The Sexology Outpatient Clinic of São João Hospital Center is specialized in the attendance of users with problems or dysfunctions related to sexuality, such as male sexual dysfunctions.

46 year old man, single, with late onset of sexual activity which relates with his fears (partner becoming pregnant and sexually transmitted diseases) and his markedly obsessive personality.

He describes previous occasional or short-term relationships and premature ejaculation on his first sexual experiences. During a phase without relationships, he began to discover his sexuality through masturbation, which tended to occur very frequently. He reported to especially appreciate the instant that precedes ejaculation, which led him to constantly try to delay the moment of ejaculation. Finding himself in a stable relationship, he reports that he cannot ejaculate during intercourse, achieving it only through masturbation, despite he could obtain sexual pleasure and have a sustained erection. At this point, the couple decided to have sex therapy.

Premature ejaculation is a psychosexual disturbance defined as a persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it to occur. The main option for treating premature ejaculation are behavioral therapies such as the stop-start technique. In this case, the patient used this technique autonomously, by the means of masturbation, to delay his ejaculation, leading him to the point of being unable to ejaculate during intercourse.

Mental illness has a large effect on sexual function and the expression of sexuality. Many studies have illustrated that sexual dysfunction is significantly associated with depression.

Assess the quality of sexual response in a population of depressed women.

Search factors associated with impaired sexual function.

Investigate the degree of correlation between sexual dysfunction and depression.

Analytical and descriptive Study involving 30 sexually active women seen for the first time at the Razi hospital. They presents a first major depressive episode according to DSM IV.

Exclusion criteria were the presence of psychotic symptoms, the use of antidepressants in the last three months and inflammatory or neoplastic comorbidity.

The severity of depression was assessed by the Beck Depression Scale.

The evaluation of sexuality was made ??by Aziona sexual experience scale

The middle-age was 37 years, 80% were married.

Depression was severe in 60% of cases and the average time of care was 3.7 months.

Sexual function was altered in 70% of cases with a positive correlation between the severity of depression, the depressive episode duration, and the sexual dysfunction.

Sexual desire was the most affected by depression, distorted in more than half of patients. Sexual arousal and vaginal lubrication were also altered in respectively 40% and 36.7% of cases, while orgasm and satisfaction with orgasm were more conserved.

Taking into account the dimension of sexuality is important in the management of a depressive episode.

Early treatment is a protective factor from sexual dysfunction in depressed women.

According to the World Health Organization, the incidence of traumatic brain injury (TBI) is increasing every year. Sexuality is compromised following traumatic brain injury. It is important to know the background of sexual dysfunction after TBI.

To investigate predictors of sexual functioning following TBI.

The aim of the current study was to examine sexuality in men with traumatic brain injury, as well as factors affecting sexuality. The current study aims to characterize those who reported a decrease in sexuality after TBI.

A total of 104 participants with predominantly moderate to severe TBI completed the Sexual Men's Scale, The Symptom Checklist-90-R (SCL-90-R), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI). Men underwent Magnetic resonance (MR) imaging and electroencephalography (EEG).

weak sexual constitution, depression, anxiety, and location of the pathological focus in the right hemisphere significantly differentiated participants with TBI who reported decreased sexuality from those who reported increased sexuality.

study of predictors of sexual dysfunction contribute to improving the diagnosis and treatment of sexual dysfunctions.

Comorbidity of schizophrenia and transsexualism is still controversial. Some authors exclude diagnosis of transsexualism in patients with psychosis others report this coexistence as very rare.

Delusions of sex change have been described by some authors in about 20-25% of schizophrenic patients. Patient's “pseudotranssexual” beliefs are usually bizarre and do not cause diagnostic doubts. In some cases complaints of gender dysphoria are predominant and psychotic symptoms can be underestimated or even unnoticed before sex reassignment procedure.

Presentation of various clinical manifestation of gender dysphoria in patients with schizophrenia.

Three clinical cases are described.

Two patients have developed “pseudotranssexual” beliefs during course of psychosis. The first of them is an example of gender identity disorders related to psychotic process. The second patient presented complex psychopathology of schizophrenia and somatic symptoms which can hinder the diagnosis. The third patient has been diagnosed as a transsexual woman after diagnosis of severe schizophrenia and has undergone sex reassignment. Next she was hospitalized several times because relapses of psychosis but also because of alcohol withdrawal. Currently this patient has symptoms of dementia and a few severe somatic diagnoses.

The experiences of practitioners indicate that coincidence of schizophrenia and gender identity disorder is possible. Nevertheless, the consequence of misdiagnosis and sex reassignment can be serious and unconvertible. That is why the diagnosis of transsexualism in patients with psychosis should not be made hastily. It needs time, careful observation, examination and cooperation of psychiatrist and sexologist.

In the early 80’s Dr Zoran Rakic, from the Department of Psychiatry? in Belgrade was a pioneer in transgender care in Serbia and former Yugoslavia. Occasionally he used to hospitalize transsexual patients for diagnostic assessment, treatment of comorbid and concomitant psychiatric disorders and post-surgical care. His pioneer work was continued by the Counseling Service for Sexual Disfunction and Gender Dysphoria team.

To assess frequency, indication for and results of inpatient treatment of transsexual clients.

Case history review and outpatient follow-up.

During last 3 years hospitalization was performed in 16 cases (50% F?M and M?F). Mean age on admission was 23.1 for F?M and 27.5 for M?F patients. Assessment of transsexualism was performed in 3 F?M clients; 62.5% (10) were admitted for assessment and treatment of comorbid disorder (7 M?F and 2 F?M before and 1 M?F patient after gender reassignment surgery) with only one currently not in remission; physical assessment was performed in 3 F?M clients before referral for hormone therapy (financial reasons).

Transsexual individuals are exposed to double stigmatization, as members of the LGBT community and as „psychiatric patients'. Therefore inpatient psychiatric assessment and treatment should be avoided. Results of our clinical work show that inpatient care can be beneficial for these patients and accelerate further treatment process especially in cases with comorbid and concomitant psychiatric disorder when adequate setting is provided and medical staff are educated and sensitized to address specific needs of this population.

Substance misuse is a major public health problem with high morbidity and mortality. Sleep disorders in this group of clients often escape the attention of the treating professionals which can worsen the substance abuse in turn. Quite often, these subjects would use substances hoping it will aid their sleep.

The primary objective of our review was to look at how psychoactive substances influence our sleeping patterns.

A review of the available literature was done to look into the effects of various drugs of misuse on the sleep architecture.

We have discussed a variety of drugs in the poster – Alcohol, Marijuana, Cocaine and Stimulants, Opiates, GBH, MDMA, Caffeine and Nicotine. For each drug, we have discussed the effects they have on sleep structure in the states of intoxication, withdrawal and chronic use.

There is a high prevalence of sleep disturbances in patients using or abusing psychoactive substances. There is a case of routine screening for sleep problems in subjects using substances. This can help in early identification of the problems and hopefully, better quality of life for these clients.

Insomnia is a risk factor (odds ratio 39,8) as well as symptom of depressive disorder and other psychiatric conditions. Therefore, psychiatrists require appropriate training in diagnosing and treating insomnia. To date, there is no data available in Europe on training in sleep medicine for early career psychiatrists.

To establish how accessible training in insomnia management is to European early career Psychiatrists, and how confident they feel in treating this disorder.

Europe wide survey carried out jointly by the European and World Psychiatric Associations Early Career Psychiatrists Committees. Representatives of Early career Psychiatrists from each participating European country filled in a questionnaire about training in sleep medicine in their country. Early Career Psychiatrists were also invited to fill out a questionnaire at the EPA congress in Nice in 2013.

55 participants from 27 European countries responded. Only 24% had sleep medicine training mandatorily included in their national training curriculum. A majority (60%) felt that the quality of training they did receive was either average or below average. 88% felt either very or fairly confident in treating insomnia. However, when asked to select the correct management options for insomnia from a provided list of 6 options, only 19% and 33% of respondents chose the two correct options.

There is a clear gap between the level of confidence and the clinical judgements being made to treat insomnia among European Early Career Psychiatrists. There is a definite need to improve the availability and structure of insomnia training in Europe.

Patients with psychiatric disorders, including schizophrenia and bipolar disorder, are reported to suffer from sleep disorders.

To investigate the effects of lurasidone on sleep architecture in rats using sleep electroencephalography.

Seven adult male rats were used in this study. A pair of electrode wires was implanted in the dura of each rat and electromyograms were recorded from their dorsal neck muscles. Drugs were administered at the start of the lights-on period, and electroencephalograms (EEG)were recorded for 6 hours in individual soundproof boxes. The course of sleep in rats has been classified into 3 stages: WAKE, non-REM (NREM) sleep and rapid eye movement (REM) sleep. Total NREM duration, REM duration, and latencies to the initial REM and NREM were calculated. In addition, the number and mean duration of bouts in every 2-hour period were calculated in each stage. EEG power in each of the following frequency bands during NREM sleep was quantified: delta (0.5-4 Hz), theta (4-8 Hz), alpha (8-12 Hz), beta (12-30 Hz) and gamma (30-80 Hz).

Lurasidone shortened REM sleep duration and prolonged the mean duration of one bout in WAKE and NREM sleep. Quantitative frequency analyses during NREM sleep revealed that lurasidone increases slow waves and decreases fast waves. The serotonin 5-HT1A receptor partial agonist, tandospirone, and selective serotonin 5-HT7 receptor antagonist, SB-258741, also exhibited REM-inhibitory effects similar to those of lurasidone.

These results suggest that lurasidone ameliorates sleep disorders associated with psychosis through, at least partly, serotonin 5-HT1A and serotonin 5-HT7 receptors.

Lucid Dream (LD) is a phenomenon occurring at the end of REM sleep and during which one is aware that one is dreaming. It is possible thanks to the activation of the dorsolateral prefrontal cortex reinforced by other cortical areas of the brain. As previous studies show, it is much more common among children and adolescents than among adults, as prevalence of LD relate to a degree of maturity of the CNS.

The study was designed to assess incidence of lucid dreaming among youth and compare it with the prevalence in general population.

A questionnaire about sleep hygiene, distinguishing also between past and present experiences of lucid dreaming, has been developed. It was distributed both in paper version and on-line. IP control has been introduced for the virtual participants. Timeline for material gathering covered 01/01-15/03/2014.

Study confirmed that age has a significant role on lucid dreams appearance. Participants of the study with bad sleep hygiene (irregular time of sleeping, watching TV before going to sleep, hard to digest dinners) less frequently experienced lucid dreams. Women seems to be more interested in LD’s developing techniques, however there is a small knowledge about positive aspects of lucid dreaming among Poles.

Lack of knowledge about the phenomenon of lucid dreaming among the population may affect the results of future studies in this field.

Analyze quantitatively and qualitatively, the impact of relaxation techniques and autogenic training program on sleep quality in patients with insomnia related to anxiety disorder or depression.

The study went on for six months. Each subject completed twelve group sessions, which took place always on the same weekday and at the same time. During the sessions, subjects were taught respiratory training techniques, Schultz's Autogenic Training (inferior and superior cycles), Jacobson's progressive relaxation, creative visualization and meditation, as well as group exercise dynamics and the hug technique. To evaluate results, in sleep quality, the Insomnia Severity Index (ISI) was applied, in the beginning and in the last session of the program. The data was statistically analyzed using SPSS version 19.0.

A total of 28 patients were enrolled: 22 were female and 6 male, with a mean age of 42.2 years. There was a statistical significant (p=0.007) decreased in the insomnia severity level (from 16.36 to 11.89; i.e. moderate to mild). Subjectively, the patients demonstrated satisfaction with the improvement in sleep pattern, with lower interference in performance of daily tasks, as well a decrease in the inconvenience caused by a sleep disorder. There was also improvement in mood, vigor, self-esteem and self-control.

The most common causes of insomnia are cognitive and emotional dysfunctions. Our results shows that psychopharmacological therapy, combined with relaxation techniques and autogenous training programs, that can be learned and implemented independently, can help improve sleep quality. Further studies are needed to validate these results in other populations.

Depression, irritability and fibromyalgia have been linked to obstructive sleep apnea (OSA) which in turn presents with decreased slow wave sleep, the sleep phase responsible for cerebral recovery and consolidation of sleep.

Pregabalin increases slow wave sleep and sleep efficiency; while simultaneously combining mood stabilizing properties, being a theoretical therapeutic option for the psychiatric complications of OSA.

Case report of a patient with full remission of a major recurrent depressive disorder and resistant insomnia after treatment with Pregabalin; bibliographic search using PubMed/MedLine database with the following keywords: mood disorder; personality disorder; obstructive sleep apnea; pregabalin.

We report and discuss the case of a 63-year-old woman with a history of major recurrent depressive disorder, histrionic personality disorder and chronic resistant insomnia. The patient presented with chronic widespread pain, nonspecific somatic complaints, depressive mood and chronic resistant insomnia. After several unsuccessful treatment trials with Venlafaxine, benzodiazepines and Zolpidem; the patient presented slight relief of depressive mood with Trazodone (150mg/day). Complete resolution of all disorders was obtained following adjunctive therapy with Pregabalin (50mg/day). Polysomnography revealed severe supine apnea hypopnea index (32.1), sleep architecture fragmentation, global efficiency of 57%; with an increased slow wave sleep of 33%.

The patient was referred to sleep apnea consultation and remains asymptomatic.

Our case suggest that Pregabalin may be useful in the treatment of several psychiatric conditions secondary to OSA. Literature revision suggests theoretical mechanisms that could explain the underlying mechanisms of this therapeutic effect such as increased slow wave sleep.

To determine effect of Valerian/Lemon balm combined capsules on Sleep Disorder.

In this triple blind randomized control clinical trial, 100 volunteer healthy menopause women with aged 50-60 years, who complained of sleep disorders, were selected randomly in clinics of West of Tehran (50 in each group). After filling in informed consent, intervention group received two combined capsules of 160 Mg Valerian and 80 Mg Lemon Balm in a day and control group received 50 Mg Starch as placebo capsules two times in a day for one month. Pittsburg Sleep Quality Index (PSQI) had been used. All ethical points were considered.

The average age of the experimental group was 52.5 ± 7.8 and 53.7 ± 3.5 in the control group with a menopausal onset age of 47.6± 4.1 and 49.1 ± 3/9 respectively. Equality ofdemographic characteristics and PSQI before intervention had been checked in two groups. 36% of the experimental group and 8% of the placebo group showed an improvement in the quality of their sleep and sleep scores have decreased 5 points. (P = 0.0001). There was significant difference in PSQI between groups (p > 0.05)

Findings support use of Valerian and Lemon balm combined capsules in the clinical management of sleep disorder in menopause. No side effects had been seen during study and one month later. It is suggested to continue this study with more duration.

Physicians discover more and more patients with Hypertension (HTN) whose blood pressure (BP) values during work appear to be higher than those values during free time. This form of HTN is called ‘HTN at work’ (Stork at al., 1992).

To evaluate the specifics of psychophysiological mechanisms of stress reaction in patients with HTN at work, as compared with patients with essential HTN.

170 patients with EAH, stage 1-2 took part in the study. Among them 85 patients with HTN at work (mean age is 44.7±4.3years) and 85 patients with essential HTN (mean age is 47.4±4.5 years). The research was carried out with the implication of methods of psychological experiment, psychological testing, and methods of physiological data registration.

Patients with HTN at work, were characterized by reliably greater increase of Systolic BP (on the average by 16 and 4 mmHg respectively) as a reaction to emotional stress. The BP increase in this group was revealed in combination with a lowering of the level of anxiety, gradual decrease of catecholamines' level in urine and renin and angiotensin-1 in blood plasma during the experiment, the fluctuant aspirations' level, and scarcity of behavioral manifestations accompanied by an abundant variety of facial expressions. This psychophysiological combination is an indicator of repression of emotions, chronic stress and psychophysiological exhaustion.

Repression of emotions come as a significant pathogenetic factor in genesis of psychosomatic syndrome among patients with HTN at work, as opposed to patients with essential HTN.

Suicide is a global issue among the elderly, but few studies have explored the experiences of suicide ideation in older Asian psychiatric outpatients.

The purposes of this study were to explore triggers of suicide ideation among older first onset cases in psychiatric outpatients in Taiwan and their reasons for not executing suicide.

Older psychiatric outpatients (N=24) were recruited by convenience from one medical centre and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analysed by content analysis.

Suicide ideation was triggered by illness and physical discomfort, conflicts with family members/friends, illness of family members, death of family members/friends, and loneliness. Participants’ reasons for not executing suicide were family members’ and friends’ support, receiving treatment, finding a way to shift their attention, fear of increasing pressure on one’s children, religious beliefs, and not knowing how to execute suicide.

Understanding these identified triggers of suicide ideation may help psychiatrists open a channel for conversation with their elderly clients and more readily make their diagnosis. Understanding these identified protective factors against executing suicide can help psychiatrists not only treat depression, but also enhance protective factors for their clients.

It is well-known that depression is one of the significant risk factors for suicidality, but alone it is not sufficient.

Research has shown that the correlation between depression and suicidality became non-significant when hopelessness was statistically controlled, and that it is psychache that directly leads to suicide and mediates the effects of depression and hopelessness. We therefore explored depression, hopelessness and psychache (DHP) as a predictors of suicidality in patients diagnosed with psychotic disorders (PDs).

To identify patients at risk of suicidality.

The study sample consisted of 59 patients diagnosed with a PDs (schizophrenia spectrum and delusional disorders), mean age of 35.25 years (SD 8.25). Assessment instruments included the Beck Scale for Suicide Ideation, the Beck Depression Inventory II, the Beck Hopelessness Scale and The Psychache Scale.

There was a positive correlation between DHP and intensity of suicidality and factors of suicidal motivation and preparation. Regression analysis indicates that DHP contribute to 45,9% of the variance of intensity of suicidality (F=17,433, df=3, p 0,01), to 32.9% of the variance of suicidal motivation (F = 10.479, df = 3, p 0,01), and to 57.1% of the variance of suicidal preparation (F = 26.775, df = 3, p 0,01). Depression was the only significant predictor of intensity of suicidality and suicidal motivation, with hopelessness as the only significant predictor of suicidal preparation.

In patients diagnosed with PDs, depression was a significant predictor of intensity of suicidality and suicidal motivation, and hopelessness was a significant predictor of suicidal preparation.

Chernobyl nuclear reactor accident was the greatest technological disaster in history. There is evidence that the accident has had a significant long-term impact on psychological well-being of the affected population. In particular, the rate of suicidal behavior has increased dramatically among the exposed population. At the same time, little epidemiological information about parasuicidal individuals is available.

This study was design to extend our understanding of suicidal behavior by examining urban-rural differences in the sociodemographic and mental health characteristics of male suicide attempters in the region affected by Chernobyl nuclear disaster.

We interviewed 243 male suicide attempters (166 urban residents (UR) and 77 rural residents (RR)) received treatment at Gomel regional psychiatric hospital (Belarus).

The most important risk factors identified were younger age (18-29), being single (71.4% of RR and 70.5% of UR), being unemployed (37.7% of RR and 38.6% of UR), having mental disorders (100% of RR and 98.2% of UR), having previous suicide attempts (19.5% of RR and 16.9% UR). The most frequent diagnoses were mental disorders due to psychoactive substances use (76.6% of RR and 71.1% of UR). The prevalence of alcohol dependence was higher among RR compared with UR (50.6% vs. 45.8%). Consumption of alcohol at the time of the parasuicidal act was reported more commonly by RR than by UR (61.0% vs. 56%).

These findings are consistent with previous research indicating a causal role for mental health problems and alcohol abuse in suicidal behavior.