Clinical characterisation of women with persistent genital arousal disorder: the iPGAD-study.

Persistent Genital Arousal Disorder (PGAD) is a rare condition-mostly in women-where patients perceive prolonged genital arousal without any sexual desire or stimulation. Etiopathological considerations reach from peripheral to central issues over local disturbance of the pudendal nerve to neuropathy, psychosocial, and pharmacological theories. Since well controlled clinical studies about PGAD in conjunction with a mental and somatic health status are missing, this study is a detailed clinical investigation of PGAD patients compared to healthy controls. 26 women who fulfilled diagnostic criteria for PGAD were compared to 26 age matched healthy controls. Investigations included comparison of vegetative, gynaecological and sexual history, psychiatric features as well as a (neuro-)radiological, neurophysiological and gynaecological examination. Moreover, a detailed clinical characterisation of PGAD symptoms was performed. PGAD symptoms were mostly characterised as tingling or prickling and were permanently present. In over 80%, PGAD symptoms were located in the clitoris. Almost 70% reported radiations to other regions of the body. Most frequent trigger factors were tight clothes, mental stress, driving a car/bus/bicycle and sexual intercourse. Relieving factors were mainly distraction, relaxation, physical exercise, masturbation and swimming. In group comparisons, PGAD presented with significant higher rates of sexual dysfunctions, spontaneous orgasms, swelling of the genitals, extraordinary lubrication as well as higher rates in depression, agoraphobia, generalized anxiety disorder and lifetime panic disorder. Significantly more PGAD patients were diagnosed with restless legs symptoms. In contrast childhood traumatization, somatization disorder, suicidality, gynaecological as well as neurophysiological examination of the pudendal nerve were not different between the groups. MRI of the brain, pelvis and spinal cord was unsuspicious and incidental findings - including Tarlov cysts or pelvic venous congestion - were equally distributed among the groups. In summary, our study provides a careful characterization of women with PGAD highlighting a serious mental burden, most probably as a consequence of PGAD. With the current set of clinical investigations there was no evidence of a clear causal relationship to a specific clinical finding as it has been previously discussed. Future studies and additional techniques will have to further explore where and how in the peripheral or central nervous systems PGAD develops.

The androgen system across the menstrual cycle: Hormonal, (epi-)genetic and psychometric alterations.

The menstrual cycle is characterized by various hormonal alterations and associations with mental and physical conditions have been postulated. Among endocrine factors, the androgen system has been a target of major interest in males and to a lesser extent in females and may influence emotion, cognition, behavior and somatic factors. Only few studies investigated alterations of these parameters throughout the menstrual cycle and there is a lack of studies exploring a link towards epigenetic and genetic regulation. This multisite longitudinal study examines behavioral parameters including affectivity, stress perception and various diary parameters of mental and physical well-being in conjunction with testosterone and LH plasma levels in 87 menstruating women. Additionally, Cysteine-Adenenine-Guanin (CAG) repeat length and methylation of the androgen receptor gene collected at four time points across two cycles comprising the menstrual, pre-ovulatory, mid-luteal and premenstrual phase were assesed. There was a significant increase of LH and testosterone plasma levels during the pre-ovulatory phase as well as a decrease of methylation of the androgen receptor at mid-luteal phase. Subjective ratings of physical condition and sexual interest peaked during the pre-ovulatory phase and the former correlated negatively with the androgen receptor gene methylation level. This longitudinal study shows alterations of the androgen system including epigenetic measurements throughout the menstrual cycle. While a link between peripheral testosterone and sexual activity and between increased physical condition and an upregulation of testosterone receptor protein expression can be assumed, the majority of parameters remained unchanged. These initial findings need validation by subsequent studies.

Potentially inappropriate prescriptions of antibiotics in geriatric psychiatry-a retrospective cohort study.

Introduction: Older patients are frequently affected by infectious diseases and adverse drug reactions (ADRs) of consecutively prescribed antibiotics. Particularly within geriatric psychiatry, high rates of potentially inappropriate prescriptions (PIPs) have been described, significantly complicating pharmacological treatment. Therefore, this study aimed to investigate the frequency and characteristics of antibiotic PIPs in geriatric psychiatry. Methods: Medication charts of 139 patient cases (mean age 78.8 years; 69.8% female) receiving antibiotic treatment on a geriatric psychiatric ward were analyzed. Utilizing previously published definitions of antibiotic PIPs, adequacy of the antibiotic prescriptions was subsequently assessed. Results: 16.3% of all screened patient cases (139/851) received an antibiotic treatment during their inpatient stay. 59.5% of antibiotic prescriptions were due to urinary tract infections, followed by pulmonary (13.3%) and skin and soft tissue infections (11.3%). 46.7% of all antibiotic prescriptions fulfilled at least one PIP criterium, with the prescription of an antibiotic course for more than seven days as the most common PIP (15.3%). Discussion: Antibiotic PIPs can be considered as a frequent phenomenon in geriatric psychiatry. Especially the use of fluoroquinolones and cephalosporins should be discussed critically due to their extensive side effect profiles. Due to the special characteristics of geriatric psychiatric patients, international guidelines on the use of antibiotics should consider frailty and psychotropic polypharmacy of this patient population more closely.

Negative affect is unrelated to fluctuations in hormone levels across the menstrual cycle: Evidence from a multisite observational study across two successive cycles.

BACKGROUND: Female sex hormones may play a crucial role in the occurrence of cycle-related mood disorders. However, the literature is inconsistent and methodologically stringent observational studies on the relationship between sex hormones and negative affect are lacking. METHODS: In this longitudinal multisite study from Hannover, Germany, and Zurich, Switzerland, we examined oestrogen, progesterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone serum levels in association with negative affect as measured with the Positive and Negative Affect Schedule (PANAS). Negative affect and hormone assays were collected at four consecutive time points comprising menstrual, pre-ovulatory, mid-luteal and premenstrual phase across two cycles (n=87 and n=67 for the first and second cycles). The Beck Depression Inventory (BDI) was assessed once prior to the first cycle and included as a secondary measure. RESULTS: Mean negative affect scores did not significantly fluctuate across both cycles and there was in particular no symptom increase premenstrually. No sex hormone consistently related to repeated measures of negative affect across two consecutive cycles. The BDI sum-score assessed at baseline was not related to hormone levels across the first cycle. CONCLUSIONS: This is the first multisite longitudinal study on the association between negative affect and sex hormone levels encompassing two consecutive menstrual cycles. Negative affect did not fluctuate across the cycle and there was no direct and uniform association between sex hormones and self-reported negative affect. These findings suggest that moderators such as personality traits and epigenetics should be considered in future research.

Individual and dyadic barriers to a pharmacotherapeutic treatment of hypoactive sexual desire disorders: results and implications from a small-scale study with bupropion.

This article describes the results of an independent small-scale trial with the centrally acting agent bupropion for female hypoactive sexual desire disorder. The main goals were to gain insight into the intrapsychic and interpersonal barriers to improvement associated with the pharmacological treatment of this common disorder. Eligible subjects entered a 2-week run-in period and a 4-week placebo phase, followed by a 20-week treatment phase. In addition to semi-structured clinical interviews and a set of standardized questionnaires, we used 2 self-developed questionnaires, addressing the period between visits and the week preceding each visit. Participants were 16 women who entered the placebo phase and 10 who completed the medication period. Analyses of pre-post scores and of the questionnaire addressing the time between visits yielded no significant changes. The questionnaire focusing on the week preceding each visit indicated improvements in sexual desire, arousability, and orgasmic ease after Week 8. In the clinical interviews, half of the women reported subjective improvements of sexual desire and arousability that could not be transferred to the sexual relationship as a result of individual and dyadic barriers. Overall, a centrally acting agent such as bupropion may be a viable option for female sexual dysfunction, but it seems mandatory to embed it in a psychotherapeutic approach.

Endoscopy for repeatedly ingested sharp foreign bodies in patients with borderline personality disorder: an international survey.

BACKGROUND: The general guidelines on the management of ingested foreign bodies (FBs) do not address specific aspects raised by psychiatric patients, particularly in patients with borderline personality disorders (BPD) who repeatedly ingest FBs. The aim of this survey was to collect data on experience and opinions on the management of FBs in psychiatric patients with BPD and to review the relevant literature. METHODS: A survey focusing on the indication and the timing of endoscopy for sharp FB removal in patients with BPD was e-mailed to 215 gastroenterologists, psychiatrists, and surgeons in Switzerland, Germany and Austria, discussing this clinical problem using a specific case vignette. RESULTS: Responses were received from 63 of 215 (29%) contacted physicians. Two-thirds of the respondents knew patients with BPD who had swallowed FBs repeatedly; 86% recommended removing sharp FBs endoscopically even in the case of repeated FB ingestion and 14% of respondents argued against emergent endoscopic FB removal in the case of repeated ingestions. Different specialities expressed partially divergent opinions regarding the management of these patients. CONCLUSION: Repeated FB ingestions can be a problem in patients with BPD. Although published data show that the perforation risk of unremoved FBs is low, most clinicians support repeated endoscopies also in the case of repeated FB ingestions. Nevertheless, in selected cases, repeated endoscopies need to be discussed and an interdisciplinary consensus and/or the involvement of an ethical committee is advised.

Endocrine alterations during a detoxification treatment with carbamazepine in male alcoholics.

This study aimed to evaluate the prevalence and time-course of endocrine alterations in male alcohol addicts during a detoxification treatment and to examine a possible relation between endocrine alterations and depressive symptoms and overall mental distress. Blood samples were drawn in 54 male alcohol addicts on admission, at day 7 of treatment and at day 14 on discharge. Endocrine analysis was performed for cortisol, luteinizing hormone, prolactin, androgens, free testosterone and 17beta-estradiol. Psychometric measures (Beck's depression inventory and the symptom checklist-90-R) were taken on admission and on discharge and were correlated with endocrine measures. Cortisol plasma levels were substantially increased at the beginning of the detoxification, whereas all other endocrine parameters were within the normal range. Although subjects depicted mild to moderate levels of depressive symptoms and mental distress, there were no correlations with endocrine variables. Further analysis revealed a high variation in sex steroid levels with approximately 55% of participants showing initial (n = 19) or developing (n = 11) hypogonadal values during detoxification. In conclusion, chronic alcohol consumption induces disturbances of gonadal function which are reversible in the majority of cases. However, few patients develop a hypogonadal state during detoxification. Initially increased cortisol levels indicate a bodily stress response with the onset of alcohol withdrawal but are not related to mental disturbances.