The DSM-IV diagnostic criteria for premature ejaculation remain to be investigated by a clinical study. A prospective study was therefore conducted to investigate the DSM-IV definition and to provide an empirical operationalization of premature ejaculation. In this study 140 men suffering from lifelong premature ejaculation were interviewed separately from their partners. Various means of assessing the intravaginal ejaculation latency time (IELT) were compared: assessment by spontaneous answer, by questionnaire, by imagining foreplay and intercourse and estimating the ejaculation time without a clock or with a clock, and by stop-watch measurement at home over a one-month period. The number of thrusts and feelings of control during foreplay and intercourse were also assessed. A total of 110 men used the stop-watch method. Ninety percent of all the subjects ejaculated within one minute of intromission, with 80% actually ejaculating within 30 seconds. The age of the men and duration of their relationship were not correlated with IELT; however, the IELT tended to be longer for couples who had a higher frequency of intercourse. There was only a moderate correlation between the various methods of assessing IELT. The results suggest that premature ejaculation could be operationally defined as an IELT < 1 min in more than 90% of episodes of sexual intercourse, independent of age and duration of relationship.

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BackgroundInterventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individual's non-adherence.AimsTo examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly.MethodRandomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159).ResultsTreatment adherence therapy v. TAU significantly benefited service engagement (Cohen's d = 0.48) and medication adherence (Cohen's d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve.ConclusionsTreatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.

Explicit requests for physician-assisted suicide are not uncommon in psychiatric practice in the Netherlands, but these requests are rarely granted. Psychiatric consultation for medical patients who request physician-assisted death is relatively rare.

This study indicates that enhancing serotonergic function with an SSRI may reduce suicidal behavior in a subgroup of patients who have attempted suicide more than once but who do not suffer from major depression.