Ed Treatment Options For Men With Ptsd
Erectile dysfunction is almost always treatable. In addition to improving your mental health by treating post-traumatic stress disorder, you can treat erectile dysfunction by using medication and making healthy, positive changes to your habits and lifestyle.
Currently, the FDA has approved four medications to treat ED, all of which belong to a class of drugs called PDE5 inhibitors:
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Sildenafil. The active ingredient in Viagra®, sildenafil provides relief from ED for around four hours per dose.
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Tadalafil. The active ingredient in Cialis®, tadalafil is a long-lasting medication that can provide relief from ED for up to 36 hours per dose.
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Vardenafil. The active ingredient in Levitra®, vardenafil provides relief from ED for four to six hours per dose.
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Avanafil. Available as Stendra®, avanafil is a newer ED medication that works in 15 to 30 minutes and has a reduced risk of causing side effects.
We offer several ED medications online, following a consultation with a licensed physician who will determine if a prescription is appropriate.
Beyond using medication, making simple changes to your daily habits can help to reduce your risk of dealing with recurrent erectile dysfunction. These include keeping yourself active, eating a balanced diet, quitting smoking and maintaining healthy sleeping habits.
Understanding The Impact Of Executive Dysfunction
Executive dysfunction can create real problems for people from a young age into adulthood. Its important they learn about the issue and then find ways to address the struggle that can help them. Often this means addressing an illness like ADHD.
For more information on executive function and how the dysfunction can impact you, contact us today.
An example from my own life:
I have experienced problems with my focus and attention all my life. It has been so integral to the way I work and live that I have always accepted it as normal. During grade school and high school I was an average student academically. While I would put in effort to do better academically, I never could focus enough to excel in any subject. When I entered college it really became difficult. I was very driven to do well so I would spend outrageous amounts of time mastering the courses I took. I started comparing myself to others and realized I was probably putting in two to three times as much study as my friends. Part of the problem was an inferior public school education but there was something else. I remember how quickly I forgot what I studied and it took repeated readings of books before significant retention occurred.
The Neurobiology Of Fear
A comparable two-day fear conditioning and extinction paradigm was developed to study these processes in humans3 where subjects received mild shocks when seeing blue and red lights in a specific environmental context. Subjects underwent fear extinction learning for the blue light, but not the red, which was left as an unextinguished stimulus. Functional MRI was used to measure brain activation during conditioning, as well as extinction learning and extinction recall .
In fear learning, several areas of the brain, including the dorsal anterior cingulate cortex , the amygdala, and the hippocampus, are more activated. In extinction learning, the brain cools, though the amygdala is still implicated. In late extinction learning, the ventromedial prefrontal cortex , which was not activated in conditioning and early extinction, is activated. In extinction memory retrieval, this same area is even more activated. The hippocampus, meanwhile, is key in context gating the conditioning and extinction memory. The insular cortex is another important area, especially in the formation of fear memories.
Combined, these brain areas are what we refer to as the fear circuit, interacting with each other during different phases of this paradigm, be it fear acquisition, extinction learning, consolidation of the learning, or extinction of memory expression.
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Is Executive Dysfunction A Symptom Of Adhd
Yes, executive dysfunction is one of the key symptoms of ADHD. Research shows that the parts of the brain involving executive functions tend to be smaller, less developed or less active in people with ADHD. Thats why ADHD nearly always involves this symptom. Its also a common feature among many conditions that affect people who are neurodivergent.
Finally What Could This Mean For Future Treatment
So, if someone has PTSD and executive dysfunction, they could also carry the brain marker of interrupted emotional regulation. This could change how they respond to traditional treatment.
Jagger-Rickels further commented: These individuals may respond best to specific treatment strategies but may also have difficulty engaging in treatments that require high levels of emotional regulation and executive functioning.
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Biological Bases In Post
Irregularities in the biological system involved in the response to stressful events largely lead to damages in the body, setting a pathological mechanism, compared to normal behavior . Dysfunctions in the spinal sympathetic-adrenal-axis and the hypothalamic-pituitary-adrenal-cortical axis, neuroendocrine dysregulation in glutamatergic, noradrenergic, and serotonin systems result in an imbalance and consequently an increased vulnerability to developing PTSD .
Studies using models of psychological stress to evaluate the function of the HPA axis revealed an exaggerated cortisol response and hypersecretion of CRH in the PTSD-state, as a result of physiological failures of the system . Paradoxically, there is evidence showing low plasma cortisol levels and an increase in the negative feedback of the HPA axis under basal conditions . The presence of low concentrations of cortisol in people who survive traumatic events is a fact that seems contrary to the idea that stress may be associated with elevated levels of cortisol. One explanation that can be made is that in the course of adaptation to trauma, low cortisol concentrations are detected first, reflecting a chronic adaptation of the HPA axis to stress.
FIGURE 4.Schematic summary of the classical model of neurobiology in the expression of PTSD: hypothalamic-pituitary-adrenal axis. Source: made by myself.
What Is Executive Dysfunction
Executive dysfunction is an impairment of one or more aspects of executive function. This can interfere with a persons ability to take care of themselves, interact with family and friends, maintain peace of mind, or work productively. Often, executive dysfunction begins with just a few symptoms and can progress to involve more aspects of life.
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Executive Function Skills In Action
Organization skills might come into play when making a to-do list for the day. These skills help you plan not only the tasks you need to complete but in what order.
Youd probably want to take your dogs to the dog park beforethe appointment at the groomers, for example, and plan your weekly menu before you stop by the grocery store.
Regulation skills, on the other hand, might help you keep frustration and anger in check during a work meeting where your supervisor introduces a new, more restrictive policy for requesting time off.
After taking a moment to find a sense of calm and note that your co-workers reactions seem pretty aligned with your feelings you feel able to offer a more respectful protest.
Executive function skills dont develop in the exact same way for everyone, so the signs of executive dysfunction can vary from person to person.
If you have trouble with certain executive function skills, you might:
Executive Dysfunction: How To Cope With Impaired Executive Functioning
Impairment of executive functions is referred to as executive dysfunction, and it can severely impact the quality of life. Our executive functioning refers to the imperative cognitive skills we use when we multitask, pay attention to details, solve problems, organize our day, respond to stimuli and interpret events. Most of the brain activity associated with executive functioning occurs in the prefrontal cortex of the brain.
A self-employed entrepreneur might need organizational skills and executive functioning more than another person, but in general, we all need executive functioning.
Below, well discuss executive dysfunction, and review what can be done about it.
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Neurobiology Of Attention Deficit Disorder/hyperactivity
Scientific studies demonstrate the involvement in ADHD of several neuroanatomical structures within the frontal cortex, especially the prefrontal area, the basal ganglia, and the posterior parietal cortex .
Along with the PFC, the caudate nucleus and its associated circuitry play an important role in the pathogenesis of ADHD. With MRI studies, structural abnormalities have been found in individuals with ADHD, related to reduced volumes of the left caudate nucleus and right anterior frontal cortex, indicating a reversal of the normal asymmetrical pattern. A bilateral reduction in the size of the putamen has also been found, as well as a reduction in the volume of the right globus pallidus .
It is also known that through the use of neuroimaging techniques, structures such as the cerebellum show significantly lower measurements in children with ADHD throughout childhood and adolescence, compared with the same structures in children without the disorder In addition, the right PFC is slightly larger in the general population, and its counterpart in the left hemisphere is more symmetrical in people with the disorder, affecting mental abilities such as inhibition of responses, planning behavior, selective focus and organization of information necessary for solving problems and using specific cognitive operations . See Figure 3.
FIGURE 3.Main altered brain structures in ADHD and their effects on cognitive components associated with EFs. Source: made by myself.
Applying The Fear Network To Human Studies Of Ptsd
In line with the findings of the fear network of amygdala-mPFC-hippocampus from animal work, human neuroimaging studies also suggest critical roles for this network in PTSD. The amygdala, ventromedial prefrontal cortex , the anterior cingulate cortex , and the hippocampus have been identified as the key regions underlying the etiology, progression, and maintenance of PTSD . These regions are anatomically aligned with the fear network identified in the animal studies. Importantly, structural and functional connectivity within these brain regions support fear acquisition and extinction processes in humans . Notably, there is emerging evidence demonstrating that these brain regions interact with inflammation, which suggests novel PTSD intervention targets.
Fig. 1
Fear network in humans. The amygdala and the dACC exhibit robust activation during fear acquisition and expression. Extinction learning and recall of extinction memory are strongly associated with reduced activity of the vmPFC and the Hipp. vmPFC=ventromedial prefrontal cortex dACC=dorsal anterior cingulate cortex Amg=amygdala Hipp=hippocampus
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Attention And Processing Speed Of Information
Recent evidence suggests that deficits in attention and processing speed are closely linked to the progression of PTSD . Notably, inflammation has been associated with deficits in attention and slow processing speed , further underscoring the potential interplay of these inflammatory and cognitive mechanisms in PTSD etiology, progression, or severity. The severity of PTSD symptoms is strongly associated with poor performance on attention tasks , up to a year following exposure to a traumatic event . Most frequently, PTSD symptoms correlate with deficits in sustained and selective attention . Indeed, elevated symptoms of PTSD have correlated with a marked reduced ability to resist distractors . Additionally, PTSD symptom severity can further impact the ability to maintain attention to task-relevant stimuli and screen out irrelevant information, a difficulty that is not confined to specific trauma-related stimuli . Together, these findings suggest deficits in the attentional control required to disengage attention from trauma-related stimuli in patients with PTSD .
Chronicity Of Ptsd Symptoms
Follow-up clinical assessments were conducted 1090 months following baseline assessments . Of these, we focused the following analyses on the 175 with a PTSD diagnosis at baseline, in order to assess chronicity of PTSD. With this additional assessment, we calculated a reliable change index to measure the chronicity of PTSD symptoms. The reliable change index is a continuous regression-based change measure developed by McSweeny et al. , and subsequently updated by Hilton-Bayer . This method, unlike a simple subtraction-based measure, adjusts for regression to the mean, test-retest reliability, and inequality of variance. First, the total CAPS score at follow-up was adjusted for the total CAPS at baseline , while also adjusting for test-retest reliability of CAPS-IV . Since there was a wide range of time between baseline and follow-up assessments, we included time between baseline and follow-up as a covariate in the reliable change index analysis. This analysis controlled for any systematic differences of time between baseline and follow-up on chronicity of PTSD symptoms . In a subset of these participants , we were able to examine medical records between baseline and follow-up to identify those who had sought treatment for PTSD. Treatment was investigated as a potential covariate in reliable change index analyses .
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Assessment Of Executive Functioning
EF subgroups were defined in an a priori manner using a previously validated procedure that employs a battery of six neuropsychological tests with five measures examining EF . Using DSM-5 criteria for mild neurocognitive impairment, impaired EF was defined as performance falling greater than one standard deviation below normative expectations on two or more neuropsychological measures of EF. In addition, we used a parallel approach to identify individuals with above-average EF as evidenced by performing at greater than one standard deviation above normative expectations on two or more neuropsychological measures . All other participants scoring between these cutoff ranges were considered to have average EF. We used these previously published and normative-based cutoffs to characterize clinically significant differences in EF and increase reliability . In addition, a continuous measure of EF was assessed with a composite mean z-score across all five measures.
Broaching The Topic With Health Care Providers
Though the situation is far from ideal, the researchers write that there are avenues to addressing sexual dysfunction among Veterans with PTSD. A prerequisite, though, is that clinicians feel confident and qualified to address the problem.
“Some providers view sexual dysfunction as a medical issue, others as a psychological issue, leading providers to believe it is not within their purview to asses or treat such disorders,” write the authors. “Moreover, there is controversy about the qualifications providers should have to treat sexual dysfunction. It has been argued that sexual problems should be addressed solely by those who specialize in sexual issues.”
The researchers suggest clinicians and providers first educate themselves so that they feel more confident to treat patients’ sexual concerns and, perhaps most importantly, to bring them up at all. While many providers may feel more comfortable waiting for patients to express their concern about sexual dysfunction, according to the research, Veterans consistently report the topic would be easier to broach if their providers initiated the discussion.
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Conceptualization Prevalence Comorbidity And Clinical Criteria
According to the APA and the guidance provided in the DSM-5 , PTSD is characterized as a psychiatric disorder, described as a categorical entity clinical order. It is currently classified as one of the disorders related to trauma and stress factors, and can occur in people who have experienced or witnessed a traumatic event such as a natural disaster, a serious accident, an act of terrorism, war or combat, violent personal assault or rape. PTSD is part of a real disorder that leads to short and long term involvement after having experienced or witnessed an event of great emotional impact . Psychological distress following exposure to a traumatic or stressful events is variable. It has been shown that some people who have been exposed to a stressful or traumatic event do not exhibit clinical features related to PTSD or pathogenesis. This reveals a major contribution by modern science in relation to the existing biological predisposition in some individuals associated with a low susceptibility to this disorder, and therefore provides arguments that PTSD represents a specific phenotype associated with a failure to recover from the normal effects of trauma .
TABLE 2.Summary of specific criteria and symptoms for the diagnosis of PTSD .
What Can I Do At Home To Deal With Executive Dysfunction
Its not possible to self-diagnose and treat conditions that cause executive dysfunction on your own. Because of this, you should see your healthcare provider if you suspect you have symptoms of executive dysfunction. They can either offer you treatment recommendations, such as medication, or suggest providers who can help you with other treatment options.
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Ptsd Increases Risk For Sexual And Urinary Problems
Post-traumatic stress disorder is categorized as a mental health problem, but it can also produce a range of physical symptoms. UCSF urologist Benjamin Breyer, MD, and his research team have found that in Iraq and Afghanistan war veterans, these physical effects can include sexual dysfunction and, to a lesser extent, urinary tract symptoms.
Sexual and urinary problems remain stigmatized issues in our society, so they havent been well studied, said Breyer. Addressing these issues can significantly improve a patients quality of life.
PTSD and sexual dysfunction
Prior investigations by other researchers had found an association with trauma-related mental illness, including PTSD, and sexual difficulties, but Breyers is the largest study of this kind to date. Breyer and his research team, which included PTSD experts Karen Seal, MD, Raymond Rosen, PhD, and Thomas Neylan, MD, conducted a retrospective record review of 406,275 male Iraq and Afghanistan veterans who received health care through the Department of Veterans Affairs from 2001 to 2009. Over half of the vets from these deployments who have enrolled for VA healthcare have received mental health diagnoses, with PTSD being the most common.
When we looked at the data and factored out other conditions that could contribute to sexual difficulties, such as medical and substance abuse problems, we found that PTSD resulted in a three-fold increase in a veterans risk for sexual problems, said Breyer.
Firstly What Is Executive Dysfunction
According to Headway, executive dysfunction occurs in people with frontal lobe injuries. It can look like anti-social behaviour or misunderstood as depression, lack of motivation, selfishness, or aggression. This can bleed into relationships with others, impacting their emotional intimacy.
Executive dysfunction can create symptoms like:
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