Respond to your colleagues by comparing the differential diagnostic features of the disorder you were assigned to the diagnostic features of the disorder your colleagues were assigned.
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Substance /Medication Induced Sexual Dysfunction (SMISD)
The purpose of this discussion is to explain the diagnostic criteria for SMISD, and evidence-based psychotherapy and psychopharmacological
treatment for SMISD. I will be supporting these treatments and diagnostic criteria with learning course resources and other academic resources. The
diagnosis of SMISD is when there is evidence of substance intoxication or withdrawal that is apparent from the history physical examination or laboratory
results. The sexual dysfunction SMISD occurs soon after significant substance intoxication or withdrawal, or after exposure to a medication or a change in
medication use. Some examples of substances and medications that cause SMISD are alcohol amphetamines or related substances, cocaine, opioids,
sedatives-hypnotics, anxiolytics, and other known or unknown substances (Sadock et al., 2014). Almost every pharmacological agent, especially those in the
psychiatry field have been associated with an effect on sexuality. In men these effects include low sex drive, erectile failure, low volume of ejaculate, and
delayed or retrograde ejaculation. In women there is decreased sex drive, decreased vaginal lubrication, inhibited, or delayed orgasm and decreased or
absent vaginal contractions may occur. Drugs may also enhance the sexual responses and increase the sex drive, but this is less common than adverse
effects (Sadock et al., 2014).
The diagnostic criteria for SMISD requires that a significant disturbance in sexual function is predominant in the clinical picture. There SMISD must be
evident from the history, physical examination, or laboratory findings of a significant sexual dysfunction during or soon after substance intoxication or
withdrawal or after exposure to her medication. The involved medication can produce sexual dysfunction symptoms. In addition, the dysfunction must not
be a result of another dysfunction that is not drug- induced must not occur during delirium and must cause clinically significant distress in the client
Psychopharmacology and Psychotherapy for SMISD
SMISD can be treated by pharmacologic or psychotherapy or both. Some classes of medication that can cause sexual dysfunction antipsychotics. The
prevalence of low libido and problems with orgasm in patients treated with antipsychotics regardless of sex is 54.2% and 41.7% respectively. A widely
accepted mechanism underlying antipsychotic associated sexual dysfunction is dopamine D2 receptor antagonism. This causes high prolactin levels, which
can subsequently lead to a variety of sexual problems including erectile dysfunction, ejaculatory disturbances and gynecomastia in men, amenorrhea, and
vaginal dryness in woman. Also, low libido, anorgasmia, and galactorrhea in both sexes. Some other medications that cause sexual dysfunction are
antipsychotics, antiparkinsonian drugs, anticholinergics, antiepileptics, muscle relaxants, cannabis, opioids and anti-anxiety drugs (Downing et al., 2019).
Dose reduction or abstinence
Switching to a prolactin sparing antipsychotic example Aripiprazole, Olanzapine and Quetiapine
Augmenting with Aripiprazole.
Adding Phosphodiesterase inhibitors specifically to treat Ed, PDE-5 inhibitors like Sildenafil can be used.
Androgen therapy for male and female.
Bupropion and some second-generation antipsychotics.
Testosterone replacement and low hepatic impact medications, H1 receptor antagonism with allergic antihistamine use improves ED.
Alprostadil and injectable medications Edex, MUSE and Brevital.
Anti-depressants can be used for treating phobic sex.
Trazodone can be used to increase nocturnal erections (Razdan et al., 2017).
Mindfulness in cognitive technique
Specific techniques and exercises
Analytically oriented sex therapy (Sadock et al., 2014)
Clinicians need to be more vigilant about antipsychotic- associated sexual dysfunction and available treatment options, because these adverse effects
can affect a patient’s quality of life and adherence to anti-psychotic medication (Downing et al., 2019). Maintaining good sexual health and function is
especially important in these patients to help improve their mood, quality of life and medication compliance. The specific aspect of sexual function that is
affected by psychiatric drugs is often ambiguous when described in current literature. Broad questionnaires like the Arizona Sexual Experience Scale can be
used to evaluate many components of sexual health (Razdan et al., 2017).
Association, A. P. (2015). Dsm-5® (5th ed.). American Psychiatric Association.
Downing, L., Kim, D. D., Procyshyn, R. M., & Tibbo, P. (2019). Management of sexual adverse
effects induced by atypical antipsychotic medication. Journal of Psychiatry and
Neuroscience, 44(4), 287–288. https://doi.org/10.1503/jpn.190053
Razdan, S., Greer, A. B., Patel, A., Alameddine, M., Jue, J. S., & Ramasamy, R. (2017). Effect
of prescription medications on erectile dysfunction. Postgraduate Medical Journal,
94(1109), 171–178. https://doi.org/10.1136/postgradmedj-2017-135233
Sadock, B. J., Sadock, V. A., & Pedro, R. M. (2014). Kaplan and sadock’s synopsis of
psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Lww.