1/130. Genital blood flow measurement: feedback applications in sexual therapy. Laboratory techniques are now available for measurement of both male and female genital engorgement during sexual arousal. When laboratory subjects are given information on their rate and amplitude of tumescence (biofeedback), they appear to acquire greater voluntary control of the response. Data from two experiments and a case study are presented to illustrate the application of biofeedback in both facilitation and suppression of penile responding. A PhD student is currently conducting analogous research with female subjects. Clinicians are cautioned against careless application of biofeedback techniques for the treatment of erectile inadequacies. ( info) |
2/130. A refinement of the concept "reticence". This report has 1. Made a distinction between speech disorders involving defects and those that are primarily reticence, but in any case identified speech disorders as negotiated states as opposed to fixed disease states. 2. Argued that there is a clear analytical separation between speech disorders and speech behaviors which are indicative of neurotic disorders. 3. Attempted to remove anxiety as a component of the communication process by according it its rightful place, which is central in human personality. Furthermore, we have attempted to dispel the notion that anxiety is evil and the perennial (and sole) cause of speech disorders. 4. Identified a specialist known as the rhetoritherapist (a specially trained speech teacher) as the particular king of professional qualified to deal with speech disorders (in conjuction with speech pathologists and/or psychotherapists where necessary). We have accorded to the rhetoritherapist the province of instruction and training in all aspects of invention, delivery, and reception of rhetorical speech without reference to its moral intent. 5. Identified "reticence" as the most useful of the various imprecise terms used to refer to people with speech problems, because it is devoid of connotations that go beyond the speech process. Further refinement of specific categories of speech disorders is necessary to order to expand the repertoire of available treatment strategies. Such refinement will probably include reference to the various subprocesses of human speech identified earlier in this paper as they are related to the rhetorical situation. The rhetoritherapist thus emerges as the trouble-shooter, but not the "psychotherapist," of speech pedagogy. ( info) |
3/130. Adverse psychologic reactions to ileal bypass surgery. Of 33 patients who underwent ileal bypass surgery for morbid obesity and were followed up with psychiatric interviews and consultation postsurgery, five appear to have had adverse psychologic sequelae related to the procedure. The emotional problems of these five patients were in part related to or precipitated by their drastic weight loss after ileal bypass. In most cases, the patients generally had depressive symptoms and, in dynamic terms, were dependent individuals with lifelong problems in object relations. The coping styles demonstrated, while not rigorously classified as psychiatric illness, appeared to predispose them for certain difficulties even when weight had been lost. Ileal bypass surgery apparently is not psychologically innocuous as previously thought, and psychiatric follow-up of patients is indicated. ( info) |
4/130. L4-5 disk lesion resulting in back pain with bowel, bladder and sexual dysfunction without paraparesis. This is a case report of a patient with bowel, bladder and sexual dysfunction associated with low back pain. This patient had an essentially normal neurological examination. There was radiological evidence of a disk lesion, and urodynamic findings consistent with lower motor neuron bladder dysfunction. His symptoms are attributed to a L4-5 disk herniation resulting in a partial cauda equina syndrome. The relevant anatomy is reviewed, and the differential diagnosis is discussed. ( info) |
5/130. Neuropsychologic implications in erotomania: two case studies. OBJECTIVE: To explore neuroanatomic substrates and cognitive factors associated with erotomania through neuropsychologic test data and neurologic studies. BACKGROUND: Erotomania is a delusional disorder that has been examined and conceptualized both clinically and psychodynamically. It is believed that neuroanatomic and neuropsychologic correlates can provide important insights into the causes of erotomania. METHOD: Two patients with erotomania and the results of their neuropsychologic testing were examined, and neurologic studies also were examined for one of the patients. These data were compared with case studies from the literature. RESULTS: Neuropsychologic test results suggested that erotomania may be associated with deficits in cognitive flexibility and associative learning that are mediated by frontal-subcortical systems, and with deficits in verbal and visuospatial skills. Neurologic studies suggested abnormalities in temporal areas. CONCLUSIONS: Visuospatial-functioning deficits or limbic lesions, particularly in the temporal lobes, in combination with isolative and ambivalent romantic experiences, may contribute to misinterpretations in erotomania, and deficits in cognitive flexibility may contribute to the maintenance of the delusional belief. ( info) |
| OBJECTIVE: To describe a patient who exhibited a partial kluver-bucy syndrome after small bilateral ischemic lesions in the thalami. BACKGROUND: Previously reported patients with kluver-bucy syndrome had very large, mostly bilateral lesions in the limbic system and could not provide sufficient information about its anatomo-functional correlate. METHOD: Behavioral assessments and clinical examinations, including magnetic resonance imaging and positron emission tomography, were conducted. RESULTS: The patient was severely amnestic, distractible, hyperoral, and affectively dyscontrolled, and she behaved socially inappropriately. magnetic resonance imaging showed bilateral infarctions in the territories of both thalamoperforating arteries, and positron emission tomography revealed bilaterally decreased fluorodeoxyglucose uptake in the anterior parts of the ventral thalami and, to a lesser extent, in the fronto-temporal cortices. CONCLUSIONS: This behavioral syndrome has not yet been reported with isolated diencephalic lesions, but it has been observed after bilateral temporal lobe lesions. The authors conjecture that this syndrome resulted from a disruption of the pathways connecting the dorsomedial thalami with the prefrontal cortices and with other limbic areas, systems essential for memory and the regulation of impulses and emotions. ( info) |
7/130. Clincal observations of sex as a reverberation of the total relationship. In the psychiatric treatment of sexual dysfunctioning the generally accepted method has been to concentrate heavily on the intrapsychic conflicts of one or both spouses. There now is increasing evidence that treatment is sometimes more effective if the therapeutic intervention takes place directly in the interpersonal system. Such evidence has been provided by those therapists with clinical experience in marital systems who are prepared to utilize theories evolved from a multidisciplinary approach to marital problems. This paper is meant to discuss and illustrate this shift in treatment strategy as it applies to sexual dysfunctioning and deals with the function of the interplay of sex, love, and commitment through the illustrative cases. ( info) |
8/130. Psychosocial side effects of sildenafil therapy for erectile dysfunction. Sildenafil is an effective agent to restore erectile capacity in the medically ill. Two cases are presented in couples whose marital situation worsened after the husband refused to take sildenafil for erectile failure following radical prostatectomy. Treating organically based sexual dysfunctions with medication still requires understanding of the dysfunctions in a broader psychosocial context. ( info) |
9/130. Male pseudoheterosexuality and minimal sexual dysfunction. Male heterosexual activity is not always heterosexual. Frequently it only appears to be, but, in fact, it is an attempt at denial of underlying homosexual feelings. There is often a correlation between such "pseudoheterosexuality" and minor sexual dysfunctions. Insight alone is not sufficient to provide relief, but when the patient can be helped to a comfortable acceptance of his homosexual feelings as a normal and healthy facet of his personality, very often the dysfunction is relieved, and there is a marked change in the ability of the individual to achieve gratification in genuine heterosexuality. ( info) |
| About 50% of the population receiving peritoneal dialysis (PD) in the united states are women. Nephrologists generally address medical issues related to end-stage renal disease, ie, anemia, hypercholesterolemia, secondary hyperparathyroidism. In female PD patients, specific topics should also be addressed. They include menstruation, birth control methods, osteoporosis, child bearing, postmenopausal hormone replacement and its consequences, screening of gynecological malignancies, sexual problems, and hemoperitoneum. We briefly describe in a multidisciplinary view the management of these issues. ( info) |