Master the board step 3

Psychiatry
Treatment
··
Naltrexone implant has been shown to be effective in long-term treatment
of opioid dependence, alcohol dependence, and (most recently) poly-drug
dependence.
··
Acamprosate and disulferam have been used in alcohol dependence.
··
Antidepressants are the wrong answer for patients with alcohol dependence
without a comorbid mental disorder.
Human Sexuality
Homosexuality
Homosexuality is not a mental illness but instead is classified as a variant of
human sexuality.
Gender Identity Disorder and Transsexualism
This is the answer when the case describes an individual who insists that he/
she is the opposite gender and experiences intense discomfort about his or
her sex. It is not the diagnosis when the question describes an individual who
desires to be another gender because of the perceived advantages of the
other sex (e.g., a boy who says he wants to be a girl so that he will receive the
same special treatment as his younger sister).
Pharmacological Agents That Cause Sexual Dysfunction
Drug
α1-blockers
SSRIs
β-blockers
Trazodone
Dopamine agonists
Neuroleptics
Effect
Impaired ejaculation
Inhibited orgasm
Erectile dysfunction
Priapism
↑ erection and libido
Erectile dysfunction
Paraphilic Disorder
Paraphilias involves recurrent, sexually arousing preoccupations, which
are usually focused on humiliation and/or suffering and the use of nonliving
objects and nonconsenting partners. Occurs for more than 6 months and
causes impairment in patient’s level of functioning. Treatment of choice:
Individual psychotherapy and aversive conditioning. If severe impairment,
give antiandrogens or SSRIs to help reduce patient’s sexual drive.
527