Paraphilias-1 - HUMAN SEXUAL HUMAN DEVELOPMENT AND...

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Unformatted text preview: HUMAN SEXUAL HUMAN DEVELOPMENT AND PARAPHILIAS AND Prof. MUDr. Jiří Raboch, DrSc. Department of Psychiatry, First Faculty of Medicine, Charles University and General University Hospital in Prague sexual deviations sexual delinquents deviant sexual delinquents SEXUAL DEVELOPMENT SEXUAL GONADAL DIFERENTIATION GONADAL mesoderm WT1 NR5A1 Bipotential gonad DMRT1,2, SRY, SOX9 testis DAXI ovary AMH testosterone Estrogens gestagens Kucinskas and Just, 2005 SEXUAL DEVELOPMENT SEXUAL RAT´S BRAIN RAT´S RAT´S SEXUAL ACTIVITY RAT´S SEXUAL CENTERS IN THE HYPOTHALAMUS HYPOTHALAMUS sex center Female area praeoptica Male Hypothalamus ventralis mediobasalis hypothalamus mating center nc. ventromedialis area praeoptica DIFERENTIATION OF HYPOTALAMIC NUCLEI AND EPITHELIAN OF THE 3rd. BRAIN VENTRICLE VENTRICLE FETAL TESTOSTERONE LEVELS FETAL HOHLWEG´S EFFEKT HOHLWEG´S Kiss1/kisspeptin system Kiss1 gene expression and kisspeptin protein levels in anteroventral periventricular nucleus – higher levels in females Kauffman 2009 RESULTS OF HYPOTHALAMOTHOMY HYPOTHALAMOTHOMY SEXUAL DEVELOPMENT SEXUAL SIGMUND FREUD SIGMUND 1856 - 1939 1856 THEORY OF UNCONSCIOUNESS PSYCHOSEXUAL DEVELOPMENT CHILDHOOD SEXUALITY CONFLICTS, COMPLEXES Consequences of early Consequences stress and childhood maltreatment (child sexual abuse) (child …The major structural consequences of early stress include reduced size of the mid­portions 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 CUMMULATIVE FREQUENCY OF EXPERIENCES WITH FORCEFULL SEXUAL ACTIVITY ACTIVITY 174 female students and 137 male students of 1st. Medical School 1st. 70 female male 60 % 50 40 30 20 10 0 0 2 4 6 8 10 12 age (years) 14 16 18 20 22 Raboch, 1996 24 REDUCTION OF BRAIN STRUCTURES DEPENDENT ON AGE OF THE CHILD OF STRUCTURE AGE AT CSA HIPPOCAMPUS 3 – 5, 11 – 13 CORPUS CALLOSUM 9 – 10 FRONTAL CORTEX 14 – 16 AMYGDALA No differences Teicher et al., 2008 Plasticity of the brain Plasticity EVOLUTIONARY REACTIVE ADAPTIVE REPARATIVE SYNAPTIC LEVEL LOCAL CIRCUITS DISTANT CIRCUITS PROLIFERATION MIGRATION DIFERENTIATION CRITICAL (SENSITIVE) PERIODS HIPPOCAMPUS AND DEPRESSION Vaidya a Duman, 2001 Neuroanatomical sex-specific differences 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 Sexual diferentiation of the brain Sexual HYPOTHALAMUS SDN­POA (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 DEVELOPMENT OF HYPOTHALOAMIC SDN-POA (INAH) (INAH) SEXUAL DEVELOPMENT SEXUAL BED NUCLEUS OF STRIA TERMINALIS DEVELOPMENT TERMINALIS 4 3,5 3 2,5 males females 2 1,5 1 0,5 0 fetal/neonat infant/pub adult Chung et al., 2002 VOLUMES OF BED NUCLEUS OF STRIA TERMINALIS 2,5 2 1,5 mm3 1 0,5 0 male female MTF­T – malet to female transsexuals N=6 MTF-T Zhou et al., 1995 Criteria of sexual „normality“ „normality“ Adequate gender identity PREFERENCE OF Heterosexuality (?) Mature object Mutual contrived (voluntary) Adequate interaction technique Other… F64 Gender identity disorders F64.0 Transsexualism F64.1 Transvestitism of the double role F64.2 Gender identity disorder in childhood F66 Mental and behavioral disorders connceted with the sexual development and orientation orientation F66.0 Sexual maturation disorder F66.1 Ego­dystonic sexual orientation F66.2 Sexual relationships disorder F65 Disorders of sexual preferences preferences F65.0 F65.1 F65.2 F65.3 F65.4 F65.5 F65.6 – Fetishism – Transvestic fetishism – Exhibitionism – Voyerism – Pedophilia – Sexual sadism, masochism – Multiple disorders of sexual preferences Treatment of paraphilias Treatment voluntary involuntary out­patient in­patient Psychotherapy • individual • group • CBT Sociotherapy Pharmacoterapy • (estrogens) • antiandrogens • gestagens • lithium • neuroleptics • LH­RH analogs Operations (?) • hypothalamo­thomy • castration THANK YOU FOR YOUR ATTENTITION ATTENTITION ...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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