Comment Ruby

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).
Diagnostic criteria 
            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
(Association, 2015).
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).
Psychopharmacological treatments: 

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). 


Dual-sex therapy 
Behavior therapy 
 Mindfulness in cognitive technique 
Group therapy 
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.
           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.
            Sadock, B. J., Sadock, V. A., & Pedro, R. M. (2014). Kaplan and sadock’s synopsis of 
                          psychiatry: Behavioral sciences/clinical psychiatry (11th ed.). Lww.