Sexual and Miscellaneous Disorders, Abuse, and Assault Flashcards
Describe the diagnostic criteria for exhibitionistic disorder.
Showing genitals to unsuspecting person over a period of at least 6 months.
What is important to clarify when assessing a person with suspected exhibitionistic disorder?
Specify whether sexually aroused by exposing genitals to prepubertal children, physically mature individuals, or both.
What is the treatment for exhibitionist disorder?
Psychotherapy and SSRIs for impulse control.
Describe the diagnostic criteria for female sexual interest/arousal disorder.
Lack of or reduced interest in sexual activity for at least 6 months and not caused by medical, substance, or medication effects.
What pharmacotherapy may be considered to treat female secual interest/arousal disorder?
Sildenafil (Viagra), testosterone.
Describe fetishistic disorder.
6+ months of sexual arousal from non-genital body parts or non-living objects.
What is the treatment for fetishistic disorder?
Insight oriented behavioral therapy, SSRIs for impulse control.
Describe male hypoactive sexual desire disorder.
Lack of or reduced interest in sexual activity for at least 6 months and not caused by medical, substance, or medication effects.
What is important to determine after a diagnosis of reduced male or female sexual desire is diagnosed?
Whether it is life-long or acquired
What is the treatment for male hypoactive sexual desire disorder?
Testosterone –> safety in long term use is unclear
Describe the diagnostic criteria for pedophilic disorder.
Patient must be at least 16 years old sexually attracted to pre-pubescent children for at least 6 months.
What is important to determine after a diagnosis of pedophilic disorder is made?
Whether the patient is sexually attracted to only children or adults also.
What treatment options are available for pedophilic disorder?
Insight oriented, behavior therapy. SSRIs for impulse control.
What pharmacologic therapy may be indicated to reduce libido in a pedophilic disorder patient?
Medroxyprogesterone to block testosterone synthesis
Leuprolide blocks testosterone synthesis by blocking FSH and LH from the pituitary.
Describe sexual masochism disorder.
Arousal from being threatened or hurt during sexual activity for at least 6 months.
Describe sexual sadism disorder.
Arousal from inflicting pain, punishment, or humiliation on others during sexual activity for at least 6 months.
Describe voyeuristic disorder.
Adult that gains arousal from observing unsuspecting individuals naked or performing sexual activities.
Describe adjustment disorder.
Emotional or maladaptive behavioral symptoms that occur develop within 3 months of identifiable event and end within 6 months of event (child moving to a new house is the classic example).
What is the treatment for adjustment disorder?
Psychotherapy or group therapy is first line. Meds may be indicated for insomnia, anxiety, or depression.
What are the 5 Kubler-Ross stages of grief?
Denial –> anger –> bargaining –> depression –> acceptance
When can a diagnosis of major depressive disorder be made in a patient that experiences grief?
When grief symptoms do not resolve –> may take up to a year.
For a patient whose severe grief symptoms persist for more than 12 months, what diagnosis, other than major depressive disorder, may be considered?
Persistent Complex Bereavement Disorder
Describe conversion disorder.
Neurologic symptoms that are not self induced and cannot be explained by a clinical condition.
What are the most common symptoms associated with conversion disorder?
Shifting paralysis, blindness, mutism
What is the best treatment for conversion disorder?
Psychotherapy is first line. Most cases are self-limiting –> avoid medications most of the time.
What is the best general description for a dissociative disorder?
Loss of self
Differentiate dissociative amnesia from fugue from identity.
Amn: loss of memory of traumatic event
Fug: sudden, unexpected travel or wandering in a dissociative state
Iden: two or more distinct personalities
What signs and symptoms may be associated with elder abuse?
bruises, fractures, lack of eyeglasses or hearing aids, injuries from restraints, excessive drugging, violation of basic rights (opening mail).
What actions by a caregiver are suspicious for elder abuse?
Prior Hx of abuse, conflicting accounts of accidents, unwilling to implement treatment plans, defensiveness, not allowing patient to respond to questions.
What is the best general indication to suspect child abuse?
Any injury that cannot be explained, is inconsistent with history, or is beyond the child’s developmental abilities.
What is the most common type of child abuse?
Neglect
What is the most common age of child sexual abuse?
9 - 12
What is the best action when factitious disorder imposed on another is suspected?
Admit the patient to the hospital to observe the caregiver-patient interaction, and determine the relationship between the symptoms and the perpetrator’s presence.
What is the greatest risk when a victim of domestic partner abuse leaves their abuser?
They are at 70% greater risk of being killed by their abuser than someone that stays in the relationship.
