Psychiatry - Sexual disorders, psychotherapy

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  1. Sexual response cycle
    • 1. Desire: interest in sexual activity
    • 2. Excitement: fantasy or physical contact
    • 3. Plateau: increased size of testicles, tightening scrotal sac, secretion of seminal fluid; women experience contraction of the outer one third of vagina, enlargement of the upper one third of vagina
    • 4. Orgasm: Men ejaculate and women have contractions of the uterus and lower one third of the vagina
    • 5. Resolution: muscles relax; men have refractory period
  2. Testosterone
    promotes libido in both men and women
  3. Progesterone
    inhibits libido in both men and women by blocking androgen receptors; found in oral contraceptives, hormone replacement therapy, and treatments for prostate cancer
  4. Medications that can cause sexual dysfunction
    • antihypertensives
    • anticholinergics
    • antidepressants (SRIs)
    • antipsychotics (block dopamine)
  5. Dopamine
    enhances libido
  6. Serotonin
    inhibits libido
  7. Most common sexual disorder in women
    sexual desire disorder and orgasmic disorder
  8. Most common disorders in men
    • secondary erectile disorder
    • premature ejaculation
  9. hypoactive sexual desire disorder
    • absence or deficiency of sexual desire or fantasies
    • 20% of general population
    • women > men
  10. Sexual aversion disorder
    avoidance of genital contact with a sexual partner
  11. Erectile dysfunction
    • primary: never had one
    • secondary: acquired after previous ability to maintain erections
  12. Female sexual arousal disorder
    • inability to maintain lubrication until completion of sex act
    • high prevalence: up to 33%
  13. Pedophilia
    • Sexual gratification from fantasies or behaviors involving sexual acts with children
    • most common paraphilia
  14. Voyeurism
    Watching unsuspecting nude individuals in order to obtain sexual pleasures
  15. Exhibitionism
    Exposure of one's genitals to strangers
  16. FEtishism
    Sexual preference for inanimate objects (shoes, pantyhose)
  17. Transvestic fetishism
    Sexual gratification in men from wearing women's clothing
  18. Frotteurism
    • Sexual pleasure in men from rubbing their genitals against unsuspecting women;
    • usually occurs in a crowded area
  19. Masochism
    Sexual excitement from being humiliated or beaten
  20. Sadism
    Sexual excitement from hurting or humiliating another
  21. Necrophilia
    Sexual pleasure from engaging in sexual activity with dead people
  22. Telephone scatologia
    Sexual excitement from calling unsuspecting women and engaging in sexual conversation with them
  23. Mature defenses
    • Altruism: benefit others
    • Humor:
    • Sublimation: satisfying socially objectionable impulses in an acceptable manner
    • Suppression: purposely ignoring an unacceptable impulse or emotion
  24. Neurotic defenses
    • Controlling:
    • Displacement: shifting emotions from an undesirable situations to one that is personally tolerable
    • Intellectualization: avoiding negative feelings by excessive use of intellectual functions and by focusing on irrelevant details
    • Isolation of affect: unconsciously limiting the experience of feelings or emotions
    • Rationalization: creating explanations of an event in order to justify outcomes
    • Reaction formation: doing the opposite of an unacceptable impulse
    • Repression: unconsiously preventing a thought or feeling from entering consciousness
  25. Immature defenses
    • Acting out
    • Denial
    • Regression
    • Projection: attributing objectionable thoughts or emotions to others
  26. Splitting
    labeling people as all good or all bad
  27. Undoing
    Attempting to reverse a situation by adopting a new behavior
  28. Free association
    the patient is asked to say whatever comes into his or her mind during therapy session
  29. Dream interpretation
    Dreams are seen to represent conflict between urges and fears
  30. THerapeutic alliance
    This is the bond between the therapist and the patient
  31. Transference
    Projection of unconscious feelings about important figures in the patient's life onto the therapist
  32. Countertransference
    Projection of unconscious feelings about important figures in the therapist's life onto the patient
  33. Classical conditioning
    Stimulus can eventually evoke a conditioned response
  34. Operant conditioning
    Behaviors can be learned when followed by positive or negative reinforcement
  35. Deconditioning
    • Systemic desensitization: relaxation techniques while being exposed to anxiety-provoking stimulus
    • Flooding and implosion: flooding is real, implosion is imagined
    • Aversion therapy: A negative stimulus is repeatedly paired with a specific behavior to create an unpleasant response
    • Token economy: rewards are given after specific behaviors to positively reinforce them
    • Biofeedback: physiological data are given to patients as they try to mentally control physiological states
  36. Cognitive therapy
    • Faulty assumptions: if I were smart I would do well on tests. I must not be smart since I received average grades this semester
    • Negative thoughts: I am stupid
    • Psychopathology: depression
  37. Dialectical behavioral therapy
    • Specific treatment for borderline personality disorder
    • teaching coping skills with both individual and group therapy
    • Goals: reduce SIB, decrease hospitalization
    • Topics covered: mindfulness, interpersonal effectiveness, emotion regulation, distress tolerance
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Psychiatry - Sexual disorders, psychotherapy
2013-07-29 00:41:17
Psychiatry shelf

Psychiatry - sexual disorders, psychotherapy
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