Paraphilias - Psychiatry - Lecture Slides, Slides of Psychiatry

Download Paraphilias - Psychiatry - Lecture Slides and more Slides Psychiatry in PDF only on Docsity! HUMAN SEXUAL DEVELOPMENT PN ated tS P yee — Ba es ie i = Bea a uae pe ai | i oes sexual sexual deviations delinquents deviant sexual delinquents docsity.com SEXUAL DEVELOPMENT TEE rT [GONOSOMAL SEX ] Sex determining genes and H-Y antigen 2 Mullerian inhibiting substance GONADAL SEX Androgens (and fetal environment) and androgens —_—_ Month 2-3 ee NY neurotransmitters “f3\. ! Cacia 4 GENITAL( SOMATIC) SEX ‘ NEURONAL and PSYCHIC SEX (Sexual brain differentiation during fetal life starting month 4) > [Mternal genitalia @" Sex centres” __(Manth 2-3) b External genitatia b “Mating centres ” (Month 3-4) \ Prenatal life > ANAM MTA Postnatal life So aN Sex -specific gonadotropin secretion nem Sex hormones Positive oestrogen feedback” JA fb 8 Sex-specitic mating behaviour |@ 0 | orientation” nual orientation’ | eee ba Sex-specitic social behaviour "Gender role" _ _ docsity.com Nucteus paraventricularis ’ Nucleus » Commissura dorsaormedialis vit a anterior 4 ae Area if ‘ye praeoptica é Vordere hypathaldmo- praoptische suprachasmatische Region ak ® Chasma apticum “Nucleus © Mmammiullaris medialis Nucleus suprachiasmaticiis. Nucleus supraopticus | Vordere hypothalamische Area Hypophyse Hypophysiotropische Nucleus Eminentia Area arquatus. mediana RAT S SEXUAL ACTIVITY Pati) . N hed, . FETAL TESTOSTERONE LEVELS Tin ng/100 mi FSH inm! U/ml Male foetuses Fermalefoetuses Male foetuses Femalefoetuses Malefoetuses Female foetuses Testosterone glucuronide (TG), testosterone e (T) and FSH levels in amniotic fluids of male and female fetuses between weeks 15 and 26 of pregnancy (means + 5.D.). docsity.com HOHLWEG´S EFFEKT Kiss1/kisspeptin system Kiss1 gene expression and kisspeptin protein levels in anteroventral periventricular nucleus – higher levels in females Kauffman 2009 docsity.com RESULTS OF HYPOTHALAMOTHOMY Gerichtliche MaSnahmen vor und nach Hypothalamotomie wegen Sexualstérungen (28 einseitige, 6 doppelseitige Operationen) Gerichtliche MaSnahmen Anzahl Patienten vorher nachher! Gefangnis, meist mehrfach, meist verbunden mit anschlieSender psychiatrischer Zwangsunterbringung 19 Psy chiatrische Zwangsunterbringung Untersuchungshaft 4 gesamt 26 Keine Mafsnahmen 8 32 Gesamtzahl Patienten j 34 332 1 Durchschnittliche Nachbeobachtungszeit 6 Jahre und 9 Monate 2 Der Patient, der wenige Tage nach der Operation starb, ist in der rechten Spalte der Ta- belle nicht beriicksichtigt docsity.com Consequences of early stress and childhood maltreatment (child sexual abuse) …The major structural consequences of early stress include reduced size of the mid-portions of the corpus callosum and attenuated development of the left neocortex, hippocampus, and amygdala… …Early stress alters the development of monoamine neurotransmitters and affects their degree of laterality… Teicher et al., 2003 docsity.com CUMMULATIVE FREQUENCY OF EXPERIENCES WITH FORCEFULL SEXUAL ACTIVITY 174 female students and 137 male students of 1st. Medical School 0 10 20 30 40 50 60 70 0 2 4 6 8 10 12 14 16 18 20 22 24 female male % age (years) Raboch, 1996 docsity.com REDUCTION OF BRAIN STRUCTURES DEPENDENT ON AGE OF THE CHILD STRUCTURE AGE AT CSA HIPPOCAMPUS 3 – 5, 11 – 13 CORPUS CALLOSUM 9 – 10 FRONTAL CORTEX 14 – 16 AMYGDALA No differences Teicher et al., 2008 docsity.com Neuroanatomical sex-specific differences  MALE BRAIN CONTAINS ON AVERAGE 16% NEURONS MORE  MALE CORPUS CALLOSUM IS BIGGER  FEMALE TEMPORAL CORTEX HAS ON AVERAGE 11% GREATER DENSITY OF NEURONS  THE MOST SIGNIFICANT DIFFERENCES - HYPOTHALAMUS Sickel a McCarthy, 2000 docsity.com Sexual diferentiation of the brain  HYPOTHALAMUS  SDN-POA (sexually dimorphic nucleus of praeoptic area) - rats  INAH 1,2,3,4 (interstitial nuclei of the anterior hypothalamus) – human beings  Bed nucleus of stria terminalis docsity.com & MUZI © ZENY @ HOMOSEXUAL MUZE 103 0,5 T1 100 narozeni Swaab et al., 1995 BED NUCLEUS OF STRIA TERMINALIS DEVELOPMENT 0 0,5 1 1,5 2 2,5 3 3,5 4 fetal/neonat infant/pub adult males females Chung et al., 2002 docsity.com VOLUMES OF BED NUCLEUS OF STRIA TERMINALIS 0 0,5 1 1,5 2 2,5 male female MTF-T mm3 MTF-T – malet to female transsexuals N=6 Zhou et al., 1995 docsity.com Criteria of sexual „normality“  Adequate gender identity  PREFERENCE OF  Heterosexuality (?)  Mature object  Mutual contrived (voluntary)  Adequate interaction technique  Other… docsity.com F65 Disorders of sexual preferences F65.0– Fetishism F65.1– Transvestic fetishism F65.2– Exhibitionism F65.3– Voyerism F65.4– Pedophilia F65.5– Sexual sadism, masochism F65.6– Multiple disorders of sexual preferences docsity.com Treatment of paraphilias  voluntary  involuntary  out-patient  in-patient  Psychotherapy • individual • group • CBT  Sociotherapy  Pharmacoterapy • (estrogens) • antiandrogens • gestagens • lithium • neuroleptics • LH-RH analogs  Operations (?) • hypothalamo- thomy • castration docsity.com THANK YOU FOR YOUR ATTENTITION docsity.com