Sexual needs and sexual function of patients with Parkinson's disease.

BACKGROUND: Sexual dysfunction (SD) is a frequent non-motor symptom in Parkinson's disease (PD) that is rarely addressed, and sexual counseling is sporadic. OBJECTIVES: To investigate PD patients' SD and sexual counseling motivation and to propose an interventional strategy for movement disorder specialists. METHODS: All consecutive PD patients who presented to a movement disorder unit between 2018 and 2019 completed anonymous questionnaires containing the Female Sexual Function Index, the International Index of Erectile Function, and a questionnaire on sexual needs and motivation to receive sexual counseling. RESULTS: The age range of the 100 recruited patients (78 men) was 40-80 years, and the mean disease duration was 8.64 ± 6.84 years. SD appeared at all PD stages. The presence of SD pre-PD diagnosis significantly predicted SD post-diagnosis in men. Erectile dysfunction was the most common male SD (70%). Women reported frequent SD before PD diagnosis and currently. More than half of the responders (74% of the men and 40% of the women) were motivated to receive sexual counseling. Most of them (77.4%) were in a relationship. CONCLUSIONS: The findings of this analysis revealed that most PD patients had experienced SD before being diagnosed with PD and were interested in receiving sexual counseling. We propose a six-step intervention strategy for the management of SD in PD designed for application in a movement disorder unit. We also recommend that neurologists and other healthcare providers undergo training to provide basic sexual counseling tailored to the needs of PD patients.

Treating depression in Alzheimer's disease: integration of differing guidelines.

BACKGROUND: The developments in the understanding of Alzheimer's disease (AD) have led to genetic testing, expansion of research centers, and emergence of novel treatment modalities. However, behavioral symptoms and disturbances remain the leading cause of distress to families and patients. The management of these disturbances is not fully elucidated and not without controversies. AIM: To review and integrate the two important approaches to management and treatment of depression in AD as published in the American Psychiatric Association's guidelines for the treatment of patients with AD versus the American Academy of Neurology's official publication on managing AD. METHOD: Both publications are analyzed focusing on the pharmacological treatment of depression. The analysis includes sources of data, generalization, and common and conflicting recommendations. CONCLUSION: Selective serotonin reuptake inhibitors are the drugs of choice for the treatment of depression in AD patients.

Clozapine in elderly psychiatric patients: tolerability, safety, and efficacy.

Psychotic disorders in the elderly are frequent, of multiple etiologies, and little researched. With the advent of "atypical" neuroleptics, their role in treating elderly psychiatric patients needs to be investigated. Clozapine is widely used; however, its use is common in the elderly whose psychosis is a feature of neurological morbidity (Parkinson's disease, dementia, etc.), making it difficult to ascertain the safety, tolerability, and efficacy in psychiatric disorders in late life. The aim of the present review is to evaluate clozapine's effect in elderly psychiatric patients with no neurological comorbidity. A computerized literature search (MedLine 1966 to 1997) revealed 133 patients fulfilling said criteria. Fifteen patients had side effects and/or adverse events during treatment; nine of these were receiving a dosage greater than 100 mg clozapine daily. In 19 patients, treatment was discontinued, three due to noncompliance and 16 due to side effects. In seven patients, leukopenia/agranulocytosis was reported. The majority of side effects (27 of 34) and treatment discontinuations were within the first 90 days of treatment. Although efficacy is difficult to compare across studies because of differing methods of evaluation, the great majority of patients showed moderate to marked improvement of psychotic features. The reported effectiveness in patients able to continue treatment for extended periods is significant. Thus, clozapine at a relatively low mean dose (134 mg daily) seems to be safe, tolerated, and effective in elderly psychiatric patients. Agranulocytosis is more frequent than in younger adults and should be monitored carefully.

The serotonin antagonist mianserin for treatment of serotonin reuptake inhibitor-induced sexual dysfunction in women: an open-label add-on study.

The aim of this study was to determine if the serotonin antagonist mianserin improves antidepressant-induced sexual dysfunction in women. The work was prompted by an earlier study of men by our team of researchers. The study population included 16 women aged 20-65 years undergoing treatment at a psychiatric outpatient clinic, who presented with sexual dysfunction subsequent to intake of a serotonin reuptake inhibitor (SRI) for depression. Sexual function (four domains) was evaluated by semistructured interviews before and after the administration of mianserin 15 mg/d for 3 weeks. The most prominent sexual dysfunction was anorgasmia. Clinically significant improvement was noted in all domains in two thirds of the patients, in most cases in the first or second week of treatment. None of the patients with panic disorder (PD) responded to mianserin, in contrast to those with affective disorder or obsessive compulsive disorder (OCD), indicating a possible relevance of the psychiatric diagnosis to mianserin effectiveness. There were no major adverse effects and no changes in the patients' stabilized psychiatric status. We conclude that mianserin is beneficial in reversing sexual function caused by SRI intake. Further large-scale, placebo-controlled studies are needed to confirm these findings.

["Saddam syndrome:" acute psychotic reactions during the Gulf War--renewal of concept of brief reactive psychosis].

6 patients came to our psychiatric emergency room during the first 2 weeks of the Gulf War presenting the clinical picture of acute delusional paranoid psychosis (4 women and 2 men between the ages of 30-77). 4 were without previously known psychopathology, while the other 2 were known to have had some nonpsychotic cognitive impairment. The first 4 recovered completely within a short time while the other 2 continued to have psychopathological symptoms. We discuss psychogenic or reactive psychosis, and the concept of reactivation when cumulative trauma exceed the individual's personal threshold, as may occur during a war. Different phenomenological syndromes may follow.

[Combined tricyclic antidepressants and ritalin in elderly depressives].

Psychostimulants, including ritalin (methylphenidate), were used as antidepressives in the '50s but were then replaced by tricyclics and MAO inhibitors. Treatment of depression with psychostimulants is still controversial. Several anecdotal reports in the past decade approved the use of tricyclic antidepressants (TCA) together with methylphenidate in apathetic and withdrawal states in medically ill and in elderly patients. Ritalin elevates mood by releasing catecholamines and blocking their re-uptake, and also increases serum TCA levels. 5 men and 5 women between the ages of 65 and 79 were diagnosed as suffering from major depressive disorders, either single or recurrent, based on the Revised Diagnostic and Statistical Manual for Mental Disorders (DSM-III-R). They had been treated with TCA for up to several months with no response. Following addition of methylphenidate, 5-15 mg/d for 2 weeks, 4 men and 3 women improved rapidly, 2 of them within 24 hours.

Pain responsivity in women with premenstrual syndrome across the menstrual cycle.

11 women with a clinical diagnosis of Premenstrual Syndrome (PMS) and 10 control women with no such diagnosis were compared on pain threshold and pain-tolerance measures in the intermenstrual and premenstrual phases of their menstrual cycles. No significant differences were found between the groups for behavioral measures of pain sensitivity. Ratings of pain intensity, however, were higher in both phases for the PMS group.

Correlation between emotional reaction to loss of an unborn child and lymphocyte response to mitogenic stimulation in women.

PIP: The effect of emotional stress due to the loss of a loved object such as an unborn child on some parameters of cell-mediated immunity was studied in 77 women who had undergone abortions. Based on their psychiatric reaction to this loss, these women were subdivided into 2 groups: 1) Group NA--those not accepting this loss and 2) Group A--those appearing to accept this loss. The response of lymphocytes from peripheral blood taken during the psychiatric interview to the mitogens phytochemagglutinin (PHA) and concanavalin-A (Con-A) in Group NA was compared with the lymphocyte response in blood from Group A. The percent of T-cells was also measured in the 2 groups. It was found that nonacceptance of the loss of a fetus correlated with a significant reduction in the proliferative response to both PHA and Con-A. The percent of T-cells remained constant across both groups. When each of the psychiatric parameters of anxiety, guilt, and despression were correlated separately with the immune response, the most marked effect was found in those women who had the highest score on the depression scale.^ieng