Sexual dysfunction due to SSRI antidepressants: How to manage?Apollo Hospitals
Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of commonly prescribed antidepressants in clinical practice. Sexual dysfunction is a common side effect of SSRIs, which often goes unrecognized but adversely affects the quality of life of the patient. This review takes a look at the occurrence of sexual dysfunction among patients receiving SSRIs from a clinical viewpoint. The review explores into the possible reasons of such a dysfunction and the differential diagnoses to be entertained while dealing patients receiving SSRIs and experiencing sexual dysfunction. The review discusses the management strategies for addressing such dysfunction due to SSRIs, including cessation or reduction of dose, changing to another antidepressant, augmentation with another antidepressant, additional use of medications for erectile dysfunction and use of other add-on strategies. The choice of a specific strategy should be customized to individual needs of the patient.
A brief discussion about Neurocognitive disorders.
NCD are on the rise especially due to the ageing population and good treatment modalities leading to less mortality.
The burden of NCD is to increase with time especially due to the little interventions available
Sexual dysfunction due to SSRI antidepressants: How to manage?Apollo Hospitals
Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of commonly prescribed antidepressants in clinical practice. Sexual dysfunction is a common side effect of SSRIs, which often goes unrecognized but adversely affects the quality of life of the patient. This review takes a look at the occurrence of sexual dysfunction among patients receiving SSRIs from a clinical viewpoint. The review explores into the possible reasons of such a dysfunction and the differential diagnoses to be entertained while dealing patients receiving SSRIs and experiencing sexual dysfunction. The review discusses the management strategies for addressing such dysfunction due to SSRIs, including cessation or reduction of dose, changing to another antidepressant, augmentation with another antidepressant, additional use of medications for erectile dysfunction and use of other add-on strategies. The choice of a specific strategy should be customized to individual needs of the patient.
A brief discussion about Neurocognitive disorders.
NCD are on the rise especially due to the ageing population and good treatment modalities leading to less mortality.
The burden of NCD is to increase with time especially due to the little interventions available
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years.
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
Aging is associated with cognitive decline, and older subjects can have demonstrable cognitive impairment without crossing the threshold for dementia.
This condition has been termed “mild cognitive impairment” (MCI), and these patients have an increased risk of developing dementia, especially Alzheimer disease (AD).
Studies conducted in referral clinics have shown that patients with MCI progress to AD at a rate of 10% to 15% per year, and 80% of these patients have converted to AD after approximately 6 years of follow-up.
The identification and classification of MCI can be a major challenge.
Depression is a common illness worldwide, with an estimated 3.8% of the population affected, including 5.0% among adults and 5.7% among adults older than 60 years.
Obsessive-Compulsive and Related Disorders (DSM-V)Adesh Agrawal
The disorders those characterized by repetitive behavior, are included under this broad chapter in DSM-5. Here we prepared this PPT in which we tried to cover the whole topic in a very comprehensive and concise manner. We hope that this will help you to understand it in an easy way.
your further suggestions will be appreciated.
Even though depression is so common, there are many misconceptions about its symptoms, causes and treatment. The problem is that misinformation gives rise to stigma and isolation. Individuals with clinical depression often feel alone because others expect them to simply snap out of it or stop being lazy. These kinds of myths can make people not want to seek treatment. Untreated depression also can have devastating consequences like health complications, drug or alcohol abuse and suicide. Here’s a selection of myths n facts you might not know about.
Sexual health and function for women with pelvic floor disordersDr. Martha Tara Lee
"Sexual health and function for women with pelvic floor disorders" presented at Urofair Nursing Symposium at Grand Hyatt Hotel, on Sat 14 July 2018
About Dr. Martha Tara Lee
Dr. Martha Tara Lee is Relationship Counselor and Clinical Sexologist of Eros Coaching. She is a certified sexuality educator with AASECT (American Association of Sexuality Educators, Counselors, and Therapists) as well as certified sexologist with ACS (American College of Sexologists). Martha holds a Doctorate in Human Sexuality, Masters in Counseling, Certificates in Sex Therapy, Practical Counselling and Life Coaching, as well as two other degrees. She was recognised as one of ‘Top 50 Inspiring Women under 40′ by Her World Singapore in July 2010 and ‘Top 100 Inspiring Women by CozyCot Singapore in March 2011.
Subscribe so you don't miss a thing! http://www.ErosCoaching.com
Social media links
https://www.facebook.com/eroscoaching
https://twitter.com/drmarthalee
https://www.linkedin.com/in/leemartha
Programs
Ready Get Sex Go http://www.eroscoaching.com/rgsg
Sex Jumpstart http://www.eroscoaching.com/sex-jumpstart
Tongue Twisters http://www.eroscoaching.com/tongue-twisters
Sex Possible http://www.eroscoaching.com/sex-possible
Clean and Clear http://www.eroscoaching.com/clean-and-clear
Books
Orgasmic Yoga: Masturbation, Meditation and Everything In-Between https://www.amazon.com/Orgasmic-Yoga-Masturbation-Meditation-Between/dp/1515118193
Love, Sex and Everything In Between https://www.amazon.com/Love-Sex-Everything-Between-Martha/dp/9814484199/ref=reg_hu-rd_add_1_dp
From Princess to Queen http://www.eroscoaching.com/queen
Drugs which affecting sexual health may be a big problem and must keep it in your mind before prescribing a medication
Monitoring and treatment of drug induced sexual dysfunction is important step if the physician can not stop the causative agent
Different kinds of sexual dysfunction and their management.
Sexual difficulties in Spinal cord injury patients
Evaluation of sexual problems and differentials
New pharmacologic agents in management of sexual dysfunctions
Unraveling Sexual Dysfunction Causes, Impacts, and Solutions.pdfWatRudy
Understanding Sexual Dysfunction Sexual dysfunction is a problem that can occur during any phase of the sexual response cycle, which includes excitement, plateau, orgasm, and resolution2. It can prevent individuals from experiencing satisfaction from sexual activity, and it is more common than many people realize2. Here are some key points to understand about sexual dysfunction: Defining sexual…
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Assessing and Treating Adult Clients with Mood DisordersA mood d.docxgalerussel59292
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh.
Assessing and Treating Adult Clients with Mood DisordersA mood d.docxcargillfilberto
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh.
Assessing and Treating Adult Clients with Mood DisordersA mood d.docxfestockton
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh ...
Assessing and Treating Adult Clients with Mood DisordersA mood dmurgatroydcrista
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh ...
Assessing and Treating Adult Clients with Mood DisordersA mood dVinaOconner450
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh ...
Assessing and Treating Adult Clients with Mood DisordersA mood ddirkrplav
Assessing and Treating Adult Clients with Mood Disorders
A mood disorder describes a psychological disorder which is characterized as a fluctuation of one’s mood, such as a major depressive or bipolar disorder. An estimated 20 million individuals in the United States have depression which comprises of symptoms such as a loss of pleasure in activities, sadness, weight changes, feelings of hopelessness, fatigue as well as suicidal ideation; all of which can significantly impact daily functioning (Mental Health.gov, 2017). According to Park and Zarate (2019) onset of depression in adulthood continues to flourish where an estimated 30 percent of adults have a lifetime risk of experiencing a major depressive episode with a median age of 32.5. The author further indicates screening for depression, a thorough evaluation, and monitoring is necessary to ensure safety and wellbeing (Park & Zarate, 2019). Pharmacotherapy, along with psychotherapy are first-line therapies for effective outcomes (Park & Zarate, 2019). The purpose of this paper is to review a case study, choose the appropriate selection utilizing research, and discuss ethical considerations.
Case Study
A 32-year-old Hispanic American client presents to the initial appointment with depression. Health history, along with medical workup, appears to be unremarkable except for the slight back and shoulder pain due to his occupation. The clinical interview reveals past feelings of being an “outsider” and has few friends (Laureate Education, 2016). There is a decline in daily activities, a weight increase of 15 pounds over two months, along with diminished sleep and the inability to fully concentrate (Laureate Education, 2016). The results of the depression screening administered by the psychiatric mental health nurse practitioner (PMHNP), indicates severe depression with a score of 51 (Montgomery & Asberg, 1979).
Decision Point One
The selections include Zoloft 25 mg orally daily, Effexor 37.5 XR mg orally daily, or Phenelzine 15 mg orally TID. As a healthcare professional treating a client, Zoloft (sertraline) 25 mg is the first choice at decision point one. Selective serotonin reuptake inhibitors (SSRIs) impede the reabsorption of this neurotransmitter; thus, increasing the serotonin levels of the nerve cells in the brain to allow for improvement in mood (Stahl, 2013). SSRIs have been utilized as first-line therapy to treat major depressive disorder due to efficacy, fewer side effects, cost-effectiveness as well as a wider availability (Masuda et al., 2017). The therapeutic dosing range is typically 50 mg-200 mg (Stahl, 2017). However, beginning at 25 mg and gradually titrating the dose, depending on tolerability, is an appropriate health care decision (National Alliance on Mental Illness, 2018b). Therefore, a low dose of Zoloft appears to be the best option in caring for this client.
Effexor (venlafaxine) is classified as a selective serotonin-norepinephrine reuptake inhibitor (SNRI) wh ...
Similar to Management of antidepressant induced sexual dysfunction (20)
Dr.Shukri and Dr.Ahmad Eid collaberated together to teach us how to tackle difficult cases and how to deal with a typical presentation to psychiatry symptoms
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
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25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
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CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
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Management of antidepressant induced sexual dysfunction
1. Management of
Antidepressant-induced
Sexual Dysfunction
Literature Review
Prepared and Presented by:
Badr Saleh Alaseeri
Psychiatry R2
King Abdulaziz Medical City
National Guard Health Affairs
Jeddah
Reviewed by:
Dr. Tarek Sherif
Consultant Psychiatrist
King Abdulaziz Medical City
National Guard Health Affairs
Jeddah
2. Content
Overview
Epidemiology
How Antidepressants affect sexuality?
What leads to the other depression or sexual dysfunction?
Management
3. Overview
How common are antidepressants used?
264 million prescriptions filled for antidepressants
in the USA in 2011, accounting for $11 billion and
making antidepressants the most commonly used
group of medications at that year .
Lindsley 2012.
4. Overview
What is meant by sexual dysfunction?
Sexual dysfunction could affect any of the
following phases of the sexual response
cycle:
Desire decreased libido
Arousal/ erection erectile
dysfunction
Orgasm anorgasmia
Ejaculation Delayed ejaculation
5. Overview
Consequences of antidepressants-induced sexual
dysfunction:
Early discontinuation of antidepressant.
Relapse of depression.
Poor quality of life.
Gregorian et al 2002; Rosenberg et al 2003; Clayton and Balon 2009, in Reichenpfader
et al 2014.
9. Epidemiology
Citalopram* was found to cause:
54%: Decreased libido.
36%: Difficulty achieving orgasm.
37% of men: Erectile dysfunction.
*In 14-week prospective study that involved 1473 patients taking citalopram by Perlis RH et al
(2009).
SSRIs and SNRIs were associated with sexual
dysfunction in 50%*.
* In a cross-sectional survey that included 740 patients by Williams VS et al (2010).
10. Epidemiology
A systematic review and meta analysis (Reichenpfader et al
2014) concluded that:
Bupropion has a statistically significantly lower risk of
sexual dysfunction than some other antidepressants,
escitalopram and paroxetine show a statistically
significant higher risk of sexual dysfunction than some
other antidepressants.
11. Epidemiology
Clayton et al* (2015) found that desvenlafaxine
did not affect sexual functioning more than
placebo.
No head-to-head comparisons were conducted to
compare desvenlafaxine to other antidepressants
regarding effects on sexual functioning.
*Some authors have affiliation with Pfizer.
12. Epidemiology
Genetic Polymorphism may be involved.
Perlis RH et al (2009).
Men have more dysfunction in desire and orgasm.
Women have more arousal dysfunction.
Clayton et al (2006)
13. Epidemiology
Men showed more incidence of sexual dysfunction
than women, but women's sexual dysfunction was
more intense than men's.
Incidence of antidepressant-indeuced sexual
dysfunction was higher when asked directly (58%)
than when reported spontaneously (14%).
Montejo-González et al 1997
14. Overview
“Both men and women who are taking
antidepressants should be asked whether sexual
side effects are occurring with these medications
[level I*].”
American Psychiatric Association (APA). Practice guideline for the treatment of patients with
major depressive disorder. 3rd ed. Arlington (VA): American Psychiatric Association (APA); 2010 Oct.
*Levels of evidence:
[I] Recommended with substantial clinical confidence.
[II] Recommended with moderate clinical confidence.
[III] May be recommended on the basis of individual circumstances.
15.
16. What leads to the other?
Depression itself can cause sexual dysfunction in
50% of patients.
Angst J. (1998) and Kennedy SH et al (1999).
Treatment with SSRI helps improving sexual
satisfaction in those with depression and sexual
dysfunction.
Baldwin DS and Foong T (2013).
17. What leads to the other?
A systematic review and meta-analysis by Atlantis and
Sullivan (2012) concluded the presence of
biderctional association between depression and
sexual dysfunction, and that the presence of one
necessitate the screening of the another.
Atlantis and Sullivan (2012).
Amongst those presenting with sexual dysfunction,
some will see an improvement, some no change and
some a worsening when taking on antidepressant.
Werneke U et al (2006)
18. Mechanisms by which antidepressants
cause sexual dysfunction
Desire:
The mesolimbic system has an essential role in sexuality,
mediated by dopaminergic neurotransmission
Segraves (1989), Bitran et al (1988) and Baldessarini and Marsh (1990) in Serretti and Chiesa (2009)
Serotonin reuptake blockade reduce dopamine activity in
that area through 5-HT₂ receptors
Baldessarini (1990) and Meltzer (1979) in Serrtti and Chiesa (2009)
19. Mechanisms by which antidepressants
cause sexual dysfunction
Arousal dysfunction could be a result of:
Low dopamine in the mesolimbic system.
Inhibition of peripheral spinal reflexes of the
sympathetic and parasympathetic systems which
mediate erection and clitoral engorgement and this is
influenced by several neurotransmitters including
serotonin.
Segraves (1989), Bitran et al (1988) and Pollack (1992) in Serretti and Chiesa (2009).
Possible role of low nitric oxide, that was shown to be
reduced by paroxetine in a study.
Finkel et al (1996).
20. Mechanisms by which antidepressants
cause sexual dysfunction
Orgasm dysfunction could be related to low dopamine and
noradrenaline levels caused by 5-HT₂ activation.
Pollack et al (1992), Zajecka et al (1991) and Crenshaw (1996) in Serretti and Chiesa (2009)
Those changes seems to alter the sympathetic and
parasympathetic systems, that are essential for orgasm
and ejaculation.
Bitran et al (1988) and Pollack et al (1992) in Serretti and Chiesa (2009)
Agents that exert antagonism at 5-HT₂ (e.g., mirtazapine
and nefazodone) do not appear to cause sexual
dysfunction. (57).
21. Mechanisms by which antidepressants
cause sexual dysfunction
Agents that exert antagonism at 5-HT₂ (e.g., mirtazapine
and nefazodone) do not appear to cause sexual
dysfunction.
Zajecka et al (1991) in Serretti and Chiesa (2009)
29. Management: Strategies
Options to treat Antidepressant-induced sexual
dysfunction:
Wait for spontaneous resolution.
Drug holiday.
Decrease the dose.
Switch to another antidepressants.
Augmentation with (add) another agent.
30. Management: Strategies
Wait for Spontaneous resolution
19-30% of patients with antidepressant-induced sexual
dysfunction have moderate to total regain of their
sexual functions after 6 months of using
antidepressants.
Serretti and Chiesa (2009) and Montejo-González et al (1997).
31. Management: Strategies
Drug holiday
Rothschild (1995) concluded that holding the antidepressant
during the weekend for those on paroxetine or sertraline
(but not fluoxetine) significantly improved sexual
functioning without significant worsening of depressive
symptoms.
Maudsley prescribing guidelines in psychiatry doesn’t prefer
this strategy as it may carry a risk for relapse of depression
or experiencing antidepressant discontinuation symptoms.
32. Management
Decrease the dose
Antidepressant-induced sexual dysfunction appears to
be dose-related.
Zajecka (2001)
In a prospective observational study, 77% had moderate
to complete improvement in sexual functioning when
antidepressant dose was reduced by 50%.
Montejo-González et al (1997).
33. Management
Switch to another antidepressant:
Bupropion
Agomelatine
Mirtazapine
Nefazodone
Moclobemide
Selegiline
34. Management: Switch
Bupropion:
Incidence of sexual dysfunction among those treated by
bupropion is less than other antidepressants and was
comparable to placebo.
Thase ME et al (2005) and Clayton AH (2006).
Walker et al (1993):
39 patients who had sexual dysfunction while on fluoxetine
were switched to bupropion and were followed for 8 weeks
94%: Orgasm dysfunction completely or partially resolved.
81%: Libido improved “much” or “very much”.
81%: Overall sexual functioning was “much” or “very much”
more satisfying.
35. Management: Switch
Mirtazapine:
In a systematic review, it was found to cause less
sexual dysfunction than SSRIs (OR: 0.31, 95% CI:[0.13, 0.74])
Watanabe et al (2011)
54% of patients with SSRI-induced sexual
dysfunction regained their normal sexual functioning
after switching to mirtazapine, with no worsening of
depressive symptoms.
Gelenberg et al (2000)
36. Management: Switch
Agomelatine:
Causes less sexual dysfunction than escitalopram
in healthy individuals.
Montejo et al (2015)
Causes less sexual dysfunction than paroxetine (OR
0.14. 95% CI: [ 0.04, 0.47 ])
Guaiana G et al (2013)
37. Management: Switch
Agomelatine:
44.9% of patients having sexual dysfunction due to
SSRIs or SNRIs had resolved their sexual dysfunction
after switching to agomelatine. 18.4% still had
moderate-severe sexual dysfunction. Others stopped
agomelatine due to inefficacy or tolerability issues.
Montejo et al (2014)
Bear in mind the risk of liver injury (4.6% for
agomelatine vs 2.1% for placebo).
Freiesleben and Furczyk (2015).
38. Management: Switch
Nefazodone:
Ferguson et al (2001):
105 Patients with sexual dysfunction induced by treatment
with sertraline stopped it for 2 weeks.
At the end of 2 weeks, those whose sexual functioning
returned back to normal were enrolled in the study.
Participants were divided into 2 groups, the first restart
sertraline 100 mg/day, and the other was put on
nefazodone 400 mg/day.
76% of sertraline group had re-emergence sexual
dysfunction.
26% of nefazodone had sexual dysfunction.
39. Management: Switch
Selegiline (Stryjer R et al 2009) and trazaodone
(Clayton AH et al 2007) were found to have a similar
incidence of sexual dysfunction to placebo.
Moclobemide
No significant difference with placebo in
incidence of sexual dysfunction.
Serretti A and Chiesa A (2009)
41. Management: Augmentation
Bupropion:
A systematic review and meta-analysis (Taylor MJ et
al 2013) favoured bupropion as an augmenting agent
over placebo
(SMD: 1.60, 95% CI 1.40 to 1.81)
‘The most promising approach studied so far’ in
treating women with antidepressant-induced sexual
dysfunction.
(Taylor et al 2013)
42. Management: Augmentation
Phosphodiesterase-5 inhibitors:
Sildenafil:
Metal-analysis (Taylor MJ et al 2013) found that sildenafil
(50 to 100 mg on demand) was associated with greater
improvement of antidepressant-induced erectile
dysfunction than placebo.
(MD 1.04, 95%CI 0.65 to 1.44)
An 8-week trial found that sildenafil (50 to 100 mg on
demand) helped women who have disturbed orgasm due to
antidepressants more than placebo (72 vs 27 %).
Nurnberg et al. 2008
43. Management: Augmentation
Phosphodiesterase-5 inhibitors:
Tadalafil:
An RCT (Evliyaoğlu Y et al 2011) showed greater
improvement in each domain of sexual activity than
placebo.
A pooled analysis of 19 RCTs (Segraves RT et al 2007)
showed greater improvement than placebo in erectile
dysfunction caused by antidepressants.
45. Management: Augmentation
Mirtazapine:
A systematic review and meta-analysis (Taylor MJ et al 2013)
found no benefit of mirtazapine as an augmenting
agent.
Another two studies showed reduction of sexual
side‐effects in patients treated with duloxetine or
SSRIs when mirtazapine was added.
Ravindran LN et al (2008) and Ozmenler NK et al (2008).
46. Management: Augmentation
Busprione:
2 trials were done, one showed no more
improvement in sexual functioning than placebo.
The other one showed a difference, favouring
buspirone, that was statistically insignificant.
Michelson D et al (2000) and Landen M et al (1999)
47. Management: Augmentation
Ginkgo biloba:
Kang (2002) showed no significant difference
between Gingko biloba and placebo.
‘Satisfaction to orgasm’ was better in placebo.
(Kang 2002)
Wheatley (2004) concluded that Gingko biloba
added no more benefit than placebo.
48. Management: Augmentation
Exercise:
30 minutes of moderate strength training and
cardiovascular exercise immediately before sexual
activity improved sexual desire and global sexual
function in women compared to exercise separate
from sexual activity.
High dropout rate (46 %).
(Lorenz TA and Meston CM 2014)
49. Management: Augmentation
Maca root:
A small RCT (Dording et al 2015) showed higher
remission rates for the maca versus placebo group
were associated with postmenopausal status.
Lepidium meyenii
50. Management: Augmentation
Saffron:
Improved overall sexual satisfaction in SSRI-induced
sexual dysfunction in both men and women.
Modabbemia et al (2012) and Kashani et al (2013)
51. Management: Augmentation
A systematic review and meta-analysis (Taylor MJ et al 2013) failed to
prove the benefit of augmentation with:
Amantadine
Bethanechol
Cyproheptadine
Ephedrine
Granisetron
Mirtazapine
Olanzapine
Yohimbine
52. Summary
Sexual dysfunction is one of the most frequent and problematic
side effects of antidepressants.
It can affect not only sexual functioning, but also worsen the
depressive illness and quality of life.
SSRIs and SNRIs have the highest risk for sexual dysfunction,
while bupropion, agomelatine, mirtazapine has the lowest risk.
It's prevalence is underreported.
Direct questioning is essential to pick up patients with this side
effect.
53. Summary
Assessment for baseline sexual functioning helps accurately
assessing any subsequent change in sexual functioning.
Depression and sexual dysfunction has a reciprocal relationship.
A thorough assessment for risk factors contributing to the
sexual dysfunction is important to improve overall outcomes.
Many strategies have been suggested to manage antidepressant-
induced sexual dysfunction, many of which are with insufficient
body of evidence.
54. Summary
Those strategies include: watchful waiting, drug holiday,
reduction of the dose, switch or augmentation.
Augmentation with bupropion seems to have the best
evidence yet.
Augmentation with Phosphodiesterase-5 inhibitors seems
helpful specially for men with erectile dysfunction related
to antidepressants.
Further research is highly needed to reach a clearer
consensus about management.
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