• To test the validity, magnitude, and clinical significance of the signs and symptoms of tobacco withdrawal defined byDSM-III, both observed and reported signs and symptoms were measured in 50 smokers during two days of ad lib smoking and then during the first four days of abstinence. Observer and subject ratings of theDSM-IIIsymptoms of craving for tobacco, irritability, anxiety, difficulty concentrating, and restlessness increased after cessation. In addition, bradycardia, impatience, somatic complaints, insomnia, increased hunger, and increased eating occurred after cessation. The frequency and intensity of these symptoms varied across subjects; however, the average distress from tobacco withdrawal was similar to that observed in psychiatric outpatients. Subjects who had more withdrawal discomfort were more tolerant to the cardiovascular effects of nicotine. Subjects who had more withdrawal discomfort did not have a lower rate of smoking cessation.

https://jamanetwork.com/journals/PSYCH/articlepdf/493770/archpsyc_43_3_013.pdf

Signs and Symptoms of Tobacco Withdrawal

This study tested the ability of nicotine to alleviate the tobacco withdrawal syndrome. Signs and symptoms of tobacco withdrawal were measured in 100 smokers who fulfilled DSM-III criteria for tobacco dependence and a past history of tobacco withdrawal. After 2 evenings of baseline measurement, subjects were randomly assigned to receive either nicotine or placebo gum in a double blind manner. Subjects then stopped smoking, chewed gum freely, and returned on the 1st, 2nd, and 4th evenings of abstinence for further measurement. Nicotine reduced the increase in irritability, anxiety, difficulty concentrating, restlessness, impatience, and somatic complaints that subjects reported after cessation. Reductions in these withdrawal symptoms by nicotine were confirmed by ratings of significant others and by subjects' scores on the Profile of Mood States. Nicotine did not reduce the increases in cigarette craving, hunger, eating, insomnia, tremulousness, or supine heart rate after cessation. The effects of nicotine occurred immediately and persisted throughout the study. Although many subjects correctly identified their drug group, the efficacy of the gum was independent of subjects' identifications of drug. The relief of tobacco withdrawal by nicotine gum suggests that the tobacco withdrawal syndrome is caused, in part, by nicotine deprivation.

Effect of nicotine on the tobacco withdrawal syndrome.

• Evidence concerning pharmacological effects on human sexuality suggests that dopaminergic receptor activation may be associated with penile erection. Erection also appears to involve inhibition of α-adrenergic influences and β-adrenergic stimulation plus the release of a noncholinergic vasodilator substance, possibly vasoactive intestinal peptide. Ejaculation appears to be mediated primarily by α-adrenergic fibers. Serotonergic neurotransmission may inhibit the ejaculatory reflex. An understanding of the neurobiological substrate of human sexuality may assist clinicians in choosing psychotropic agents with minimal adverse effects on sexual behavior and may also contribute to the development of pharmacological interventions for sexual difficulties.

https://jamanetwork.com/journals/psych/articlepdf/494507/archpsyc_46_3_011.pdf

Effects of Psychotropic Drugs on Human Erection and Ejaculation

Background Antipsychotic drugs are associated with sexual dysfunction but the mechanisms are poorly understood.

Aims To ascertain the frequency of sexual dysfunction in patients taking conventional antipsychotics and to determine the possible underlying mechanisms.

Method Sexual dysfunction was assessed in 101 patients receiving conventional antipsychotic medication, 57 normal controls and 55 controls attending a sexual dysfunction clinic.

Results Sexual dysfunction occurred in 45% of patients taking antipsychotic medication, 17% of normal controls and 61% of controls attending a sexual dysfunction clinic. Sexual dysfunction was associated with autonomic side-effects in normoprolactinaemic males, but the presence of hyperprolactinaemia overrode other causes of sexual dysfunction. For women, hyperprolactinaemia was the main cause of sexual dysfunction.

Conclusions Conventional anti-psychotic medications cause significant levels of sexual dysfunction. Clinicians should routinely enquire about sexual symptoms prior to the prescription of antipsychotics and on follow-up.

/pdf/sexual-dysfunction-in-patients-taking-conventional-4kg3ady4qx.pdf

Sexual dysfunction in patients taking conventional antipsychotic medication

This study was a prospective examination of tobacco withdrawal symptoms in a controlled environment. Smokers (N=27) were hospitalized for a 7-day period during which a battery of tests was administered. Smokers were assigned to either an experimental group (N=20) or a control group (N=7). Subjects in the experimental group smoked ad libitum for a 3-day baseline period and then underwent 4 days of tobacco deprivation. Subjects in the control group continued to smoke ad libitum throughout the study. Of the 37 measures of tobacco withdrawal employed in this study, nine showed significant changes following tobacco deprivation. These changes include decreased heart rate and increased caloric intake, weight, craving for tobacco, confusion, depression-dejection, number of awakenings, duration of awakenings, and increased poor concentrations as observed by others.

Tobacco withdrawal symptoms: an experimental analysis.

The authors found a 60% incidence of difficulties in sexual functioning in 57 male patients who had taken thioridazine. Ejaculatory problems were the most frequent dysfunction; a third of these patients experienced retrograde ejaculation. The incidence of sexual difficulties in 64 patients who had taken other major tranquilizers was only 25%. None of the latter group experienced retrograde ejaculation-most had difficulty achieving and maintaining erection. The authors recommend consideration of the possibility of sexual dysfunction in patients given thioridazine.

J Kotin

Papers

Thioridazine and sexual dysfunction.