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PubMedDate not supplied

Preoedipal determinants of a beating fantasy.

A discussion of "The Psychodynamics of a Beating Fantasy," by Wayne Myers, M.D. This paper emphasizes the role of the parental ambivalence towards the patient in the formation of beating fantasies described by Dr. Myers. It is postulated that excessive maternal ambivalence interfered with the normal resolution of ambitendency during the patient's second year, particularly with the impact of the discovery of sexual differences which takes place at that time. Under such circumstances, a split in both self- and object representations occurs, with a heightening of unbound aggression--the combination of which might well have led to the formation of the maternal aspect of the beating fantasy. Subsequent primal scene expousre, along with the excessively ambivalent paternal attitude toward the patient could only intensify the aggression and the already faltering sense of self and object. Through defensive identification with the aggressor in relation to both parents, the aggression was warded off but also led to confusion in her sense of sexual identity and further problems of self- and object constancy.

Adult↗
PubMed1981

Taking the sexual history.

Sexual concerns are commonly presented to family physicians in the course of routine care. Familiarity with issues central to most sexual concerns can facilitate history taking and appropriate treatment or referral for treatment. Physician requisites include comfort in discussing sexual issues directly, tolerance of value differences in patients and a working knowledge of various treatment options.

Communication↗
PubMed1995

Sexual dysfunction in male schizophrenic patients.

BACKGROUND: Neuroleptic treatment in schizophrenic patients is associated with sexual dysfunction. However, it is not clear to what extent the psychiatric disorder and/or the pharmacologic treatment are responsible for the sexual impairment. The aim of the present study was to evaluate the sexual function of untreated and treated male schizophrenic patients in comparison with healthy subjects. METHOD: Participants included 122 male subjects: 20 drug-free schizophrenic patients, 51 neuroleptic-treated (depot form) schizophrenic patients, and 51 normal controls. A detailed structured interview was used to quantitatively and qualitatively assess sexual function. RESULTS: A high frequency of sexual dysfunction was reported by both schizophrenic groups of patients. Impairments in arousal items (erection) and orgasm during sex were reported mainly by the treated patients. Desire parameters were reduced in both schizophrenic groups, but reduction in the frequency of sexual thoughts was confined to the untreated one. The schizophrenic patients were more involved in masturbatory activity in comparison with the control subjects. Treated patients disclosed dissatisfaction with their sexual function. CONCLUSION: Untreated schizophrenic patients exhibit decreased sexual desire. Neuroleptic treatment is associated with restoration of sexual desire yet it entails erectile, orgasmic, and sexual satisfaction problems. Clinicians' awareness and open discussion of sexual problems with patients may improve comprehension and compliance.

Adult↗
PubMed1995

Timing of penile color flow duplex ultrasonography using a triple drug mixture.

Duplex ultrasonography is an accepted method to assess noninvasively arterial inflow to the penis. Optimal pharmacological agents as well as timing of the scan and stimulation during the scan continue to be debated. In an effort to achieve a more complete smooth muscle relaxation and capture what we perceived was a wide variation in interval to maximum arterial velocity, we revised our duplex protocol in January 1991. We report on 280 consecutive patients evaluated in this manner. Patients received 0.25 or 0.5 cc of a triple drug mixture containing 22.5 mg./cc papaverine, 0.83 mg./cc phentolamine and 8.33 micrograms/cc prostaglandin E1. Scans were performed at 0, 5, 15 and 30 minutes after injection in all patients. Any patient not having a full erection at 15 minutes performed private self-stimulation while in the standing position for at least 5 minutes before the 30-minute scan. If we conservatively define normal arterial inflow as a peak Doppler velocity of 25 cm. per second or greater in the best artery, only 35% of our patients achieved this velocity at 5 minutes. Of the remainder 26% and 22% did not reach normal velocity values until 15 and 30 minutes, respectively, after the injection. By delaying initial measurements of velocity until 5 minutes, could the highest inflow velocity be missed and patients diagnosed incorrectly? The group at risk would be those who had good tumescence at 5 minutes and who had presumably already decreased the inflow velocities. Of the 280 patients 74 (26%) had greater than 10% tumescence at 5 minutes. Only 6 of these 74 patients did not reach velocities of 25 cm. per second or more in the best artery at some time during their study. In conclusion, our study clearly supports delaying the initial scan until 5 minutes, since only 6 of our 280 patients (2.1%) may have been incorrectly diagnosed. The study also strongly argues for additional scans until 30 minutes and self-stimulation when necessary.

Alprostadil↗
PubMed1994

Compulsive exhibitionism successfully treated with fluvoxamine: a controlled case study.

BACKGROUND: Paraphilias are psychosexual disorders that are usually conceptualized as deviant in nature. Yet in some cases, paraphilia can be conceptualized as an obsessive compulsive disorder. METHOD: We describe an exhibitionist treated under partial single-blind conditions (patient was blind to placebo but was aware he was receiving desipramine and fluvoxamine) with the serotonin selective reuptake inhibitor fluvoxamine, followed by desipramine and a placebo that looked like fluvoxamine, in an ABACA design. He was serially assessed with the Yale-Brown Obsessive Compulsive Scale. RESULTS: Fluvoxamine eliminated the undesired impulse and behavior without affecting sexual desire. Desipramine and single-blind fluvoxamine-placebo treatment were both associated with relapses. CONCLUSION: A subset of paraphiliacs may be suffering from obsessive-compulsive-related disorders and may benefit from serotonergic agents.

Adult↗
PubMedDate not supplied

[Physical restraints and gagging in unnatural death].

Practices of binding and gagging can be found in different types of unnatural death; three case reports concerning fatal autoeroticism, suicide and homicide are presented. In such cases investigations are usually concentrated on the question whether binding and gagging could be carried out by the persons themselves. Loosely bound final loops, especially of the hands, missing local haemorrhages and the discovery of binding instructions support the assumption of self-binding. Accompanying injuries and the entire situation must be taken into special consideration.

Adolescent↗
PubMed1993

A fundamental dilemma of psychoanalytic technique: reflections on the analysis of a perverse paranoid patient.

The work refers to the general topic of the traumatic effects of transference in the analytic situation. The author defines the fundamental dilemma of interpretive technique as the technical difficulty, sometimes insurmountable, faced by the therapist in the treatment of severely ill patients, particularly in the case of narcissistic, self-centred disorders, where the interpretive action itself often produces negative side effects that are not countered by the curative effect of the insight achieved through interpretation. In a brief theoretical introduction, this dilemma is described as a longstanding problem in psychoanalysis that has been systematically concealed by the protracted discussion on the subject of 'analysability' and which has still not been resolved by the theory of technique. Clinical case material on a perverse patient is then presented to illustrate the dilemma described and to demonstrate some general strategies by which it may be overcome.

Adult↗
PubMed1993

Sexualization and desexualization.

This paper is a reconsideration of the role of sexualization in psychoanalysis. After a review of the accepted definitions of sexualization as defense and/or part of normal sexuality, a new explanation is offered. This posits sexualization as a psychological manifestation of a structural deficit and suggests analytic treatment as a process of structuralization. These terms are defined and illustrated. A case example demonstrates the thesis, and some implications of this concept are discussed.

Adult↗
PubMed1993

The female genital dress-rehearsal: a prospective process at the oedipal threshold.

Rather than focus on the girl's phallic identification as a compensatory reaction to her femininity, I offer a conceptual framework through which to examine how the girl symbolically masters and elaborates her biologically unfolding sexuality. Presumably, because her genital inner space can be defined and filled only through the playful retention and expulsion of an external object, the girl's phallic identification paradoxically affords her the first experience of her genital femininity. Borne out of her genital stimulation at the oedipal threshold, the genital dress-rehearsal turns on outside gestures becoming registered as sensations inside her body. As a result of her dual experience, the girl is both phallic and vaginal, giver and receiver, father and mother. Through the magic of play, the girl renegotiates her oath of fidelity to her internal, pre-oedipal mother, while laying claim to the kind of sexual vibrancy that her external, oedipal mother shares with her oedipal father.

Body Image↗