reduced migrating motor function in the small intestine E. Increased myoelectrical motility in the large intestine
d. functional heartburn
27.6 The most frequent functional GI disorder is A. globus B. irritable bowel syndrome C. functional abdominal bloating D. functional heartburn E. functional chest pain
Normal thyroid hormone concentrations
27.7 Which of the following is not a sign of overt hypothyroidism? A. Normal thyroid hormone concentrations B. Patients are symptomatic C. Thyroid-stimulating hormone (TSH) is elevated D. Low thyroid hormone concentrations E. None of the above
Freud believed the skin is susceptible to unconscious sexual urges.
27.8 Which of the following statements regarding psychogenic excoriations is true? A. Freud believed the skin is susceptible to unconscious sexual urges. B. Lesions are typically found in hard-to-reach areas. C. Scratching does not occur in response to an itch. D. The behavior never becomes ritualistic. E. All of the above
The immune system is affected by conditioning.
27.9 Which of the following statements about psychoneuroimmunology is true? A. Immunological reactivity is not affected by hypnosis. B. Lymphocytes cannot produce neurotransmitters. C. The immune system is affected by conditioning. D. Growth hormone does not affect immunity. E. Marijuana does not affect the immune system.
Initiation
29.1 Which of the following is not a stage of the human sexual response cycle? A Initiation B Excitement C Refractory period D Orgasm E Resolution
Many changes begin before the fifth decade of life.
29.2 Which of the following statements regarding the changes in sexual response that occur with aging is true? A. Less stimulation is required to achieve an erection. B. There is a shorter phase of sexual excitement. C. There is no change in the length of the refractory period after orgasm. D. Increased intensity of ejaculation occurs. E. Many changes begin before the fifth decade of life.
A. central nervous system
29.3 Fetal sex steroid exposure exerts organizational effects upon the fetal A. central nervous system B. testes C. ovary D. neuromuscular system E. cardiovascular system
the development of the classic symptoms of pregnancy in a nonpregnant woman
29.4 Pseudocyesis is A. another name for Braxton-Hicks contractions (i.e., false labor) B. when the father of a child undergoes a simulated labor as if he were giving birth C. the development of the classic symptoms of pregnancy in a nonpregnant woman D. falsely elevated human chorionic gonadotropin levels occurring with choriocarcinoma and hydatidiform moles E. masking of the symptoms of postpartum depression
B. Vaginismus
29.5 Which of the following terms refers to a condition in which the muscles around the outer third of the vagina have involuntary spasms? A. Anorgasmia B. Vaginismus C. Dyspareunia D. Vulvodynia E. None of the above
B. Laparoscopically several weeks after delivery
29.6 It is generally considered safest to perform a tubal ligation at which of the following times? A. Immediately postpartum B. Laparoscopically several weeks after delivery C. As an open procedure several weeks after delivery D. As an open procedure 6 months after delivery E. Hysterectomy is the safest method of sterilization
C. 5 percent
29.7 Premenstrual dysphoric disorder (PMDD) affects what percentage of reproductive age women? A. 1 percent B. 3 percent C. 5 percent D. 7 percent E. 9 percent
may be associated with women who have histories of anorexia nervosa or bulimia nervosa
29.8 Hyperemesis gravidarum A. may be associated with women who have histories of anorexia nervosa or bulimia nervosa B. has a poor prognosis for the mother and fetus C. is rarely chronic or persistent D. is definitively caused by psychological factors E. none of the above
Exhibitionism
A.Over period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving exposure of one's genitals to an unsuspecting stranger. B.Person has acted on sexual urges, or sexual urges or fantasies has caused marked distress or interpersonal difficulty. DSM5 specifiers - exposing to prepubertal children, exposing to physically mature individuals, or to both.
vaginismus
Among the following, the sexual dysfunction not correlated with phases of the sexual response cycle is A. sexual aversion disorder B. vaginismus C. premature ejaculation D. postcoital dysphoria E. male erectile disorder
Sensate focus exercises
Attempts to decrease \"spectatoring\"
Selective serotonin reuptake inhibitors
Bradycardia Increased ejection fraction
Colon and rectal cancer Pancreatic cancer Esophageal cancer Stomach cancer Liver cancer
Cancer of the gastrointestinal tract
Highly emetogenic
Cisplatin Dacarbazine Streptozocin Actinomycin Nitrogen mustard
-Incongruence btw expressed and assigned gender; -Want to be / treated as another gender, trapped in the wrong body'; -Distress or impairment related to gender identity & persistent anatomic dysphoria.
Clinical features of gender dysphoria in adults:
-Clearly state their wish to be another gender -Prefer clothing, toys, games typical of another gender. -Choose playmates of another gender; -Take on the roles of another gender during play. -Strong desire to be the other gender, dislike of own sexual anatomy -May express desire or have different genitals or urinate in the position typical of another gender. DSM, p.454: -Boys may shave legs, bind genitals to make erections less visible. -Girls may bind breasts, walk a stoop, wear loose sweaters -Only small % of children expresses anatomic dysphoria.
Clinical features of gender dysphoria in children:
Androgen insensitivity syndrome (testicular feminization syndrome)
Congenital X-linked recessive disorder that results in inability of tissues to respond to androgens; external genitals look female, and cryptorchid testes present; assigned as females even though they have XY genotype; in extreme form, patient has breasts, normal external genitals, short blind vagina, and absence of pubic and axillary hair
Enzymatic defects in XY genotype (e.g., 5-[alpha]-reductase deficiency, 17-hydroxysteroid deficiency)
Congenital interruption in production of testosterone that produces ambiguous genitals and female habitus; usually assigned as female because of female-looking genitalia
Resolution Phase
Detumescence
Hemorrhoids Anal fissures Perirectal abscess
Diseases of the anorectum
Infectious hepatitis Toxic and drug-induced hepatitis Primary biliary cirrhosis Primary sclerosing cholangitis Metabolic liver disease Gallstones and cholecystitis
Diseases of the liver and gallbladder
Acute pancreatitis Chronic pancreatitis
Diseases of the pancreas
Reflux esophagitis (GERD) infectious esophagitis Esophageal motility disorders
Disorders of the esophagus
Peptic ulcer disease Gastroparesis Malabsorption and maldigestion Inflammatory bowel disease Crohn's disease Ulcerative colitis Diverticular disease
Disorders of the stomach and intestines
A recurrent or persistent genital pain occurring before, during, or after intercourse. Related to and often coincides with vaginismus. Repeated vaginismus can lead to dyspareunia and vice versa. Can occur post partum, but usually temporarily. Should be diagnosed as genito-pelvic pain/penetration disorder.
Dyspareunia
25% 50
Exhibitionism-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
male coping with real/perceived relationship changes ambivalence about plans for pregnancy ***loss of sexual attraction to partner ***demands from partner for increased commitment expressed by sex ***sometimes unexpressed hostility toward a woman is evidenced via delayed ejaculation ***more often seen in men with obsessive/compulsive disorder
How can an ongoing relationship cause delayed ejaculation disorder?
Benign procedure · Monitoring nocturnal penile tumescence · Monitoring tumescence with a strain gauge · Measuring blood pressure in the penis with a penile plethysmograph or an ultrasound flowmeter Diagnostic tests · Glucose tolerance test · Plasma hormone assays · Liver and thyroid function test · Prolactin and follicle -stimulating hormone levels · Cystometric examinations. Invasive procedures (use only for patients who are candidates for vascular reconstructive procedures) · Penile arteriography · Infusion cavern sonography · Radioactive xenon penography.
How can the clinician differentiate between organically caused impotence from functional impotence?
the use of hormones to treat the infertility may result in increase in depression in some patients. Mood an cognition can be altered by pharmacological agents used to treat disorders of ovulation or to hyper stimulate the ovaries.
How can treatment of infertility complicate the psychological reaction?
-The term is reserved for those cases in which a sexually deviant fantasy or impulse has been expressed behaviorally. -A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others.
How does the DSM 5 define paraphilic disorders types of disorders?
- Type A Bx pattern characterized by aroused anger, impatience, aggression, competitive striving & time urgency is associated with a nearly 2-fold increased risk of MI & CAD-related mortality -Type A persons are similar to the "coronary personality" are predisposed to CAD
How does type A behavior effect cardiovascular disorders?
-Susceptible persons thought to have strong ungratified dependency needs
How is Peptic Ulcer Disease related to psychological stress?
Bupropion (Wellbutrin)
Hypotension
Monoamine oxidase inhibitors
Hypotension Peripheral edema
Venlafaxine (Effexor)
Hypotension, especially at doses >300 mg per day
-refusal to go to school, -depression, anxiety, substance abuse. -Distress may be mitigated by supportive environment and education regarding biometrical Tx.
Impairment of gender dysphoria as a consequence:
excitement phase
In what phase of the Sexual Response Cycle would premature ejaculation occur?
Sensate focus exercises
Intercourse is interdicted initially
Themselves
Masochist direct aggression toward whom?
Prolong use of androgens produces hypertension and prostatic enlargement Testosterone is most effective when given parenterally; however, effective oral and transdermal preparations are available.
Men - What are the testosterone-implications related to HTN and prostate enlargement?
accept continued abuse as an adult or to become an abuser of others
Molestation as a child can predispose a person to:
Excitement phase
Orgasmic platform
45 % 5
Pedophilia- Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Voyeurism
Preoccupation with fantasies and acts that involve observing people who are naked or engaging in sexual activity
Squeeze technique
Raises the threshold of penile excitability
Turner's syndrome
Results from absence of second female sex chromosome (XO); associated with web neck, dwarfism, cubitus valgus; no sex hormones produced; infertile; usually assigned as females because of female-looking genitals
Virilizing adrenal hyperplasia (adrenogenital syndrome)
Results from excess androgens in fetus with XX genotype; most common female intersex disorder; associated with enlarged clitoris, fused labia, hirsutism in adolescence
Specified substances include; alcohol, amphetamine, cocaine, opioids, sedatives, hypnotics
Review the pharmacological agents and other substances associated with sexual dysfunction.
Frotteurism
Rubbing up against a fully clothed woman to achieve orgasm
The pattern of a person's biological sexual characteristics: chromosomes, external genitalia, internal genitalia, hormonal composition, gonads, and secondary sex characteristics. In normal development, these characteristics form a cohesive pattern that leaves a person in no doubt about his or her sex. Sexual identity and gender identity are interactive. Genetic influences and hormones affect behavior, and the environment affects hormonal production and gene expression.
Sexual identity
3% 36
Sexual masochism-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Describes the object of a person's sexual impulses: heterosexual (opposite sex), homosexual (same sex), or bisexual (both sexes).
Sexual orientation
3% 3
Sexual sadism-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Transvestic fetishism
Sexual urges by heterosexual men to dress in female clothes for the purposes of arousal
***Contraindicated in persons who are taking organic nitrates in any form. ***amyl nitrate (poppers), a popular substance of abuse used by homosexual men to enhance the intensity of orgasm, should not be used with any of the erection-enhancing drugs. ***The combination of organic nitrates and PDE inhibitors can cause a precipitous lowering of blood pressure and can reduce coronary perfusion to the point of causing MI and death.
Sildenadil (viagra) - contraindications
Orgasmic Phase
Slight clouding of consciousness
Acute heart disease, stroke, uncontrolled hypertension, retinal disorders, or impaired liver or renal failure Use of PDE-5 inhibitors is contraindicated in persons who are taking organic nitrates in any form. Amyl nitrate (poppers), a popular substance of abuse used by homosexual men to enhance the intensity of orgasm, should not be used with any of the erection-enhancing drugs. The combination of organic nitrates and PDE inhibitors can cause a precipitous lowering of blood pressure and can reduce coronary perfusion to the point of causing MI and death.
Tadalafil (cialis) - contraindications
Drug-drug interactions occur with inhibitors of CYP3A4, including grapefruit juice, nitrates, yohimbine, and St. John's Wort.
Tadalafil (cialis) - drug interactions
Excitement phase
Testes increase in size by 50 percent
-Stress resulting from the cosmetic disfigurement and social stigma of psoriasis rather than life events
What are the external factors that can trigger a relapse of psoriasis?
persons modeling their behavior on the behavior of others who have carried out paraphilic acts, mimicking sexual behavior depicted in the media, or recalling emotionally laden events from the past
The onset of paraphilic acts can result from:
3% 25
Transvestic fetishism- Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Hermaphroditism
True hermaphrodite is rare and characterized by both testes and ovaries in same person (may be 46 XX or 46 XY)
paraphilia
Uncommon sexual expression
Pseudohermaphroditism
Usually the result of endocrine or enzymatic defect (e.g., adrenal hyperplasia) in persons with normal chromosomes; female pseudohermaphrodites have masculine-looking genitals but are XX; male pseudohermaphrodites have rudimentary testes and external genitals and are XY; assigned as males or females, depending on morphology of genitals
Excitement phase
Vaginal lubrication
Constriction of the outer third of the vagina due to involuntary pelvic floor muscle tightening. Interferes with penile insertion and intercourse.
Vaginismus
Contraindications ***Use of PDE-5 inhibitors are contraindicated in persons who are taking organic nitrates. The combination will lower the blood pressure and can reduce coronary perfusion to the point of causing MI or death. ***Persons with coronary disease, cardiac failure, stroke hypertension or diabetes mellitus, renal failure and aged above 70 should have cardiac evaluation regarding the use of nitrates and exercise. These medicines will increase the oxygen demand and coronary perfusion will be severely impaired and cardiac failure may occur. ***Vardenafil have to be adjusted in patient with hepatic impairment or renal impairment and in patients using the CYP34 inhibitors. ***Amyl nitrate should not be used with any of the erection enhancing drugs
Vardenafil (levitra) - contraindications
***Inducers or inhibitors of these enzymes (CYP3A4) and (CYP2C9) will affect the plasma concentration and half-life of sildenafil. ***800 mg of cimetidine (Tagamet), a nonspecific CYP inhibitor, increases plasma sildenafil concentrations by 56 percent ***Erythromycin (E-mycin) increases plasma sildenafil concentrations by 182 percent. Other, stronger inhibitors of CYP3A4 include ketoconazole (Nizoral), itraconazole (Sporanox), and mibefradil (Posicor). ***In contrast, rifampicin, a CYP3A4 inducer, decreases plasma concentrations of sildenafil.
Vardenafil (levitra) - drug interactions
-Paraphilia: uncommon sexual expression -Classified as non coercive vs. coercive paraphilias -behaviors represent extremes on a continuum -more males reported and prosecuted -clustering of paraphilias -unconventional behavior may alienate others leading to difficulty in establishing relationships
What constitutes atypical sexual behavior?
***Vardenafil drug interaction occurs with CYP3A4 and CYP2C9 inhibitors, grapefruit juice, nitrates ***Metabolized by the major route CYP3A4 enzyme system and minor route through CYP2C9 which can increase the plasma concentration and half-life of Vardenafil ***Erythromycin, Tagamet will also increase the plasma concentrations and also with stronger inhibitors of CYP3A4 like ketoconazole, itraconazole and mibefradil
Vardenafil (levitra) - drug interactions
Minimally emetogenic
Vincristine Vinblastine 5-Fluorouracil Bleomycin
12 % 17
Voyeurism-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Womans subjective sense of arousal Life stresses Aging Menopause Adequate sexual stimulation Adequate lubrication Alterations in testosterone, estrogen, prolactin, and thyroxine levels General health Medication regimen Relationship problems or marital discord
What are factors to consider for patients presenting with female sexual interest/arousal disorder?
-Induced abortion- most women satisfied, few negative psych issues Long term- 10% regret decision -Miscarriage- high rate of dysphoric reactions -2nd trimester abortion- more psychologically traumatic, bond formed Most due to abnormal karyotype or fetal anomaly -Prior to legalization of abortion, many women chose suicide over unwanted pregnancy -When women forced to carry unwanted fetus to term = increased risk of infanticide, abandonment, and neglect of newborn -Men- fathers may experience considerable grief
What are some of the psychological reactions to abortion?
medications surgeries DM Heart disease smoking drinking
What are some physical causes of erectile dysfunction?
stress, depression, poor relationship
What are some psychological causes of erectile dysfunction?
Male Prostheses: For males who are resistant to other treatment methods or who have medically caused deficiencies. 2 types-a semi-rigid rod and inflatable Vascular Surgery: when vascular insufficiency due to atherosclerosis, blockage, bypass surgery of penile arteries
What are the Surgical procedures implicated in male erectile disorders?
-Reduces the rate of cesarean section and forceps deliveries -Reduces need for anesthesia -Reduces use of oxytocin (Pitocin) -Reduces duration of labor
What are the benefits of emotions support during labor?
Genotype is XXY: male habitus presents with small penis and rudimentary testes because of low androgen production; weak libido; usually assigned a male.
What are the characteristics of Klinefelter's Syndrome?
Deliberate falsification of physical or psychological symptoms in an attempt to achieve a secondary gain such as: • Avoiding military duty • Avoiding work • Obtaining financial compensation • Evading criminal prosecution • Obtaining drugs Malingering may also represent adaptive behavior —for example, feigning illness while a captive of the enemy during wartime
What are the characteristics of Malingering
manifested by the recurrent delay in, or absence of orgasm after a normal sexual excitement phase adequate in focus, intensity, and duration for a diagnosis to be made, must be experienced on almost all or all (75-100%) occasions of sexual activity must have persisted a minimum of 6 months, cause clinically significant distress, not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress, and no the effect of a substance/medication or other medical condition causes are often multifactorial or cannot be determined prevalence varies between 10% - 42% approximately 10% of women to not experience orgasm throughout their lifetime lifelong disorder more common in unmarried women than married women
What are the characteristics of female orgasmic disorder?
Vomiting is chronic, persistent, and frequent, leading to ketosis, acidosis, weight loss, and dehydration.
What are the characteristics of hyperemsis gravidarum?
-Lesions caused by scratching/picking in response to an itch/skin sensation because of an urge to remove an irregularity on the skin from preexisting dermatoses (acne) -Lesions located in easy to scratch areas -few mm in diameter with weeping, crusted, or scars
What are the characteristics of psychogenic excoriations?
Feeling of being depressed, tense, anxious, and irritable with psychomotor agitation during the resolution phase of sexual activity when muscular and psychomotor relaxation normally occur.
What is Postcoidal dysphoria?
Male hypoactive Sexual desire disorder is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity for a minimum duration of approximately six months Men for whom this is a lifelong condition have never experienced many spontaneous erotic/sexual thoughts Minimal spontaneous sexual thinking or minimal desire for sex ahead of sexual experiences is not considered a diagnosable disorder in women, particularly if desire is triggered during the sexual encounter The reported prevalence of low desire is greatest at the younger and older ends of the spectrum Only 2% of men ages 16-44 years are affected by this disorder, whereas 6% of men ages 18-24 and 40% ages 66-74 have problems with sexual desire Some men may confuse decreased desire with decreased activity. Their erotic thoughts and fantasies are undiminished but they no longer act on them due to health issues, unavailability of a partner or another sexual dysfunction such as erectile disorder In making this diagnosis, the clinician must evaluate the patient's age, general health, medication regimen and life stresses. Baseline sexual interest before problem begun must be established Need for sexual contact and satisfaction varies over time in any person. This diagnosis should not be made unless the lack of desire is a source of distress to a patient.
What are the clinical characteristics of male hypoactive sexual desire disorder?
-Coded as a subtype of MDD in the DSM-5 (with postpartum onset) so diagnostic criteria is the same as MDD. Characterized by; -Depressed mood -excessive anxiety -insomnia -change in weight -Feelings of guilt, inadequacy May have thoughts of harming baby or of suicide -Onset is generally 12 weeks after delivery (table 27-8 indicates onset 3-6 months) -Duration is months to years if untreated
What are the clinical characteristics of postpartum depression?
● Men persistently or recurrently achieve orgasm and ejaculation before they wish to. ● Diagnosis is made when a man regularly ejaculates before or within approximately 1 minute after penetration. ● Also can occur in men who are homosexual. ● Consider factors that affect the duration of the excitement phase of the sexual response, such as age, novelty of the sex partner, and frequency of coitus. ● Not diagnosed when it is caused exclusively by organic factors or when it is symptomatic of another clinical psychiatric syndrome. ● More commonly reported in college-educated men. ● Chief complaint of 35-40% of men treated for sexual disorders. ● Difficulty in ejaculatory control can be associated with anxiety regarding the sex act, with unconscious fears about the vagina, or with negative cultural conditioning. ● Men whose early sexual contacts occurred with prostitutes or situations with embarrassing discovery might have been conditioned to achieve orgasm rapidly. ● The disorder may resolve in time with young, inexperienced men. ● A stressful marriage exacerbates the disorder. ● Psychodynamics of premature ejaculation and erectile disorder are similar.
What are the clinical characteristics of premature ejaculation?
-is an incongruence between expressed and assigned gender, the most important criterion is desire to be another gender or insist that one is another gender. -Onset in children - between ages 2 and 4, when children begin expressing gendered behaviors. Usually expressed at entry into elementary school
What are the clinical features and general characteristics of patients with gender dysphoria?
•Pt's believe they have a serious disease that has not yet been detected; cannot be persuaded otherwise •Maintains belief that they have a particular disease or, as time progresses, belief may be transferred to another disease •Convictions persist despite negative lab results, benign course of alleged disease, & appropriate reassurance from MD •Beliefs are not sufficiently fixed to be delusion •Commonly coexists with depressive or anxiety disorder •Transient manifestations can occur after major stresses (the death or serious illness of someone important to the patient)
What are the clinical features of somatic symptom disorder?
-Pts embellish their personal history, chronically fabricate sxs to gain hospital admission, and move from hospital to hospital
What are the clinical features/characteristics of Munchausen syndrome
-There MUST be a psychological factor significantly involved in the pain sxs & their ramifications -Often have long hx of medical/surgeries -Insist their desire for surgery -Are preoccupied w/ pain as the source of their misery -Substance related disorders & depression is common -MDD is present in 25-50%
What are the diagnostic/clinical features of pain disorder?
-Somatic Symptom disorder -Malingering -Conversion disorder -Borderline -Medical condition/mental disorder not associated with intential sxs falcification -Other personality disorders -Ganser's Syndrome
What are the differential diagnoses for Munchausen Syndrome
-Up to 30% meet criteria for panic disorder or agoraphobia -personality traits include intense fear, emotional lability, sensitivity to rejection, & lack of persistence in difficult situations
What are the epidemiological characteristics of asthma as they relate to psychiatric disorders?
-6mo prevalence 5% -Lifetime prevalence: 12% -3% of people have persistent pain, w/ atleast 1day/month of activity restriction
What are the epidemiological characteristics of pain disorder?
•6-month prevalence is 4 to 6% but may be as high as 15%. •Men & women equally affected. •Most commonly age of onset is 20-30 years of age. • More common among blacks than among whites. •Social position, educational level, gender, & marital status do not appear to affect the diagnosis. •Occurs in 3% of medical students, usually in the first two years but they are generally temporary
What are the epidemiological characteristics of somatic symptom disorder?
•Persons augment and amplify their somatic sensations. -Have low thresholds/low tolerance of physical discomfort. -Focus on bodily sensations, misinterpret them & become alarmed by them •Social learning model: Sxs are viewed as request for admission to the sick role. Sick role is an escape that allows a pt to avoid noxious obligations, postpone unwelcome challenges & to be excused from usual duties •80% have coexisting depressive/anxiety disorders •Psychodynamic school of thought: aggressive & hostile wishes towards others are transferred (through repression & displacement) into physical complaints. •Can be a defense against guilt, a sense of innate badness, an expression of low self-esteem, and a sign of excessive self-concern. •Pain/somatic suffering become means of atonement & expiation (undoing). •Pain can be experienced as deserved punishment for past wrongdoing (either real or imaginary). •Pain can be experienced as a person's sense of wickedness & sinfulness.
What are the etiological factors for somatic symptom disorder?
-Most common sxs: Paralysis, Blindness & Mutism • Sensory sxs: Anesthesia & parasthesia especially of extremities. May also involve organs of special sense (deafness, blindness & tunnel vision) •Motor sxs: abnormal movement, gait disturbance, weakness, paralysis, & paresis, rhythmic tremors, choreiform mov'ts, tics, & jerks •Pseudoseizures may also occur -Most commonly associated w/ the personality disorders •passive-aggressive •dependent •antisocial •histrionic
What are the features of Conversion disorder?
In Turner's syndrome, one sex chromosome is missing, such that the sex karyotype is simply X.
What are the genetic characteristics of Turner's Syndrome?
-Increased acne -Increased muscle mass -Increased libido
What are the initial side effects of testosterone taken by women (transgender men)?
Sildenafil (Viagra) Vardenafil (Levitra) Tadalafil (Cialis) Phentolamine (Vasomax) (oral) Alprostadil (Caverject) (oral) Injectable medications: Papaverine Prostaglandin E1 Phentolamine Combo of above (Edex) Alprostadil (MUSE) (transurethral) Topical agents: ***Cream w/3 vasoactive substances (aminophylline, isosorbide dinitrate, co-dergocrine mesylate) ***Gel w/alprostadil & additional agent (makes skin more permeable) Methohexital sodium (Brevital) (IV) Antianxiety agents (to reduce tension, may interfere w/sex response) SSRI's & TCA's (to prolong sex response w/premature ejaculation) Topical anesthetic creams (to ↓intravaginal ejac latency time w/premature ejac) Antidepressants (w/sex phobias & PTSD following rape) Trazodone (Desyrel) (improves nocturnal erections) Bromocriptine (Parlodel) (↑sex function impaired by hyperprolactemia) Other agents: -Ginseng root (aphrodisiacs - unconfirmed) -Yohimbine (Yocon) (aphrodisiac - unconfirmed; a-receptor, dilation of penile artery - not recommended to tx organic dysfunction) -Recreational drugs (may have initial benefit but overall impairs sex functioning) Cocaine Amphetamines Alcohol Cannabis Dopaminergic agents: -L-dopa (dopamine precursor) -Bromocriptine (dopamine agonist) -Bupropion (↑sex drive) -Selegiline (MAOI) (↑sex function in older persons) o Testosterone (most effective parenterally; prolonged use produces HTN & ↑prostate)
What are the pharmacological agents used to increase sex drive in men with erectile dysfunction and delayed ejaculation?
-female genitalia, are short, and sometimes have anomalies such as a shield-shaped chest and a webbed neck. -Because of dysfunctional ovaries they require exogenous estrogen to develop female secondary sex characteristics. Gender identity is typically female
What are the physiological characteristics of Turner's Syndrome?
-May be symbolically expressing intrapsychic conflict through the body -Alexithymia: inability to express state feelings in words, so they express through their bodies -Pain can function as a method of obtaining love, a punishment for wrongdoing, & a way of expiating guilt/atonement for innate sense of badness. Think they deserve to suffer -Defense mechanisms: displacement, substitution, & repression
What are the psychodynamic factors of pain disorder?
-feelings of guilt, depression -inadequacy frequently accompanies the perception of being barren -self-blame increases the likelihood of psychological causes -older women with no kids are at an increased risk of psychological issues -marital disharmony, emotional conflicts about intimacy, sexual relations, or parenting role can directly affect endocrine fxn such as erection, ovulation, and ejaculation.
What are the psychological/psychosocial reactions to infertility?
Sexual identity Gender identity Sexual orientation Sexual behavior *they affect personality, growth, development and function *more than physical sex, coital or noncoital *less than all behaviors directed toward attaining pleasure
What are the psychosexual factors that make up sexuality?
-method chosen by a person to cope with anxiety caused by the threat of castration by the father and separation from the mother -failure to resolve the oedipal crisis -classic psychoanalytic theory - holds that transexualism and transvestic fetishism are disorders because each involves identification with the opposite-sex parent instead of the same-sex parent -Other theories attribute the development of paraphilia to early experiences that condition or socialize children into committing a paraphilic act
What are the psychosocial factors in the etiology of paraphilic disorders?
-group psychotherapy -group behavioral intervention (relaxation, guided imagery, & biofeedback)
What are the psychosocial interventions for cancer?
-Serve as consultants to medical colleagues or to other mental health professionals -Consult regarding pts in medical or surgical settings & provide f/u psych tx PRN -Are associated w/ diagnostic, therapeutic, research, & teaching services -Serve as a bridge b/w psych & other specialties
What are the roles of a consultant/liaison in psychiatry?
-decrease sex drive, erections and ejaculation -decrease body hair -no change in voice -increased risk of blood clots (avoid cigarettes) -increase prolactin (rare cases develop prolactinomas) -permanent sterility
What are the side effects of estrogen taken by men (transgender women)?
Deepening of the voice Increased body hair Enlargement of the clitoris
What are the subsequent/permanent side effects of testosterone taken by women (transgender men)?
A combined preparation of estrogen and testosterone has been used effectively
What are the therapeutic options for women who are on hormone replacement therapy who have a decreased libido?
5 types of psychiatric interventions are used to treat paraphilic disorders: -External control (prison and informing supervisors, peers, or other adult family menbers) -Reduction of sexual drive (antipyschotics or antidepressants if related to schizophrenia or depressive disorders. antiandrogens and serotonergic agents are useful as well) depressive disorders. antiandrogens and serotonergic agents are useful as well) -Treatment of comorbid conditions -Cognitive-behavioral therapy (used to disrupt learned paraphilic patterns and modify behavior to make it socially acceptable -Dynamic psychotherapy (Insight-oriented psychotherapy is a long standing tx approach)
What are the treatment options for paraphilic disorders?
-telephone and computer scatologia -necrophilia -partialism -zoophilia -coprophilia and klismaphilia -Urophila -masterbation -hypoxyphilia
What are the types of other specified paraphilic disorders?
urophilia
a form of urethral eroticism, is interest in sexual pleasure associated with the desire to urinate on a partner or be urinated on.
A. Either of the following symptoms must be experienced on almost all or all occasions (approximately 75%-100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desiring delay: 1. Marked delay in ejaculation. 2. Marked infrequency or absence of ejaculation. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: ***Lifelong: The disturbance has been present since the individual became sexually active. ***Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: ***Generalized: Not limited to certain type of stimulation, situations, or partners. ***Situational: Only occurs with certain types of stimulation, situations, or partners. Specify whether: ***Mild: Evidence of mild distress over the symptoms in Criterion A. ***Moderate: Evidence of moderate distress over the symptoms in Criterion A. ***Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
What is the DSM 5 Diagnostic Criteria for delayed ejaculation disorder?
Gender Dysphoria in Children A. A marked incongruence between one's experience/expressed gender and assigned gender, of at least 6 months' duration, as manifested by at least six of the following (one of which must be Criterion A): 1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one's assigned gender). 2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing. 3. A strong preference for cross-gender roles in make-believe play or fantasy play. 4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender. 5. A strong preference for playmates of the other gender. 6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and tumble play; or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities. 7. A strong dislike of one's sexual anatomy. 8. A strong desire for the primary and/or secondary sex characteristics that match one's experienced gender. B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning. Specify if: With a disorder of sex development (e.g., a congenital adrenogenital disorder such as 255.2 congenital adrenal hyperplasia or 259.50 androgen insensitivity syndrome). Coding note: Code the disorder of sex development as well as gender dysphoria.
What is the DSM 5 Diagnostic Criteria for gender dysphoria in children?
A. At least one of the three following symptoms must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts): 1. Marked difficulty in obtaining an erection during sexual activity. 2. Marked difficulty in maintaining an erection until the completion of sexual activity. 3. Marked decrease in erectile rigidity. B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months. C. The symptoms in Criterion A cause clinically significant distress in the individual. D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: ***Lifelong: The disturbance has been present since the individual became sexually active. ***Acquired: The disturbance began after a period of relatively normal sexual function. Specify whether: ***Generalized: Not limited to certain types of stimulation, situations, or partners. ***Situational: Only occurs with certain types of stimulation, situations, or partners. Specify current severity: ***Mild: Evidence of mild distress over the symptoms in Criterion A ***Moderate: Evidence of moderate distress over the symptoms in Criterion A ***Severe: Evidence of severe or extreme distress over the symptoms in Criterion A
What is the DSM 5 Diagnostic Criteria for male erectile disorder?
A. Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and social the contexts of the individual's life. B. The symptoms of Criterion A have persisted for a minimum duration of approximately 6 months C. The symptoms of criterion A cause clinically significant distress in the individual D. The sexual dysfunction is not better accounted for by a non-sexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition. Specify whether: **Lifelong: The disturbance has been present since the individual became sexually active **Acquired: The disturbance began after a period of relatively normal sexual function Specify whether: **Generalized: Not limited to certain types of stimulation, situations or partners **Situational: Only occurs with certain types of stimulation, situations or partners Specify current severity: **Mild: Evidence of mild distress over the symptoms in criterion A **Moderate : Evidence of moderate distress over the symptoms in criterion A **Severe: Evidence of severe or extreme distress over the symptoms in criterion A
What is the DSM 5 Diagnostic Criteria for male hypoactive sexual desire disorder?
Four criterions, and seven sub-features: A. Consistently ejaculating within one minute or less of vaginal penetration and before desired (nonvaginal activities also pertinent, but timeframe not established for nonvaginal activity) B. Criterion A persisted for at least six months, and 75%-100% of the time. C. Criterion A symptom significant distress D. Not better accounted for by another non-sexual mental disorder, severe relationship distress, medication or illicit substance use, or medical condition. May add the following specifiers: ● Lifelong- experienced since the 1st encounter ● Acquired- appeared after a period of sufficient orgasmic latency. ● Generalized- occurs with different partners and situations. ● Situational- only occurs with a specific partner and situation. The severity of Premature (Early) Ejaculation can also be specified: ● Mild- ejaculation occurs 30 -60 after vaginal penetration ● Moderate- ejaculation occurs 15-30 seconds after vaginal penetrations. ● Severe- ejaculation occurs prior to penetration, upon penetration, or < 15 seconds after vaginal penetration (American Psychiatric Association, 2013).
What is the DSM 5 Diagnostic Criteria for premature ejaculation?
A. One or more somatic symptoms that are distressing or result in significant disruption of daily life. B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following: 1. Disproportionate and persistent thoughts about the seriousness of one's symptoms. 2. Persistently high level of anxiety about health or symptoms. 3. Excessive time and energy devoted to these symptoms or health concerns. C. Although any one somatic symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months). Specifiers: -predominant pain (previously pain disorder): This specifier is for individuals whose somatic symptoms predominantly involve pain. Persistent: a persistent course is characterized by severe symptoms, marked impairment, and long duration (more than 6 months). -Mild: Only one of the symptoms specified in Criterion B is fulfilled. Moderate: Two or more of the symptoms specified in Criterion B are fulfilled. Severe: Two or more of the symptoms specified in Criterion B are fulfilled, plus there are multiple somatic complaints (or one very severe somatic symptom).
What is the DSM 5 diagnostic criteria for somatic symptom disorder?
-Used to rank the relative degree of adjustment required by changing life events such as (divorce, death of spouse..) -Each event is given a certain # of points ->200 points in any given year increases the risk of developing a psychosomatic d/o that year
What is the Social Readjustment Rating Scale? Review table 13.5-1
-"Baby blues" is a transient mood disturbance characterized by mood lability, sadness, dysphoria, subjective confusion and tearfulness. -Onset 3-5 days after delivery and may last several days. If it lasts longer than 2 weeks evaluate for postpartum depression -Ascribed to the rapid changes in hormone levels, stress of birth and awareness of increased responsibility -No treatment required
What is the difference between the "Baby Blues" and postpartum depression?
-GI -Cardiovascular -Endocrine -Respiratory -Adrenal -Skin -Musculoskeletal
What organ systems are commonly affected by stress?
Male prostheses: Surgical treatment is infrequently advocated Penile prosthetic devices are available Semi-rigid rod prosthesis-produces a permanent erection that can be positioned close to the body for concealment Inflatable type - is implanted with its own reservoir and pump for inflation and deflation It is designed to mimic normal physiological functioning Vascular surgery: Bypass surgery of penile arteries has been attempted in selected cases with some success
What surgical procedures are implicated in male erectile disorder?
-Tense, high-strung, competitive personalities -Initial Tx: antianxiety agents or even antidepressants -Psychotherapy -Biofeedback -Relaxation Exercises
What types of personalities are more prone for tension headaches? What are their treatment options?
C. There is a higher prevalence of sexual addiction among women.
Which of the following is not true about sexual addiction? A. Individuals who engage addictively in one form of sexual behavior are likely also to engage addictively in other forms of sexual behavior. B. Sexual addiction is usually a chronic disorder. C. There is a higher prevalence of sexual addiction among women. D. Obsessions and compulsions with sexual content can occur in individuals with obsessive-compulsive disorder (OCD). E. Hypersexual behavior can occur in individuals with bipolar disorder.
1% 2
Zoophilia-Paraphilia patients seeking outpt. txmt, number of acts per paraphilia patient
Pseudocyesis
a false belief of being pregnant with: -objective signs -reported symptoms of pregnancy -false pregnancy due to psychological dysfunction
Frotteurism
a man rubs his penis against the buttocks or another body part of a fully clothed woman to achieve orgasm. -may also use hands to rub victim and achieve orgams. This usually happens in public crowded spaces -patients with frotteurism are usually passive and isolated -this is usually their only sexual pleasure -aggression of the act is very apparent
Pedophilia and sexual sadism
a need to dominate and control their victims to compensate for their feelings of powerlessness during the oedipal crisis
Fetishism
an attempt to avoid anxiety by displacing libidinal impulses to inappropriate objects
zoophilia
arousal fantasies or sexual activities, including intercourse, masturbation, and oral-genital contact with an animal.
Partialism
concentrates their sexual activity to one part of the body and excludes all the others. refuses to have coitus and will only focus on this one part
masturbation
defined as a person achieving sexual pleasure-which usually results in orgasm-by himself or herself (autoeroticism)
sexualized by a child and form the basis for a paraphilia (resulting in an eroticized child)
early experiences of abuse that are not sexual, like spanking, enemas, or verbal humiliation, can be:
calm anxiety about castration
exhibitionism and voyeurism may be attempts to:
Sexual masochism
fear of injury and sense of powerlessness is overcome by showing that they are impervious to harm
take age, sexual experience, and adequacy of sexual stimulation into account.
how does one diagnosis female orgasmic disorder?
necrophilia
obsession with obtainting sexual gratification from cadavers.
oralism
oral contact only with genitals and refuses to have sex.
Exhibitionism
recurrent urge to expose the genitals to a stranger or to an unsuspecting person; sexual excitement in anticipation of exposure and orgasm due to masturbation during or after
Fetishism
sexual focus on objects intimately associated with the human body or focus on non-genital parts of the body (partialism) -Each fetish is usually linked to a quality associated with an important childhood loved one or even a traumatizing person -begins in adolescence and is chronic -almost exclusive to men -Freud associates fetishes with the phallus
Hypoxyphilia
the desire to achieve an altered state of consciousness secondary to hypoxia while experiencing an orgasm.
klismaphilia
the use of enemas as part of sexual stimulation, related to anal fixation
neurological damage, antihypertensive drugs, antidepressants, tranquilizers, heart attacks, relationship crisis
what are some of the causes of female orgasmic disorder?
delayed or absent orgasms following normal sexual excitement
what are some symptoms of female orgasmic disorder?
-Temperamental: atypical gender behavior in early age persists into adulthood. -Environmental: males with gender dysphoria more commonly have older brothers. -Genetic & physiological: some genetic contribution and familiality of transsexualism.
what are the risks for gender dysphoria?
directed program of self-stimulation and increased communication between couple
what is a treatment of female orgasmic disorder?
10-15% never experience orgasms; 2/3rds don't experience orgasms regularly.
what is the prevalence of female orgasmic disorder?
-Adult males - 0.005% to 0.014%; 1 in 11,000 males -Adult females - 0.002% to 0.003%; 1 in 30,000 -Adults male to female ratio - between 1:1 to 6:1 -Boys to Girls ratio: 4-5 boys to 1 girl (Sadock 601) or from 2:1 to 4.5:1 (DSM 454)
what is the prevalence of gender dysphoria?