Sexual function in patients taking bupropion sustained release.
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Bupropion↗
Biomedical subjects
K B Segraves
Publications and source records attributed to K B Segraves.
Hypoactive sexual desire disorder: prevalence and comorbidity in 906 subjects.
The frequency of hypoactive sexual desire disorder (HSDD) and the frequency of comorbidity of sexual disorders was recorded from a total population of 906 subjects studied in a multisite pharmaceutical study. Sixty-five percent had a primary diagnosis of HSDD, HSDD was far more common in females than male subjects. Males diagnosed with HSDD were significantly older than women diagnosed with HSDD. Approximately, 40% of the subjects with a primary diagnosis of HSDD had second diagnoses of arousal or orgasm disorders.
Cross-Sectional Studies↗
Seeking psychological treatment as a cure for a medical problem.
Today health care providers are more likely to experience legal, moral and ethical dilemmas regarding their treatment principles given the climate of health care. Clinical practice in the United States is being affected by many external forces which can affect patient care. Government and insurance companies are attempting to legislate treatment as evidenced by DRG's and reimbursement patterns. Hospital and clinic administrators are pressuring faculty and staff to increase revenue by participating in more income generating activities. Within this milieu of dwindling resources, consumers continue to demand a variety of health care services. A case example of a woman who asked for a psychological intervention to treat a medical condition is presented. This case focuses on the important issue of offering efficacious treatments to informed patients with carefully diagnosed disorders. Whether scientific, ethically-based treatments are being rendered when any of the criteria, efficacious, informed and diagnosed are altered or missing, is open to doubt. This case is presented, not as a model of clinical management, but rather to stimulate discussion and generate ideas on how to better address future situations: (a) Where the patient requests an available treatment for a problem which would not be directly helped by such treatment; (b) how far must a clinician go to insure that informed consent has been reached?; (c) what is the physician's responsibility in providing what a patient wants in the way of treatment?; and (d) conversely, should clinicians provide medical interventions (at the patient's insistence) for psychological problems, for example, provide a penile prosthetic implant to a man whose disorder is clearly psychogenic impotence?
Biofeedback, Psychology↗
Categorical and multi-axial diagnosis of male erectile disorder.
Diagnostic information was examined on 258 men with male erectile disorder in a multi-site study. Of the sample, 78% was diagnosed as having difficulty both in obtaining and maintaining erections; 20% had a secondary or tertiary diagnosis of hypoactive sexual desire disorder. There was minimal evidence that the multi-axial diagnostic system has advantages over the categorical DSM-III-R diagnosis of male erectile disorder.
Adult↗
Current and lifetime incidence of psychiatric disorders among a group of extremity sarcoma survivors.
Thirty-five survivors of extremity sarcomas being followed in a University-Hospital orthopedic clinic were evaluated for current and lifetime presence of psychiatric disorders. Patients were assessed for cognitive abilities using the Cognitive Capacity Screening Examination and for psychiatric disorders using a structured interview format, the Schedule for Affective Disorders and Schizophrenia-Lifetime version. The criteria for psychiatric disorders were the Research Diagnostic Criteria. Two patients were excluded because of cognitive deficiencies; thirty-three patients (mean age = 37.7 yr) were formally evaluated at a mean time of 2.6 yr following cancer diagnosis and surgery. Forty-five per cent of patients were given the diagnosis of at least one lifetime psychiatric disorder. Fifteen per cent of patients reported a current episode. Affective disorders and alcoholism were the most frequently reported disorders.
Adaptation, Psychological↗
Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage.
When compared to amputation, limb salvage procedures for extremity sarcomas have been advocated because of potential functional benefits and presumed psychological-outcome advantages. The purpose of this study was to compare psychological outcomes between survivors who underwent either amputation or limb salvage procedures for extremity sarcomas. Fifteen amputees and 20 patients with salvaged limbs (mean age, 37.9 years; range, 15 to 71 years) were evaluated 1 to 5 years after surgery for extremity sarcomas. Demographic and medical information was obtained and cognitive functioning, affect, mood, body image, physical functioning, global psychological adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before and after surgery were assessed. Two patients were excluded because of the presence of an incapacitating organic mental syndrome. The remaining patients, 14 amputees and 19 patients with salvaged limbs, had a variety of soft-tissue and bone sarcomas. No significant differences were found between the groups in age, sex, marital status, surgically involved extremity, chemotherapy status, and social class at the time of surgery and interviews. There were no significant differences between the groups in scores of cognitive capacity, symptoms, mood, body image changes, global physical functioning, global adjustment to illness and surgery, and lifetime prevalence of psychiatric disorders before or after surgery. Most patients revealed only mild psychological symptoms and 55% demonstrated good to excellent adjustment to their surgeries and diseases. There were no significant differences in measures of psychological outcome for patients with extremity sarcomas who underwent limb salvage procedures compared to those who underwent amputation. A psychological-outcome advantage of limb-salvage surgery compared to amputation has yet to be demonstrated.
Adaptation, Psychological↗
Plasma MHPG response to yohimbine treatment in women with hypoactive sexual desire.
The use of yohimbine to treat impotence has suggested that decreased male sexual desire may relate to decreased activity of central noradrenergic neurons. Previous trials of yohimbine to treat female sexual problems are not available. Yohimbine is an alpha 2-adrenergic antagonist that stimulates norepinephrine (NE) release. In the present study, plasma concentrations of 3-methoxy-4-hydroxyphenylglycol (MHPG), the major central nervous system metabolite of NE, were measured in 9 women diagnosed with hypoactive sexual desire. Daily logs of mood and sexual activity, and trimonthly MHPG blood drawings, were obtained over an initial baseline menstrual cycle followed by two subsequent treatment cycles (yohimbine or placebo), in randomized order. Blood samples were obtained at 9:00 a.m. during (a) the early follicular phase of each cycle (24 hr after the onset of each cycle), (b) the ovulatory phase (i.e., within 1 day of an oral temperature rise), and (c) the midluteal phase (i.e., 20-25 days into each cycle). Comparisons were made with a group of 7 healthy female controls. Women with hypoactive sexual desire had slightly lower plasma MHPG values than controls at baseline, although there was only a trend toward significance during the early follicular phase (p = .09). Yohimbine (5.4 mg orally, 3 times daily, beginning at menses) caused a sustained rise in plasma MHPG of similar magnitude to that reported in men. However, in terms of improved sexual desire, yohimbine had no obvious therapeutic effect. Thus, plasma MHPG and the alpha 2-adrenergic response to yohimbine appeared within normal ranges in women with hypoactive sexual desire, with no therapeutic response to yohimbine.
Adrenergic alpha-Antagonists↗