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Psyc-2020 > Sexual and Sleep Disorders > Flashcards

Sexual and Sleep Disorders Flashcards

1
Q

What are the four phases of the sexual response cycle? What sex does this cycle typically describe and why?

A
  1. Desire (libido)
  2. Excitement (arousal)
  3. Orgasm
  4. Resolution

Typically males -> women can experience more than one orgasm per cycle

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2
Q

What gender do we not separate sexual interest and arousal in?

A

Women - they cannot separate this according to DSM 5

Men can disconnect this

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3
Q

What mental illness is a decreased libido associated with?

A

Depression -> used to be part of the diagnostic criteria

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4
Q

What physical illnesses are correlated with impairment of sexual functioning?

A

Erectile dysfunction - cardiovascular illness, diabetes mellitus, MS, spinal cord injury

Decreased libido - hypothyroidism

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5
Q

Describe the effects on sexual functioning of the following drugs: alcohol, amphetamines, cocaine, ecstasy.

A

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

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6
Q

Who is most likely to get sexual dysfunction disorders?

A

Women, increased age, lower SES, married, smokers

-> can have comorbid disorders, they interfere with sexual response and experience of pleasure

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7
Q

What additional diagnostic criteria apply to all sexual dysfunctions?

A

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

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8
Q

What is Delayed ejaculation?

A

Delayed, infrequent, or absent ejaculation experienced in all or almost all sexual activities without the individual desiring delay

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9
Q

What is Erectile disorder?

A

Difficult obtaining an erection, maintaining an erection til completion, or decrease in erectile rigidity

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10
Q

What is Female orgasmic disorder?

A

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

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11
Q

What is Female Sexual Interest / Arousal Disorder?

A

Reduced interest, fantasies, lack of initiation / response to partner’s initation, reduced excitement / pleasure in engaging in almost all or all encounters, reduced sensations.

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12
Q

What is Genito-Pelvic Pain / Penetration Disorder?

A

Pain during intercourse, pelvic pain or vulvovaginal pain, associated with anxiety or fear of pain and tensing / tightening of pelvic floor in attempted penetration

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13
Q

What is Hypoactive Sexual Desire Disorder?

A

Usually occurs in Males (they can separate desire and arousal)
-> persistent deficit in sexual / erotic thoughts and desire for sexual activity

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14
Q

How do we define Premature Ejaculation?

A

Cumming within 1 minute following vaginal penetration and before the individual wishes it

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15
Q

What is a paraphilia?

A

Love beyond the usual
-> any intense or persistent sexual interest other than sexual interest in genital stimulation or fondling between two partners

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16
Q

How is paraphilic disorder distinguished from paraphilias in general? How long must they be present?

A

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

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17
Q

What are the courtship disorders? (A subset of anamalous activity preference)

A

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

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18
Q

What are the algolagnic disorders? (A subset of anamalous activity preference)

A

They involve pain:

Sexual Masochism - humilitation or being beaten, bound, etc
Sexual Sadism - humilitating, beating, or binding another person

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19
Q

What are important specifiers for exhibitionistic disorder?

A

Exposure to prepubertal children, mature adults, or both

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20
Q

What is an important specifier for Sexual Masochism disorder?

A
  1. Asphyxiophilia -> could choke themselves to death while masturbating
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21
Q

Who are paraphilic disorders more common in, and what is the exception?

A

All more common in men, except women are more often masochistic (like being dominated)

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22
Q

What are paraphilic disorders comorbid with?

A

Personality disorders (antisocial particularly), mood, anxiety, and substance use disorders

23
Q

What are the anomalous target preference disorders?

A
  1. Pedophilic Disorder
  2. Fetishistic Disorder
  3. Transvestic Disorder
24
Q

What are the criteria for Pedophilic Disorder? What should you specify

A

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

25
Q

Who should you not diagnose with Pedophilic Disorder?

A

An individual in late adolescence involved in a relationship with a 12-13 year old who is sexually mature.

26
Q

What is Fetishistic Disorder?

A

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
27
Q

What is transvestic disorder? Specifiers?

A

Sexual arousal from cross-dressing

Specify with fetishism (as well) or autogynephilia (man aroused by thinking he is a woman)

28
Q

What is the first step in management of sexual dysfunction?

A

Healthy lifestyle

-> weight reduction, exercise, smoking cessation

29
Q

What are the treatment mainstays for sexual dysfunctions and paraphilic disorders?

A

Primarily psychotherapy

Sex therapy and CBT for sexual dysfunctions

30
Q

What do the PDE5 inhibitors end in?

A

-afil, i.e. sildenafil

Relax smooth muscles of the penis with blockade of PDE-5 for treatment of erectile disorder

31
Q

What alternate drugs are used for treatment of Erectile Disorder than PDE5 inhibitors?

A

Intraurethral alprostadil - PGE1 analog decreases vascular tone
Intracorporeal papaverine, or papaverine + prostaglandin analogs

32
Q

What are some mechanical devices use for treatment of ED?

A

Vacuum pumps -> suck air out for better blood flow

Constriction rings -> after prostaglandin injection

33
Q

What is the hormonal treatment of Female Sexual Interest/Arousal Disorder? What are the risks?

A

Testosterone increases libido + sexual functioning, especially postmenopausal

Risks:
Hirsutism, enlarged clitoris, deepening of voice

34
Q

What drug treats female hypoactive sexual desire in premenopausal women?

A

Flibanserin - 5HT1A agonist

35
Q

What can be used to treat Male Hypoactive Sexual Desire Disorder? When will this work?

A

Testosterone replacement - only works if they have a testosterone deficit, supraphysiological levels will not help

36
Q

What is the treatment for premature ejaculation?

A

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

37
Q

How many times is it normal to get up during the night / how long does it take to fall asleeep?

A

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

38
Q

What are the two processes of sleep which are being balanced? Which type of sleep is independent of this?

A

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)

39
Q

What two sleep tests are commonly used?

A
  1. Polysomnography - all night sleep study

2. Multiple Sleep Latency Test - EEG quantifying nature and degree of sleepiness / naps, used for narcolepsy

40
Q

Can insomnia be normal? What causes it?

A

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

41
Q

What conditions must be ruled out when diagnosing insomnia?

A
  1. Patient is a short sleeper
  2. Patient has poor sleep hygiene
  3. 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

42
Q

What is insomnia disorder / how long must it be present?

A

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

43
Q

What is the first treatment for insomnia disorder and what are a few of the things? What amino acid is good?

A

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)
44
Q

What do we need to do with the elderly to treat insomnia?

A

Sleep Restriction - they sleep so much they can’t sleep at night

45
Q

Does Ramelteon work instantly and how does it work?

A

No, acts on MT1 and MT2 melatonin receptors in suprachiasmatic nucleus

46
Q

Who is suvorexant contraindicated in?

A

Narcolepsy

Also pls briefly glance at the other drugs of this lecture, its dumb to flashcard them

47
Q

What is hypersomnolence disorder and what should it be differentiated from?

A

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
48
Q

How to treat hypersomnolence?

A

Polysomnogram and MSLT, andn treating the underlying cause (i.e. sleep apnea, mood disorder, circadian rhythm disorder).

49
Q

What are the criteria for diagnosing narcolepsy?

A

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

50
Q

How does cataplexy manifest in narcolepsy?

A
  1. Bilateral loss of muscle tone with maintained consciousness which is precipitated by laughing
  2. Jaw-opening episodes with tongue trusting or global hypotonia (spontanoeous grimaces without any emotional triggers)
51
Q

What are two important lab findings in Narcolepsy?**

A
  1. Hypocretin deficiency - orexin-1 is less than 110 pg/mL in CSF
  2. REM sleep latency in less than 15 minutes (normal is 90 min)
52
Q

What are the behavioral treatments for narcolepsy?

A

Better sleep hygiene, schedule naps

53
Q

What are the pharmacological treatments for narcolepsy?

A

Stimulants (methylphenidate, amphetamines) to control daytime sleepiness, anticataplexy drugs -> TCAs, sodium oxybate - also used in insomnia

Psyc-2020 (41 decks)

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