["More is less": a retrospective study of haloperidol dosages in acute schizophrenia]. / "Weniger ist mehr": Eine retrospektive Untersuchung der Haloperidoldosierungen bei akut erkrankten schizophrenen Patienten.

UNLABELLED: With the background of a number of meta-analyses on the optimal neuroleptic dosages [1,2] the average daily dosage for the treatment of acute schizophrenic episodes recommended in the internal treatment guidelines of our psychiatric clinic was reduced from 24 mg to 15 mg haloperidol equivalent. In the present retrospective study it was investigated what effect this change in guideline had on the actual dosing behavior and on the efficacy and the side effect rate of the antipsychotic treatment. For this purpose all haloperidol treated patients of a two year interval prior to the change of the guideline (1987/88, n = 103) were compared with all treated of a two year interval (1991/92, n = 87) following it. RESULTS: The evaluation of the treatment data showed that the dosing guideline was adhered to and in 1991/92 on the average actually only 15 mg haloperidol were prescribed daily in acute schizophrenic episodes. The antipsychotic efficacy was just as good under this dosage as under the average daily dose of 24 mg haloperidol given in the preceeding interval; the average time in hospital was even reduced from 76 to 67 days. Under the lower daily doses an additional medication with biperiden was less often required. CONCLUSION: Average daily doses of 15 mg haloperidol appear to be at least equally as effective and more tolerable for the treatment of acute schizophrenic episodes than average daily doses of 24 mg haloperidol.

Sex ratio of transsexuals in Germany: the development over three decades.

OBJECTIVE: The higher incidence of man-to-woman transsexuals compared to woman-to-man transsexuals varies markedly from country to country. This is the first survey of the sex ratio to be made in Germany. METHOD: It covers 1785 patients who between 1964 and 1998 were diagnosed as transsexual at the four largest German centres offering treatment. RESULTS: From 1970 to 1994 the sex ratio remained constant at 2:1 in favour of man-to-woman transsexuals. Over the past 4 years, however, it has altered considerably and reached 1.2:1. CONCLUSION: Up to 1994 our results do not support the assumption that transsexualism is gradually becoming equally prevalent in both sexes. The drop in the sex ratio after 1994 can be explained either as a reduction of an overhang of male-to-female transsexuals or as an artificial phenomenon caused by recent developments in therapy and by the views of transsexuals' groups on the treatment they are offered.

[Transsexualism--when is gender transformation operation indicated?]. / Transsexualität--wann ist die Transformationsoperation indiziert?

The indications for transformation surgery for transsexuals cannot be defined at one single examination; they gradually become apparent over a period of long-term care lasting a minimum of 1.5 years, beginning with the first contact with the therapist and ending with surgery. Patients who have been well prepared for the sex change over this period usually become socially well integrated after the operation. Positive results do not depend on sexually corrective surgery alone, but on the overall therapeutic package. Although the operation represents the last step in the course of treatment for most transsexuals, surgical correction per se is not the solution for every patient with problems of sexual identity.

[Homicide and hebephrenia-like syndrome in metachromatic leukodystrophy]. / Kindstötung und hebephrenes Syndrom bei metachromatischer Leukodystrophie.

We report a patient with metachromatic leukodystrophy (MLD) with a first manifestation of homicide. On admission the patient showed a hebephrenia-like syndrome with inappropriate affect, thought disorder and behavioral changes. Magnetic resonance tomography (MRT) findings suggested a diagnosis of MLD, which was confirmed by a decreased activity of leucocyte arylsulfatase A and an excessive urinary sulfatide excretion.

[Standards for treatment and expert opinion on transsexuals. The German Society for Sexual Research, The Academy of Sexual medicine and the Society for Sexual Science]. / and the Society for Sexual Science]chtung von Transsexuellen der Deutschen Gesellschaft für Sexualforschung, der Akademie für Sexualmedizin und der Gesellschaft für Sexualwissenschaft.

Over the last two-and-a-half years a committee of experts, consisting of members of the three leading German sexology associations, developed guidelines for treating and assessing transsexuals. Their purpose is to improve the care for patients with sex identity disorders and to ensure that such care is of uniform quality to avoid erroneous decisions to the disadvantage of those affected. The guidelines are set out in full.

Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction.

This double-blind, placebo-controlled clinical trial of yohimbine hydrochloride included 86 patients with erectile dysfunction and without clearly detectable organic or psychologic causes. The patient group fulfilled all entry criteria; 85 of these could be considered for the Safety-respectively 83 for the Intention-to-treat (ITT)-analysis. Yohimbine was administered orally in a dosage of 30 mg a day (two 5 mg tablets three times daily) for eight weeks. Patients were seen for follow-up after four weeks' treatment, and for a final visit after eight weeks. Efficacy evaluation was based on both subjective and objective criteria. Subjective criteria included improvement in sexual desire, sexual satisfaction, frequency of sexual contacts, and quality of erection (penile rigidity) during sexual contact/intercourse. Objective criteria of outcome were based on improvement in penile rigidity determined by use of polysomnography in the sleep laboratory. Overall Yohimbine was found significantly more effective than placebo in terms of response rate: 71 vs 45%. Yohimbine was well-tolerated: Only 7% of patients rated tolerability fair or poor, and most adverse experiences were mild. There was no serious adverse event.

Sexual disorders in nonacute psychiatric outpatients.

One hundred schizophrenics and 58 patients with an affective psychosis who were in relatively stable condition and were being treated as outpatients, as well as 30 patients receiving dermatological treatment, were questioned in a semistructured interview about their sexual history. Forty-nine percent of schizophrenics, 36.2% of those with affective disorders, and 13.3% of control patients had a sexual dysfunction. The most frequent form experienced by psychiatric patients was hypoactive sexual desire disorder. Underlying causes were presumed to be multifactorial in most cases (expert rating). The patients most frequently affected by sexual dysfunctions were schizophrenics on neuroleptic medication, whereas schizophrenic patients not on any medication had fewer dysfunctions and control patients were only minimally affected. Neither the nature of the psychopharmaceuticals nor the dose level had a specific influence on the frequency of sexual dysfunctions.

[Male and female sexuality--differences according to sex and age]. / Männliche und weibliche Sexualität--geschlechtstypische und altersabhängige Unterschiede.

Sexual physiology, sexual behaviour and attitude to sexuality vary according to sex and age. The sexual reaction cycle is very uniform in men, but much more variable in women; at a more advanced age the reactions of this cycle are delayed in both sexes. While hormones have been proved to influence male sexuality, their influence on female sexuality has not been clarified. Sexual appetite changes with age. It reaches a climax earlier in men than women, but also declines more in men with increasing age. In the last three decades the number of women who masturbate has considerably increased. The difference between the sexes as far as attitude to sexuality is concerned is particularly evident in those with sexual difficulties: men usually see their problems in an isolated way as a purely physical disorder, whereas women are usually aware of the connection between their sexual problems and personal, partner or work problems.

[Adverse effects of long-term psychopharmacologic therapy on sexual functions]. / Unerwünschte Wirkungen psychopharmakologischer Langzeittherapie auf die sexuellen Funktionen.

103 patients who were in a psychopathologically relatively stable condition and under long-term psycho-pharmacological treatment on an outpatient basis, were questioned on sexual functional disorders and changes in sexual behaviour, basing on a semistructured interview. This is of particular importance with regard to compliance problems in long-term therapy. 50% of the patients stated that there had been changes from the beginning of the psychiatric disorders, mostly as functional sexual disorders (42%). Multifactorial causes were presumed in most of the cases; the medication was thought to be solely responsible in only 15% of all the cases (expert rating). Schizophrenic patients under neuroleptic treatment were most frequently affected by functional disturbances. In some of the patients of the total random sample (36 patients) medication was changed under experimental conditions for a period of four weeks. Improvement of the sexual function was most frequently stated whenever a medication was given with a reduced dosage; however, the examined partial random sample is very small.

[Impotence]. / Impotenz.

"Impotence" is a vague term for a variety of sexual dysfunctions in the male, such as libido disturbance, erectile impotence, dyspareunia and a number of ejaculatory problems. They are very rarely caused and maintained by any single factor. Usually a combination of organic and psychic factors is involved; the symptoms may give some indication as to what factors are dominant. Organic and surgical treatment should be considered cautiously and should have a clear indication. Frequent psychic causes are partnership or personality problems and the so-called vicious circle of performance anxiety. Sexual counselling is often all the therapy needed, especially when sexual knowledge is inadequate or when relative trivial partnership problems are involved. The kind of psychotherapy offered depends on the main problem: partner therapy, therapy directed at the control of personality problems, or therapy based on the Masters and Johnson method may be indicated.

[Diagnostic and therapeutic possibilities in psychological disorders as a cause of impotence]. / Diagnostik und Therapiemöglichkeiten bei seelischen Störungen als Ursache der Impotenz.

Sexual dysfunction in the male is very rarely caused and maintained by any single factor. Usually a combination of organic and psychogenic factors is involved: the symptoms may give some indication as to what factors are dominant. Frequent psychic causes are partnership or personality problems and the so-called vicious circle of performance anxiety. Sexual counselling is often all the therapy needed, especially when sexual knowledge is inadequate or even faulty or when relatively trivial partnership problems are involved. The kind of psychotherapy offered depends on the main problem: partner therapy, therapy directed at the control of personality problems, or therapy based on the Masters and Johnson method may be indicated.

[Frequency analytic EEG study on the topic of temporal function disorders in transsexuality]. / Frequenzanalytische EEG-Untersuchung zur Frage temporaler Funktionsstörungen bei Transsexualität.

A high rate of (temporal) EEG abnormalities within the group of transsexual patients has been previously described. These reports however were based on visual EEG analyses, which were not sufficiently statistically supported. It therefore seemed necessary to test this observations by utilizing quantitative frequency EEG analysis by using a larger group of transsexuals (n = 33). Fourier transformed data were recordings from T3-A1, T3-P3, T5-Cz, 01-Cz. The power of the delta-, theta-, alpha, and beta-bands were calculated as the percent of the total power (1,00-30,00 Hz). Different ratios of the absolute power values were computed. No significant differences of frequency-band related power, global power or power ratios between patients and normal subjects were found. There was also no separation on the basis of the genotypic sex of the subjects (Mann-Whitney-test). However 7 EEG's (21%) of the transsexual patients showed according to our interpretation temporo-parietal abnormalities.

Male-to-female and female-to-male transsexuals: a comparison.

Male-to-female and female-to-male transsexuals differed with respect to social, partnership, and sexual behavior, independently of whether they had had surgery. Female-to-male transsexuals more often had close ties to their parents and siblings, established stable partnerships more frequently solely with the same biological sex, and were more satisfied sexually. When they first consulted a physician about sex change, they were already more integrated socially. By the time the follow-up assessment took place, male-to-female transsexuals were as integrated socially as their female-to-male counterparts. The differences in partnership behavior between male-to-female and female-to-male transsexuals were not altered as a result of surgery, despite the better surgical match with which surgery provides male-to-female transsexuals in comparison with their female-to-male counterparts. The reasons for the relational differences remain unclear and raise issues in the areas of developmental psychology and genetics.

Transsexuals who have not undergone surgery: a follow-up study.

Transsexuals who had not undergone surgery, although it had been offered to them providing they fulfilled the usual requirements, were classified into various subgroups, measured according to their attitude towards sex reassignment surgery: they were transsexuals with an unaltered wish for surgery, transsexuals who were ambivalent towards surgery (hesitating patients), and transsexuals who had relinquished their wish for surgery and lived in the initial gender role. Whereas transsexuals with an unaltered wish for surgery did not differ substantially from transsexuals who had had surgery, the hesitating patients were noticeably older, more often married, more often had children of their own, their partnerships were of long duration, and exclusively with partners of the opposite biological sex. These characteristics were seen when the diagnosis was first made. They can therefore be considered prognostic criteria for this subgroup. Transsexuals who relinquished their wish for surgery did not differ substantially from transsexuals with an unaltered wish for surgery. The reasons for relinquishing the wish for surgery were individual or could not be clearly established. At the time of follow-up, all transsexuals who had not undergone surgery indicated that they were experiencing the same degree of difficulty with respect to social adjustment as at the time of diagnosis. Slight improvements were seen in patients with an unaltered wish for surgery. Significant changes were seen only in transsexuals who had surgery. Transsexuals who have not had surgery and have no present wish for it are in the minority. Hesitating patients have a particular need for psychotherapy.

[Impotence]. / Impotenz.

The term impotence can be defined as "disturbances in sexual behavior and sexual feeling in males as evidenced by impaired or atypical genitophysiological reactions or the complete absence of such reactions." There are two main forms: erectile impotence and premature ejaculation. Differential diagnosis between "organic" and "psychogenic" impotence is very often impossible due to the fact that the causal factors of both areas can play a role in individual cases. Psychotherapy is not always necessary. Sexual counseling can be appropriate when sexual problems are the result of inadequate sex education, sexual inhibitions or minor conflicts with the partner. Depending upon the main causes for the sexual inadequacy, the specific psychotherapy is directed towards the problems in the partnership, towards the personality difficulties, or towards the sexual behavior itself. For the treatment of the latter, the behaviorally oriented therapyprogram of Masters and Johnson has been shown to be very successful.