Respond to your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.
NOTE: Positive comment (bellow is attached the sleep disorder assigned to me)
Main Post
Substance /Medication Induced Sexual Dysfunction (SMISD)
The purpose of this discussion is to explain the diagnostic criteria for SMISD, and evidence-based psychotherapy and psychopharmacological
treatment for SMISD. I will be supporting these treatments and diagnostic criteria with learning course resources and other academic resources. The
diagnosis of SMISD is when there is evidence of substance intoxication or withdrawal that is apparent from the history physical examination or laboratory
results. The sexual dysfunction SMISD occurs soon after significant substance intoxication or withdrawal, or after exposure to a medication or a change in
medication use. Some examples of substances and medications that cause SMISD are alcohol amphetamines or related substances, cocaine, opioids,
sedatives-hypnotics, anxiolytics, and other known or unknown substances (Sadock et al., 2014). Almost every pharmacological agent, especially those in the
psychiatry field have been associated with an effect on sexuality. In men these effects include low sex drive, erectile failure, low volume of ejaculate, and
delayed or retrograde ejaculation. In women there is decreased sex drive, decreased vaginal lubrication, inhibited, or delayed orgasm and decreased or
absent vaginal contractions may occur. Drugs may also enhance the sexual responses and increase the sex drive, but this is less common than adverse
effects (Sadock et al., 2014).
Diagnostic criteria
The diagnostic criteria for SMISD requires that a significant disturbance in sexual function is predominant in the clinical picture. There SMISD must be
evident from the history, physical examination, or laboratory findings of a significant sexual dysfunction during or soon after substance intoxication or
withdrawal or after exposure to her medication. The involved medication can produce sexual dysfunction symptoms. In addition, the dysfunction must not
be a result of another dysfunction that is not drug- induced must not occur during delirium and must cause clinically significant distress in the client
(Association, 2015).
Psychopharmacology and Psychotherapy for SMISD
SMISD can be treated by pharmacologic or psychotherapy or both. Some classes of medication that can cause sexual dysfunction antipsychotics. The
prevalence of low libido and problems with orgasm in patients treated with antipsychotics regardless of sex is 54.2% and 41.7% respectively. A widely
accepted mechanism underlying antipsychotic associated sexual dysfunction is dopamine D2 receptor antagonism. This causes high prolactin levels, which
can subsequently lead to a variety of sexual problems including erectile dysfunction, ejaculatory disturbances and gynecomastia in men, amenorrhea, and
vaginal dryness in woman. Also, low libido, anorgasmia, and galactorrhea in both sexes. Some other medications that cause sexual dysfunction are
antipsychotics, antiparkinsonian drugs, anticholinergics, antiepileptics, muscle relaxants, cannabis, opioids and anti-anxiety drugs (Downing et al., 2019).
Psychopharmacological treatments:
Psychotherapy
Conclusion
Clinicians need to be more vigilant about antipsychotic- associated sexual dysfunction and available treatment options, because these adverse effects
can affect a patient’s quality of life and adherence to anti-psychotic medication (Downing et al., 2019). Maintaining good sexual health and function is
especially important in these patients to help improve their mood, quality of life and medication compliance. The specific aspect of sexual function that is
affected by psychiatric drugs is often ambiguous when described in current literature. Broad questionnaires like the Arizona Sexual Experience Scale can be
used to evaluate many components of sexual health (Razdan et al., 2017).
References
Association, A. P. (2015). Dsm-5® (5th ed.). American Psychiatric Association.
Downing, L., Kim, D. D., Procyshyn, R. M., & Tibbo, P. (2019). Management of sexual adverse
effects induced by atypical antipsychotic medication. Journal of Psychiatry and
Neuroscience, 44(4), 287–288.
https://doi.org/10.1503/jpn.190053
Razdan, S., Greer, A. B., Patel, A., Alameddine, M., Jue, J. S., & Ramasamy, R. (2017). Effect
of prescription medications on erectile dysfunction. Postgraduate Medical Journal,
94(1109), 171–178.
https://doi.org/10.1136/postgradmedj-2017-135233
Sadock, B. J., Sadock, V. A., & Pedro, R. M. (2014). Kaplan and sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Lww.
Running head: DISCUSSION 1
DISCUSSION 1
Discussion
Student’s Name
Institution
Course
Date
Sexual Dysfunctions
The focus of this discussion shall be a sexual dysfunction. According to the Diagnostic and Statistical Manual of Mental Disorders, sexual dysfunctions are basically a heterogenous group of disorders that are characterized by clinically significant disturbance in the ability of an individual to respond sexually or even to experience sexual pleasure (APA, 2013). Sexual expression as well as sexual health are very important aspects of a life of any individual. In fact, it is without a doubt that scholars now recognize sexual health and sexual expression as important aspects of quality of life as well as well-being of an individual (Gore-Gorszewska, 2020). Therefore, it is important to say that when an individual is suffering from a particular sexual dysfunction, their quality of life is significantly affected and they need an evidence-based intervention in order to improve on their wellness. The sexual dysfunction that shall be discussed is erectile disorder. Once the diagnostic criteria have been presented, the available evidence-based psychotherapeutic and psychopharmacological interventions for the disorder shall be discussed.
In order to diagnose erectile disorder, the client should either complain of marked difficulty in obtaining an erection during sexual activity, difficulty in maintaining an erection from the start to the completion of the sexual activity or significant decrease in erectile rigidity. The client can complain about at least one of these symptoms. These difficulties need to have been experienced in at least 75% of all occasions. This should either be in an identified situation or a generalized context. The complaint should have persisted for at least 6 months and should have caused significant clinical distress to the individual. It is very important to rule out other causes of the erectile disorder such as other mental health illnesses, relationship distress as well as other stressors. There is also need to make sure that the difficulties as elaborates are not caused by the use of alcohol or other drugs and substances (APA, 2013).
It is important to specify whether the disturbance has been lifelong, since the client started being sexually active or acquired, meaning that the client had a period of normalcy in as far as their sexual activities are concerned. The context is also very important. It could be generalized, meaning that the problem is not specific to a stimulation, a situation or a partner. The opposite is that it may be situational such as when the problem is limited to a particular partner. In addition, the erectile dysfunction is mild, moderate or severe depending on the level of distress caused by the disturbance as already described (APA, 2013). In diagnosing the problem, some health providers require that tests should be done such as morning testosterone assay especially if it is suspected that the cause is hypogonadism (Sooriyamoorthy & Leslie, 2020).
Evidence-Based Treatment
Treatment for erectile disorder can be implemented in different ways. When psychotherapy is chosen, the use of cognitive behavioral sex therapy has been proven to have promising results especially in young men that have nonorganic erectile dysfunction (Bilal, 2020). The psychopharmacological intervention that ha been proved to be effective is an antidepressant. This is Bupropion. In fact, it helps in cases that include erectile dysfunction that is caused by other antidepressants (Razaei et al., 2018). Most medications that are used may not be psychopharmacological agents. It is always important to understand the cause for the erectile disorder before selecting the best choice that is evidence-based and acceptable to the patient.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.
Bilal, A. (2020). Cognitive Behavioral Sex Therapy: An Emerging Treatment Option for Nonorganic Erectile Dysfunction in Young Men: A Feasibility Pilot Study. Sexual Medicine, 8(3), 396-407
Gore-Gorszewska, G. (2020). “Why not ask the doctor?” Barriers in help-seeking for sexual problems among older adults in Poland. International journal of public health, 65(8), 1507-1515
Rezaei, O., Fadai, F., Sayadnasiri, M., Palizvan, M. A., Armoon, B., & Noroozi, M. (2018). The effect of bupropion on sexual function in patients with Schizophrenia: A randomized clinical trial. The European Journal of Psychiatry, 32(1), 11-15.
Sooriyamoorthy, T., & Leslie, S. W. (2020). Erectile Dysfunction (Impotence). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562253/
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