Chronic illness and the psychology of erectile dysfunction.

The toll of chronic illness on the sexual functioning of the male patient can be devastating both physically and psychologically. The practitioner is encouraged to address the patient's sexual concerns early on in the course of treatment. The involvement of the patient's partner, if available, is strongly recommended to assist in their sexual adjustment and in their overall relationship. There is no uniform course in the deterioration in erectile function in the patient with chronic illness as is true of the illness, itself. This article presents a multistage progression of interventions by practitioner (and staff) that suggests a course of involvement for the practitioner, time, expertise, inclination, and reimbursement, allowing. It also encourages consultation with or referral to specialists, as appropriate.

Traumatic masturbatory syndrome.

This article describes a previously unreported pattern of atypical masturbatory behavior, which presents as either an erectile or orgasmic disorder in men. Four case histories are described of men who masturbated in an idiosyncratic manner. The distinguishing features of the masturbatory style include a prone position and daily masturbation over a period of years. It is suggested that the primary care physician or specialist (urologist or neurologist) screen for this problematic style when presented with male sexual dysfunction. Further, and more controversially, it is suggested that a primary prevention model would argue for masturbatory instruction in the home, classroom, or pediatric clinical setting.

Resection of a vipoma of the pancreas in a 15-year-old girl.

A 15-year-old girl had massive watery and protein-losing diarrhea. She was found to have a pancreatic islet cell tumor secreting high levels of vasoactive intestinal polypeptide. Eighty-five percent pancreatic resection was needed to remove the tumor. She has normal serum VIP levels and no tumor recurrence 6 years later.

Cost effectiveness of individual vs. group cognitive behavior therapy for problems of depression and anxiety in an HMO population.

Randomly assigned 44 outpatient Ss, enrollees of the George Washington University Health Plan, a Health Maintenance Organization (HMO), to one of three treatment modalities: (1) a cognitive behavior therapy group; (2) a traditional process-oriented interpersonal group; and (3) cognitive behavior therapy in an individual format. All Ss were referred by their physicians to the HMO Mental Health Practice for treatment for anxiety and/or depression. Beck's Depression Inventory, Speilberger's State-Trait Anxiety Inventory and Gay and Galassi's Adult Self-Expression Scale (an assertion measure) were administered pre- and post-treatment to all Ss. A subsample of these Ss also were rated pre- and post-treatment on the Hamilton Rating Scale for Depression by experienced clinicians blind to the treatment groups. All three experimental groups significantly improved on all dependent measures from pre- to post-treatment, and no differential treatment effects were found.