Erectile dysfunction (ED) has an intricate pathogenesis, with organic and psychosocial factors contributing to the shaping of its clinical manifestations and functional impairment. ED disrupts not only an individual’s sexual life but may also contribute to impairments of self-esteem, social functioning, quality of life, overall well-being, mood, etc. The assessment process and therapeutic interventions should be adequate to the specific profile of each patient, therefore an interdisciplinary approach is usually recommended, in order to find the vulnerability factors, recent triggers, psychiatric and organic comorbidities or causes, and elements that contribute to maintaining the sexual dysfunction, such as lifestyle factors, interpersonal conflicts, or inadequate sexual education. This narrative review explores the evidence-based approaches to structured psychiatric, psychological, and therapeutical assessment in patients with ED, and the most validated psychosocial treatments available. The results support the use of recognized diagnostic criteria within DSM-5TR and ICD-11, together with structured instruments (scales, questionnaires, and inventories), in a multidisciplinary approach. The cognitive model and cognitive-emotional model of ED support the initiation of cognitive-behavioral therapy in these patients. Other interventions, like the PLISSIT model, sexual therapy, couple therapy, and sexual-focused psychoeducation are also supported by evidence. In conclusion, ED requires a combined, psychiatric, psychologic, psychotherapeutic, and organic-oriented assessment, with the purpose of tailoring the treatment to the patient’s particularities.
The assessment of coping mechanisms in patients diagnosed with oncological diseases is essential for mental health specialists, who have to design the most appropriate case management strategy for comorbid mood disorders, anxiety disorders, adjustment disorders, and other psychiatric conditions that may be detected in this vulnerable population. The adequate treatment of these disorders is important for the preservation of mental health status, quality of life, and overall functionality in patients diagnosed with cancer. Coping mechanisms modulate the vulnerability toward psychiatric disorders, but they also have an impact on treatment adherence, which is an important factor correlating with prognosis. Appraisal-focused, problem-focused, emotion-focused, and occupation-focused coping represent the most well-defined strategies patients use when confronted with a stressful life situation, like a diagnosis with potentially vital consequences. Maladaptive coping strategies may also be identified in these patients, e.g., withdrawal from reality, including complete or partial denial of the disease, substance abuse, behavioral addictions, refusal of the recommended treatment, etc. The psychotherapeutic approach in patients with oncological diseases should include an initial evaluation of the coping strategies used either currently or in the past stressful conditions, an assessment of all the psychosocial resources the patients have (e.,g., support group, professional insertion, hobbies), and screening for mood and anxiety disorders that may have been triggered by the cancer diagnosis. Consequently, within the psychotherapeutic framework, a trained specialist can enhance the role of adaptive coping strategies and highlight the disadvantages of dysfunctional ones. This process may possess a favorable impact on treatment adherence, mental health status, and quality of life in patients with cancer.
Nutritional interventions in the field of psychiatry have been explored more intensively in the last two decades, but definitive conclusions based on the retrieved data in the literature about the efficacy of this therapeutic approach are difficult to formulate. This observation has multiple explanations, e.g., these therapeutic interventions are very heterogenous, cohort studies usually enroll different psychiatric populations or healthy subjects with minor psychiatric symptoms, nutritional supplements or special diets are commonly recommended as add-ons to the pharmacological interventions (thus making it difficult to differentiate the impact of each therapy on the outcomes), placebo-controlled randomized studies are still very few, etc. Therefore, a narrative review focused on the main challenges reported during the research in the field of nutritional psychiatry (NP) may be useful for clinicians interested in strategies to augment the efficacy of pharmacological treatments or to find new solutions with low risk of adverse events in patients with organic comorbidities or multiple concomitant medications. Data about the efficacy and tolerability of nutritional interventions explored for psychiatric disorders were searched in four electronic databases (PubMed, Cochrane, Clarivate/Web of Science, and EMBASE). Omega-3 polyunsaturated fatty acids supplementation, healthy diet interventions, folate and vitamin B12, S-adenosyl-L-methionine, N-acetyl cysteine, vitamin B1 and B6, vitamin D, minerals, psychobiotics, inositol, and herbal products were the main interventions identified, and their demonstrated efficacy was quite heterogenous, while their tolerability and safety were good. Therefore, NP is a domain of research that may benefit from more good-quality and longer-duration trials, in order to verify the effectiveness of such augmentation strategies to the already validated treatments.
The conundrum of post-psychotic depression (PPD) is still present in the psychiatric literature, for more than a century since it was first described by Mayer-Gross. After a short existence in the DSM-IV and ICD-10, this nosological construct was excluded from newer versions of the mental disorders classifications. Therefore, an exploratory analysis of the PPD concept was considered useful both from clinical and theoretical perspectives. There is a high prevalence of depressive symptoms in patients with schizophrenia spectrum disorders (SSD) and, although not all of them represent cases of PPD, they are considered risk factors for suicide. The arguments and contra-arguments for/against PPD were reviewed, and the potential pharmacological interventions for this disorder were analyzed. The explored evidence indicates that PPD is worth further investigation, and in order to differentiate it from schizoaffective disorder, negative symptoms of SSD, or depressive manifestations within the acute psychotic episodes, clearly defined criteria should be found. The use of validated scales, like the Calgary Depression Scale for Schizophrenia and the InterSePT Scale for Suicidal Thinking, is recommended for the initial assessment of depression and suicidal risk in patients with SSD, but also for their monitoring during the acute and maintenance phases. Besides the administration of combined, antidepressant and antipsychotic treatment, the use of clozapine, and the recommendation to initiate treatment for SSD with atypical antipsychotics whenever possible, there is a dearth of studies exploring specific interventions for PPD. Future studies are expected to address the validity of the nosological construct of PPD and the most adequate therapeutic and prophylactic interventions in patients with SSD.
