Behavioral Science IV
Terms
undefined, object
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- What are the normal phases of sexual functioning?
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Appetitive (desire)
Excitement (erection)
Plateau (Incr HR,BP,Resp,Skin Flush, intensification of erection)
Orgasm (vaginal/uterine contraction, expulsion semen)
Resolution (Men,refractory, Women restim possible) - What happens to sexual functioning with aging?
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Men - slower erection/ejaculation, longer refractory period
Women - less lubrication, vaginal shortening,thinning,dryness - What is primary sexual dysfunction? Secondary?
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Primary - orgasm never achieved
Secondary - men - inability to maintain despite past erections - What is the triad associated with hyposexuality?
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Reduced or absent interest in sex. (Appetitive phase disorder)
Key psych triad: Problems in Relationship, Performance Anxiety, Fear of Consequences(STD,Pain,Etc)
Others:
Depression
Psychotic Disorders
Meds
Epilepsy
Bipolar Mood Disorder - Define paraphilia and name some.
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Disorders of appetitive phase.
Exhibitionism, etc -
Define
Exhibitionism
Fetishism
Frotteurism -
Exhibitionism - exposing genitals
Fetishism - inanimate objects
Frotteurism - rubbing penis against nonconsenting, nonaware woman -
Necrophilia
Pedophilia (how define?)
Sexual Masochism
Sexual sadism -
Children (perpetrator must be at least 16 and 5 years older than victim)
Recieving physical suffering
Causing physical suffering -
Transvestic Fetishism
Voyuerism
Zoophilia -
Wearing women's underclothing
observing sexual activity/undressing
animals - Sexual problems in the excitement phase (define and name causes)
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Inability to maintain erection (40% exp at some time)
Inability to maintain vaginal lubrication, relaxing vagina (60%)
Key Triad:
Comorbid psychopathology
Recreational Drug Use/Meds
Fatigue
others:
Diabetes
Peripheral Vasc Disease
Perineal surgery/radiation
renal failure
Aortic occlusion at iliac bifurcation (Leriche syndrome)
peripheral neuropathy
Multiple Sclerosis
Spinal cord transection - What are some treatment for excitement phase disorders?
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Relaxation training
Education
Sensate focus (increase awareness of touch/sens stimuli to decrease pressure for orgasm)
Relaxation training
Education
Hormone injections
Prostheses
Penile injections
Vacuum pump -
Plateau phase disorders?
Primary Sexual Pain Disorders -
Dyspareunia - pain during coitus (2nd to endometriosis, tissue trauma, insuff lubrication, hymenal tags, phemosis, meds)
Vaginismus - involuntary muscle spasms before/during coitus, penetration impossible (tx. mech dilation) -
Orgasmic Phase Problems
Premature Ejaculation
Female Orgasmic Disorder -
Premature ejaculation - Primary due to key triad
Secondary due to meds/drugs
Tx-Squeeze technique when ejac. inevitability felt, stops ejaculation and backward conditions.
Female Orgasmic Disorder- delayed/absent orgasm.
Primary - partner trust
Secondary - genital pathology, endocrinopathy, meds, alcohol, drugs -
What are the effects of the following substances on sexuality:
Alcohol
Amphetamine -
Alcohol: Incr libido acutely, chronic liver damage increases estrogen, decr arousal
Incr libido (direct brain stim) -
Cocaine
Heroin/Methadone
Marijuana -
Cocaine - Incr libido, priapism
Heroin - Decr libido, inhibits ejaculation (less with methadone)
Marijuana - Incr libidio acutely, lowered GnRH/Testosterone with chronic use - What substances are connected with increased aggression?
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Alcohol
Cocaine
Amphetamines
PCP
High dose Marijuana
HEROIN is NOT assoc - At what age do children understand death?
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Children under 5 do not understand death.
Understand permanence of death at age 8. - What are the Kubler-Ross stages of dying?
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Death (Denial)
Arrives (Anger)
Bringing (Bargaining
Grave (Grief/depression)
Adjustments (Acceptance) - What are the risk factors for suicide completion?
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S (Sex-male)
A (Age - elderly, teens)
D (Depression)
P (Previous Attempt)
E (Ethanol)
R (Rational Thought)
S (Sickness)
O (Organized Plan)
N (No Spouse)
S (Social Support Lacking) - What are exceptions to informed consent?
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Patient not legally competent
Implied consent in emergency
Therapeutic Privilege - withold info when would harm patient or undermine decision-making capacity
Waiver by patient of right - What are factors that substantiate decision making capacity?
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1. Patient makes/communicates choice
2. Patient is informed
3. Decision stable over time.
4. Decision consistent with patient values/goals.
5. Decision not result hallucinations/delusions. - What are two types of written advance directives and which takes precedence?
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Living will = patient direct witholding life-sustaining tx in terminal disease or vegetative states.
Durable Power of Attorney - patient designates surrogate to make medical decisions (may also specify decisions themselves) Surrogate retains power UNTIL REVOKED BY PATIENT. - Define Beneficence
- Physicians have ethical responsibility to act in patient's best interest. Patient hold's ultimate decision making power (with informed decisions)
- What are exceptions to confidentiality?
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1. Likely Harm to others (impaired auto drivers)
2. Possible Harm to self
3. No alternative to warn those at risk
4. Doctor can take steps to prevent harm
Tarasoff Rules - patient must warn potential victims of their patients plans -
What are the requirements of a civil suit under negligence?
What is the burden of proof in a malpractice suit? -
Dereliction (physician breach of duty to patient)
Damage (patient suffers harm)
Direct (breach of duty causes harm)
Burden of proof - "more likely than not".