[Interplay between depression and sexuality]

BACKGROUND

Disorders of sexual function are a frequent comorbidity of depression and have complex interactions on psychological, sexual and relationship qualities.

OBJECTIVE

To determine the prevalence of sexual functional disorders in depressed patients, the effects of antidepressant drugs and development of treatment recommendations.

MATERIAL AND METHOD

Evaluation of the current literature and discussion of fundamental studies.

RESULTS

Depression and sexual dysfunction frequently affect each other in complex ways which makes it important to address interpersonal relationship dynamics and to include these in the therapy. The use of serotonergic antidepressants can greatly increase the risk for sexual dysfunction by up to 27 times. In addition to (couples) therapeutic interventions, reducing the dose or switching medications to, e.g., bupropion or using additive medications can also be treatment options.

CONCLUSION

Despite the shame associated with the topic, it is crucial for therapists to address sexual topics early and openly. Relationship dynamics should be considered during therapy. If antidepressant medications are used it is recommended to provide a more detailed clarification for patients about their potential sexual side effects and their limited treatment options before starting the medication.

Sexual symptoms in post-traumatic stress disorder following childhood sexual abuse: a network analysis

BACKGROUND

Even though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse.

METHODS

Post-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization.

RESULTS

A total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms.

CONCLUSIONS

Sexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

Factors Associated with Sexual Satisfaction among Veterans Who Have Experienced Military Sexual Trauma

Veterans who have experienced military sexual trauma (MST) report lower sexual satisfaction than veterans without a history of MST. The current study examined the relationship between demographic, physical health, mental health, and trauma variables and sexual satisfaction among a national sample of U.S. veterans who endorsed MST. Results demonstrated that lower sexual satisfaction was associated with uncoupled relationship status, poor physical health, and symptoms of depression, post-traumatic stress disorder, and sexual dysfunction among male and female veterans. Several additional factors were related to lower sexual satisfaction among female veterans. Findings highlight the importance of gender-targeted assessment, prevention, and treatment of sexual satisfaction problems.

Effects of the Thai Health Improvement Profile intervention on the physical health and health behaviours of people with schizophrenia: A quasi-experimental study

Physical health problems and unhealthy lifestyle behaviours are common in people with severe mental illness (SMI), leading to high levels of mortality.There is some evidence that nurse-led interventions involving comprehensive health checks may be effective in improving physical health in people with SMI. This quasi-experimental before-and-after study investigated the impacts of the Thai Health Improvement Profile (HIP-T) on the physical health and health behaviours of people with schizophrenia over 1-year. All 105 service-users who volunteered to participate completed the study. There were significant reductions in mean BMI (-0.78 kg/m² , P < .001) and bodyweight (-1.13 kg, P < .001) at post-test. There was also a significant decrease in the total number of "red-flagged" HIP-T items, suggesting lowered potential health risks (P < .001). Overall, 23 patients (22%) were found to have moved to a healthier BMI classification after 1-year. The findings suggest that the HIP-T intervention has potential for improving the physical health of people with SMI when integrated into routine community mental health care.

Coming In: Queer Narratives of Sexual Self-Discovery

Many models of queer sexuality continue to depict a linear narrative of sexual development, beginning in repression/concealment and eventuating in coming out. The present study sought to challenge this by engaging in a hermeneutically informed thematic analysis of interviews with eight queer people living in Western Australia. Four themes were identified: "searching for identity," "society, stigma, and self," "sexual self-discovery," and "coming in." Interviewees discussed internalized homophobia and its impact on their life; experiences and implications of finding a community and achieving a sense of belonging; the concept of sexual self-discovery being a lifelong process; and sexuality as fluid, dynamic, and situational rather than static. The article concludes by suggesting that the idea of "coming in"-arriving at a place of acceptance of one's sexuality, regardless of its fluidity or how it is viewed by society-offers considerable analytic leverage for understanding the journeys of sexual self-discovery of queer-identified people.

[Sexual dysfunction associated with psychotropic drugs and treatment options]

BACKGROUND

Sexual dysfunction associated with psychotropic drugs is a threat to patient quality of life and a major reason for non-compliance. Psychotropic agents can impair the sexual response in different ways due to their neurobiological mode of action.

OBJECTIVE

Presentation of the frequencies of sexual functional disorders for selected psychopharmacological groups and the available treatment modalities.

METHODS

Literature search, selection and review of relevant studies.

RESULTS

The most relevant groups for impairments are antidepressants and antipsychotics due to the serotonin agonistic and anti-dopaminergic properties as well as the prolactin increasing characteristics. Agents with a favorable side effects profile are now available. All phases of the sexual response are affected.

DISCUSSION

The treatment of psychiatric disorders should follow a comprehensive treatment plan that anticipates a likely sexual dysfunction at the initiation of treatment. The main aim is improvement of the underlying primary disorder. Some limited evidence-based treatment strategies are available.

Perspectives on Sexual Health and Function of Recent Male Combat Veterans of Iraq and Afghanistan

Background

U.S. veterans of recent wars in Iraq and Afghanistan may be at greater risk for sexual dysfunction due to injuries, mental health conditions, medications used to treat those conditions, and psychosocial factors.

Objective

To explore the perceptions of recent Veterans about sexual health and dysfunction, contributing factors, its impact and solutions.

Design

Qualitative study.

Participants

Eight men who screened positive for sexual dysfunction at initial presentation to a postdeployment clinic at a Veterans Affairs medical center

Approach

Patients who screened positive for sexual dysfunction and indicated an interest in participating were contacted and scheduled for an in-person private interview with a researcher. Interviews were semistructured, utilizing open-ended and follow-up probe questions to elicit the individual's perspective about sexual dysfunction and its cause, impact and solutions. Interviews were recorded, transcribed and analyzed for themes.

Key Results

These heterosexual men discussed a range of sexual dysfunction in their activities including lack of desire, erectile dysfunction, delayed orgasm, premature ejaculation, and distraction. They also discussed the importance of setting or context and changes over time to their sexual health and function. The men shared their ideas about contributory factors, including normal aging, medication side effects, injury and a possible role for combat deployment more generally. Reported solutions for sexual dysfunction included medications, herbal remedies, and new positions and approaches to sexual activity. Participants reported discussing sexual dysfunction with their health-care providers and what was helpful. Finally, the men expressed in their own words the significant impact of sexual dysfunction on their self-perception, their partners, and their relationships.

Conclusions

Sexual dysfunction in recent combat veterans can have important negative effects on their health and relationships. Our findings elucidate perceived contributory factors and preferred solutions, which can be applied by health-care providers to improve the management of sexual dysfunction in these patients.

Sexual dysfunctions in schizophrenia: Professionals and patients perspectives

BACKGROUND

Sexual dysfunction (SD) is not commonly reported by persons with schizophrenia unless an enquiry is made by a doctor or staff during routine clinical visits.

MATERIALS AND METHODS

A cross-sectional study was carried out to determine reporting of drug-induced sexual side-effects and the attitude of the treating team in clarifying or detecting this issue.

RESULTS

A vast majority of professionals (73.2%) did not enquire about SDs in routine clinical setting and admitted that they lack expertise based on the Attitude Survey Questionnaire. More than one-third of the patients (35.3%) attributed sexual side-effects to medications. Many patients (91.7%) reported good to fair tolerance to sexual side-effects according to the Psychotropic Related Sexual Dysfunction Questionnaire.

CONCLUSION

The treating team plays a crucial role. Sexual side-effects are often under-reported and need to be addressed by the treating physician.

Sexual dysfunction associated with second-generation antidepressants in patients with major depressive disorder: results from a systematic review with network meta-analysis

BACKGROUND

Sexual dysfunction (SD) is prevalent in patients with major depressive disorder (MDD) and is also associated with second-generation antidepressants (SGADs) that are commonly used to treat the condition. Evidence indicates under-reporting of SD in efficacy studies. SD associated with antidepressant treatment is a serious side effect that may lead to early termination of treatment and worsening of quality of life.

OBJECTIVES

Our objective was to systematically assess the harms of SD associated with SGADs in adult patients with MDD by drug type.

METHODS

We retrieved English-language abstracts from PubMed, EMBASE, the Cochrane Library, PsycINFO, and International Pharmaceutical Abstracts from 1980 to October 2012 as well as from reference lists of pertinent review articles and grey literature searches. Two independent reviewers identified randomized controlled trials (RCTs) of at least 6 weeks' duration and observational studies with at least 1,000 participants.

STUDY SELECTION

Reviewers abstracted data on study design, conduct, participants, interventions, outcomes and method of SD ascertainment, and rated risk of bias. A senior reviewer checked and confirmed extracted data and risk-of-bias ratings.

ANALYSES

Random effects network meta-analysis using Bayesian methods for data from head-to-head trials and placebo-controlled comparisons; descriptive analyses calculating weighted mean rates from individual trials and observational studies.

RESULTS/SYNTHESIS

Data from 63 studies of low and moderate risk of bias (58 RCTs, five observational studies) with more than 26,000 patients treated with SGADs were included. Based on network meta-analyses of 66 pairwise comparisons from 37 RCTs, most comparisons showed a similar risk of SD among included SGADs. However, credible intervals were wide and included differences that would be considered clinically relevant. We observed three main patterns: bupropion had a statistically significantly lower risk of SD than some other SGADs, and both escitalopram and paroxetine showed a statistically significantly higher risk of SD than some other SGADs. We found reporting of harms related to SD inconsistent and insufficient in some trials.

LIMITATIONS

Most trials were conducted in highly selected populations. Search was restricted to English-language only.

CONCLUSION AND IMPLICATIONS

Because of the indirect nature of the comparisons, the often wide credible intervals, and the high variation in magnitude of outcome, we rated the overall strength of evidence with respect to our findings as low. The current degree of evidence does not allow a precise estimate of comparative risk of SD associated with a specific antidepressant. In the absence of such evidence, clinicians need to be aware of SD as a common adverse event and should discuss patients' preferences before initiating antidepressant therapy.

Women's experiences of coping with the sexual side effects of antidepressant medication

A growing body of evidence has highlighted the sexual side effects of selective serotonin reuptake inhibitor (SSRI) medication. Whilst most of the research has focused on the prevalence and treatment of sexual difficulties, little is known about how patients cope with the SSRI-related sexual side effects. The objective of this study was to explore women's experiences of coping with the sexual side effects of SSRI medication and interpretative phenomenological analysis was employed for an in-depth exploratory study of a sample of 10 women. Four broad themes emerged which are discussed under the following headings: searching, suffering in silence, trying to resolve and accepting what is. The themes provide an insight into the different strategies used by women to cope with the sexual side effects of SSRI medication and highlight the importance of contextualising these difficulties as part of an overall approach to improve the management and treatment of SSRI-related sexual side effects.

Sexual dysfunction among male veterans returning from Iraq and Afghanistan: prevalence and correlates

INTRODUCTION

Sexual dysfunction (SD) is not well described in the Iraq/Afghanistan veteran population despite high prevalence of multiple risk factors for this issue.

AIM

To estimate the prevalence and examine the association of various sociodemographic, mental health, comorbid conditions and life style factors with sexual dysfunction in Iraq/Afghanistan veterans.

METHODS

This exploratory cross-sectional study was conducted using data from the VA administrative database. A total of 4,755 Iraq/Afghanistan veterans were identified who sought treatment from the Michael E. DeBakey Veterans Affairs Medical Center inpatient and outpatient clinic between September 2007 and August 2009.

MAIN OUTCOME MEASURES

Sexual dysfunction was determined by ICD9-CM codes related to sexual health issues and/or by specific medications, primarily phosphodiesterase-5 inhibitors (PDE5i), prescribed for erectile dysfunction.

RESULTS

The overall prevalence of sexual dysfunction was 5.5% (N = 265). By age category, it was 3.6% (N = 145) for Iraq/Afghanistan veterans aged 18-40 years and 15.7% (N = 120) for Iraq/Afghanistan veterans aged > 40 years, respectively. A multivariate logistic-regression model revealed that annual income, marital status, post-traumatic stress disorder, and hypertension were significant risk factors of SD (all P < 0.05) among younger Iraq/Afghanistan veterans, whereas among the older Iraq/Afghanistan veterans, being African American and having PTSD and hypertension were significant risk factors of SD (all P < 0.05). There was marked discrepancy between documented erectile dysfunction and prescription of a PDE5i.

CONCLUSIONS

These data demonstrate that a significant proportion of Iraq/Afghanistan veterans have SD and that the risk factors differ between younger and older veterans. Our findings also suggest that SD is likely under-coded. To better identify the scope of the problem, systematic screening for sexual dysfunction may be appropriate perhaps as part of an initial post-deployment health evaluation.

Standard operating procedures for female orgasmic disorder: consensus of the International Society for Sexual Medicine

INTRODUCTION

As the field of sexual medicine evolves, it is important to continually improve patient care by developing contemporary "standard operating procedures" (SOPs), reflecting the consensus view of experts in sexual medicine. Few, if any, consensus SOPs have been developed for the diagnosis and treatment of Female Orgasmic Disorder (FOD).

AIM

The objective is to provide standard operating procedures for FOD.

METHODS

The SOP Committee was composed of a chair, selected by the International Society for the Study of Sexual Medicine, and two additional experts. To inform its key recommendations, the Committee used systematic reviews of available evidence and discussions during a group meeting, conference calls and e-mail communications. The Committee received no corporate funding or remuneration.

RESULTS

A total of 12 recommendations for the assessment and treatment of FOD were generated, including suggestions for further research.

CONCLUSIONS

Evidence-based, practice recommendations for the treatment of FOD are provided that will hopefully inform clinical decision making for those treating this common condition.

Management of ejaculatory disorders in infertile men

Ejaculatory dysfunction is a highly prevalent clinical condition that may be classified along a continuum that ranges from premature ejaculation (PE), through retarded or delayed ejaculation (DE), to complete anejaculation (AE). Retrograde ejaculation (RE) represents a distinct entity in which ejaculate is expelled either partially or completely into the bladder. While DE and PE are significant sources of sexual dissatisfaction among men and their partners, patients with these disorders retain normal fertility in most cases. Conversely, men with AE and RE are unable to deliver sperm into the female genital tract and are therefore rendered subfertile. Therefore, in reviewing ejaculatory disorders as they relate to fertility, this paper will primarily focus on the diagnosis and management of AE and RE. Physiology, diagnostic strategies, pharmacological treatments, and procedural interventions relevant to AE and RE are discussed.

[Sexual function in married women with rheumatoid arthritis]

OBJECTIVE

The aim of this study is to assess sexual functioning in a group of married women with rheumatoid arthritis using a self-questionnaire.

METHODS

This is a horizontal study for descriptive and analytical purposes. (between October and November 2010). Married women with a confirmed diagnosis of rheumatoid arthritis (RA), with no co morbidities that may affect sexual activity, were interviewed about their sexual functioning and their quality of life by a self report questionnaire.

RESULTS

A total of 10 patients who met the criteria have accepted to participate to the study. Their mean age was 42.5±5.8 years (32-50 years), their mean age at the marriage was 24.8±8.9 years (16-48 years). Six women thought that the disease had affected their sexual relationship and their sexual activity. Six patients reported a decrease in the frequency of intercourse since the onset of their disease. The reported mean age at the beginning of sexual (SD) dysfunction was 37.1±5.8 years (30-48 years). Six of the sample reported a diminished desire for a sexual relationship since the disease onset. The reasons were pain, physical disability and fatigue. The assessment of sexual functioning using the Female sexual function index (FSFI) showed a mean FSFI score at 19.2±9.8 (2-30) with seven women scoring in the range associated with clinical SD (<26). All the subscales were affected: desire, arousal, lubrication, orgasm and satisfaction. Our patients reported a mean total score on World Health Quality of Life-Brief Version (WHOQOL-brief) of 60 out of 120 indicating a moderate altered quality of life.

CONCLUSION

The prevalence of sexual dysfunction in women with RA is high when a specific questionnaire is used to assess it. The reasons for disturbed sexual functioning are multifactorial: impaired function, chronic pain and important fatigue.

Reconceptualizing medication adherence: six phases of dynamic adherence

Nonadherence is the Achilles' heel of effective psychiatric treatment. It affects the resolution of mental health symptoms and interferes with the assessment of treatment response. The meaning of the term adherence has evolved over time and is now associated with a variety of definitions and measurement methods. The result has been a poorly operationalized and nonstandardized term that is often interpreted differently by providers and patients. Drawing extensively from the literature, this article aims to (1) describe changes in the concept of adherence, drawing from the mental health treatment literature, (2) present a more comprehensive definition of adherence that recognizes the role of patient-provider transactions, (3) introduce dynamic adherence, a six-phase model, which incorporates the role of transactional processes and other factors that influence patients' adherence decisions, and (4) provide recommendations for providers to improve adherence as well as their relationships with patients.

A comparative study of the sexual function of institutionalized patients with schizophrenia

INTRODUCTION

Sexual dysfunction occurs frequently in patients with schizophrenia.

AIM

To assess the sexual function of institutionalized patients with schizophrenia and compare it to both that of noninstitutionalized schizophrenic patients as well as patients without any mental illness.

METHODS

A cross-sectional comparative analysis between three groups: Group A: 75 patients with schizophrenia and/or schizoaffective disorder according to the International Classification of Diseases, 10th Edition (ICD-10) criteria, admitted into public psychiatric residential facilities; Group B: 41 patients with the same diagnosis who live in the community; Group C: 152 patients with no mental illness attended to by a Primary Care Medical Center.

MAIN OUTCOME MEASURES

The Mini-International Neuropsychiatric Interview, Positive and Negative Syndrome Scale for Schizophrenia and Changes in Sexual Function Questionnaire were used to complete the study.

RESULTS

When institutionalized patients were compared to the control group, the impairment of sexual function was identified in all areas except Arousal in women and the percentage of dysfunction in Desire-Interest for both sexes. The results for noninstitutionalized schizophrenic males indicated a deficit in Pleasure and Orgasm and in Pleasure and Desire-Frequency for females, when compared with the control group. The overall subscale indicated that 71.2% of males and 57.1% of females in the institutionalized group experienced sexual dysfunction compared with 10% of males and 50% of females in the noninstitutionalized group, and only 12.7% of women in the control group.

CONCLUSIONS

Most areas of sexual function are impaired among patients with schizophrenia, especially among institutionalized patients. However, their percentage of sexual dysfunction associated with sexual thoughts or fantasies was similar to that of patients without mental illness.

Use of duloxetine in patients with an anxiety disorder, or with comorbid anxiety and major depressive disorder: a review of the literature

IMPORTANCE OF THE FIELD

Except for generalized anxiety disorder, few reports have been published on the efficacy, safety and tolerability of duloxetine in patients with anxiety disorders individually or in comorbidity with major depressive disorder (MDD).

AREAS COVERED IN THIS REVIEW

The literature search in Medline (dating back to 1966) and Embase (dating back to 1988) databases was conducted using the OVID interface on 9 April 2009, restricted to any article or abstract in English, per title, reporting any information on the use of duloxetine in patients with any anxiety disorder with or without concomitant MDD. A systematic review approach was taken.

WHAT THE READER WILL GAIN

The reader will gain knowledge of the current data available on the use of duloxetine to treat patients with anxiety disorders individually or in comorbidity with MDD.

TAKE HOME MESSAGE

Duloxetine could be considered an effective treatment option in the treatment of anxiety disorders individually or in comorbidity with each other, or with MDD; however, apart from the well-demonstrated efficacy, tolerability and safety of duloxetine in the treatment of MDD with or without anxiety and GAD, data on this subject are preliminary and very limited, and more research is warranted.