••• Chapter 42^ Ethics, Psychosocial, and Psychiatric Pearls^429
❍ What is vaginismus?
Inability to engage in any form of vaginal penetration (intercourse, tampon use, gyn examinations) due to
involuntary muscle contractions in the vagina.
❍ True or False: Sexual trauma such as rape can cause vaginismus.
True.
❍ What are paraphilias? Are they ever considered normal?
Paraphilias are abnormal expressions of sexuality (exhibitionism, fetishism, pedophilia, etc), and are never
considered to be normal variants of sexual expression.
❍ What psychiatric medications are absolutely contraindicated during pregnancy?
Estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halicon).
❍ What treatment of bipolar disorder has yet to be linked to major fetal anomalies and is an option for
treatment during pregnancy?
Lamotrigine (Lamictal).
❍ What side effects have been observed in infants born to mothers using carbamazepine during pregnancy?
Transient cholestatic hepatitis and hyperbilirubinemia; however, these side effects are rare. Carbamazepine has been
declared as “probably safe” during pregnancy.
❍ What side effect is seen in infants born to mothers using benzodiazepines shortly before delivery?
Floppy infant syndrome.
Symptoms consist of hypothermia, lethargy, poor respiratory effort, and feeding difficulties.
Table 42.3 Teratogenic Effects of Certain Psychiatric MedicationsDrug effect on Fetus
Carbamazepine Spina bifida, craniofacial defects, fingernail hypoplasia
Benzodiazepines Cleft lip, cleft palate
Lithium Ebstein anomaly
Valproic acid Neural tube defects, craniofacial and cardiovascular abnormalities, IUGR, cognitive
impairment