[Adverse side-effect on sexual function caused by psychotropic drugs and psychotropic substances]. / Beeinträchtigung der Sexualfunktion durch Psychopharmaka und psychotrope Substanzen.

Unhindered sexuality plays an important role in the quality of life and this also holds true for patients with psychiatric illnesses. Knowledge concerning the complex neuronal and endocrine control mechanisms of sexual function reveals areas of possible dysfunction caused by the interactions between the control system, psychiatric drugs and addictive psychoactive substances. The differentiation of the cause of the dysfunction between being caused by the underlying illness and caused by other factors is difficult in practice. Both classical tri-cyclic antidepressants and selective serotonin uptake inhibitors can frequently cause adverse effects in multiple dimensions of sexual function. This same is true for neuroleptics, whereby the differentiation between symptoms of schizophrenia and side-effects from the medication can make an evaluation difficult. The medication-based strategy used to treat opiate dependency by administration of methadone causes sexual dysfunction in many cases. The consideration of medication-induced sexual dysfunction has a great importance with regard to compliance. Possible solutions can be modification of the medication regime, additional medication, e.g. partial antagonists and PD5 inhibitors, as well as dysfunction-specific psychotherapy and psychoeducation.

[The"difficult" patient in psychiatric care]. / Der "schwierige" Patient in der psychiatrischen Versorgung.

A small subgroup of patients who access psychiatric care proves to be "difficult" in many respects. Characteristic features include excessive use of services that entail high costs, enormous problems involved in interacting with the professional staff and fellow patients, and a high complication rate. The central problems comprise noncompliance, aggressiveness, and highly disruptive behavior. Young men predominate and the diagnosis frequently consists of schizophrenic psychoses and cluster B personality disorders. There are often signs of organic brain impairment and substance abuse as well as various comorbid mental disorders. In addition to psychopharmacological and psychotherapeutic treatment options, social psychiatric approaches play a prominent role in satisfactory problem solving. Attitude adjustments and suitable supervision and support of the therapeutic staff are essential.

Sexual impairment in psychiatric inpatients: focus on depression.

INTRODUCTION: Although sexual side effects are a common reason for noncompliance with medication, information on impairment of sexuality in psychiatric inpatients is scarce. METHODS: In the present multi-center study, data on several aspects of sexual functioning were collected in psychiatric inpatients using a previously validated questionnaire. RESULTS: A high overall prevalence of sexual dysfunction was reported by participants and was highest in depressed subjects. Patients receiving antidepressants suffered from more frequent and more severe impairment of sexuality than did subjects receiving neither antidepressants nor antipsychotics or opioids. DISCUSSION: Judging from this data, sexual impairment appears to be a frequent and underestimated problem in psychiatric inpatients with a high prevalence across all diagnostic groups, particularly in depressed subjects. Female patients attribute this impairment mainly to their mental illness, whereas male patients tend to assign their impairments primarily to their medication.

Sexual dysfunction in psychiatric inpatients the role of antipsychotic medication.

INTRODUCTION: Sexual dysfunction is a common side effect of antipsychotic medication. Although increased prolactin levels caused by antipsychotic agents are believed to play a major role with regard to sexual side effects, the underlying mechanism of antipsychotic agent-induced sexual dysfunction remains poorly understood. METHODS: In a multicentric study 587 psychiatric inpatients were assessed by means of a self-rating sexual questionnaire. Focussing on antipsychotic treatment three subgroups were drawn from the original sample. One group was treated with prolactin-increasing antipsychotics (n=119), the other with prolactin-neutral medication (n=109) and the third patient group was comprised of non-medicated clinical controls (n=105). RESULTS: The majority of all patients (50-75%) reported at least minor sexual dysfunction. On comparison of the subgroups, only female patients treated with prolactin-increasing medication reported more severe sexual dysfunction. However, multiple regression analysis did not confirm an association between the type of treatment and sexual impairment. DISCUSSION: Sexual dysfunction frequently occurs in psychiatric inpatients treated with antipsychotics. Our findings only partly support the assumptions concerning a major role of prolactin-increasing neuroleptics for medication-induced sexual impairment.

[Sexual dysfunctions from a neuropsychiatric perspective]. / Sexuelle Funktionsstörungen aus nervenärztlicher Perspektive.

Sexual dysfunctions are widespread and have an enormous effect on quality of life. To understand them, it is necessary to look at both somatic and psychosocial factors, especially those concerning partnership. Psychiatric and neurologic disorders play an important role. Normally, treatment consists of qualified sex counseling and, if necessary, intensive sex therapy. Somatic treatment options exist as well.

[Public vocational integration: a new method for integrating psychiatrically handicapped patients into occupational life?]. / Gemeinnützige Arbeitnehmerüberlassung: Ein neuer Weg zur Eingliederung psychisch behinderter Menschen in das Arbeitsleben?

Suitable conditions of employment represent a central factor in the rehabilitation of mentally ill people. In this case both the normality of the job--as felt by the individual--and adequate instrumental and social working conditions are determining factors. According to the ideas of the Workshop for the Handicapped (Werkstatt für Behinderte) and the movement for the Self-help Firms, the integration of the mentally ill into normal jobs is an important step in the right direction. Appropriate preparations (i.e. assessment of patients' working capabilities and the drawing up of expectation profiles, work-preparation measures) and well-organized follow-up care are required to achieve this. Statutes which make access easier must be created in the fields of both labour and social law in order to make integration into the labour market possible. In this respect the non profit-making provision of employees (Gemeinnützige Arbeitnehmerüberlassung) represents a model. The procedure has been described and first experiences with its realization have been reported upon.

[Role of psychiatry and psychotherapy in sexual medicine after introductory marketing of viagra]. / Die Rolle von Psychiatrie und Psychotherapie in der Sexualmedizin nach der Markteinführung von Viagra.

Sildenafil (Viagra) is a substance for the treatment of erectile dysfunction. Great expectations are connected with its introduction into the market. In this situation the multidimensionality in the control-mechanismus of the sexual reaction and of the satisfaction in the sexual experience are pointed out. These aspects affect the diagnostic and therapeutic competence of psychiatry and psychotherapy in a high degree. Efficient psycho-educative and psychotherapeutic ways of treatment for sexual dysfunction are available. Increased specific knowledge in this area is required by psychiatrists, medical psychotherapists and neuropsychiatrists.

[The importance of proficiency in the German language in development and treatment of psychiatric diseases]. / Die bedeutung der "Deutschkenntnisse" für die Entwicklung und Behandlung von psychiatrischen Erkrankungen.

The study investigates the relations between proficiency in German language and manifestation and course of psychiatric diseases in migrants from Eastern Europe. Analyses were conducted for all migrants, who were treated in the local psychiatric state hospital between 1990 and 1996. Results showed that migrants with low language proficiency fall sick earlier, are admitted to the hospital faster and are kept in hospital treatment longer than those with good German language proficiency.