Concluded Case

Sexual dysfunction

How to proceed in a case where in a couple suffers from psychopathology? Husband suffers from sexual dysfunction and wife suffers from delusional disorder(del of infedility) with grade 1 insight in the wife?kindly suggest.

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Concluded answer

Treat the couple according to their psychopathology. Husband suffers from sexual dysfunction, what type of sexual dysfunction ------ ED/PME/Drug Induced Sexual Dysfunction/Depressive loss of libido/Sexual Performance Anxiety?? Treat him according to the psychopathology. Wife suffers with Delusional Disorder. Treat her with Olanzapine, starting with 5-10mg & titrate according to the response. If u fear of sexual dysfunction in wife on long term treatment, U can taper the Olanzapine later and start with Lurasidone 20-40mg, which is free of sexual S/Es. If wife has additional Depressive Features, treat her for that.

All Answers

Treat the couple according to their psychopathology. Husband suffers from sexual dysfunction, what type of sexual dysfunction ------ ED/PME/Drug Induced Sexual Dysfunction/Depressive loss of libido/Sexual Performance Anxiety?? Treat him according to the psychopathology. Wife suffers with Delusional Disorder. Treat her with Olanzapine, starting with 5-10mg & titrate according to the response. If u fear of sexual dysfunction in wife on long term treatment, U can taper the Olanzapine later and start with Lurasidone 20-40mg, which is free of sexual S/Es. If wife has additional Depressive Features, treat her for that.

Valuable opinion
1

First done the complete assessment of wife and check the status of ADL . If she is having severe impairment as you have stated that she has grade 1 insight . Then firstly we should start an antipsychotic olanzapine 5 to 10 mg od and titrate according to symptoms . For husband prescribe treatment . If he has ED or PME or both then give Paroxetin 20mg with pde5 inhibitor and assess further.

Thank you doctor
1

Firstly to identify type of sexual problem of husband n abt wife a detailed history nMSE should be taken before proceeding 4 therapy

Better to separate

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