False: Penile and clitoral erections occur during REM sleep or dream sleep. They are unrelated to the content of dreams (Gelder et al 2000, p. 996; Johnstone et al 2004, p. 773).

True: Organic causes for erectile dysfunction can be considered negligible if a man has good erections with masturbation or with partners other than his usual one, or has spontaneous erections at times when he does not plan to have intercourse, morning erections or erections during sleep. Erections during REM sleep or nocturnal penile tumescence can be measured using the ‘stamp test’ or strain gauge. In the stamp test postage stamps are stuck round the base of the penis at night. If in the morning they are broken it would indicate that he had an erection during sleep (Sadock & Sadock 2005, p. 1923).

True: Homosexuals have higher rates of anxiety, mood and substance use disorders, and suicidal ideation and suicide attempts compared with heterosexual populations. The risk of completed suicide is up to 13-fold greater than that of heterosexuals. This may be related to victimization and abuse during adolescence and stigmatization and discrimination during adulthood (Johnstone et al 2004, p. 769; Sadock & Sadock 2005, p. 1960).

False: Premenstrual tension or premenstrual syndrome occurs cyclically during the luteal phase and resolves once menses start. Many, but not all, studies have found low progesterone, high oestrogen, or low progesterone to oestrogen ratio during the luteal phase (Sadock & Sadock 2005, p. 2317).

False: More than 50 different treatments have been proposed, including progesterone, oral contraceptives, diuretics and psychotropics, indicating that there is no single effective cure. Moreover, placebo response has been as high as 65%. There have been encouraging reports of the effectiveness of SSRIs and CBT, especially for mood symptoms (Gelder et al 2006, p. 404; Sadock & Sadock 2005, p. 2319).

True: Phenothiazines such as chlorpromazine and thioridazine impair erection and ejaculation in men and vaginal lubrication and orgasm in women due to their ability to block adrenergic and cholinergic receptors. Thioridazine may cause retrograde ejaculation in up to 50% of patients. Retrograde ejaculation is a startling but harmless condition in which the seminal fluid backs up into the bladder rather than being propelled through the penile urethra. Patients still have the orgasmic pleasure, but the orgasm is dry (Sadock & Sadock 2005, p. 1924).

True: SSRIs can cause erectile dysfunction. However, decreased libido, ejaculatory delay and anorgasmia are much more common than erectile dysfunction. Sexual side-effects including erectile dysfunction may be more common with paroxetine than with other SSRIs. Paroxetine may contribute to erectile dysfunction by inhibiting nitric oxide synthetase. Moreover, tricyclic antidepressants are more likely to cause erectile dysfunction than SSRIs. Overall, sexual side-effects most frequently occur with antihypertensives, antipsychotics, MAOIs and SSRIs (Cookson et al 2002, p. 253; Crenshaw & Goldberg 1996, p. 292; Gelder et al 2006, p. 477; King 2004, p. 588).

True: Imipramine causes sexual side-effects in more than 50% of patients. The commonest side-effects are decreased libido and delayed orgasm (Crenshaw & Goldberg 1996, p. 276).

False: Pseudocyesis refers to the condition when a person who is not pregnant is convinced that she is pregnant and develops symptoms and signs of pregnancy. The differential diagnoses include:

Pseudocyesis is usually associated with organic psychiatric disorders, schizophrenia and learning disability. Pseudocyesis has been associated with social deprivation, long-stay inpatients, being unmarried and widowhood.

True: Most of those who voluntarily abort suffer no adverse pychological effects, either in the short or the long term. The psychological consequences of termination are usually mild and transient, although they are greater for mothers who have cultural or religious beliefs against termination. Termination of a wanted pregnancy because of an abnormal karyotype or fetal abnormalities can be traumatic. The emotional consequences of miscarriage are comparable to those of perinatal death. They are likely to be less severe because there has been little time for attachment to the newly conceived, but such an event may still represent the loss of a greatly desired child. The incidence of depression is four times the rate in the general population (Gelder et al 2000, p. 1200; Gelder et al 2006, p. 401; Sadock & Sadock 2005, p. 1702).

True: About half of all mothers experience a brief period of lability of mood, irritability, crying, dysphoria and puzzlement at their condition. They frequently complain of feeling ‘confused’ and muddled. It occurs between the third and fifth days postpartum and usually lasts a few hours (Gelder et al 2000, p. 1202).

True: Patients often complain of being confused but tests of cognitive function are normal (Gelder et al 2006, p. 401).

True: The EPDS is a simple 10-item self-report scale. It can be completed in less than 5 minutes. The mother is asked to underline 1 of 4 possible responses that describes how she has been feeling over the previous 7 days. The EPDS reliably identifies women at high risk of developing depression. However, EPDS is not a diagnostic instrument and clinical judgement should always take precedence over any score obtained (Johnstone et al 2004, p. 751).

False: The 10 questions cover depressive symptoms including thoughts of self-harm. It does not ask about risk to the baby (Johnstone et al 2004, p. 751).

True: Postnatal depression adversely affects the mother–infant relationship and the cognitive and emotional development of the infant. Evidence of negative consequences later in childhood is less clear (Gelder et al 2006, p. 403; Johnstone et al 2004, p. 749).

False: Mother–infant relationship or bonding disorders such as lack of emotional response, rejection of the infant and pathological anger occur in a quarter of cases of postnatal depression (Gelder et al 2000, p. 1204).

True: The onset of puerperal psychosis is usually within the first 1–2 weeks or the first month after delivery, but rarely may occur in the first 2 days (Gelder et al 2006, p. 402; Johnstone et al 2004, p. 747).

True: The majority of puerperal psychoses are affective in nature, with rapid fluctuations in mood and often a mixture of manic and depressive symptoms. The first episode of bipolar disorder is seven times more likely to occur in the postpartum period. The greatest risk factors are a past history of puerperal psychosis and past or a family history of bipolar disorder. There is also a specific familial risk for puerperal psychosis in bipolar disorder (Johnstone et al 2004, p. 747).

True: Women with a previous history of puerperal psychosis or bipolar disorder have a 20–30% risk of puerperal psychosis in subsequent pregnancies. The risk rises to above 50% in those who have a family history of bipolar disorder (Gelder et al 2000, p. 1203; Johnstone et al 2004, p. 747).

True: Behaviour therapists view sexual dysfunction as a phobia of sexual interaction and use the traditional treatment for phobias, i.e. systematic desensitization (Sadock & Sadock 2005, p. 1931).

False: In masturbatory reconditioning the subject picks a more appropriate and acceptable image to arouse himself and uses this while masturbating in order to recondition himself to a more appropriate stimulus. In aversive therapy the subject picks a non-acceptable deviant image and allows himself to become aroused before receiving an electric shock (www.soc.ucsb.edu/sexinfo).

True: Sensate focus exercises are designed to allow the couple to develop an awareness of their arousal level by lessening the demand characteristics of the sexual experience and the associated anxiety. In a slow graduated fashion they take turns giving and receiving pleasure. Initially, the touching is restricted to non-genital/non-breast stimulation. They later progress to genital stimulation and intercourse (Gelder et al 2000, p. 892; Sadock & Sadock 2005, p. 1929).

False: There is no particular advantage of a co-therapy team over an individual therapist. A single female therapist may have advantages over a single male therapist. Similarly, there are no apparent advantages of daily over weekly or even monthly sessions.

True: The normal process of penile erection is as follows:

Sexual stimulation → nitric oxide activates enzyme guanylate cyclase → increased cyclic guanosine monophosphate (cGMP) → arteriole smooth muscle relaxation and vasodilatation in the corpus cavernosum → penile erection.

Sildenafil is a nitric oxide enhancer. It inhibits phosphodiesterase type 5 (PDE-5), the isoenzyme that degrades cavernosal cGMP. cGMP, the second messenger of nitric oxide, is the crucial mediator of penile erection. By inhibiting PDE-5, sildenafil protracts penile cGMP activity and prolongs erection. Sildenafil does not initiate erections, but solely augments erections that occur in response to a natural sexual stimulation (Gelder et al 2006, p. 481; Sadock & Sadock 2005, p. 1932).

True: Antidepressant drugs often cause decreased libido, impaired erection and delayed or absent ejaculation and orgasm. Erectile, ejaculatory and orgasmic side-effects respond to sildenafil, taladafil and vardenafil (Sadock & Sadock 2002, p. 980; Sadock & Sadock 2005, p. 1925).