RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, …



SYNOPSIS

Rajiv Gandhi University of Health Sciences , Karnataka

Bengaluru

‘‘ SEXUAL DYSFUNCTION IN MALE PATIENTS WITH

ALCOHOL DEPENDENCE SYNDROME ’’

-A CLINICAL STUDY

Name of the candidate : Dr. PAVAN KUMAR KADIYALA

Guide : Dr. DENZIL A PINTO

Course and Subject : M.D. (PSYCHIATRY)

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Department of Psychiatry

Father Muller Medical College

Kankanady, Mangalore- 575002

AUGUST-2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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|1 |Name of the Candidate |Dr. PAVAN KUMAR KADIYALA |

| |And address |DEPARTMENT OF PSYCHIATRY |

| |(In Block letters) |FATHER MULLER MEDICAL COLLEGE , KANKANADY, |

| | |MANGALORE -575 002 |

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|2. |Name of Institution |FR. MULLER MEDICAL COLLEGE |

| | |KANKANADY, |

| | |MANGALORE – 575 002 |

|3. |Course of study and Subject |M.D. PSYCHIATRY |

|4. |Date of admission to Course |31 MAY 2011 |

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|5. |TITLE OF THE TOPIC |

| |“ SEXUAL DYSFUNCTION IN MALE PATIENTS WITH ALCOHOL DEPENDENCE SYNDROME ” |

| |-A CLINICAL STUDY |

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|6 |BRIEF RESUME OF THE INTENDED WORK : |

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| |NEED FOR STUDY: |

| |Sexual function is the physiological capacity to experience desire, arousal, and orgasm. Alcohol may foster the |

| |initiation of sexual activity by removing inhibitions, but it impairs performance1. Sexual dysfunction in the |

| |alcoholic may be due to depressant effect of alcohol itself, alcohol related disease or due to a multitude of |

| |psychological forces related to the alcohol use2. Chronic and persistent alcohol use impairs erectile, orgasmic, and|

| |ejaculatory capacities, which leads to marked distress and interpersonal difficulty3. This, in turn, is known to |

| |worsen the alcohol abuse. A study by Benegal V and Arackal B S in |

| |NIMHANS found that 72% of alcohol dependent men had one or more sexual dysfunction, most common being premature |

| |ejaculation, low |

| |sexual desire and erectile dysfunction4. There are some studies that have looked into sexual dysfunction due to |

| |alcohol but there are only few studies reported from India. |

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| |REVIEW OF LITERATURE : |

| |Alcohol is long regarded as a risk factor for sexual dysfunction5. |

| |Virtually all aspects of the human sexual response are affected by |

| |alcohol: Libido is reduced, performance is impeded, and dissatisfaction |

| |ensues. These effects can be seen by examination of the phases of |

| |excitement, plateau, orgasm, and resolution in the human sexual |

| |response6. The mechanism of association between alcohol and sexual |

| |dysfunction is thought to be due to hypogonadism characterized by loss |

| |of endocrine and reproductive function of gonads5 or central nervous |

| |system depressive action1 or due to reduction in penile blood flow 7. |

| |It was found that during heavy drinking, 84.4% of patients had |

| |experienced at least one kind of sexual dysfunction, |

| |59% patients experienced erectile dysfunction, 48% reported |

| |ejaculation incompetence8. |

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| |In a community epidemiological sample of over 3000 adults |

| |it was found that the most common sexual dysfunction associated |

| |with alcohol was anorgasmia5. A study in Nigeria found 10.3% of |

| |men with erectile dysfunction had alcohol abuse9.  |

| |Sexual dysfunction in alcohol addicted males is related with |

| |age of subject ,education level, unemployment, age of onset of alcohol, |

| |quantity, frequency, onset of regular drinking and cigarette use 10. |

| |A study in Chinese men found that compared to never drinkers, |

| |those who consumed three or more standard drinks (one standard drink |

| |equals 12g of alcohol) a week were more likely to report |

| |erectile dysfunction11. Both moderate (4–6 drinks/day) or |

| |severe (>6 drinks/day) alcohol abuse was associated with low perceived |

| |partner's sexual desire and worse couple relationship7. |

| |Schiavi RC et al found that sexual dysfunction likely abate after |

| |prolonged periods of abstinence in the absence of substantial hepatic |

| |or gonadal failure12. |

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| |OBJECTIVES OF THE STUDY : |

| |To study the frequency of sexual dysfunction in male patients |

| |with alcohol dependence syndrome. |

| |To study the nature and severity of sexual dysfunctions in male |

| |patients with alcohol dependence syndrome. |

| |To study the relationship of sexual dysfunctions to |

| |socio- demographic and clinical variables. |

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|7. |MATERIALS AND METHODS : |

| |Source of Data : |

| |The clinical study will be conducted in de-addiction centre of |

| |department of psychiatry in Father Muller Medical College, Kankanady, |

| |Mangalore. All patients admitted during the period between 2011 and 2014 |

| |with a clinical diagnosis of alcohol dependence syndrome will constitute the |

| |population for the study. Controls for the study would be non alcoholic |

| |volunteers who are relatives of the patients. |

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| |7.2 Methods of Collection of data : |

| |CASES: |

| |Sample for study will consists of 100 consecutive in-patients |

| |admitted in the de-addiction centre with alcohol dependence syndrome |

| |who satisfy the inclusion and exclusion criteria. |

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| |INCLUSION CRITERIA: |

| |In-patients with ICD-10 diagnosis of Alcohol Dependence Syndrome. |

| |Male patients |

| |Age: 25 - 60 years. |

| |Those who have given written informed consent. |

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| |EXCLUSION CRITERIA: |

| |Female patients. |

| |Patients with prior sexual dysfunction. |

| |Patients with co-morbid physical disorder that can potentially cause |

| |sexual dysfunction. |

| |Patients with co-morbid psychiatric disorders that can potentially |

| |cause sexual dysfunction. |

| |Patients with other substance dependence other than nicotine. |

| |Patients on drugs affecting sexual functioning |

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| |CONTROLS: |

| |50 volunteers who are |

| |Male |

| |nonalcoholic relatives of patients with Alcohol Dependence Syndrome |

| |between age 25 to 60 years |

| |satisfying exclusion criteria as that of patients |

| |selected consecutively will constitute the control for the study. |

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| |TOOLS FOR ASSESSMENT: |

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| |ICD-10-AM Symptom Checklist for mental disorders. |

| |Sexual Dysfunction Checklist |

| |International Index of Erectile Function questionnaire (IIEF) |

| |Premature Ejaculation Diagnostic Tool (PEDT) |

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| |TYPE OF THE STUDY: |

| |Observational, analytical, case-control, cross sectional, clinical study |

| |Procedure: |

| |After explaining the purpose and design of the study, a written informed |

| |consent would be obtained for participation from all patients with Alcohol |

| |Dependence Syndrome and the controls recruited for the study. |

| |The socio-demographic and clinical variables will be recorded in a specific |

| |proforma prepared for the clinical study. |

| |All patients and the controls will be administered with |

| |ICD-10-AM Symptom Checklist for mental disorders screener. Those who |

| |require further examination will be administered the appropriate modules of |

| |same to establish Alcohol Dependence Syndrome in patients and to |

| |rule out other psychiatric disorders in patients and controls. |

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| |All the patients and controls will be asked for complete treatment history |

| |and will undergo a thorough clinical examination to rule medical disorders |

| |if any. Basic biochemical and clinical pathological laboratory investigations |

| |will be done. |

| |On the 3rd week of admission, all the patients of clinical sample and the |

| |subjects in control group will be screened using sexual dysfunction checklist to |

| |find out the presence and the type of sexual dysfunction. |

| |Those with sexual dysfunction will be further assessed with |

| |International Index of Erectile questionnaire (IIEF) and |

| |Premature Ejaculation Diagnostic Tool (PEDT) to establish and |

| |assess the severity of sexual dysfunctions . |

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| |STATISTICS: |

| |The results obtained will be analyzed using the following statistical methods. |

| |t- test |

| |Chi-square test |

| |Analysis of variance (ANOVA) |

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| |Does the study require any investigations or interventions to be conducted on patients or the humans or animals ? If |

| |so, please describe briefly. |

| |– NO – |

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| |Has ethical clearance been obtained from your institution in case of 7.3 |

| |- YES - |

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|8. |LIST OF REFERENCES: |

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| |Sadock VA. Normal human sexuality and sexual dysfunctions. In: Kaplan & Sadock's Comprehensive Textbook of Psychiatry, 9th edn, |

| |(Ed) Sadock B J, Sadock VA, Ruiz P. Lippincott Williams & Wilkins: Philadelphia, PA; 2009, |

| |2027-2060. |

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| |Graham C A, Bancroft J. The sexual dysfunction. In: New Oxford Textbook of Psychiatry, 2nd edn, (Ed) Gelder M G, Andreasen C N, |

| |Lopez-Ibor J J, |

| |Geddes J R. Oxford University Press: Oxford, UK; 2009, 821-832. |

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| |First M B, Tasman A. Substance-related disorders: Alcohol. In: Clinical Guide |

| |to the Diagnosis and Treatment of Mental Disorders,2nd ed. John Wiley & sons, Ltd: West Sussex, UK; 2010, 153-166. |

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| |Benegal V, Arackal B S, Prevalence of sexual dysfunction in male subjects with alcohol dependence. Indian Journal of Psychiatry.|

| |2007; 49(2): 109–112. |

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| |Tate S R, Drapkin M L, Brown S A. Substance Abuse Diagnosis, |

| |Comorbidity and Psychopathology. In: Oxford Textbook of Psychopathology, |

| |2nd edn, (Ed) Blaney P H, Millon T. Oxford University Press: |

| |Oxford, UK; 2009, 227-248. |

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| |Miller, Norman S, Gold, Mark S. The human sexual response and alcohol |

| |and drugs. Journal of Substance Abuse Treatment. 1988; 5(3): 171-177. |

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| |Boddi V, Corona G, Monami M, Fisher A D, Bandini E, Melani C, |

| |Balzi D, Sforza A, Patussi V, Forti G, Mannucci E and Maggi M. |

| |Priapus is Happier with Venus than with Bacchus. The Journal of |

| |Sexual Medicine. 2010, 7: 2831–2841. |

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| |Mandell W and Miller C M. Male Sexual Dysfunction as Related |

| |to Alcohol Consumption: A Pilot Study. Alcoholism: Clinical and |

| |Experimental Research. 1983, 7: 65–69. |

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| |Okulate G, Olayinka O, Dogunro A S. Erectile dysfunction: prevalence and |

| |relationship to depression, alcohol abuse and panic disorder. General Hospital |

| |Psychiatry, 2003; 25: 209–213. |

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| |Dissiz M and Oskay U Y. Evaluation of Sexual Functions in |

| |Turkish Alcohol-Dependent Males. The Journal of Sexual Medicine. |

| |2011, online version. |

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| |Lee A C K, Ho L M, Yip A W C, Fan S and Lam T H. The effect of alcohol |

| |drinking on erectile dysfunction in Chinese men. International Journal of |

| |Impotence Research, 2010, 22: 272-278. |

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| |Schiavi R C, Stimmel B B, Mandeli J, White D. Chronic alcoholism and |

| |male sexual function. American Journal of Psychiatry. 1995, 152: 1045-1051 |

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|9. |Signature of Candidate | |

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|10. |Remarks of Guide | |

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|11. |Name and Designation of |DR. DENZIL.A.PINTO |

| |(in Block letters) |PROFESSOR |

| | |DEPARTMENT OF PSYCHIATRY |

| |Guide |FATHER MULLER MEDICAL COLLEGE , MANGALORE - 575002 |

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| |Signature | |

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| |Co-Guide (if any ) | |

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| |Signature | |

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| |Head of Department |DR.P JOHN MATHAI |

| | |PROFESSOR & HOD |

| | |DEPARTMENT OF PSYCHIATRY |

| | |FATHER MULLER MEDICAL COLLEGE MANGALORE – 575002. |

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| |Signature | |

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|12 |12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL | |

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| |12.2 SIGNATURE | |

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