liason psych day 5 Flashcards
The commonest psychosexual disorder among men is:
E.Erectile dysfunction
The commonest psychosexual disorder among women is:
Loss of sexual desire
Risk factors for male erectile dysfunction include
A.Smoking
B.Diabetes
C.Radical prostatectomy
D.Depression
What is the treatment of choice for male sexual performance anxiety?
B.CBT
what is sildenafil
viagra
OSCE Scenario - Mr Lyman is a 45 year old man who has been referred because of depression. He has tried three different antidepressants but has reported a number of side effects from these.
•He has had longstanding problems with interpersonal relationships and his current depressive episode has arisen in the context of relationship problems.
•Please take a psychosexual history
Candidates should demonstrate:
•An ability to quickly establish trust and rapport
•Ease in discussing sensitive subjects
•That they are comfortable asking very personal questions and able to decide which questions are relevant to the history.
Marking sheet •Current relationship –Duration of relationship –Quality of relationship –Sexual behaviours – libido, freq, practices, preferences, satisfaction –Sexual orientation –Contraception –History of splits, aggression –Children
Other questions
•Difficulties with initiating an erection
•Difficulties with maintaining an erection
•Frequency of masturbation
•Worries about ejaculation (too fast, too slow)
•Frequency of waking erections
•Previous relationships
–Overall number, longest lasting, sexual orientation, patterns of behaviour
–Patients views on quality of relationships in past
–Fantasies, encounters
•Sexual history –Age of first sexual activity –Age at first intercourse –Age at first girl/boyfriend –Sexual abuse / trauma
•Attitudes –Development of secondary sexual characteristics –Acquisition of sexual information –Sexual attitude, inclinations, practice –History of sexual problems
Masturbation: What is common or usual?
98% men, ? 70% women
Common sexual problems –men (GP population)
Common problems –men (GP population) Erectile dysfunction – 9% Impaired sexual drive – 7% Sexual aversion – 3% Premature ejaculation – 4% Anorgasmia – 3% Non-organic dyspareunia -1% Any disorder – 22%
Erectile dysfunction in smoking
Relative risk of ED - 1.3 for each 10-
pack-years smoked
86% of smokers have an abnormal
penile vascular state
Sildenafil (Viagra) action
Inhibits phosphodiesterase 5 Prolongs cyclic GMP in erectile tissue Therefore amplifies vasodilation effect of NO Enhances ‘stimulated’ erections Rapidly absorbed (30-90 min) Half life 3-5 hours
Useful in psychological difficulties if
CBT or other psychotherapy not effective
Restores confidence
Restrictions on prescribing in UK
what is Vaginismus
“Phobic” avoidance Anxiety + spasm of pelvic musculature Not necessarily lack of arousal Approach depends on sex of therapist Patient centred examination Self examination Education/self focusing (desensitisation)
Management of Sexual Variations (paraphilias) such as Exhibitionism
Voyeurism
Sadomasochism
Paedophilia
Management
Biopsychosocial
Reduce undesirable/inappropriate thoughts,
feelings and behaviour
Increase alternative thoughts, feelings and
behaviour
4 Abnormal Reactions to stress
Acute stress reaction
• Acute Stress disorder
• PTSD
• Adjustment disorder
what is Acute Stress Reaction
Transient reactions to exceptional physical
and or mental stress.
• ICD-10 diagnosis
Clinical Features • Initial daze • Narrowing of attention • Inability to comprehend stimuli • Disorientation
Time course:
Start within 1 hr
Diminish within 8 hrs for transient and 48 hrs
for enduring stressor.
synonymous with DSM’s acute stress disorder
what is Acute stress disorder
DSM-IV diagnosis • Dissociation • Hyperarousal • Anxiety • Re-experiencing
synonymous with ICD’s acute stress reaction
Treatment
Psychoeducation
• Normalisation of symptoms
• Practical support
Psychological therapies • Debriefing • CBT Medication • Tricyclic anti-depressant use, benzodiazepines and anxiolytics- little evidence
what are Adjustment disorders
• ICD-10 • F43 • Identifies disorders not only on the basis of symptoms but also the presence of stressor.
Development within 1 month of an exposure
to a psychosocial stressor not of an unusual
or catastrophic type.
Generally do not last more than 6 months ()
(except in cases of prolonged depressive reactions)
wiki - An adjustment disorder (AD) occurs when an individual is unable to adjust to or cope with a particular stressor, like a major life event. Since people with this disorder normally have symptoms that depressed people do, such as general loss of interest, feelings of hopelessness and crying, this disorder is sometimes known as situational depression. Unlike major depression the disorder is caused by an outside stressor and generally resolves once the individual is able to adapt to the situation. The condition is different from anxiety disorder, which lacks the presence of a stressor, or post-traumatic stress disorder and acute stress disorder, which usually are associated with a more intense stressor.
According to the DSM-IV-TR, there are six types of adjustment disorders, which are characterized by the following predominant symptoms: depressed mood, anxiety, mixed depression and anxiety, disturbance of conduct, mixed disturbance of emotions and conduct
what is PTSD
DSM-IV
‘experienced, witnessed or was confronted
with an event or events that involved actual or
threatened death or serious injury or a threat
to the physical integrity of self or others.
ICD10- a stressful situation or event…of an
exceptionally threatening or catastrophic
nature which is likely to cause pervasive
distress in almost anyone
Clinical features • Flashbacks • Avoidance • Inability to recall • Arousal
Co-morbidity o Mental health • Affective disorders • Anxiety disorders • Substance misuse • Somatization o Social • Family and marital adjustment problems • Violence
o Psychological processes • Fear conditioning • Appraisal of traumatic event and its sequelae • Traumatic memories • Maintaining behaviours
Treatment Psychological • CBT • Psychodynamic therapy • Hypnotherapy • EMDR Pharmacological • SSRIs
Mr A is a 24 year old in A&E with palpitations,
chest pain, nausea and irritability shortly after
being rescued from a car crash. Physical
investigations reveal no abnormalities.
What psychiatric diagnosis would you consider? treatment?
Acute Stress Reaction
If you believe Mr A has an acute stress
reaction, you will offer Mr A - c)Social support and information
True or false
Flashbacks are not essential for diagnosis of
PTSD
False
True or false
Medication plays no role in treatment of PTSD
False
effects both short and long term of amphetamines
Feel powerful, alert, energised
Sweat, tremor, headaches, sleepiness, blurred vision
Increase in HR, RR, BP
Crash- irritable/depressed for 1-2 days
Prolonged use – hallucinations and intense paranoia
Psychologically addictive – aggression, anxiety, intense
cravings
effects of benzodiazepines
Effects relief of anxiety sedation relaxation impaired memory muscle relaxation anticonvulsant confusion stupor
different ways of consuming cannabis
smoked in rolled paper – ‘joint’ hollowed out cigar – ‘blunt’ pipes – ‘bowls’ water pipes – ‘bongs’ mix in food or brewed as an infusion
effects of cannabis
Effects;- euphoria anxiety/panic altered perceptions impaired coordination and memory red eyes sleepy hungry paranoia hallucination
what is ‘coke’
cocaine
what is ‘crack’
cocaine minus the hydrochloride = freebase, rocks.
Cocaine: snort, inject, rub on gums, Crack:
smoked, inject
