Erectile dysfunction (ED) is defined as the inability to achieve or maintain an erection sufficient for sexual activity.

ED is a common condition in psychiatric patients, which can modify their quality of life.

The aim of this study is to assess the prevalence and the severity of ED in psychiatric patients.

This naturalistic, observational study was conducted during a six months period. The International Index of Erectile Function (IIEF) 15-item questionnaire was used to assess 144 male inpatients with different psychiatric disorders. IIEF is a brief, cross-culturally valid, self-administered scale for detecting treatment-related changes in patients with erectile dysfunction and addresses the relevant domains of male sexual function: erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction. The patients were analyzed by age, psychiatric diagnosis, medication, IIEF scores at admission.

Then mean age was 36.4 years. The lot included 44 patients with Psychotic Disorders, 68 with Mood Disorders, 21 with Alcohol Dependence, 11 with Personality Disorders. Severe ED was registered in 38% of investigated patients, which determined abandon of sexual attempts in 57% of cases; 12% had moderate ED, 15% had mild to moderate ED, 18% had mild ED and 17% had normal sexual function. No orgasm was reported in 32% of patients and 37% had no sexual desire. Under treatment with antipsychotic medication 78% had severe or moderate ED.

Severe ED was correlated with age, also being seen in young patients. ED was correlated with depression, schizophrenia and antipsychotic medication.

Depression as a pathology and the side effects of pharmacology therapy have been pointed proven to be as responsible for the lack of sexual desire. Among the drugs used in the treatment of depression, anti-depressives are the ones mostly connected to sexual dysfunction.

To study the relationship between depression and its impact on the sexual desire in psychiatric patients.

The chosen sample is composed of 89 subjects, 73 females and 16 males, with ages ranging from 21 to 70 years, who present with depressive symptomatology (mild to moderate symptomatology (MMS) and severe symptomatology (SS).To each patient 3 instruments were applied:

1. 1) Questionnaire used to collect demographic and clinical data from the sample;

2. 2) Instrument of estimation of the depression degree (BDI - Beck Depression Inventory);

3. 3) Instrument of valuation of the sexual desire (SDS - Sexual Desire Scale).

Depression average value obtained with BDI was 25.58 (SD = 11.86). The majority was satisfied with their marital relationship (72.7% and 52.9%, respectively), and the group with most sexual damaged (actual sexual performance regarding sexual desire) being the one with severe depression (54.5% versus 82.4%, respectively). Regarding total SDS value, the group with MMD present with higher levels of sexual desire (M = 54.93; DP = 14.56) than the group with SD (M = 41.82; DP = 11.86).

This study presents an exploratory character and the obtained results revealed that depressive symptomatology severity is directly related with sexual desire, by saying the higher the depression's severity is the lower sexual desire will be.

The sexual functioning problems in women after breast cancer are common. Certain factors related to treatment and its clinical implications may contribute to these problems.

- Evaluate the changes in sexual life after treatment of breast cancer relative to the general population.

- Identify the influence of demographic and clinical factors on sexuality.

We recruited 50 patients who were in remission for at least 3 months after initial treatment of breast cancer, and 50 healthy women.

Sexuality and body image was evaluated using the Arabic version of the specific scale of breast cancer QLQ-BR23, which is an additional module to the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire.

Compared with control subjects, patients reported more dyspareunia (61.5% vs 38.5%) and vaginal dryness (61.3% vs 38.7%). A diminished sense of sexual attractiveness was significantly more frequent within patients (p = 0.001).

The patients had poor sexual functioning and sexual satisfaction and the mean scores were respectively 45.3% and 43.9%. Additional analyses indicated that menopausal status and sexual difficulties in the partner was significantly related to poorer sexual satisfaction (p respectively 0.018 and 0.014).

The mean score of body image was 47.7% and its alteration had no significant impact on the themes of sexuality.

These findings confirm and extend previous reports of impaired sexual functioning among breast cancer survivors. Results suggest that relief of sexual difficulties in partner should be an essential component of efforts to improve sexuality of patients.

To evaluate mutual interaction between sexuality and personality we tried to study 111 patients with QSAF 2009 and MCMI-III.

Hundred and eleven consecutive patients with sexual problems (76) or personality disorders (35) were examined with two tests. Only volunteer personality disorder patients were enrolled to this trial. The results were compared with 325 examinees evaluated with QSAF and 1600 patients evaluated with MCMI-III.

All patients with sexual problems showed at least two scores higher than 72 in their MCMI-III. This was more prominent in sexual deviations than dysfunctions. Homosexuals had higher scores in schizoid and schizotypal, pedophiles in schizoid and antisocial, voyeurs in schizoid and avoidant, masochists in dependent and self defeating personality scales …. Sexually deviated persons remain clinically latent and show themselves as alien, aloof and eccentric. Almost all deviated persons show high scores in personality disorder scales. On the contrary, only a minority of personality disorder patients show prominent sexual problems in the form of deviation. They predominantly have disturbed sexual self image, show inhibited sexual desire problems (dependent, schizoid and avoidant) personality, dyspareunia and vaginism (avoidant and schizotypal personality), spouse abuse (borderline and antisocial personality) postcoital disorders (borderline, dependent and narcissistic personality) and extramarital relationship in a series of disorders including histrionic personality …. as studied by the QSAF 2009 which evaluates 64 sexual scales.

Evaluation of personality disordered patients in regard to sexuality and vice versa is essential for better understanding the pathogenesis of each disease and helps in smoother treatments.

To study sexual problems of our patients and standardizing it for patients with or without religious and cultural restrains we developed a questionnaire with 240 phrases that were extracted from a pool of 1400 sentences addressing sexual problems. Sixty four scales under four headings (sexual general characteristics, deviations, dysfunctions and psychodynamic syndromes) (16 items each) were evaluated based on criteria of DSM-IV and ICD 10. Five validity scales (honesty, desirability, debasement, guilt feeling and overall validity) were also used for better assessment.

A total of 1300 patients in the four variants of the test were evaluated during a time span of 7 years. The questions were presented to examinees at 8th. Grade and higher in a calm environment and the results were evaluated by a computer software specifically developed for this purpose.

The last version of the test was completed by 734 patients with excellent compliance. It was of nice politeness and comprehensiveness. For almost all scales the sensitivity and specificity were around 85 and 92% respectively.

We conclude that QSAF 2009 is an excellent tool both in clinics (diagnosis and follow up) and epidemiology with high sensitivity and specificity. It has also application in cross cultural studies, medico - legal issues and medical documentation. It prevents face to face interviews, breaks patients’ resistance and is less time consuming than scheduled interviews.

Sexual dysfunction is common among individuals with major depressive disorder but not optimally treated often.

The aim of this study was to determine differece in sexual dysfunction among male patients on antidepressant theraphy.

Stadu group consisted of 69 male outpatients who met DSM IV criteria for Major depressive disorder; aged 21–65 (mean 46.3 years). Studu excluded patients: with a previous history of sexual dysfunction, somatic diseases, other psychiatric co morbid condition. They did not used medication able to cause sexual dysfunction unless antidepressants or medications to improve erectile dysfunction. The ASEX and HDRS scales were applied at a single interview.

The prevalence of sexual dysfunction observed was 66% patients, 57, 7% in group under 50 and 74, 3% in group being 50 years old or older.

Sexual dysfunction, revealed by a high score on the ASEX scale (mean overall score of 26.9) was in group of patient over 50 years old. (p < 0, 01). There are no statistical, significant differences in the points obtained on the HDRS scores in both groups. (p < 0.01). Sexual dysfunction were reported more frequently in patients taking TCA (p < 0.005) or SSRIs (p < 0.001) compared to patients treated with mirtazapine.

The use of TCA is associated with loss of libido and erectile dysfunction, SSRIs with delayed ejaculation as well as impairment of libido and arousal.

Frequency of sexual dysfunction is higher in patients over 50 years. The less impact on sexual function have mirtazapine.

Sexuality is an important and integral part of every woman's life. The aim of this study was to assess the degree of sexual dysfunction among infertile women and its correlation with age, duration of marriage and etiology of infertility in women.

300 infertile women who were referred to IVF center for management of their infertility problem involved in this study after informed consent. They were asked to fill a questionnaire that contained three parts of demographic, infertility and sexual function items. Distribution of sexual dysfunction and its relationship to infertility and marriage duration were analyzed through SPSS software.

The most common sexual dysfunction was orgasm disorder (83.76%) and the rate of sexual desire disorder, dyspareunia and vaginismus were 80.7%, 67.7% and 76.7% respectively. More than 50% of cases mentioned decreased frequency of coitus after diagnosis of infertility. Vaginismus and dyspareunia were more common in 20–24 years age group.

According to the high rate of sexual dysfunction in this study and almost the same rate in other studies, gynecologists should pay more attention to this important issue and encourage the patients to have an evaluation by a psychiatrist or psychologist.

The Insomnia Severity Index (ISI) is a Questionnaire to screen insomnia in clinics;so,it has been translated into many languages.

To determine the relaibility and validity of the Chinese Translation of Insomnia Severity Index(C-ISI) in patients with Insomnia and compare it with Chinese version of Pittsburgh Sleep Quality Index(C-PSQI).

To prove the relaibility and validity of C-ISI for using it in chinese speakers.

English version ISI was translated into Chinese base on standard guidelines then Chinese version was filled in 83 patients with insomnia as a clinical group and 45 persons without sleep complain as the control group by themselves in Neuropsychiatery Department of DongzhiMen hospital. For finding Test-Retest reliability they refilled ISI questionnaire 2 weeks later.

Cronbach-α coefficient of C-ISI for the clinical group, control group and both of them was 0.72, 0.75 and 0.91 respectively. The C-ISI component and total scores in test were significantly correlated with their related components and total scores in re-test (P < 0.05). Mean Ranks for All C-ISI components, total score were significantly higher in clinical group than control group that presents low sleep quality in clinical group. There are Significant correlations between C-ISI component and total scores and C-PSQI components and Total scores in related Items.

C-ISI has acceptable reliability and good sensitivity for assessing insomnia patients; besides, C-ISI can evaluate the insomnia patients similar to the PSQI-C so it can be used as a good scale to measure sleep quality in Chinese speakers.

Acupuncture, as complementary medicine, has been used since many years ago in china and many researches have proved its effect separately or combined with other treatment methods.

To compare therapeutic effects of Acupuncture plus estazolam and Cognitive - Behavioral Therapy plus estazolam on insomnia.

To determine the efficacy of acupuncture as complementary medicine in treating insomnia.

64 insomnia patients were randomly divided into an acupuncture group and a behavioral group, 30 cases in acupuncture group and 18 cases in behavioral group completed research. The acupuncture group was treated by administration oral estazolam before sleeping each day and needling, three times a week, the behavioral group received Stimulus control as a Cognitive - Behavioral Therapy plus oral estazolam before sleeping each day. Treatment course was 3 weeks. The insomnia severity index (ISI) scores before and after treatment were observed in the both groups.

The total effective rate was 86.7% in the acupuncture group and 50% in the behavioral group with statistically significant difference (P < 0.05). The cured rate of 30% in the acupuncture group was significantly higher than 16.7% in the behavioral group (both P < 0.05).

The therapeutic effect of Acupuncture as a complementary medicine on insomnia is better than stimulus therapy as a Cognitive - Behavioral Therapy.

In 1983: 1.687 subjects, aged 30–44 years, answered a sleep questionnaire (USI).

In 2003: In a follow-up, 1.192 subjects, aged 50–64 years, answered the same sleep questionnaire. Subjects were asked about difficulties initiating sleep (DIS) and difficulties maintaining sleep (DMS), and not being rested by sleep (NRS). The questions were answered on a five-point scale

(1 = no problems,

2 = minor problems,

3 = moderate problems,

4 = severe problems,

5 = very severe problems).

At least severe problems (scores 4 and 5) were considered to be a complaint. Insomnia was defined as having at least one complaint. In year 2003 questions about health included a statement about being “burnout”.

In year 2003 “burnout” was reported by 7,3% of women, and in 3,9% in men.

In a logistic regression we examined the risk for “burnout” in relation to DIS, DMS and NRS at baseline. For women DMS (OR 2,8 CI 1,1-8,0) and NRS (OR 3,3 CI 1,2-9.3) were significant. DIS which was the only significant association for men (OR 7,3 CI 2,0-25,3).

Sleep complaints are predictive for a “burnout”-condition later in life.

Sleep restriction has adverse effects on performance and neurobehavioral function. However, the mechanism of impaired performance and neurobehavioral function has not been studied yet.

We examined the effect of insufficient sleep on cerebral blood flow and cognitive function in 8 healthy adults (mean age 22.4 years).

All participants were in bed for 8 h (sufficient sleep), and for < 4 h (insufficient sleep). The oxyhemoglobin (oxyHb) level by a word fluency task was measured with a near-infrared spectroscopy recorder on the morning following sufficient and insufficient sleep periods. Wisconsin card sorting test (WCST), continuous performance test (CPT) and N-back test were evaluated on the same days.

The peak oxyHb level was significantly lower in the left and right frontal lobes after insufficient sleep than after sufficient sleep (left: 0.25 ± 0.10 vs. 0.70 ± 0.29 mmol, P < 0.05; right: 0.23 ± 0.13 vs. 0.73 ± 0.22 mmol, P < 0.05). There was no significant difference in the number of words generated during the word fluency task between sufficient and insufficient sleep states. The percentage of correct responses on CPT after insufficient sleep was significantly lower than that after sufficient sleep (86.6 ± 10.2 vs. 96.0 ± 4.9%, P < 0.05). The reaction time of WCST was significantly longer after insufficient sleep than after sufficient sleep (76.6 ± 13.4 vs. 70.6 ± 16.2 sec, P < 0.05).

One night sleep restriction decreased the concentration changes of oxyHb in brain tissue, leading to impaired cognitive function.

The link among melatonin levels, pineal function, insomnia and affective spectrum is strengthened by epidemiologic and chronobiological evidence. From the affective spectrum, we selected the hyperthymic temperament, which is characterized by exuberant, upbeat, overenergetic, and overconfident lifelong traits.

We examined whether insomnia in persons with hyperthymic temperament responds particularly to the treatment with melatonin, in comparison with the euthymics patients with insomnia.

We ran an open label study on 20 subjects. None suffered from depression, mania or hypomania.

The study population comprised two groups: one group with patients with insomnia whose temperament presented hyperthymic traits (10 subjects) and the other group with euthymic adults, (10 subjects).

The Athens Insomnia Scale 5-item version (AIS-5) was administered to the two groups before and after the treatment with melatonin. The AIS is a self-assessment psychometric instrument designed for quantifying sleep difficulty based on the ICD-10 criteria.The patients took a single daily dose of 5 mg of melatonin with 30 minutes before bedtime. Using the AIS-5, we have assessed sleep at baseline and after 4 weeks of treatment. SPSS version 11 was used for statistical analysis.

After 4 weeks of melatonin therapy (5 mg/day), the comparison of the two groups showed that melatonin is more effective in the insomniacs with hyperthymic temperament comparative with the euthymic patients.

Melatonin has shown promising results in the treatment of insomnia in patients with hypertimic temperament. Further studies are necessary to better investigate the role of melatonin on insomnia in bipolar spectrum.

In contrast to the abundance of visual qualitative EEG reports in patho-endocrinology, there is a paucity of quantitative EEG findings.

Electrophysiology may be utilized for differential diagnosis of hypersomnolence.

To investigate long-term daytime sleepiness in a young female neurologist with the tentative diagnosis of narcolepsy in addition to moderate depression/anxiety and congenital thyroid hypoplasia treated with thyroxin.

Three-night polysomnography, multiple sleep latency test (MSLT), visual EEG/ERP-mapping, LORETA, psychometrics and blood analyses were performed.

Polysomnography revealed normal sleep efficiency and sleep architecture, but a high arousal index of up to 63/h TST. The MSLT showed a shortened mean sleep latency of 3.7 min. without REM-sleep onsets, objectifying the high Epworth Sleepiness score of 18. Visual EEG evaluation exhibited a fast alpha rhythm with intermittent theta and delta intrusions and paroxysmal activities. EEG-mapping showed an accelerated dominant frequency and ubiquitous increase in absolute (especially delta and beta) power, ERP revealed shortened N1 latency and very high amplitudes in all components (P300 > 5 SD). LORETA demonstrated significant regional increases in delta, alpha-2 and beta-1 power in the anterior cingulate, orbital, ventromedial, dorsolateral prefrontal cortex and temporal cortex, predominantly right hemispherically. Psychometry showed increased anxiety (SAS) and depression (SDS) and reduced quality of life. Finally, hormonal analysis pointed to thyrotoxicosis factitia (ICD-10 E05.4).

Diagnostic investigations clearly elucidated the pathogenesis of the presenting diagnosis of organic hypersomnia triggered by increased sleep-microarousals due to thyrotoxicosis factitia. Discontinuation of hormone substitution led to a normalization process that will be discussed.

Sleep-wake cycle is one of human biological rhythm highly correlated to well being and general health status.Poor sleep quality, sleep disruption and changes in regular Sleep-wake pattern may cause physical and psychological burden such as impairment in job performance, decreased work efficiency and learning disability.

Health care students trained in medical, nursing and midwifery fields is a population who are at great risk to develop sleep disruption and its subsequent physical and mental morbidity.

The aim of this study was to describe how sleep quality correlated to general health status among 280 health care students.

280 health care students studying in health related fields participated in this cross section study. Pittsburg sleep quality index (PSQI), sleep- wake questionnaire and the general health questionnaire (GHQ) administered to gather data describing sleep quality, sleep wake disruption and the general health status.

Preliminary results showed that 61.4% of subjects defined as poor sleeper. In further co relational analysis there was a significant correlation between sleep quality and general health status (r = .6, p = . 000, n = 280). Regression analysis showed that number of nights with sleep disruption due to shift work or academic needs was a strong predictor for both poor sleep quality and general health status.

In conclusion, Sleep disruption due to shift work or other academic demands is a predictor for poor sleep and its subsequent mental health morbidity, which should be considered as a part of mental health policy for health related college students.

Some of common non-communicable diseases deteriorate sleep quality, which worsens the disease itself. This study aims to evaluate

1. (1) whether common non-communicable diseases are associated with poor sleep quality and

2. (2) whether the combination of such diseases increase the possibility of poor sleep quality.

The subjects were civil servants in local government in Japan. A questionnaire survey was conducted in January 2003. Altogether 4272 subjects responded (response rate: 79.2%). Subjects were asked about whether they were diagnosed as having common non-communicable diseases (i.e. heart disease, cerebrovascular disease, hypertension, hyperlipidemia, diabetes, bronchial asthma, gastroduodenal ulcer, mental disorders, and low back pain). Overweight was evaluated by using BMI. Poor sleep quality was evaluated using Pittsburgh Sleep Quality Index (PSQI).

The age- and sex-adjusted odds ratio (OR) for poor sleep quality was higher among patients with heart disease, cerebrovascular disease, hypertension, hyperlipidemia, diabetes, bronchial asthma, gastroduodenal ulcer, mental disorders, low back pain, and obesity but the associations were not necessarily significant. However, the combination of such common non-communicable diseases significantly increased the possibility of poor sleep quality, with a dose-response relationship.

Although individual common non-communicable diseases may not necessarily cause poor sleep quality, the combination of these may increase the prevalence of poor sleep quality. Clinician should think that patients may have poor sleep quality if they have several non-communicable diseases.

To evaluate long-term efficacy and safety of zolpidem extended-release, in old patients for chronic primary insomnia.

Multicenter, randomized, double-blind, placebo-controlled, parallel-group.

Population: Outpatient with aged more of 65 years. Diagnosis: DSM-IV criteria for chronic primary insomnia; Treatment: Single-dose zolpidem extended-release 12.5 mg (n = 128) or placebo (n = 127), self-administered every night.

Patient's Global Impression (PGI) and Clinical Global Impression-Improvement (CGI-I) were assessed every 4 weeks up to six month. Patient Morning Questionnaire (PMQ), recorded daily, assessed subjective sleep measures-sleep onset latency (SOL), total sleep time (TST), number of awakenings (NAW), wake time after sleep onset (WASO), and quality of sleep (QOS)-and next-day functioning. Zolpidem extended-release also was statistically significantly superior to placebo at every time point for PGI (Items 1–4) and CGI-I (P < 0.0001, rank score), TST, WASO, QOS (P < 0.0001), and SOL (P < or = 0.0014); NAW (Months 2–6; P < 0.0001). Sustained improvement (P < 0.0001, all time points) was observed in morning sleepiness and ability to concentrate (P = 0.0014, month 6) with zolpidem extended-release compared with placebo. Most frequent adverse events for zolpidem extended-release were headache, anxiety and somnolence to the morning. No rebound effect was observed during the first 3 nights of discontinuation.

These findings establish the efficacy of dosing of zolpidem extended-release 12.5 mg for up to 6 months. Treatment provided sustained and significant improvements in sleep onset and maintenance and also improved next-day concentration and morning sleepiness.