The development of treatment-resistant schizophrenia in a 16-year-old Maltese girl was analyzed in terms of its biopsychosocial model of disease.

To highlight the presentation of treatment-resistant schizophrenia.

To investigate the etiology of treatment-resistant schizophrenia.

To utilize the biopsychosocial model of disease in order to investigate the aetiology of treatment-resistant schizophrenia.

To highlight the treatment modalities utilized in this case of treatment-resistant schizophrenia.

Interviewing the patient.

Analyzing all investigations and documentation made during her admission in an acute psychiatric hospital.

Evaluating the response to various treatment modalities.

Carrying out literature reviews.

Image attached.

Although the aetiology of treatment-resistant schizophrenia remains somewhat unclear even after many years of study, the biopsychosocial model is nevertheless useful in understanding the development of this condition. The treatment modalities to which the patient was resistant were also identified.

Figure not available.

The authors have not supplied their declaration of competing interest.

Psychiatry's viewpoint of sexual deviance has waved between the normal and the pathological. “Normal” is not determined by nature but by the values of a specific society.

To review the main landmarks in paraphilias history and the importance of social and cultural dimensions to it.

PubMed database was searched using the keywords perversion, sexual deviance, paraphilia, culture and society.

Throughout Middle Age and Renaissance any sexual act that differed from the natural/divine law was considered a vice. Unnatural vices (masturbation, sodomy, bestiality) were the most severely punished, as they could not result in conception. In 1886, Krafft-Ebing stated perversions were functional diseases of the sexual instinct caused by “hereditary taintedness” in the family pedigree and worsened by excessive masturbation. Proper perversions were sadism, masochism, antipathic sexuality (homosexuality, transvestism, transsexuality) and fetishism. Later, Havelock Ellis and Hirschfeld claimed sexual interest in the population followed a statistical norm, opposed the idea that masturbation led to diseases and demanded the decriminalization of homosexuality. Freud believed the “perverse disposition” to be universal in the childhood giving rise to healthy and pathological adult behaviors. In 1950's, Albert Kinsey surprised America when he proved many supposedly deviant sexual practices were quite common. The first Diagnostic and Statistical Manual (1952) was mainly psychoanalytic. Later, by 1973, homosexuality was removed from classifications. Recently, DSM-5 distinguishes between paraphilias and paraphilic disorders.

A progress in the paraphilic instincts’ acceptance has occurred. We hypothesize, in the future, paraphilias will follow homosexuality out of the diseases’ classifications.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

It is only in the last decade that trans people have been accorded rights and give protection in law from discrimination. A survey of 10,000 people undertaken by the Equality and Human Right Commission showed that 1% of the population was gender-variant to some extent. Gender-variant people continue to suffer restricted opportunities, discrimination and harassment at work despite the existence of anti-discrimination and equalities legislation. It is estimated that up to 40% of people with gender dysphoria may not be receiving appropriate help.

Review of UK policies, guidelines, legislation and research on challenges faced by gender-variant people and ways to improve their care and lives.

To improve gender-variant people access to care and ways to fight inequalities.

MEDLINE, PsycINFO databases were searched for articles published between 2005–2015 containing the keywords “gender dysphoria”, “gender-variant people” and “transgender people”. Relevant policies, guidelines and legislations were also reviewed.

Transgender people still face major health inequalities and discrimination. National statistics show that 80% have experienced harassment, 62% suffered discrimination at work or home and 54% reported being denied access to NHS care due to lack of cultural competency from staff. Guidelines, research, policies and equality legislation have begun to be implemented to protect transgender people from discrimination and accord rights.

Many areas need attention and improvement including not only healthcare but also employment, education, housing and media perception. Promotion of equality in the general population with the aim of achieving cultural change and improvement of cultural competency of health professionals is needed.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Sex abuse within the military has long been an open-secret afflicting both male and female veterans whose etiology is often attributed to character deficits (personality disorders or paraphilic disorders). Few studies look at the sex-stress phenomenon as a feature of military life itself and the role this plays in sex abuse within the military milieu. While much attention is focused on US forces, this problem in endemic within military cultures per se. The recent sex abuse scandal involving the French military in the Central African Republic illustrates the pervasiveness of the problem.

To explore the psycho-cultural mechanisms of stress and its sexual expression and how certain scenarios within the military milieu exacerbates this impulse-control reaction. To address the relationship of the availability of sex-release options – without and/or without the military population (and how increased enlistment of women has changed the nature of the target population in today's military).

Look at the problem historically (from WWII – present) with particular illustrations. Evaluate common (often failed) approaches to addressing the problem, including the fallacy that superior officer know best how to handle these cases. Explain the psycho/physiology of the sex-stress phenomenon – mechanism of the hypothalamic-pituitary-adrenal-gonad axis. Look at the relationship between sex-trauma and suicides among veterans.

Offer a viable assessment/diagnostic of sexual problems within the military culture along with a treatment model that offers both psychotherapeutic (cognitive-behavioral protocols…) as well as identifying acute clinical symptoms that may respond to psychotropic medications.

The author has not supplied his declaration of competing interest.

Gender dysphoria is incoherence between the sex a person feels or expresses and the biological.

Revise the inclusion criteria for hormone therapy and sex reassignment surgery in gender dysphoria. Expose the multidisciplinary approach. Make differential diagnosis with other psychological disorders.

A 45 years old male patient (biological female), who was sent from Endocrinology Unit for a psychiatric evaluation before restart a hormonal treatment. Since his childhood, he has presented dissatisfaction with his sexual characteristics; he has had fantasies and dreams, in which he belonged to the other sex. He has always chosen male activities and male stereotypes companies. He has presented preference for cross-dressing from 9 years. Always felt the sexual attraction for women. He first consulted for this reason in 1995.

It reported favorably to start hormone treatment after completing the eligibility criteria: > 18 years old; knowledge of the effects of hormones; and more 3 months documented real-life experience. The hormone therapy caused the growth of microprolactinoma, which was treated with dopamine agonists until it disappeared and the cessation of galactorrhea. Testosterone treatment is restarted. Laboratory tests are done every 3 months during the first year and then, every 6 months.

Is the gender disphoria a pathology? The EU recommends a reclassification as no pathological disorders in ICD-11. The treatment of gender dysphoria is necessary, and there is no reason to postpone it. The main difficulty is the differential diagnosis; there may be comorbidity with others mental disorders which are not exclusive (psychotic disorder, OCD, personality disorders and other disorders of gender identity).

The authors have not supplied their declaration of competing interest.

Transsexualism suffers from several definitions that evolve across time. Therefore, some discrepancies appear progressively in regard of evidence-based medicine and psychological approaches as sexo-analysis.

In our present study, we test if “primary” or “secondary” transsexualism defines in accordance with sexo-analysis definitions will be reliable with the pathology course.

Clarify the definition of transsexualism to obtain a better understanding of this trouble and perhaps to change psychological approaches of gender disorders.

Nine transsexual male-to-female (MtF) aged between 25 to 65 were voluntary recruited. They were diagnosed by a psychiatrist. We adapted the GID scale to measure the lifetime process. Descriptive statistics were reported. Results are expressed as mean ± standard deviation.

Age of the group is 41 ± 12. All subjects were treated by hormone therapy. One of them was surgical reassigned. All subjects reported a persistent feeling to be a woman across their entire life. None showed a decreased female feeling during a part of their life or a brutal apparition of this trouble during the adult period.

In regards of our preliminary results, we concluded that secondary transsexualism should be redefined and was probably induced by sociocultural aspects. Our results are limited by amount of subjects and should be confirmed by a large population included MtF and FtM people.

The authors have not supplied their declaration of competing interest.

The side effects of the various antidepressant drugs on the sexual field (with very few exceptions) are well known, and they affect the quality of life in important manners. The incidence rate, communicated spontaneously by the patient, has been estimated around 10–15%, and can reach amounts of 50–60% with SSRIs when studied specifically. It has been suggested that these effects compromise treatment adherence.

To estimate the incidence and intensity of the side effects on the sexual field with different antidepressants, as well as its relationship with treatment adherence.

Transversal study on 50 patients assisted in medical consultation. Collection of data in office (October 2014–October 2015).

Administration of survey PRSexDQ-SALSEX. In order to research the relationship with treatment adherence, one question surveyed the patient whether he/she had thought about finishing treatment for this reason.

Twenty-nine patients (58% of the sample) presented some degree of sexual dysfunction. Five individuals (17.2%) communicated it spontaneously. Nine individuals (31%) responded that they did not accept positively the changes in their sexual field, and they had thought about withdrawing treatment for this reason. They were given the test of self-compliance statement (Haynes-Sackett), with a result of four non-compliant (44.4%). The most frequently involved drugs were fluoxetine (n = 5, 10% of the sample total) and paroxetine (n = 4, 8%).

The high impact of sexual side effects with a low rate of spontaneous communication coincides with previous existent studies.

Limitation when estimating adhesion due to methodological difficulties in the design of the study. However, high impression by using the selected method of determination.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The sexual compulsive behavior also known as sex addition is the repetitive and intense sexual behavior of the individual. Although the few studies carried out, the prevailing rates vary between the 2% and the 20%.

We present the case of a 46-year-old male with psychiatric treatment records since he was 17 and a personality disorder group B diagnosis and depressive reactions reactive to environmental frustrations. Several short-, medium- and long-term hospitalizations. Currently he is admitted after having expressed some autolytic ideas.

The patient started a treatment in the Unit of Addictive Behaviors. He says he started to frequent the brothels 10 years ago to satisfy his sexual needs, but gradually increased the frequency. Later, he started to have sex online, also in fee-paying web pages. This has had a negative influence in the different aspects of his life, leading him to economic stress and endless debts.

Borderline personality disorder. 301.83 (F60.3).

Other specified disruptive, impulse-control, and conduct disorder (sex). 312.89 (F91.8).

Pathological gambling. 312.31 (F63.0).

Persistent depressive disorder. 300.4 (F34.1).

It is clear that the compulsive sexual behavior is a disorder that includes repetitive, intrusive and distressing thoughts and leads to behaviors that affect negatively several aspects of the lives of people suffering such disorder, so that is why it is associated with other psychiatric disorders. Even though it has been described and discussed for years in literature, it is difficult to classify within psychiatric nosology and nowadays its categorization is still a challenge within the mental health.

The authors have not supplied their declaration of competing interest.

Within psychiatry, sexology is a very particular area of expertise both by the nature and specificity of its diagnosis, as by the various difficulties and challenges their patients place. Sexology is a sub-specialty niche, but also a vast universe that covers such diverse conditions as paraphilia, gender dysphoria or sexual dysfunction. The sexology consultation of Santa Maria Hospital (HSM) is one of the biggest centers specialized in sexual disorders in the country. Consultations depend on the collaboration of a sexologist psychiatrist and psychiatry residents in close connection with endocrinology, urology and plastic surgery services.

We intend to conduct a characterization of the population observed in the HSM sexology consultation, in a period of 2 years, from the analyses of different general and diagnosis-specific relevant variables.

We intent to make a descriptive analysis of the population that attended the sexology consultation over the last 2 years. The sample study refers to all patients who have been specifically referred to sexology department or that directly requested access to this consultation. Data will be collected from medical computer records.

Through systematic evaluation of different variables we can possibly conclude by some putative associations. A comprehensive characterization of this particular population is a possible method for a better and deeper insight on the diagnosis itself.

The purpose of this work is to increase peers’ sensitivity both to sexology and to the patients sexology serves.

The authors have not supplied their declaration of competing interest.

Addiction refers to a pattern of:

– loss of control, as shown by unsuccessful efforts to stop the behaviour;

– continuation of the behaviour despite adverse consequences – such as marriage breakdown;

– an obsession with obtaining, using or recovering from the behaviour.

To date, DSM-5 does not recognize sex addiction as a disorder, however when problematic sexual behaviours fulfil these same three criteria, the process is considered to be an addiction.

This case report describes the development of problematic addictive sexual behaviour, possibly as a result of other psychiatric comorbidities including obsessive-compulsive disorder (OCD), alvinophilia, and obsessional fetishism. The presence of the Madonna-Puttana syndrome is also explored.

To use the biopsychosocial model to investigate the aetiology of addictive problematic sexual behaviour. To explore the role of psychiatric comorbidities in the expression of such behaviour. To examine the holistic impact of sexual addictions. To examine the treatment modalities of addictive problematic sexual behaviour.

A 25 year old happily-married nurse who confessed to serial extramarital affairs was interviewed. Underlying psychiatric comorbidities were identified. Family members were also interviewed for a collateral history. The above objectives were explored and the response to various treatment modalities were evaluated. Literature reviews were carried out.

This case illustrates a form of OCD which manifested as addictive problematic sexual behaviour. The message portrayed is that hope exists for such couples once various treatment modalities are put into action.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Cancer of the uterine cervix represents 10% of malignant tumors affecting women. Despite occupying fifth place in the global mortality rate it is described with the highest healing potential. One of the most used treatments is radiotherapy, which has a particularly significant impact on women's quality of life, especially in their sexuality. Biological and psychic factors are suggested as possible etiologies for sexual dysfunction situations. Changes in body image may arouse feelings of shame and low self-esteem. In what concerns biology, vaginal stenosis is referred as a cause of vaginism and vaginal bleeding, with consequent decrease in libido and pleasure.

Describe the implications in the sexuality of women with cancer of the uterine cervix after radiotherapy.

A literature search using the PubMed and Scielo databases of scientific articles published in the last 10 years.

In the literature, there are significant changes in sexual behavior in women with cervical cancer in the period after radiotherapy. A large percentage reveals sexual abstinence and an equally significant part presents sexual dysfunction caused by lack of lubrication, arousal and orgasm. Moreover, it is reported decreased libido and sexual pleasure, vaginal bleeding and vaginism. On the other hand, there is a small account of cases in which it is mentioned increase libido and pleasure.

Despite the high probability of healing this disease, the patients’ quality of life after advanced stages of radiotherapy, should be a source of concern, especially with regard to sexuality.

The authors have not supplied their declaration of competing interest.

Premature ejaculation (PE) corresponds to “a persistent or recurring ejaculation pattern that occurs during sexual activity with a partner approximately 1 minute after vaginal penetration and before the person wishes to”. It affects 5–20% of men, having its origin in psychological factors and with important biological contribution. It is considered generalised, when not confined to certain patterns of stimulation, situations, or partners, or may be situational. It may occur soon after the onset of sexual activity (primary) or after a normal sexual functioning (acquired). Primary EP is associated with the hyposensitivity 5-HT2C receptors and/or hypersensitivity 5-HT1A receptors. High performance anxiety levels are related to acquired EP. Increasing this physiological knowledge has enabled significant advances in treatment.

Approach the therapeutic options of EP and its peculiarities.

Literature review of articles published in the last five years, using the PubMed and Scielo databases.

At present, the approaches include psychosexual counseling, behavioral and pharmacotherapy. Among the most popular drugs, antidepressants stand out, particularly dapoxetine, the first medication specifically approved. Local anesthetics, phosphodiesterase-5 inhibitors and tramadol are also used. Acupuncture is suggested as a useful therapeutic, but needs more research.

The behavioral therapies are referred to as first-line treatment in the long-term, associated or not with medication. Dapoxetine is the preferred symptomatic treatment. However, a holistic approach, including psychotherapy and sex therapy, is the most beneficial modality for sexual and marital relationship.

The authors have not supplied their declaration of competing interest.

To asses the effect of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum on postmenopausal women's sexual satisfaction.

In this triple blind randomized control clinical trial, 80 healthy volunteer postmenopause women with age 50–60 years old in one of clinics of west of Tehran had been involved (year 2013–2014). Participants were randomly assigned to intervention and placebo group and received one month same shape capsules two times in a day. Tools of this study had two main parts of personal characteristics and sexual satisfaction. All ethical points were considered and approved by Ethics committee of Research Institute for Islamic & Complementary Medicine (RICM, IUMS).

After a month intervention, there is significant increase in the mean score of sexual satisfaction between two groups (P = 0.01), but when sexual satisfaction compared with pre-menopausal time in two groups, t-test results showed no significant difference (P = 0.16).

Use of oral capsule of mixed Tribulus Terrestris, Zingiber Officinale, Crocus Sativus and Cinnamomum Verum two times a day for a month could improve sexual satisfaction in postmenopausal women. Referring to no significant change with comparing premenopause time, it sounds they have same satisfaction as premenopause time. There were no side effects during study and one month follow-up. It is suggested to do same research on sexual satisfaction and function with more month intervention.

The authors have not supplied their declaration of competing interest.

Exhibitionistic disorder may be present when there is sexual arousal from the exposure of one's genitals to an unsuspecting and nonconsenting person. This disorder prevalence is unknown but we know it is highly unusual in females. It generally starts at adolescence and its course is likely to vary with age. There are temperamental and environmental risk factors.

Most of what we know about exhibitionistic disorder is largely based on research with individuals convicted for criminal acts involving genital exposure, and this may represent an important bias. From a clinical case of exhibitionism, the authors intend to review this type of paraphilia from an historical, conceptual and etiologic point of view.

To review the concept behind this diagnosis and its evolution, the comprehensive theories that attempt to justify and frame it, as well as the type of intervention currently considered to be the state of the art.

Patient's observation and assessment, along with an extensive review of the relevant literature.

Starting from a real clinical case, the authors present a general theoretical review on the subject.

The authors have not supplied their declaration of competing interest.