PSYCHOSEXUAL DISORDERS

—  Always rule out organic cause

Classification

1. Sexual dysfunction, not caused by organic disorder or disease
1. Lack or loss of sexual desire
2.  Sexual aversion and lack of sexual enjoyment
3. Failure of genital response
4.  Orgasmic dysfunction
5.  PreClassificationmature ejaculation
6.  Nonorganic vaginismus
7.  Nonorganic dyspareunia
8.  Excessive sexual drive
2. Sexual dysfunction covers the various ways in which an individual is unable to participate in a sexual relationship as he or she would wish

Failure of genital response

1. In men, the principal problem is erectile dysfunction, i.e. difficulty in developing or maintaining an erection suitable for satisfactory intercourse.
2. If erection occurs normally in certain situations, e.g. during masturbation or sleep or with a different partner, the causation is likely to be psychogenic.
3. REM penile tumunuscence .

Premature ejaculation

1. The inability to control ejaculation sufficiently for both partners to enjoy sexual interaction.
2. In severe cases, ejaculation may occur before vaginal entry or in the absence of an erection.
3.  Premature ejaculation is unlikely to be of organic origin but can occur as a psychological reaction to organic impairment, e.g. erectile failure or pain.
4. Ejaculation may also appear to be premature if erection requires prolongedstimulation, causing the time interval between satisfactory erection and ejaculation to be shortened; the primary problem in such a case is delayed erection.

Masturbation

1. Is it normal?
2. Frequency?
3. What is abnormal?

Disorders of sexual preference

1. Fetishism

¡  Fetishistic transvestism

2. Exhibitionism
3. Voyeurism
4. Paedophilia
5. Sadomasochism

Fetishism

1. Reliance on some non-living object as a stimulus for sexual arousal and sexual gratification.
2. Many fetishes are extensions of the human body, such as articles of clothing or footware.
3. Other common examples are characterized by some particular texture such as rubber, plastic, or leather.
4. Fetish objects vary in their importance to the individual: in some cases they serve simply to enhance sexual excitement achieved in ordinary ways (e.g. having the partner wear a particular garment).

Exhibitionism

1. A recurrent or persistent tendency to expose the genitalia to strangers (usually of the opposite sex) or to people in public places, without inviting or intending closer contact.
2. There is usually, but not invariably, sexual excitement at the time of the exposure and the act is commonly followed by masturbation.
3. This tendency may be manifest only at times of emotional stress or crises, interspersed with long periods without such overt behaviour.

Voyeurism

1. A recurrent or persistent tendency to look at people engaging in sexual or intimate behaviour such as undressing.
2. This usually leads to sexual excitement and masturbation and is carried out without the observed people being aware.

Paedophilia

1. A sexual preference for children, usually of prepubertal or early pubertal age.
2. Some paedophiles are attracted only to girls, others only to boys, and others again are interested in both sexes.

Sadomasochism

1. A preference for sexual activity that involves bondage or the infliction of pain or humiliation.
2. If the individual prefers to be the recipient of such stimulation this is called masochism; if the provider, sadism.
3. Often an individual obtains sexual excitement from both sadistic and masochistic activities.

Etiologies of psychosexual disorders

1. Sexual Dysfunction:
1. Mental Illness: Anxiety
2. Past history of abuse

2.     Disorder of sexual preference:

1. Sexual Abuse

Mental Retardation ( Disorders of Intellectual Disability)

1. Mental retardation is a condition of arrested or incomplete development of the mind, which is especially characterized by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence, i.e. cognitive, language, motor, and social abilities.
2. However, mentally retarded individuals can experience the full range of mental disorders, and the prevalence of other mental disorders is at least three to four times greater in this population than in the general population.
3. In addition, mentally retarded individuals are at greater risk of exploitation and physical/sexual abuse

The most common causes of intellectual disability are:

1. Genetic conditions. These include things like Down syndrome and fragile X syndrome.
2. Problems during pregnancy.Things that can interfere with fetal brain development include alcohol or drug use, malnutrition, certain infections, or preeclampsia.
3. Problems during childbirth. Intellectual disability may result if a baby is deprived of oxygen during childbirth or born extremely premature.
4. Illness or injury. Infections like meningitis, whooping cough, or themeasles can lead to intellectual disability. Severe head injury, near-drowning, extreme malnutrition, exposure to toxic substances such as lead, and severe neglect or abuse can also cause it.

Mild mental retardation

1. Mildly retarded people acquire language with some delay but most achieve the ability to use speech for everyday purposes, to hold conversations, and to engage in the clinical interview.
2. Most of them also achieve full independence in self-care (eating, washing, dressing, bowel and bladder control) and in practical and domestic skills, even if the rate of development is considerably slower than normal.
3. The main difficulties are usually seen in academic school work, and many have particular problems in reading and writing.
4. If the proper standardized IQ tests are used, the range 50 to 69 is indicative of mild retardation.

Moderate mental retardation

1. Individuals in this category are slow in developing comprehension and use of language, and their eventual achievement in this area is limited.
2. Achievement of self-care and motor skills is also retarded, and some need supervision throughout life.
3. Progress in school work is limited, but a proportion of these individuals learn the basic skills needed for reading, writing, and counting
4. As adults, moderately retarded people are usually able to do simple practical work, if the tasks are carefully structured and skilled supervision is provided.
5.  Completely independent living in adult life is rarely achieved.
6. The IQ is usually in the range 35 to 49.

Severe mental retardation

1. This category is broadly similar to that of moderate mental retardation in terms of the clinical picture, the presence of an organic etiology, and the associated conditions
2. Most people in this category suffer from a marked degree of motor impairment or other associated deficits, indicating the presence of clinically significant damage to or maldevelopment of the central nervous system.
3. The IQ is usually in the range of 20 to 34.

Profound mental retardation

1. The IQ in this category is estimated to be under 20, which means in practice that affected individuals are severely limited in their ability to understand or comply with requests or instructions.
2.  Most such individuals are immobile or severely restricted in mobility, incontinent, and capable at most of only very rudimentary forms of nonverbal communication

Down Syndrome

1. Down's syndrome, also known as trisomy 21, is a genetic disorder caused by the presence of all or part of a third copy of chromosome 21

Features

1. Mental impairment
2. Abnormal teeth
3. Stunted growth
4. Slanted eyes
5. Umbilical hernia
6. Shortened hands
7. Increased skin back of neck
8. Short neck
9. Low muscle tone
10. Bent fifth finger tip
11. Flat head
12. Single transverse palmar crease
13. Large ,Protruding tongue
14. Congenital heart disease
15. Flattened Nose