Q. I need a psychiatric opinion for my friend who has been treated for catatonic schizophrenia.

Hello doctor,

I need a psychiatric opinion for my good friend who has been treated for catatonic schizophrenia.

• She is a 27 year old European woman.

• She had in total three episodes of catatonia that required hospitalization.

• But I suspect it may have been depression instead, since she volunteered hospitalization.

• She has been given Solian (amisulpride) from 2011 to 2013 and then in 2014.

• Then she had problems of too high prolactin and they changed it to Abilify (aripiprazole).

• She also gained a lot of fat (about 40kg in 5 years) and seems to keep getting slowly bigger, since she is often hungry, probably as a side effect of the medicines.

• She is not taking other medications and she is otherwise healthy.

• She declared that she is not afraid any more, after switching from Solian to Abilify, but she feels unhappy.

• She appears much less talkative and lively than she used to be years ago. She is less confident too.

• I suspect that she may have depression rather than schizophrenia and I noticed that she has significant anxiety, victim mentality (quite important) and some sleeping problems.

• She is insecure and she dropped out of several educations in the last couple of years.

• She has abusive parents and she went back living with them.

• She has recently received cognitive therapy but she felt insulted and not helped.

She and I wish to find a solution for her.

Thank you.

Hi doctor,

My friend was happy with your answer and is now waiting for a change of doctor. Thanks a lot for it. In the meanwhile, I have agreed that I will ask you another personal request for myself, a sexology question.

I am a young-looking man of 43. I have always had penis sensitivity problems, in particular using condoms, and I finally decided to ask you if there is a solution for it. I am not happy with my sex life because I find my sexual response to be less pleasurable than I wish, with the addition of erection problems, which do not seem to be correlated. I frequently use fractions of pills of Cialis (Tadalafil) to help my erections which are unpredictable and often tend to deflate quickly. That happened already as a teenager.

My girlfriend does not want to be on the pill, and I do not enjoy enough intercourse with condoms because I cannot feel much and the orgasm is never satisfactory. I appreciate the other forms of sex than intercourse, but still, it is quite frustrating.

One of my best friends told me that he has no problems with condoms at all, and he claims to feel more than 90% with a condom of what he feels without a condom. He suggested that I have a "sensitivity problem" and I wonder how he does it. I tried a variety of types of condoms and, contrary to my friend and many other people I heard of, I did not feel anything with most of them; only pressure but no pleasure. With the very best condoms, it felt pretty good at the beginning of intercourse (but not always); and then the more I get aroused, and the less I seem to feel. It can be that my penis grows a bit thicker during intercourse, and thus the condom feels a bit tighter, but it cannot be the only explanation. I may have an above average penis thickness but nothing huge. I am not circumcised, so the condom's tip moves or slips out a bit sometimes.

I tested some larger condoms, and it seems that they are not much larger anyway. Apart from the small ones, I do not think that is the problem. What confuses me, even more, is that the sensitivity of my penis seems to change quite a bit from time to time, without a clear pattern. Surprisingly to me, sometimes my penis seems more enjoyable in a flaccid state than with erection. With oral sex, my penis feels either too sensitive but not pleasurable (usually at the beginning), or too little sensitive. If I touch my penis gland, it feels painful rather than pleasurable. I do not know if it is normal. Lubricants seem to fix that to some extent, but still, I cannot figure out the reason.

I believe that I may lack endorphins and maybe dopamine, and I wonder what I could do about that. That is also because I used to notice pains in my body quickly, including feet pain from walking (I need to wear special insoles), etc. Are there pills to increase endorphins and pleasure?

I would appreciate finding a solution for this. Thank you.