Sexual and Miscellaneous Disorders, Abuse, and Assault

Question 1

Describe the diagnostic criteria for exhibitionistic disorder.

Answer 1

Showing genitals to unsuspecting person over a period of at least 6 months.

Question 2

What is important to clarify when assessing a person with suspected exhibitionistic disorder?

Answer 2

Specify whether sexually aroused by exposing genitals to prepubertal children, physically mature individuals, or both.

Question 3

What is the treatment for exhibitionist disorder?

Answer 3

Psychotherapy and SSRIs for impulse control.

Question 4

Describe the diagnostic criteria for female sexual interest/arousal disorder.

Answer 4

Lack of or reduced interest in sexual activity for at least 6 months and not caused by medical, substance, or medication effects.

Question 5

What pharmacotherapy may be considered to treat female secual interest/arousal disorder?

Answer 5

Sildenafil (Viagra), testosterone.

Question 6

Describe fetishistic disorder.

Answer 6

6+ months of sexual arousal from non-genital body parts or non-living objects.

Question 7

What is the treatment for fetishistic disorder?

Answer 7

Insight oriented behavioral therapy, SSRIs for impulse control.

Question 8

Describe male hypoactive sexual desire disorder.

Answer 8

Lack of or reduced interest in sexual activity for at least 6 months and not caused by medical, substance, or medication effects.

Question 9

What is important to determine after a diagnosis of reduced male or female sexual desire is diagnosed?

Answer 9

Whether it is life-long or acquired

Question 10

What is the treatment for male hypoactive sexual desire disorder?

Answer 10

Testosterone –> safety in long term use is unclear

Question 11

Describe the diagnostic criteria for pedophilic disorder.

Answer 11

Patient must be at least 16 years old sexually attracted to pre-pubescent children for at least 6 months.

Question 12

What is important to determine after a diagnosis of pedophilic disorder is made?

Answer 12

Whether the patient is sexually attracted to only children or adults also.

Question 13

What treatment options are available for pedophilic disorder?

Answer 13

Insight oriented, behavior therapy. SSRIs for impulse control.

Question 14

What pharmacologic therapy may be indicated to reduce libido in a pedophilic disorder patient?

Answer 14

Medroxyprogesterone to block testosterone synthesis

Leuprolide blocks testosterone synthesis by blocking FSH and LH from the pituitary.

Question 15

Describe sexual masochism disorder.

Answer 15

Arousal from being threatened or hurt during sexual activity for at least 6 months.

Question 16

Describe sexual sadism disorder.

Answer 16

Arousal from inflicting pain, punishment, or humiliation on others during sexual activity for at least 6 months.

Question 17

Describe voyeuristic disorder.

Answer 17

Adult that gains arousal from observing unsuspecting individuals naked or performing sexual activities.

Question 18

Describe adjustment disorder.

Answer 18

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).

Question 19

What is the treatment for adjustment disorder?

Answer 19

Psychotherapy or group therapy is first line. Meds may be indicated for insomnia, anxiety, or depression.

Question 20

What are the 5 Kubler-Ross stages of grief?

Answer 20

Denial –> anger –> bargaining –> depression –> acceptance

Question 21

When can a diagnosis of major depressive disorder be made in a patient that experiences grief?

Answer 21

When grief symptoms do not resolve –> may take up to a year.

Question 22

For a patient whose severe grief symptoms persist for more than 12 months, what diagnosis, other than major depressive disorder, may be considered?

Answer 22

Persistent Complex Bereavement Disorder

Question 23

Describe conversion disorder.

Answer 23

Neurologic symptoms that are not self induced and cannot be explained by a clinical condition.

Question 24

What are the most common symptoms associated with conversion disorder?

Answer 24

Shifting paralysis, blindness, mutism

Question 25

What is the best treatment for conversion disorder?

Answer 25

Psychotherapy is first line. Most cases are self-limiting –> avoid medications most of the time.

Question 26

What is the best general description for a dissociative disorder?

Answer 26

Loss of self

Question 27

Differentiate dissociative amnesia from fugue from identity.

Answer 27

Amn: loss of memory of traumatic event
Fug: sudden, unexpected travel or wandering in a dissociative state
Iden: two or more distinct personalities

Question 28

What signs and symptoms may be associated with elder abuse?

Answer 28

bruises, fractures, lack of eyeglasses or hearing aids, injuries from restraints, excessive drugging, violation of basic rights (opening mail).

Question 29

What actions by a caregiver are suspicious for elder abuse?

Answer 29

Prior Hx of abuse, conflicting accounts of accidents, unwilling to implement treatment plans, defensiveness, not allowing patient to respond to questions.

Question 30

What is the best general indication to suspect child abuse?

Answer 30

Any injury that cannot be explained, is inconsistent with history, or is beyond the child’s developmental abilities.

Question 31

What is the most common type of child abuse?

Answer 31

Neglect

Question 32

What is the most common age of child sexual abuse?

Answer 32

9 - 12

Question 33

What is the best action when factitious disorder imposed on another is suspected?

Answer 33

Admit the patient to the hospital to observe the caregiver-patient interaction, and determine the relationship between the symptoms and the perpetrator’s presence.

Question 34

What is the greatest risk when a victim of domestic partner abuse leaves their abuser?

Answer 34

They are at 70% greater risk of being killed by their abuser than someone that stays in the relationship.