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Sewalem J, Kassaw C, Anbesaw T. Sexual dysfunction among people with mental illness attending follow-up treatment at a tertiary hospital, Jimma University Medical Center: A cross-sectional study. Front Psychiatry 2022; 13:999922. [PMID: 36465282 PMCID: PMC9714433 DOI: 10.3389/fpsyt.2022.999922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background Sexual function is a complex behavior influenced by several factors that can result in dysfunction. It is highly prevalent among patients with mental illness who are on psychotropic medications. Assessing those patients has paramount importance for appropriate intervention to take place. Methods This study was a facility-based cross-sectional study design conducted from 1 March to 30 June 2022. A Sexual Functioning Questionnaire (CSFQ-14) was used to assess sexual dysfunctions. Data were analyzed using SPSS version 21 software. Logistic regression analysis was performed to assess the association between dependent and independent variables. Independent variables with a p-value < 0.05 were taken as statistically significant with sexual dysfunction. Results The prevalence of sexual dysfunction was 45.4 % among respondents. The presence of chronic medical illness, being on typical antipsychotic treatment, being on psychiatric treatment for 24 months and more, moderate level of alcohol use, and being aged 35 and above were significantly associated with sexual dysfunction. Conclusion The prevalence of sexual dysfunction among people with mental illness is high. Therefore, the clinician needs to routinely enquire about sexual symptoms during follow-up treatment and give appropriate interventions with special attention to patients with chronic medical conditions and patients taking antipsychotics and psychotropic drugs for a long period of time.
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Affiliation(s)
- Jerusalem Sewalem
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Chalachew Kassaw
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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Waters K. The clinical utility of newer antidepressant agents: Understanding the role in management of MDD. Ment Health Clin 2022; 12:309-319. [PMID: 36405509 PMCID: PMC9645287 DOI: 10.9740/mhc.2022.10.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 07/07/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Whereas MDD is characterized in part by changes in mood, other symptoms can also cause significant impairment, including sexual dysfunction, cognitive impairment, and fatigue. Newer antidepressants are explored with the goal of more optimally treating these non–mood-related symptoms of MDD. The 3 oral antidepressants that have been FDA-approved most recently include vortioxetine, vilazodone, and levomilnacipran. Unique features of these antidepressants are explored through 3 patient cases.
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Affiliation(s)
- Kristin Waters
- 1 (Corresponding author) Assistant Clinical Professor, University of Connecticut, Storrs, Connecticut,
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Mariño Z, Rodríguez-Tajes S, Bartrés C, Nácar L, Lens S, Navinés R, Cavero M, Londoño MC, Sastre L, Pocurull A, Dafieno A, Martín-Santos R, Forns X. Improvement of sexuality after hepatitis C cure with direct acting antivirals. Liver Int 2020; 40:2972-2977. [PMID: 33025664 DOI: 10.1111/liv.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/14/2020] [Accepted: 09/29/2020] [Indexed: 12/17/2022]
Abstract
Despite rarely assessed, sexuality is a relevant domain in Quality of Life. We prospectively evaluated the impact of direct-acting antiviral therapy on sexuality in a cohort of 186 patients with chronic hepatitis C (HCV). Sexual dysfunction was assessed by validated scales CSFQ-14/CSFQ-VAS at baseline and one year after treatment finalization. Median age was 55 years and 87% had mild liver disease. Basal prevalence of sexual dysfunction (62%) and fear of HCV transmission (25%) were high. After HCV cure, both sexual dysfunction prevalence and CSFQ-VAS improved (P = .058 and P < .01, respectively), and fear of HCV transmission dropped to 16% (P = .02). These changes were especially relevant in young men (<55), where sexual dysfunction decreased from 48.6% to 29.7% (P = .04) and among non-depressed patients in whom sexual dysfunction decreased from 54.6% to 47% (P < .01). Age and major depression remained as independent factors of sexual dysfunction persistence after HCV cure. Our data suggest that HCV eradication is associated with an improvement in sexuality, in those patients without depression.
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Affiliation(s)
- Zoe Mariño
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Sergio Rodríguez-Tajes
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Concepció Bartrés
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Loreto Nácar
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain.,Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Sabela Lens
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Ricard Navinés
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Myriam Cavero
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - María C Londoño
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Lydia Sastre
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Anna Pocurull
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Angella Dafieno
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
| | - Rocío Martín-Santos
- Psychiatry and Psycology Department, Hospital Clínic Barcelona, IDIBAPS, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Neurociencias, University of Barcelona, Barcelona, Spain
| | - Xavier Forns
- Liver Unit, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Spain
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Bay LT, Graugaard C, Nielsen DS, Möller S, Ellingsen T, Giraldi A. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020; 8:615-630. [PMID: 32912833 PMCID: PMC7691882 DOI: 10.1016/j.esxm.2020.07.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 07/26/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction An increased risk of sexual health problems is seen among patients with chronic illnesses. The background is likely to be multifactorial, but it remains poorly understood. Aim To investigate the sexual health and functioning of patients with rheumatoid arthritis (RA) and to examine gender differences, general population comparisons, and possible somatic, psychological, and disease-specific determinants. Methods A cross-sectional study using a digital questionnaire distributed among 380 patients diagnosed with RA in a Danish university hospital outpatient setting. Main Outcome Measure A range of patient-reported outcomes were obtained, including scores from the validated rating scale Changes in Sexual Functioning Questionnaire. Furthermore, individual medical record information was collected. Results A total of 329 patients (250 women and 79 men) were included (age range: 25–73 years; mean age: 57.2 years). The Changes in Sexual Functioning Questionnaire scoring indicated an overall sexual dysfunction in 33.8% of men and 58.1% of women.More than one-third (37.6%) of patients felt that RA had made their sex life more complicated, and 32.4% feared that this might someday be the case. In total, 29.2% patients had experienced sexual problems due to their RA treatment. Of the respondents who experienced RA-related fatigue, 46.5% reported that this impacted negatively on their sexual activity. The risk of one or more sexual health adversities was significantly correlated with female gender, older age, moderate or severe depression, moderate to moderately high loneliness, more than 2 comorbidities, and a fatigue score above 75 out of 100 on a visual analogue scale. Compared to the general population, significantly fewer patients with RA considered their sex life important, and significantly fewer patients appraised their current sex life as good or very good. Moreover, significantly more women with RA (32.1%) than women from the general population (15.7%) had not had any sex life during the past year. A vast majority of patients with RA (93.5% of women and 85.5% of men) had not discussed sexual issues with a health-care professional during the last 5 years. Of all, 32.5% would like health-care professionals to address sexual topics in the consultation occasionally. Conclusion Sexual dysfunction is highly prevalent in patients with RA, but the problems are not regularly addressed in consultations provided by the rheumatology department. Bay LT, Graugaard C, Nielsen DS, et al. Sexual Health and Dysfunction in Patients With Rheumatoid Arthritis: A Cross-sectional Single-Center Study. Sex Med 2020;8:615–630.
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Affiliation(s)
- Laila Twisttmann Bay
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark.
| | - Christian Graugaard
- Center for Sexology Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Dorthe S Nielsen
- Department of Health Research, University College Lillebaelt, Odense, Denmark; Migrant Health Clinic, Odense University Hospital, Odense, Denmark; Center for Global Health, University of Southern Denmark, Odense, Denmark
| | - Sören Möller
- OPEN, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Torkell Ellingsen
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital & University of Southern Denmark, Odense, Denmark
| | - Annamaria Giraldi
- Sexological Clinic, Psychiatric Centre Copenhagen, Denmark & Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Abdelatti SI, Ismail RM, Hamed RA. Sexual dysfunctions in a sample of male psychiatric patients compared to medically ill patients. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00022-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many of the psychiatric disorders and other medical conditions may affect the sexual function of the patients. The present study aims to investigate the frequency of sexual dysfunctions in male psychiatric patients compared to other medically ill patients.
Results
Sexual dysfunction among psychiatric patients (51.2%) was significantly higher than among other medical patients (21%). Among the psychiatric patients, those with schizophrenia (75%) had the highest prevalence rate of sexual dysfunctions. The patients with bipolar disorders, depressive disorders, and anxiety disorders had the following rates respectively: 55%, 45%, and 30%. Among the other medical patients, those with the cardiac diseases (35%) had the highest prevalence rate of sexual dysfunctions. The patients with hepatic diseases, diabetes, urologic diseases, and respiratory diseases had the following rates respectively: 25%, 20%, 15%, and 10%. Prolactin level among psychiatric patients was significantly higher than among the other medical patients, while there was no significant difference between the psychiatric and other medical patients regarding total testosterone level.
Conclusion
Considering the significant relative frequency of sexual dysfunctions in psychiatric patients, more emphasis is recommended to be placed on the prevention and proper treatment of these disorders.
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Derogatis LR, Revicki DA, Clayton AH. Instruments for Screening, Diagnosis, and Management of Patients with Generalized Acquired Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt) 2020; 29:806-814. [PMID: 32096691 DOI: 10.1089/jwh.2019.7917] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Screening, diagnosis, and management of hypoactive sexual desire disorder (HSDD) and research into the condition have been challenging due to its biopsychosocial complexity and lack of consensus on relevant measures. Although physician interviews yield much clinically valid information, self-reported questionnaires appear more acceptable to patients and physicians. Consequently, validated patient-reported outcome (PRO) tools are essential for evaluation and management of HSDD, including any therapeutic intervention. The US Food and Drug Administration (FDA) has issued guidance on the use of appropriate endpoints and associated measures for female sexual dysfunction, including HSDD. Although many of the available measures were not designed specifically for HSDD assessment, as per FDA guidelines, most clinical studies have used individual domains or items from established tools, such as the Female Sexual Function Index-desire domain and Item 13 of the revised Female Sexual Distress Scale. For clinical practice, several professional societies recommend the Decreased Sexual Desire Screener and/or a sexual history as tools to diagnose HSDD. This review discusses frequently used PRO tools as well as the newly developed and validated Elements of Desire Questionnaire, which may be appropriate for clinical trials or clinical practice.
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Affiliation(s)
| | | | - Anita H Clayton
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, Virginia
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7
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Sexual dysfunction during treatment of major depressive disorder with vilazodone, citalopram, or placebo: results from a phase IV clinical trial. Int Clin Psychopharmacol 2015; 30:216-23. [PMID: 26039688 PMCID: PMC4457500 DOI: 10.1097/yic.0000000000000075] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sexual dysfunction commonly occurs with major depressive disorder (MDD). Vilazodone, a selective serotonin reuptake inhibitor and 5-HT1A receptor partial agonist antidepressant approved for the treatment of MDD in adults, was evaluated to determine its effects on sexual function. The primary study was a double-blind, randomized, controlled trial comparing vilazodone 20 and 40 mg/day with placebo; citalopram 40 mg/day was an active control (NCT01473381; http://www.clinicaltrials.gov). Post-hoc analyses evaluated change from baseline to week 10 on the Changes in Sexual Functioning Questionnaire (CSFQ); no inferential statistics were performed. CSFQ scores increased for women [1.2 (citalopram) to 3.0 (vilazodone 40 mg)] and men [1.2 (vilazodone 40 mg) to 3.5 (placebo)] in all treatment groups. Greater changes in CSFQ scores were seen in responders [women: 2.33 (citalopram) to 5.06 (vilazodone 40 mg); men: 2.26 (vilazodone 40 mg) to 4.35 (placebo)] versus nonresponders. CSFQ change from baseline was small for patients with normal baseline sexual function; in patients with baseline sexual dysfunction, CSFQ scores improved across groups [women: 2.35 (citalopram) to 4.52 (vilazodone 40 mg); men 2.83 (vilazodone 40 mg) to 6.43 (placebo)]. Across treatment groups, baseline sexual function improved in women and men, MDD responders, and patients with baseline sexual dysfunction.
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Bijlsma EY, Chan JSW, Olivier B, Veening JG, Millan MJ, Waldinger MD, Oosting RS. Sexual side effects of serotonergic antidepressants: mediated by inhibition of serotonin on central dopamine release? Pharmacol Biochem Behav 2013; 121:88-101. [PMID: 24128918 DOI: 10.1016/j.pbb.2013.10.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 10/04/2013] [Indexed: 01/26/2023]
Abstract
Antidepressant-induced sexual dysfunction adversely affects the quality of life of antidepressant users and reduces compliance with treatment. Animal models provide an instructive approach for examining potential sexual side effects of novel drugs. This review discusses the stability and reproducibility of our standardized test procedure that assesses the acute, subchronic and chronic effects of psychoactive compounds in a 30 minute mating test. In addition, we present an overview of the effects of several different (putative) antidepressants on male rat sexual behavior, as tested in our standardized test procedure. By comparing the effects of these mechanistically distinct antidepressants (paroxetine, venlafaxine, bupropion, buspirone, DOV 216,303 and S32006), this review discusses the putative mechanism underlying sexual side effects of antidepressants and their normalization. This review shows that sexual behavior is mainly inhibited by antidepressants that increase serotonin neurotransmission via blockade of serotonin transporters, while those that mainly increase the levels of dopamine and noradrenaline are devoid of sexual side effects. Those sexual disturbances cannot be normalized by simultaneously increasing noradrenaline neurotransmission, but are normalized by increasing both noradrenaline and dopamine neurotransmission. Therefore, it is hypothesized that the sexual side effects of selective serotonin reuptake inhibitors may be mediated by their inhibitory effects on dopamine signaling in sex brain circuits. Clinical development of novel antidepressants should therefore focus on compounds that simultaneously increase both serotonin and dopamine signaling.
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Affiliation(s)
- Elisabeth Y Bijlsma
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands
| | - Johnny S W Chan
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands
| | - Berend Olivier
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands
| | - Jan G Veening
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands; Department of Anatomy, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Mark J Millan
- Institut de Recherches Servier, Psychopharmacology Department, 125 Chemin de Ronde, 78290 Croissy-sur-Seine, France
| | - Marcel D Waldinger
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands
| | - Ronald S Oosting
- Utrecht Institute for Pharmaceutical Sciences and Rudolf Magnus Institute of Neuroscience, Utrecht University, Universiteitsweg 99, 3584 CGUtrecht, The Netherlands
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Rico‐Villademoros F, Calandre EP, Rodríguez‐López CM, García‐Carrillo J, Ballesteros J, Hidalgo‐Tallón J, García‐Leiva JM. Sexual Functioning in Women and Men with Fibromyalgia. J Sex Med 2012; 9:542-9. [DOI: 10.1111/j.1743-6109.2011.02513.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Garcia-Portilla MP, Saiz PA, Fonseca E, Al-Halabi S, Bobes-Bascaran MT, Arrojo M, Benabarre A, Goikolea JM, Sanchez E, Sarramea F, Bobes J. Psychometric Properties of the Spanish Version of the Changes in Sexual Functioning Questionnaire Short-Form (CSFQ-14) in Patients with Severe Mental Disorders. J Sex Med 2011; 8:1371-82. [DOI: 10.1111/j.1743-6109.2010.02043.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Psychometric Properties of the Spanish Version of the Changes in Sexual Functioning Questionnaire-Short-Form (CSFQ-14) in a Sample of Males with Drug Abuse History. SEXUALITY AND DISABILITY 2010. [DOI: 10.1007/s11195-010-9146-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gómez Veiga F, José Olmo Cozar M, Günthner S, Puyol Pallas M, Silmi Moyano Á, Baró Ramos E, Francisco Rebollo J. Desarrollo y validación del primer cuestionario español de calidad de vida en pacientes con cáncer de próstata, basado en la percepción del paciente. Actas Urol Esp 2009; 33:623-34. [DOI: 10.1016/s0210-4806(09)74200-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gil-Nagel A, López-Muñoz F, Serratosa JM, Moncada I, García-García P, Alamo C. Effect of lamotrigine on sexual function in patients with epilepsy. Seizure 2006; 15:142-9. [PMID: 16434217 DOI: 10.1016/j.seizure.2005.12.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2005] [Revised: 12/04/2005] [Accepted: 12/12/2005] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To assess the course of sexual function in epilepsy patients treated with lamotrigine. MATERIAL AND METHODS This open study included 141 patients treated with lamotrigine for a period of 8 months: 79 patients initiated treatment with lamotrigine monotherapy, and 62 were switched to lamotrigine because of lack of efficacy or adverse events to a previous antiepileptic drug (AED). Patients were assessed at baseline and after 4 and 8 months of treatment. In the baseline and final visits the Changes in Sexual Functioning Questionnaire (CSFQ) was applied. Analysis was performed in an intent-to-treat population. RESULTS In women who started treatment with lamotrigine, a significant improvement was observed, both in total CSFQ score (increase of 5.39 +/- 6.95 points; p < 0.05), and in the five dimensions of the scale (desire/frequency, desire/interest, pleasure, arousal/excitement and orgasm). In men, a significant improvement was only observed in the pleasure dimension. In the group of patients in whom a previous AED was substituted by lamotrigine, significant improvement was recorded in the dimensions of pleasure and orgasm in men and desire/frequency in women, whilst in women the desire/interest dimension showed a decrease. CONCLUSIONS In this observational study, an improvement in sexual dysfunction was observed in association with lamotrigine. This could have been the result of improvement of the epilepsy, changes in quality of life, elimination of side effects from other AEDs, or a mood-stabilizing effect of lamotrigine.
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Affiliation(s)
- A Gil-Nagel
- Epilepsy Program, Neurology Department, Ruber International Hospital, La Masó 38, 28034 Madrid, Spain.
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Nappi R, Salonia A, Traish AM, van Lunsen RHW, Vardi Y, Kodiglu A, Goldstein I. ORIGINAL RESEARCH—PATHOPHYSIOLOGY: Clinical Biologic Pathophysiologies of Women's Sexual Dysfunction. J Sex Med 2005; 2:4-25. [PMID: 16422901 DOI: 10.1111/j.1743-6109.2005.20102.x] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Data concerning the biologic pathophysiology of desire, arousal, and orgasm in women are limited. AIM To gain knowledge of biologic pathophysiology of female sexual function. METHODS. To provide state-of-the-art knowledge concerning female sexual dysfunction, representing the opinions of seven experts from five countries developed in a consensus process over a 2-year period. MAIN OUTCOME MEASURE An International Consultation in alliance with key urological and sexual medicine societies convened over 200 multidisciplinary specialists from 60 countries into 17 consultation committees. The aims, goals and intentions of each committee were defined. Expert opinion was based on grading of evidence-based medical literature, extensive internal committee dialogue, open presentation, and debate. RESULTS Three critical physiologic requirements, including intact sex steroids, autonomic/somatic nerves, and arterial inflow/perfusion pressure to women's genital organs play fundamental roles in maintaining women's sexual function. Despite this, there are nominal data supporting a direct pathophysiologic involvement of abnormal sex steroid values, and/or damage/injury to neurologic and/or blood flow integrity in women with problems in sexual desire, arousal, and/or orgasm. This summary details the available literature concerning hormonal, neurologic, and vascular organic pathophysiologies of women's sexual dysfunctions. CONCLUSIONS Additional research on clinical pathophysiologies in women's sexual dysfunction is needed. This chapter encompasses data presented at the 2nd International Consultation on Sexual Medicine in Paris, France, June 28-July 1, 2003.
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Farre JM, Fora F, Lasheras MG. Specific aspects of erectile dysfunction in psychiatry. Int J Impot Res 2004; 16 Suppl 2:S46-9. [PMID: 15496858 DOI: 10.1038/sj.ijir.3901243] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The participation of the psychiatrist in the management of erectile dysfunction (ED) is focused on three types of patients based on the origin of the dysfunction: (1) patients with functional or psychogenic ED, (2) patients with mixed, organic psychogenic ED, and (3) patients with ED and active psychopathology. The second group is influenced by three psychological factors: perpetuating factors, aggravating factors, and accompanying factors. The main psychopathological disorders that interfere directly with the erectile mechanism are depressive disorders (18-35%), anxiety disorders (37%), obsessive-compulsive disorder, psychotic disorders (46-47%), and the antipsychotic medications used to treat these disorders. The diagnostic proposal includes psychological and sexologic evaluation and differential diagnosis. The therapeutic proposal includes the basic principles of sex therapy in the model of behavioral-cognitive therapy (eg, prohibition of intercourse, sensate focus, voluntary loss of erections, no expectations about response), pharmacological therapy (eg, sildenafil, intracavernous injection of vasoactive drugs), and a combination of both therapies.
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