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: 

1. Dose reduction or abstinence  
2. Switching to a prolactin sparing antipsychotic example Aripiprazole, Olanzapine and Quetiapine 
3. Augmenting with Aripiprazole. 
4. Adding Phosphodiesterase inhibitors specifically to treat Ed, PDE-5 inhibitors like Sildenafil can be used. 
5.  Androgen therapy for male and female. 
6. Bupropion and some second-generation antipsychotics. 
7. Testosterone replacement and low  hepatic impact medications, H1 receptor antagonism with allergic  antihistamine use improves ED. 
8. Alprostadil and injectable medications Edex, MUSE and Brevital. 
9. Anti-depressants can be used for treating phobic sex. 
10. Trazodone can be used to increase nocturnal erections (Razdan et al., 2017). 

Psychotherapy 

1. Dual-sex therapy 
2. Hypnotherapy 
3. Behavior therapy 
4.  Mindfulness in cognitive technique 
5. Group therapy 
6. Specific techniques and exercises 
7. Analytically oriented sex therapy (Sadock et al., 2014) 

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/