The authors analyzed the incidence of sexual dysfunction (SD) with different selective serotonin reuptake inhibitors (SSRIs; fluoxetine, fluvoxamine, paroxetine, and sertraline) and hence the qualitative and quantitative changes in SD throughout time in a prospective and multicenter study. Outpatients (192 women and 152 men; age = 39.6 +/- 11.4 years) under treatment with SSRIs were interviewed with an SD questionnaire designed for this purpose by the authors and that included questions about the following: decreased libido, delayed orgasm or anorgasmia, delayed ejaculation, inability to ejaculate, impotence, and general sexual satisfaction. Patients with the following criteria were included: normal sexual function before SSRI intake, exclusive treatment with SSRIs or treatment associated with benzodiazepines, previous heterosexual or self-erotic current sexual practices. Excluded were patients with previous sexual dysfunction, association of SSRIs with neuroleptics, recent hormone intake, and significant medical illnesses. There was a significant increase in the incidence of SD when physicians asked the patients direct questions (58%) versus when SD was spontaneously reported (14%). There were some significant differences among different SSRIs: paroxetine provoked more delay of orgasm or ejaculation and more impotence than fluvoxamine, fluoxetine and sertraline (chi 2, p < .05). Only 24.5% of the patients had a good tolerance of their sexual dysfunction. Twelve male patients who suffered from premature ejaculation before the treatment preferred to maintain delayed ejaculation, and their sexual satisfaction, and that of their partners, clearly improved. Sexual dysfunction was positively correlated with dose. Patients experienced substantial improvement in sexual function when the dose was diminished or the drug was withdrawn. Men showed more incidence of sexual dysfunction than women, but women's sexual dysfunction was more intense than men's. In only 5.8% of patients, the dysfunction disappeared completely within 6 months, but 81.4% showed no improvement at all by the end of this period. Twelve of 15 patients experienced total improvement when the treatment was changed to moclobemide (450-600 mg/day), and 3 of 5 patients improved when treatment was changed to amineptine (200 mg/day).

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Introduction. In addition to compulsion (involuntary hospitalization, seclusion, restraint, etc.), there are broader forms of coercion (persuasion, interpersonal pressure, inducement or threat), called informal or covert coercion, all of which try to improve patients adherence to treatment. Objective. To analyse the use of covert coercion in mental health outpatients and the mental health professionals´ views on this practice comparing four countries (Spain, Italy, Mexico and Chile). Methods. We conducted a qualitative research using four focus groups in each country with mental health professionals working in mental health centres and based on a thematic analysis approach. Sample. The total sample was made up of 98 professionals (31 psychiatrists, 25 clinical psychologists, 28 nurses, eight social workers and six other professionals). Results. The use of informal coercion was recognized in clinical practice, but its intensity was related to professionals´ characteristics and to factors related to diagnosis, clinical course, perceived risk, insight, therapeutic relationship and organizational issues in the delivery of services. Its use was justified by effectiveness in improving adherence and, generally, in seeking benefits for the patient, but sometimes in a paternalistic way. Discussion and conclusion. Our results match those described in the literature in terms of: 1. sociodemographic and clinical profile; 2. the reason that leads to its use (adherence); 3. ethical justification (search for patient´s benefit, trying not to impair his freedom); hence, the most intense forms (threat) were misperceived. Our professionals acknowledged the use of covert coercion in their clinical practice, justifying it on ethical and clinical grounds. RESUMENIntroducción. Además de la coerción formal (hospitalización involuntaria, contención, etc.), en salud mental existen otras formas de coerción (persuasión, presión interpersonal, inducción o amenaza), denominada informal o encubierta, que pretenden mejorar la adherencia. Objetivo. Conocer el uso de la coerción informal en el tratamiento ambulatorio de enfermos mentales y la percepción que de ella tienen los profesionales de salud mental de cuatro países (España, Italia, México y Chile). Método. Utilizamos una investigación cualitativa con cuatro grupos focales por país, compuestos por profesionales que trabajaban en centros de salud mental, con un enfoque basado en el análisis temático. La muestra fue de 98 profesionales (31 psiquiatras, 25 psicólogos clínicos, 28 enfermeros, ocho trabajadores sociales y otras seis profesiones). Resultados. Se reconoció el uso de la coerción informal en la práctica clínica. Su intensidad dependió de características del profesional y factores relacionados con el diagnóstico, clínica, evolución de la enfermedad, peligrosidad del paciente, conciencia de enfermedad, relación terapéutica y aspectos organizativos asistenciales. Su uso se justificó por la eficacia y la búsqueda de beneficios para el paciente, a veces de forma paternalista. Discusión y...

Agitation is a common and costly phenomenon associated with a number of psychiatric conditions including schizophrenia and bipolar disorder. Early identification and prompt intervention to relieve the symptoms of agitation are essential to avoid symptomatic escalation and emergence of aggressive behaviour. Recent consensus guidelines emphasise the need for non-coercive management strategies to protect the therapeutic alliance between patients and their healthcare providers—an alliance that is critical for the effective management of chronic psychiatric conditions. Rapid symptom relief and de-escalation of agitation are necessary to avoid the costly and traumatic use of coercive techniques of physical restraint and seclusion, which require admission and prolonged hospitalisation. Inhaled loxapine is approved for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Clinical studies have confirmed the efficacy, rapid onset of action, and safety and tolerability of this agent in the psychiatric emergency and hospital settings. Emerging data have indicated the potential for inhaled loxapine as a self-administered agent for use in the community setting without the direct supervision of a healthcare professional. We discuss the evolving treatment paradigm and the place of inhaled medications for acutely agitated patients both within and outside the emergency and hospital setting.