The Bio-Psycho-Social Dimension in Women's Sexual Desire: 'Argumentum ad novitatem'.

Sexual desire includes complex motivation and drive. In the context of biological and cognitive- emotive state art of science, it is often a neglected field in medicine. In regard to the treatment, study on women's sexual function received less attention compared to the men's sexuality. In the past, this endeavor was relatively not well disseminated in the scientific community. Recently, there was a revolutionized surge of drug targets available to treat women with low sexual desire. It is timely to review the relevant biological approach, especially in the context of pharmacotherapy to understand this interesting clinical entity which was modulated by numerous interactive psychosocial inter-play and factors. The complex inter-play between numerous dimensional factors lends insights to understand the neural mechanism, i.e. the rewards centre pathway and its interaction with external psychosocialstimulus, e.g. relationship or other meaningful life events. The function of hormones, e.g. oxytocin or testosterone regulation was described. The role of neurotransmitters as reflected by the introduction of a molecule of flibenserin, a full agonist of the 5-HT1A and partial agonist of the D4 to treat premenopausal women with low sexual desire was deliberated. Based on this fundamental scientific core knowledge, we suggest an outline on know-how of introduction for sex therapy (i.e. "inner-self" and "outer-self") where the role of partner is narrated. Then, we also highlighted on the use of pharmacological agent as an adjunct scope of therapy, i.e. phosphodiasterase-5 (PDE-5) inhibitors and hormonal treatment in helping the patient with low sexual desire.

The Use of Methylphenidate for Physical and Psychological Symptoms in Cancer Patients: A Review.

BACKGROUND: One of the goals of cancer treatment is symptoms management especially at the end stage. The common symptoms in cancer include pain, fatigue, depression and cognitive dysfunction. The available treatment options for symptom management are limited. Methylphenidate, a psychostimulant, may be of benefit for these patients. In this report, we review the use of methylphenidate for symptoms control in cancer patients. METHOD: Electronic literature search on PubMed was conducted using the following keywords: methylphenidate, cancer, carcinoma, oncology, oncological and tumour. We identified forty two relevant studies and publications on the use of methylphenidate in cancer patients to be included in this review. RESULTS: Methylphenidate was found to have some evidence in reducing opioid-induced sedation, improving cognitive symptoms and reduction of fatigue in cancer patients. Nevertheless, the results were inconsistent due to variations in the study populations, study design and outcome measures, among others. There was minimal evidence on its use in treating depression. Otherwise, methylphenidate was generally well-tolerated by patients. CONCLUSION: This review potentially supports the use of methylphenidate for opioid-induced sedation, cognitive decline and fatigue in cancer patients. Further placebo-controlled trials would help in strengthening the evidence for this treatment.

Excessive internet use in young women: What are the implications?

PURPOSE OF REVIEW: There are considerable gender differences in youth engaging in excessive internet use (EIU). This review provides updates based on the recent literature focusing on the EIU in young women to describe its implications including what it constitutes of, its correlates, sequelae and preventive and/or treatment strategies. RECENT FINDINGS: Definition of EIU and its conceptualization still requires refinement. Recent studies indicate a changing trend towards female predominance of EIU. Women also differ in their internet use compared with men regarding their preference in the internet content and online activities, motives of use and factors related to access to the internet, including the device, sociocultural restrictions, etc. The correlates and sequelae of EIU encompass psychological, physical, biological, family and social domains that could form the basis of identifying individuals at risk and strategizing treatment. SUMMARY: The findings indicate the need for standardization in definition and measures of EIU for better recognition of EIU and identification of its at-higher-risk females. Effective preventive and treatment measures are still limited by various methodology flaws outlined here.

Association of social support and quality of life among people with schizophrenia receiving community psychiatric service: A cross-sectional study.

OBJECTIVE: To understand the needs of patients with schizophrenia for recovery, this study examined the type and level of social support and its association with quality of life (QOL) among this group of patients in the city of Kuala Lumpur. METHOD: A cross-sectional study was conducted on 160 individuals with schizophrenia receiving community psychiatric services in Hospital Kuala Lumpur (HKL). The WHOQOL-BREF, Brief Psychiatric Rating Scale (BPRS) and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess QOL, severity of symptoms and social support, respectively. The study respondents were predominantly Malay, aged less than 40, males, single, unmarried, had lower education levels and unemployed. RESULTS: About 72% of the respondents had poor perceived social support, with support from significant others being the lowest, followed by friends and family. From multiple regression analysis, social support (total, friend and family) significantly predicted better QOL in all domains; [B=0.315 (p<0.001), B=0.670 (p<0.001), B=0.257 (p<0.031)] respectively in Physical Domain; [B=0.491 (p<0.001), B=0.735 (p<0.001), B=0.631 (p<0.001)] in Psychological Domain; [B=1.065 (p<0.001), B=0.670 (p<0.017), B=2.076 (p<0.001)] in Social Domain and; [B=0.652 (p<0.001), B=1.199 (p<0.001), B=0.678 (p<0.001)] in Environmental Domain. Being married and having shorter duration of illness, lower BPRS (total) scores, female gender and smoking, were also found to significantly predict higher QOL. CONCLUSION: Social support is an important missing component among people with schizophrenia who are already receiving formal psychiatric services in Malaysia.

Sexual Pain among Malaysian Women Receiving Antidepressant: A Comparison between Escitalopram and Fluoxetine.

OBJECTIVES: The current study compares the risk of sexual pain in depressed female patients in remission between those who were treated with Escitalopram and Fluoxetine. The associated factors were also examined. METHODS: This is a cross-sectional study involved 112 depressed female patients (56 treated with Escitalopram and 56 treated with Fluoxetine) who were in remission (as defined by Diagnostic and Statistical Manual-IV (DSM-IV) in the past 2 months and Montgomery-Asberg Depression Rating Scale (MADRS) score of ≤ 10) from the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC). They were interviewed using Structured Clinical Interview for DSM-IV (SCID). Hypoactive sexual desire was assessed using the Pain subscale of Malay Version of the Female Sexual Function Index (MVFSFI). RESULTS: The results show that risk of sexual pain was relatively low (16.07% for all patients), with no statistical significant between the two groups (17.86% for fluoxetine group, 14.29% for escitalopram group). Older age (adjusted odds ratio = 1.524, 95% CI = 1.199, 1.938) was the only factor significantly associated with sexual pain disorder. CONCLUSIONS: There should not be any barrier when continuing the use of escitalopram or fluoxetine as antidepressants amongst the female patients.

Hypoactive sexual desire among depressed female patients treated with selective serotonin reuptake inhibitors: a comparison between escitalopram and fluoxetine.

OBJECTIVE: To determine the risk of hypoactive sexual desire (HSD) in depressed female patients treated with selective serotonin reuptake inhibitors, comparing escitalopram and fluoxetine. The associated factors were also examined. METHODS: This cross-sectional study involved 112 female patients (56 in each group) diagnosed to have major depressive disorder who were in remission (as defined by the Diagnostic and Statistical Manual-IV (DSM-IV) in the past 2 months and the Montgomery-Asberg Depression Rating Scale (MADRS) score of ≤ 10) from the psychiatric clinic, University Kebangsaan Malaysia Medical Centre (UKMMC). They were interviewed using the Structured Clinical Interview for DSM-IV (SCID). Hypoactive sexual desire was assessed using the Desire subscale of the Malay Version of the Female Sexual Function Index (MVFSFI). RESULTS: The risk of hypoactive sexual desire was 50.9% for all patients; 64.3% for the fluoxetine group and 37.5% for the escitalopram group. Multivariate logistic regression analysis showed fluoxetine therapy (adjusted OR = 3.08, CI = 1.23, 7.73) and moderate to high dosage of antidepressant (adjusted OR = 4.27, CI = 1.66, 10.95) were significantly associated with hypoactive sexual desire. CONCLUSION: Those treated with fluoxetine had significantly higher rates of HSD than those on escitalopram. Moderate to high antidepressant dosage is another significant predictor of HSD in depressed women treated with SSRIs.

Mirtazapine for anorexia nervosa with depression.

OBJECTIVE: To report the use of Mirtazapine in the treatment of anorexia nervosa with depression primarily regarding its propensity for weight gain. METHOD: We present an outpatient case report of anorexia nervosa with depression. The patient's subsequent progress was recorded. RESULTS: The patient gained 2.5 kg within 3 months to eventually attain a body mass index of 15 after 5 months. Her depression achieved full remission at 6 weeks of treatment. CONCLUSIONS: Mirtazapine is the choice medication in this case. However, treating depression requires caution, given these patients' physical vulnerability. Controlled trials of Mirtazapine for anorexia nervosa are needed.