Sexual & Sexuality

What's new in sleep medicine? The latest developments in both new and novel approaches to treating sleep disorders.

Depression is a frequent psychiatric comorbidity among patients with restless leg syndrome. The case presented here illustrates the importance of evaluating for RLS symptoms in patients with major depressive disorder who complain of insomnia.

Sexual compulsivity and sexual addiction predominantly afflict men. Clinicians need to have a higher index of suspicion for sexual impulsivity in some patients.

Cases that come to our attention as malpractice claims, ethics claims, or Board of Registration complaints raise the question: why did the treating clinician not terminate the treatment before things got so out of hand?

Sleep changes associated with psychotropic drugs are common enough to justify routinely obtaining a baseline sleep diary before beginning treatment, even when the initial screening for sleep disorders indicates that no further investigation is needed.

Charles Dickens might well say of American psychiatry, “These are the best of times and the worst of times.”

In this guest blog, Dr Deirdre D'Orazio responds to a recent commentary by Dr Allen Frances on conducting evaluations of potential sexually violent predators.

Here, Mr Hazelwood answers questions about serial murderers that are commonly posed to him. The term serial murderer (or serial killer) was not even a part of the forensic lexicon until the 1970s . . .

Accurate diagnosis is absolutely crucial in SVP hearings because the potential outcome is so consequential-involuntary incarceration in a psychiatric hospital that may well last a lifetime. In no other clinical or forensic situation does so much ride on the presence or absence of a psychiatric diagnosis.

Terrence Malick’s The Tree of Life is not easy entertainment, but for psychiatrists who might welcome an encounter with a brilliant, uncompromising mind, The Tree of Life is enthralling.

During the past year, I have been involved as an expert witness for the defense in 14 SVP cases (tried in California, Washington, and Iowa). My role has been to clarify what is meant by the wording of the Paraphilia section in DSM-IV. And it certainly does badly need explaining.

Rape is always a heinous, ugly, violent, and cruel crime. But the violence and cruelty that are part of all rapes should not be confused with the specifically motivated violence and cruelty that distinguish sexual sadism...

Ray Moynihan (who previously gave us the invaluable book "Selling Sickness: How Drug Companies are Turning us All Into Patients") has published a new expose titled "Sex, Lies, and Pharmaceuticals."

This 3-part manual on sexual disorders is edited by 2 psychiatrists who have been engaged for more than 20 years in clinical treatment of patients with sexual problems.

Which antidepressants are associated with the highest rates of sexual dysfunction in patients treated for depression? This and more in this week's quiz.

A small percentage of educators use their position of power to sexually exploit their students. While it is assumed that men are often responsible for this type of behavior, in recent years, a number of high-profile cases of female educator sexual misconduct have been covered by the media.

Consider the predicament of Mrs M, a 38-year-old premenopausal mother of two. Mrs M tells her primary care physician, “I just don’t have a strong desire for sex. It’s been about 10 years now, and I hardly ever have sexual thoughts or fantasies.

Individuals with a past history of chronic psychiatric illness are often given poor prognoses that can limit their therapeutic horizons for further treatment. This pessimism may be misplaced as is demonstrated by the case of Jay, age 71, and Kay, age 65. The couple presented at the Loyola Sexual Dysfunction Clinic in a program consisting of 7 weekly sessions of 5 hours each with 2 trainee therapists.

A documentary, “Hitler’s Children,” now in the works, may be of considerable interest to psychiatrists.

In August, the American Psychological Association Task Force on Appropriate Therapeutic Responses to Sexual Orientation released a report based on its systematic review of research on the effectiveness of sexual orientation change efforts.1

Restless legs syndrome (RLS) is a neurosensory disorder first described by Sir Thomas Willis in 1672. As early as the 19th century, Theodor Wittmaack observed the comorbidity of RLS with depression and anxiety. He termed this condition “anxietas tibiarum” and believed it to be a form of hysteria.

Historically, borderline patients were considered “help-rejecting complainers.” Clinicians should actively treat both mood/anxiety symptoms and BPD symptoms.

From time to time, health conditions emerge that are relative “orphans” when it comes to having the resources of a health care discipline or subspecialty to take ownership or accept responsibility for developing the body of knowledge that underlies their systematic evaluation and treatment. Female sexual dysfunction (FSD) is such a class of conditions.

Sildenafil (Viagra, Revatio) reduced antidepressant-associated sexual dysfunction in wom­en in a randomized controlled trial, which investigators characterize as the first conducted in women with this adverse drug effect.

In the Valley of Elah is an improvised explosive device that writer-director Paul Haggis has set to go off in the hearts and minds of Americans who still support the war in Iraq. Haggis, who earned an Oscar (Best Picture and Screenplay) for Crash, has aimed his second film at the hardworking, churchgoing, flag-flying, decent Americans who cannot imagine that the country they love would engage in an unjust war.

"I've lost my interest in sex." As psychiatrists, we hear this concern (if we ask) from women in a variety of situations: those who are depressed, postpartum, menopausal, traumatized, and those who have been treated with psychotropic medications. Thankfully, we have many interventions, both behavioral and pharmacological, to use in addressing sexual issues.

A variety of conditions may account for the sleep difficulties experienced by many older adults, including specific sleep disorders, circadian rhythm disturbances, and medical and psychiatric comorbidities.

In my work in sexual boundary violations, now spanning almost 25 years, there are 2 things that have not changed. One is the prevalence or the frequency of at least one type of sexual boundary transgression.

When I finished reading "Sexual Offenders With Mental Issues: Special Considerations for a Special Population," Psychiatric Times, September 2007) I could hardly believe that Dr Rotter had not mentioned genetics!

Paraphilias and paraphilia-related disorders (nonparaphilic sexual compulsivity or sexual addiction) are sexual disorders that predominantly afflict men.