Sexual and Sleep Disorders Flashcards
What are the four phases of the sexual response cycle? What sex does this cycle typically describe and why?
- Desire (libido)
- Excitement (arousal)
- Orgasm
- Resolution
Typically males -> women can experience more than one orgasm per cycle
What gender do we not separate sexual interest and arousal in?
Women - they cannot separate this according to DSM 5
Men can disconnect this
What mental illness is a decreased libido associated with?
Depression -> used to be part of the diagnostic criteria
What physical illnesses are correlated with impairment of sexual functioning?
Erectile dysfunction - cardiovascular illness, diabetes mellitus, MS, spinal cord injury
Decreased libido - hypothyroidism
Describe the effects on sexual functioning of the following drugs: alcohol, amphetamines, cocaine, ecstasy.
Alcohol - long term impotence / testicle atrophy in men, hypoactive sexual desire in women
Amphetamines - good in short-term, but inhibits in longterm
Cocaine - same as amphetamines, with impotence longterm
XTC - increased desire, but erectile failure
Who is most likely to get sexual dysfunction disorders?
Women, increased age, lower SES, married, smokers
-> can have comorbid disorders, they interfere with sexual response and experience of pleasure
What additional diagnostic criteria apply to all sexual dysfunctions?
Need to be present for at least 6 months, cause clinically significant distress, not better explained by severe relationship distress, substance use, or another medical condition / nonsexual mental disorder
What is Delayed ejaculation?
Delayed, infrequent, or absent ejaculation experienced in all or almost all sexual activities without the individual desiring delay
What is Erectile disorder?
Difficult obtaining an erection, maintaining an erection til completion, or decrease in erectile rigidity
What is Female orgasmic disorder?
Delay in, marked infrequency of, or absence of orgasm, and/or markedly reduced intensity of orgasmic sensations
-> based on clinical judgment, since there is so much variability in how much triggers organism
What is Female Sexual Interest / Arousal Disorder?
Reduced interest, fantasies, lack of initiation / response to partner’s initation, reduced excitement / pleasure in engaging in almost all or all encounters, reduced sensations.
What is Genito-Pelvic Pain / Penetration Disorder?
Pain during intercourse, pelvic pain or vulvovaginal pain, associated with anxiety or fear of pain and tensing / tightening of pelvic floor in attempted penetration
What is Hypoactive Sexual Desire Disorder?
Usually occurs in Males (they can separate desire and arousal)
-> persistent deficit in sexual / erotic thoughts and desire for sexual activity
How do we define Premature Ejaculation?
Cumming within 1 minute following vaginal penetration and before the individual wishes it
What is a paraphilia?
Love beyond the usual
-> any intense or persistent sexual interest other than sexual interest in genital stimulation or fondling between two partners
How is paraphilic disorder distinguished from paraphilias in general? How long must they be present?
Disorder causes distress or impairment to individual or paraphilia which involves personal harm or risk of harm to others
Must be present at least 6 months, each disorder will cause intense sexual arousal in the given situation
What are the courtship disorders? (A subset of anamalous activity preference)
Voyeuristic disorder - Peeping nonconsenting people, must be at least 18 yrs for diagnosis
Exhibitionistic disorder - Exposure of one’s genitals to an unsuspecting person
Frotteuristic disorder - touching or rubbing against nonconsenting person - basically sexual assault
What are the algolagnic disorders? (A subset of anamalous activity preference)
They involve pain:
Sexual Masochism - humilitation or being beaten, bound, etc
Sexual Sadism - humilitating, beating, or binding another person
What are important specifiers for exhibitionistic disorder?
Exposure to prepubertal children, mature adults, or both
What is an important specifier for Sexual Masochism disorder?
- Asphyxiophilia -> could choke themselves to death while masturbating
Who are paraphilic disorders more common in, and what is the exception?
All more common in men, except women are more often masochistic (like being dominated)
What are paraphilic disorders comorbid with?
Personality disorders (antisocial particularly), mood, anxiety, and substance use disorders
What are the anomalous target preference disorders?
- Pedophilic Disorder
- Fetishistic Disorder
- Transvestic Disorder
What are the criteria for Pedophilic Disorder? What should you specify
Again, 6 months+ of intense sexual arousing fantasies, sexual urges, or behaviors involving prepubescent children.
Individual must be at least 16 years old, and at least 5 years older than target child
-> specify if attracted to males, females, or both, or if limited to incest
Who should you not diagnose with Pedophilic Disorder?
An individual in late adolescence involved in a relationship with a 12-13 year old who is sexually mature.
What is Fetishistic Disorder?
Arousal from nonliving objects or a highly specific focus on non-genital parts (i.e. toe)
- > object must not be a sex toy
- > Fetish objects are not clothes
What is transvestic disorder? Specifiers?
Sexual arousal from cross-dressing
Specify with fetishism (as well) or autogynephilia (man aroused by thinking he is a woman)
What is the first step in management of sexual dysfunction?
Healthy lifestyle
-> weight reduction, exercise, smoking cessation
What are the treatment mainstays for sexual dysfunctions and paraphilic disorders?
Primarily psychotherapy
Sex therapy and CBT for sexual dysfunctions
What do the PDE5 inhibitors end in?
-afil, i.e. sildenafil
Relax smooth muscles of the penis with blockade of PDE-5 for treatment of erectile disorder
What alternate drugs are used for treatment of Erectile Disorder than PDE5 inhibitors?
Intraurethral alprostadil - PGE1 analog decreases vascular tone
Intracorporeal papaverine, or papaverine + prostaglandin analogs
What are some mechanical devices use for treatment of ED?
Vacuum pumps -> suck air out for better blood flow
Constriction rings -> after prostaglandin injection
What is the hormonal treatment of Female Sexual Interest/Arousal Disorder? What are the risks?
Testosterone increases libido + sexual functioning, especially postmenopausal
Risks:
Hirsutism, enlarged clitoris, deepening of voice
What drug treats female hypoactive sexual desire in premenopausal women?
Flibanserin - 5HT1A agonist
What can be used to treat Male Hypoactive Sexual Desire Disorder? When will this work?
Testosterone replacement - only works if they have a testosterone deficit, supraphysiological levels will not help
What is the treatment for premature ejaculation?
Behavioral: Squeezing tip of penis or start/stop
Pharmacological: Serotonergic antidepressions like clomipramine and sertraline -> cause sexual dysfunction
Lidocaine - local anesthetic, but can interfere with woman
How many times is it normal to get up during the night / how long does it take to fall asleeep?
1-2 times waking up during the night is normal (no more than 30 min each)
85% of time in bed is spent sleeping
Fall asleep within 30 min
What are the two processes of sleep which are being balanced? Which type of sleep is independent of this?
Process S - homeoStatic process
Process C - Circadian arousal process
REM sleep is independent of this - offsets process S for homeostatic dysregulation (increased variability in HR, BP, and respiratory rate)
What two sleep tests are commonly used?
- Polysomnography - all night sleep study
2. Multiple Sleep Latency Test - EEG quantifying nature and degree of sleepiness / naps, used for narcolepsy
Can insomnia be normal? What causes it?
Yes, transient / short-term insomnias (up to a few weeks) can be normal during times of stress, excitement, illness, or jet lag
Chronic insomnia has less apparent causes
What conditions must be ruled out when diagnosing insomnia?
- Patient is a short sleeper
- Patient has poor sleep hygiene
- Patient has a medication disorder or medication causing the insomnia
Need to also determine if it’s REM or nREM sleep that’s messed up
What is insomnia disorder / how long must it be present?
At least 3 nights a week for at least 3 months, sleep difficulty occurs despite adequate opportunity to sleep, which is not attributable to a substance or other medical condition
What is the first treatment for insomnia disorder and what are a few of the things? What amino acid is good?
Making sure they have good sleep hygiene + cognitive behavioral therapy
- Regular sleep times
- Wind-down time with no blue light
- Late-night high-tryptophan snack (makes melatonin)
What do we need to do with the elderly to treat insomnia?
Sleep Restriction - they sleep so much they can’t sleep at night
Does Ramelteon work instantly and how does it work?
No, acts on MT1 and MT2 melatonin receptors in suprachiasmatic nucleus
Who is suvorexant contraindicated in?
Narcolepsy
Also pls briefly glance at the other drugs of this lecture, its dumb to flashcard them
What is hypersomnolence disorder and what should it be differentiated from?
Differentiated from fatigue. Basically, this is chronic fatigue which causes sleep, with a myraid of causes.
- Prolonged sleep duration
- Persistent daytime drowsiness
- daytime lapses into microsleep, with sleep attacks
- > increases risk for MVAs
How to treat hypersomnolence?
Polysomnogram and MSLT, andn treating the underlying cause (i.e. sleep apnea, mood disorder, circadian rhythm disorder).
What are the criteria for diagnosing narcolepsy?
3x per week x3 months, recurrent episodes of irresistable need to sleep or napping occurring in the same day
Presence of cataplexy - few times per month
How does cataplexy manifest in narcolepsy?
- Bilateral loss of muscle tone with maintained consciousness which is precipitated by laughing
- Jaw-opening episodes with tongue trusting or global hypotonia (spontanoeous grimaces without any emotional triggers)
What are two important lab findings in Narcolepsy?**
- Hypocretin deficiency - orexin-1 is less than 110 pg/mL in CSF
- REM sleep latency in less than 15 minutes (normal is 90 min)
What are the behavioral treatments for narcolepsy?
Better sleep hygiene, schedule naps
What are the pharmacological treatments for narcolepsy?
Stimulants (methylphenidate, amphetamines) to control daytime sleepiness, anticataplexy drugs -> TCAs, sodium oxybate - also used in insomnia
