IntroductionPsychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.AimsTo review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.MethodsPubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.ResultsThroughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.ConclusionA progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.Disclosure of interestThe authors have not supplied their declaration of competing interest.
IntroductionOver the past decades, immunotherapy treatments have been a revolution to many chronic diseases with encouraging results in clinical outcomes and quality of life. The use of monoclonal antibodies has yielded a great variability in terms of clinical efficacy and tolerability although it’s believed the incidence of psychotic symptoms is low (0,1-0,4%).Objectives To review the effects of monoclonal antibodies on psychosis.MethodsReview of literature using PubMed database. A total of 16 studies were included.ResultsThe targeted molecules by monoclonal antibodies may determine the risk of psychosis. While those who target TNF-alfa seem to have a reduced risk of psychosis (such as Infliximab, Adalimumab, Certolizumab and Golimumab), monoclonal antibodies who modulate lymphocytes may have a greater risk of psychosis namely Natalizumab, Belimumab, Basiliximab and Daclizumab, which seems to correlate to evidence of alterations in lymphocyte subsets in groups of patients with first psychotic episode and schizophrenia. Some seem to have positive correlation with psychosis namely monoclonal antibodies who have a supressing effect on the immune system, especially those who target adaptative immunity and those who are used in autoimmune diseases (vs oncologic conditions). It is unknown if delusions prevail over hallucinations or vice-versa. Despite the paucity of evidence, these findings corroborate the variability regarding the psychiatric effects of immunotherapy.ConclusionsThe available literature reports a low prevalence of psychotic symptoms associated with the use of monoclonal antibodies but it highlights the importance in knowing the immune mechanisms involved in psychotic disorders. Greater research is needed to correctly assess that risk.
is specialized in the attendance of users with problems or dysfunctions related to sexuality, such as male sexual dysfunctions. Case Report: 46 year old man, single, with late onset of sexual activity which relates with his fears (partner becoming pregnant and sexually transmitted diseases) and his markedly obsessive personality. He describes previous occasional or short-term relationships and premature ejaculation on his first sexual experiences. During a phase without relationships, he began to discover his sexuality through masturbation, which tended to occur very frequently. He reported to especially appreciate the instant that precedes ejaculation, which led him to constantly try to delay the moment of ejaculation. Finding himself in a stable relationship, he reports that he cannot ejaculate during intercourse, achieving it only through masturbation, despite he could obtain sexual pleasure and have a sustained erection. At this point, the couple decided to have sex therapy. Conclusions: Premature ejaculation is a psychosexual disturbance defined as a persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it to occur. The main option for treating premature ejaculation are behavioral therapies such as the stop-start technique. In this case, the patient used this technique autonomously, by the means of masturbation, to delay his ejaculation, leading him to the point of being unable to ejaculate during intercourse.
IntroductionElectroconvulsive therapy (ECT) is considered a gold-standart treatment of severe and treatment-resistant depression. Lack of response to ECT often causes distress in psychiatrists regarding the next therapeutic decisions.ObjectivesTo present a case report of a patient with psychotic depression with partial response to ECT.MethodsClinical interviews and review of literature using the Pubmed platform.ResultsThe authors present a case of a 60 year-old woman admitted for severe depressive episode with psychotic symptoms. Due to lack of response to multiple antidepressive and antipsychotic treatments, 15 sessions of ECT were performed with improvement of behavioral and psychotic symptoms. However, endogenous depressive symptoms with functional impairment persisted. It was then initiated Bupropion 300mg/day resulting in vast improvements on drive, energy and activity levels with restored functionality. Previously to ECT, Bupropion was not considered a valid option due to the psychomotor restlessness that was present. This case exposes the limitations of ECT and the therapeutic conundrums that arise when there is partial response. The symptoms expressed in the patient after ECT course correlate with deficits in noradrenergic and dopaminergic pathways that are involved in endogenous depression. The use of Bupropion, with its effect on noradrenaline and dopamine receptors, may offer a therapeutic lifeline in these cases.ConclusionsECT still stands as a gold-standart for severe depressive disorder, especially when several psychopharmacological therapies have failed. In cases of partial response to ECT, the neurobiological correlates of clinical presentation can guide the therapeutic management towards improved outcomes.DisclosureNo significant relationships.
Aim of the work: To follow the significance of some psychological risk factors in patients with anxiety and depression symptoms with cardio-vascular diseases. Materials and methods: During the research we included 30 patients with anxiety and depression symptoms diagnosed with cardio-surgical diseases after cardio-surgical intervention. They were chosen randomly, hospitalized and treated in the Specialized cardio-surgical clinic Filip II, Skopje. The patients were of both sexes, aged 30-70. They were evaluated by HAMD and HAMA and non-standardized questionnaire. The patients were tested once two weeks after the cardio-surgical intervention. Results: In 25 patients there was a score increase in HAMD and HAMA in correlation with the psychological risk factors (stressful events: losing the job, losing someone you love, hostility, high professional plans and ambition) Conclusion: Psychologically unfavourable situations are risk factors which lead to anxiety and depression symptoms in cardio-vascular diseases.
Sleep disturbances are often present in addictive disorders. The atypical antipsychotic quetiapine has a favourable tolerability profile,
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