Které běžně používané léky ovlivňují negativně sexualitu? Martin Hollý

Fáze lidského sexuálního chování prof. Hynie výběr partnera dvoření erotika v ústraní koitus péče o potomstvo

Sexuálně motivační systém Narůstající sexuální chuť ………… koitus Pedofilní atraktivita Výběr partnera Dvoření Erotika v ústrani Koitus

Organické nebo psychogenní?

Klasifikace sexuálních poruch Fáze sexuálního vzrušení Apetence komorbidita s depresí, NÚ medikace, selektivní/generalizovaná Tělesné odpovědí lubrikace/erekce, dyspareunie Orgasmu PGAD/EP, retardovaná ekjakulace, retrogradní ejakulace/ anorgasmie Satisfakce

Diferenciální diagnostika organické psychogenní nezávislé na situaci pomalý rozvoj není souvislost se stresovým obdobím společně s jinou nemocí dlouhodobá farmakoterapie suspekce na abusus situační závislost náhlý vznik souvislost se stresovým obdobím nejsou údaje o jiných nemocech bez dlouhodobé farmakoterapie bez abusu

Organická nebo psychogenní? Jakákoli sexuální porucha má psychogenní komponentu Studie Manna et al. (2005), která zkoumala pacienty s psychogenní ED ve spánkové laboratoři podporuje hypotézu, že tyto jsou důsledkem „organické nemoci mozku“ Pozitivní efekt některých psychofarmak (moclobemid) na psychogenní ED naznačují podobnou hypotézu Sleep investigations in erectile dysfunction. 4: J Psychiatr Res. 2005 Jan;39(1):93-9. Mann K, Pankok J, Connemann B, Sohn M, Thuroff JW, Benkert O. Department of Psychiatry, University of Mainz, Untere Zahlbacher Strasse 8, D-55101 Mainz, Germany. mann@psychiatrie.klinik.uni-mainz.de Regarding the aetiology of erectile dysfunction, beside numerous organic causes in many cases psychological factors play an important role. The pathophysiological mechanisms underlying the so-called psychogenic erectile dysfunction are not yet understood. Based on a neurobiological approach to psychogenic erectile dysfunction, polysomnographic investigations were carried out with the aim of identifying possible alterations of the sleep EEG. 24 male patients with psychogenic erectile dysfunction without detectable organic factors or other mental disorders were studied in the sleep laboratory, as well as an age-matched control group without sexual dysfunctions. Beside a reduction of sleep efficacy, the most prominent finding was a shortening of REM latency in the patients compared to the controls. Moreover, spectral analysis revealed a reduced theta power for all sleep stages and a reduced delta power for stage II and slow wave sleep in the patients. The findings support the point of view that psychogenic erectile dysfunction is an organic disorder of the brain. The sleep EEG abnormalities may reflect dysregulations in limbic structures which are suggested to be involved in the pathophysiology of sexual dysfunctions. As these alterations had also been reported for other mental disorders, particularly depression, they appear to be non-specific biological abnormalities for different psychiatric syndromes, including psychogenic erectile dysfunction. PMID: 15504427 [PubMed - indexed for MEDLINE] 3: Psychopharmacology (Berl). 2001 Jun;156(1):86-91. Effects of moclobemide on sexual performance and nocturnal erections in psychogenic erectile dysfunction. Mann K, Pankok J, Leissner J, Benkert O. Department of Psychiatry, University of Mainz, Germany. mann@mail.psychiatrie.klinik.uni-mainz.de RATIONALE AND OBJECTIVES: We tested the hypothesis that the selective reversible MAO-A inhibitor moclobemide has a specific therapeutic effect on erectile dysfunction independent of its antidepressive properties. METHODS: In a double-blind placebo controlled study, 12 male outpatients suffering from psychogenic erectile dysfunction without any other psychiatric disorder were investigated. Based on comprehensive diagnosis before the beginning of the study, organic factors relevant for sexual function were excluded. The treatment period was 8 weeks. Half the patients received 450 mg moclobemide during the first week, and 600 mg afterwards; the others received placebo. Apart from assessment of erectile function by means of the Clinical Global Impression (CGI) scale, nocturnal erections were measured under polysomnographic control at baseline and at the end of the treatment period. RESULTS: The evaluation of the CGI scale revealed a clearly stronger improvement under moclobemide compared to placebo during the study period. The therapeutic efficacy found on the subjective level had no clear correlate on the neurophysiological level. No alterations of nocturnal erectile parameters were obvious under treatment, neither were clinically relevant alterations found regarding sleep EEG parameters. The medication was well tolerated without serious adverse events. CONCLUSIONS: The findings support the hypothesis that moclobemide has a specific effect on erectile dysfunction. Thus, patients suffering from psychogenic erectile dysfunction who are not depressed might benefit from moclobemide without relevant side effects. PMID: 11465638 [PubMed - indexed for MEDLINE]

Farmaka ovlivňující sexualitu Antidepresiva SSRI Tricyklika Venlafaxin Anxiolytika Benzidiazepiny Antipsychotika Hyperprolaktinemie, anticholinergní účinky Alternativa Mirtazapin Trazodon Bupropion Atarax Práce s dávkou Olanzapin Quetiapin

Farmaka ovlivňující sexualitu Antiparkisonika Levodopa Antiulcerosa H2 antagonisté Antiepileptika Barbituráty Fenytoin Karbamazepin Alternativa Individuální zvážení Inhibitory protonové pupmy Dle individuálního posouzení (lamotrigin, valproát)

Farmaka ovlivňující sexualitu Antihypertenziva Beta blokatory Dihydralazin Clonidin Reserpin Guanethidin Diuretika Kalium šetřící diuretika Inhibitory karboanhydrázy Thiazidová diuretika Alternativa Alfa blokátory ACE inhibitory Blokátory Ca kanálu Furosemid

Farmaka ovlivňující sexualitu Hormony Antiandrogeny LHRH analoga Estrogeny Hypolipidemika Gemfibrozil Klofibrát Alternativa Nutné vyvážení přínosů a rizik Statiny

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