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Korchia T, Achour V, Faugere M, Albeash A, Yon DK, Boyer L, Fond G. Sexual Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2023; 80:1110-1120. [PMID: 37703012 PMCID: PMC10500435 DOI: 10.1001/jamapsychiatry.2023.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/04/2023] [Indexed: 09/14/2023]
Abstract
Importance In individuals with schizophrenia, antipsychotic-induced dysfunctions are frequent but often underexplored in clinical practice. Objective To synthetize the data of observational studies exploring the prevalence of sexual dysfunction in individuals with schizophrenia-spectrum disorders as well as associated factors. Data Sources A systematic literature search without language or time restrictions was conducted in Google, Google Scholar, PubMed/MEDLINE, Science Direct, and Université Sorbonne Paris Cité for studies published up to June 8, 2022. Study Selection All observational studies reporting a prevalence of sexual dysfunction in schizophrenia-spectrum disorder were included. Data Extraction and Synthesis The MOOSE guidelines with independent extraction by 2 observers and random-effects models were used. Main Outcomes and Measures The prevalence of sexual dysfunction and each specific dysfunction. Results A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21 076 participants with schizophrenia. The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women. The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0). Factors associated with heterogeneity were study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics. Sexual dysfunctions were more frequent in schizophrenia vs schizoaffective disorders, and erectile disorders were less frequent in individuals with longer illness duration. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (β, -6.30; 95% CI, -10.82 to -1.78); P = .006 and -13.21; 95% CI, -17.59 to -8.83; P < .001, respectively) and ejaculation disorders (β, -6.10; 95% CI, -10.68 to -1.53; P = .009 and β, -11.57; 95% CI, -16.34 to -6.80; P < .001, respectively). No obvious improvements in the rates of sexual dysfunction at other times were found, and there were conflicting results regarding antipsychotic classes. Conclusions and Relevance This systematic review and meta-analysis found a high prevalence of sexual dysfunction among individuals with schizophrenia, with considerable heterogeneity in associated factors. The findings also suggest that some dysfunctions may be explained by schizophrenia. The association between lower rates of dysfunction and antidepressant use suggests that treating comorbid depression could be an effective strategy to improve sexual health. A lack of data on metabolic parameters and physical health in general was also noted, while these issues are frequent in the care of schizophrenia.
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Affiliation(s)
- Théo Korchia
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Vincent Achour
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Mélanie Faugere
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Ali Albeash
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Laurent Boyer
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Guillaume Fond
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
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Fares J, Mohamed F, Yosra Z, Oumaya H, Riadh B, Jihenne M. Influence of Antipsychotic Agents on the Sexuality of Patients Diagnosed with Schizophrenia. CURRENT THERAPEUTIC RESEARCH 2023; 99:100722. [PMID: 38021266 PMCID: PMC10654135 DOI: 10.1016/j.curtheres.2023.100722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 10/16/2023] [Indexed: 12/01/2023]
Abstract
Background Sexuality is a natural component of human behavior. The general population has been extensively studied since the first half of the 20th century. On the other hand, regarding patients treated for schizophrenia, discussing sexual disorders was initially considered inappropriate because it was believed they should not be sexually active. Given these findings, this work proposes to study the sexuality of patients with schizophrenia. Objectives Our objectives were to assess the sexuality of patients with schizophrenia, to identify factors associated with sexual dysfunction among these patients, and to determine practitioners' attitudes toward the sexuality of our study population. Methods This is a cross-sectional study carried out in the Psychiatry Department of Kairouan (outpatient department), including 46 patients diagnosed with schizophrenia. A pre-established information sheet was completed for each patient recruited, including sociodemographic and clinical data; on the other hand, 3 scales ensured a sexual psychometric evaluation: Psychotropic-Related Sexual Dysfunction Questionnaire, Arizona Sexual Experiences Scale, and Changes in Sexual Functioning Questionnaire-Male Clinical Version. Results Concerning the evaluation of sexuality according to the scales used, sexual dysfunction according to Psychotropic-Related Sexual Dysfunction Questionnaire scores was observed in 31 patients (67.4%). According to Arizona Sexual Experiences Scale scores, 24 patients (52%) had a sexual dysfunction, and for the total score of the Changes in Sexual Functioning Questionnaire-Male Clinical Version, 27 patients (58.7%) had a sexual dysfunction. We cannot confirm the existence of a relationship between the dose of the current treatment (in chlorpromazine equivalent) used and the results of the test assessing sexuality. In addition to these results, we can deduce the existence of a statistically significant association between the antipsychotic agent used and the results of the Psychotropic-Related Sexual Dysfunction Questionnaire only. Conclusions We recommend that screening for sexual dysfunction in patients followed for schizophrenia should be systematic, regardless of the antipsychotic molecule type and dosage. In this regard, we recommend the establishment of a better therapeutic relationship between caregivers and patients with schizophrenia, based on empathy and trust, so that the latter feel comfortable enough to address the sexual dimension in general and sexual dysfunction in particular.
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Affiliation(s)
- Jaballah Fares
- Department of Psychiatry, Avicenna, Razi Hospital-Mannouba, Tunis El Manar University, Tunis, Tunisia
| | - Ferhi Mohamed
- Department of Psychiatry, Ibn el Jazzar Hospital-Kairouan, Sousse University, Sousse, Tunisia
| | - Zgueb Yosra
- Department of Psychiatry, Avicenna, Razi Hospital-Mannouba, Tunis El Manar University, Tunis, Tunisia
| | - Hazem Oumaya
- Department of Psychiatry, Taher Maamouri Hospital, Nabeul, Tunisia
| | - Bouzid Riadh
- Department of Psychiatry, Taher Maamouri Hospital, Nabeul, Tunisia
| | - Mannaii Jihenne
- Department of Psychiatry, Ibn el Jazzar Hospital-Kairouan, Sousse University, Sousse, Tunisia
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Krishnegowda S, Udaykumar P, Yadiyal A. Association Between Sexual Dysfunction and Dose of Atypical Antipsychotics: Essential to Learn the Basics. J Clin Pharmacol 2023; 63:40-47. [PMID: 35939487 DOI: 10.1002/jcph.2131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
There is paucity of data on sexual dysfunction associated with atypical antipsychotics in Indian population. We estimated the prevalence of sexual dysfunction and assessed dose dependency, if any, in patients on monotherapy of atypical antipsychotics. This cross-sectional study analyzed the data from patients with F20 to F29 (International Classification of Diseases 10th Revision, ICD-10) receiving monotherapy of risperidone (group 1), olanzapine (group 2), or quetiapine (group 3) for at least 4 weeks. The sexual function of participants was assessed using Arizona sexual experiences (ASEX) scale. Chlorpromazine (CPZ) equivalent dose and doses in terms of dose years were calculated. Kruskal-Wallis test, Mann-Whitney U-test, and Pearson correlation were used for analysis. Of the 154 subjects, 65.58% were males, with 44%, 48%, and 8% receiving risperidone, olanzapine, and quetiapine, respectively. The mean duration of treatment was 20.9 weeks. Lower ASEX scores were reported with quetiapine. The differences in mean ASEX scores between groups 1 and 2 were statistically significant for sex drive (P = .016), sexual arousal (P = .025), and overall score (P = .037). Sexual dysfunction was more frequent with risperidone (48.5%) than with olanzapine (28.4%) and quetiapine (0%). In group 1, the duration of therapy positively correlated with the mean scores of sexual desire (P = .003) and arousal (P = .033), but this was not the case for group 2 (receiving olanzapine). The mean CPZ equivalent doses were comparable between the groups (P = .064); those receiving <200 mg CPZ dose equivalents showed greater sexual impairment. We conclude that the occurrence of atypical antipsychotic-induced sexual dysfunction is not dose dependent. Olanzapine has a better safety profile in terms of sexual dysfunction, whereas the data reflecting the experience with quetiapine are insufficient.
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Affiliation(s)
| | - Padmaja Udaykumar
- Department of Pharmacology, Father Muller Medical College, Kankanady, Mangalore, India
| | - Aruna Yadiyal
- Department of Pharmacology, Father Muller Medical College, Kankanady, Mangalore, India
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Shan J, Tian H, Zhou C, Wang H, Ma X, Li R, Yu H, Chen G, Zhu J, Cai Z, Lin C, Cheng L, Xu Y, Liu S, Zhang C, Luo Q, Zhang Y, Jin S, Liu C, Zhang Q, Lv L, Yang L, Chen J, Li Q, Liu W, Yue W, Song X, Zhuo C. Prevalence of Heavy Menstrual Bleeding and Its Associated Cognitive Risks and Predictive Factors in Women With Severe Mental Disorders. Front Pharmacol 2022; 13:904908. [PMID: 35910343 PMCID: PMC9326357 DOI: 10.3389/fphar.2022.904908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
There has been limited studies examining treatment-induced heavy menstrual bleeding (HMB) in women with severe mental illnesses. The aim of this study was to examine HMB prevalence and HMB-associated factors in young women (18–34 years old) diagnosed with bipolar disorder (BP), major depressive disorder (MDD), or schizophrenia (SCZ) who have full insight and normal intelligence. Eighteen-month menstruation histories were recorded with pictorial blood loss assessment chart assessments of HMB. Multivariate analyses were conducted to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Drug effects on cognition were assessed with the MATRICS Consensus Cognitive Battery (MCCB). HMB prevalence were: BP, 25.85%; MDD, 18.78%; and SCH, 13.7%. High glycosylated hemoglobin (HbA1c) level was a strong risk factor for HMB [BP OR, 19.39 (16.60–23.01); MDD OR, 2.69 (4.59–13.78); and SCZ OR, 9.59 (6.14–12.43)]. Additional risk factors included fasting blood sugar, 2-h postprandial blood glucose, and use of the medication valproate [BP: OR, 16.00 (95%CI 12.74–20.22); MDD: OR, 13.88 (95%CI 11.24–17.03); and SCZ OR, 11.35 (95%CI 8.84–19.20)]. Antipsychotic, antidepressant, and electroconvulsive therapy use were minor risk factors. Pharmacotherapy-induced visual learning impairment was associated with HMB [BP: OR, 9.01 (95%CI 3.15–13.44); MDD: OR, 5.99 (95%CI 3.11–9.00); and SCZ: OR, 7.09 (95%CI 2.99–9.20)]. Lithium emerged as a protective factor against HMB [BP: OR, 0.22 (95%CI 0.14–0.40); MDD: OR, 0.30 (95%CI 0.20–0.62); and SCZ: OR, 0.65 (95%CI 0.33–0.90)]. In SCZ patients, hyperlipidemia and high total cholesterol were HMB-associated factors (ORs, 1.87–2.22). Psychiatrist awareness of HMB risk is concerningly low (12/257, 2.28%). In conclusion, prescription of VPA should be cautioned for women with mental illness, especially BP, and lithium may be protective against HMB.
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Affiliation(s)
- Jianmin Shan
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Hongjun Tian
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Haibo Wang
- Peking University Clinical Research Institute, Peking University First Hospital, Beijing, China
| | - Xiaoyan Ma
- MECT Center, Sleep Disorder Center, Tianjin Anding Hospital, Tianjin, China
| | - Ranli Li
- MECT Center, Sleep Disorder Center, Tianjin Anding Hospital, Tianjin, China
| | - Haiping Yu
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Guangdong Chen
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Jingjing Zhu
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Ziyao Cai
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Chongguang Lin
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Langlang Cheng
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
| | - Yong Xu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Sha Liu
- Department of Psychiatry, First Hospital/First Clinical Medical College of Shanxi Medical University, Taiyuan, China
| | - Congpei Zhang
- Inpatient Department of Harbin First Psychiatry Hospital, Harbin, China
| | - Qinghua Luo
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yunshu Zhang
- Inpatient Department of Hebei Mental Health Center, Baoding, China
| | - Shili Jin
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Chuanxin Liu
- Institute of Psychiatry, Jining Medical University, Jinning, China
| | - Qiuyu Zhang
- Institute of Psychiatry, Jining Medical University, Jinning, China
| | - Luxian Lv
- Department of Psychiatry, Henan Psychiatry Hospital, Xinxiang, China
| | - Lei Yang
- Key Laboratory of Mental Health, Ministry of Health (Peking University) and National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Jiayue Chen
- Department of Psychiatry, The First Hospital Affiliated to Harbin Medical University, Harbin, China
| | - Qianchen Li
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Liu
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Weihua Yue
- Department of Psychiatry, The First Hospital Affiliated to Harbin Medical University, Harbin, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
| | - Chuanjun Zhuo
- Department of Psychiatry, Tianjin Fourth Center Hospital, Tianjin, China
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Laboratory of Psychiatric-Neuroimaging-Genetic and Cor-morbidity, Tianjin Mental Health Center of Tianjin Medical University, Tianjin Anding Hospital, Tianjin, China
- *Correspondence: Wei Liu, ; Weihua Yue, ; Xueqin Song, ; Chuanjun Zhuo,
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Martínez-Giner G, Giménez-De Llano E, Romero-Rubio D, Abad-Pérez MJ, Sánchez-Martínez V. Sexual dysfunction in people treated with long-acting injectable antipsychotics in monotherapy or polypharmacy: a naturalistic study. Int J Ment Health Nurs 2022; 31:576-590. [PMID: 34973049 DOI: 10.1111/inm.12973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 11/22/2021] [Accepted: 12/12/2021] [Indexed: 01/28/2023]
Abstract
Sexual dysfunction, psychosis, and antipsychotics are known to be related, but the precise association between them is still unknown. Most evidence about the prevalence of sexual dysfunction in people treated with antipsychotic drugs comes from studies with restrictive samples. That is why our main objective was to determine the prevalence of sexual dysfunction in a real-life sample of outpatients treated with antipsychotics, considering gender. A cross-sectional naturalistic study was developed, including people treated with long-acting injectable antipsychotics, with or without other psychotropic drugs. Participants were interviewed to assess sexual satisfaction through a Likert scale (0 to 10) and the presence of sexual dysfunction (the Psychotropic-Related Sexual Dysfunction Questionnaire, PRSexDQ-SALSEX). The participants also had a blood test to determine prolactin (men and women) and testosterone levels (men only). A total of 131 people participated in the study (90 men and 41 women). Some extent of sexual dysfunction was found in 62.2% of men and 51.2% of women. The most frequent sexual dysfunction symptom for both genders was the loss of libido (45%). Hyperprolactinemia was present in 56% of men and 61% of women. The presence of sexual dysfunction was associated with higher doses of antipsychotics, hyperprolactinemia, and smoking in men and with smoking and hyperprolactinemia in postmenopausal women. This study provides real-life evidence of sexual dysfunction and hyperprolactinemia in persons treated with long-acting injectable antipsychotics segregated by gender. The high rates of sexual dysfunction and hyperprolactinemia detected corroborate the need to consider these aspects in clinical practice.
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Karslioğlu EH, Kolcu Z, Karslioğlu Nİ, Çayköylü A. Prospective analysis of serum prolactin levels, clinical symptomatology and sexual functions in patients with schizophrenia switched to paliperidone palmitate 3-monthly from paliperidone palmitate 1-monthly: Preliminary findings of the first 3 months. Hum Psychopharmacol 2022; 37:e2827. [PMID: 34787912 DOI: 10.1002/hup.2827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 09/20/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Long-acting injectable (LAI) antipsychotics were developed to improve adherence to schizophrenia treatment. Paliperidone palmitate (PP) has two LAI forms: Monthly (PP1M) and three-monthly (PP3M). PP3M shows less difference in Peak-to-Trough drug concentration levels. This could be related to a lower incidence of hyperprolactinemia, which may negatively affect adherence. We aimed to compare prolactin levels and investigate relationships between prolactin levels, symptomatology and sexual function in patients with schizophrenia after switching from PP1M to PP3M. METHODS Twenty-five patients were enrolled. The sociodemographic data form, the Positive and Negative Syndromes Scale (PANSS) and the Arizona Sexual Experience Scale (ASEX) were used. Morning blood samples were drawn to determine prolactin levels. RESULTS Prolactin level (p < 0.001), the total score and arousal sub-score of ASEX (respectively; p = 0.015, p = 0.020) and the total score and positive scale of PANSS (respectively; p = 0.017, p = 0.021) were decreased on the 90th day (±15 days). CONCLUSIONS After switching to PP3M, the decreases in prolactin levels and potentially related sexual side effects was statistically significant. There may be a difference between two formulations of the same drug in terms of side effects, and there is a need for prospective follow-up studies with larger samples.
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Affiliation(s)
| | - Zeynep Kolcu
- Department of Psychiatry, Ankara Oncology Research and Training Hospital, Ankara, Turkey
| | | | - Ali Çayköylü
- Department of Psychiatry, Ankara Oncology Research and Training Hospital, Yıldırım Beyazıt University, Ankara, Turkey
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Zhuo C, Chen G, Lin C, Ping J, Zhu J, Wang L, Jin S, Liu C, Zhang Q, Yang L, Li Q, Zhou C, Cheng L, Tian H, Song X. Risk-to-befit ratios of consecutive antidepressants for heavy menstrual bleeding in young women with bipolar disorder or major depressive disorder. Front Psychiatry 2022; 13:1012644. [PMID: 36386987 PMCID: PMC9650378 DOI: 10.3389/fpsyt.2022.1012644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 11/24/2022] Open
Abstract
The occurrence of heavy menstrual bleeding (HMB) induced by pharmacological agents has been reported in young adult women. This study aimed to investigate a possible association between the occurrence rates of HMB and different treatment methods such as antidepressant agents alone and in combination with other pharmacological agents. The examined cohort included young women (age 18-35 years, n = 1,949) with bipolar disorder (BP) or major depressive disorder (MDD). Menstruation history for 24 months was recorded and evaluated according to pictorial blood loss assessment charts of HMB. Multivariate analyses were conducted to determine odds ratios (ORs) and 95% confidence intervals. The examined antidepressant agents had varying ORs for patients with BP vs. those with MDD. For example, the ORs of venlafaxine-induced HMB were 5.27 and 4.58 for patients with BP and MDD, respectively; duloxetine-induced HMB, 4.72 and 3.98; mirtazapine-induced HMB, 3.26 and 2.39; fluvoxamine-induced HMB, 3.11 and 2.08; fluoxetine-induced HMB, 2.45 and 1.13; citalopram-induced HMB, 2.03 and 1.25; escitalopram-induced HMB, 1.85 and 1.99; agomelatine-induced HMB, 1.45 and 2.97; paroxetine-induced HMB, 1.19 and 1.75; sertraline-induced HMB, 0.88 and 1.13; reboxetine-induced HMB, 0.45 and 0.45; and bupropion-induced HMB, 0.33 and 0.37, in each case. However, when antidepressant agents were combined with valproate, the OR of HMB greatly increased, with distinct profiles observed for patients with BP vs. those with MDD. For example, the ORs of HMB induced by venlafaxine combined with valproate were 8.48 and 6.70 for patients with BP and MDD, respectively; for duloxetine, 5.40 and 4.40; mirtazapine, 5.67 and 3.73; fluvoxamine, 5.27 and 3.37; fluoxetine, 3.69 and 4.30; citalopram, 5.88 and 3.46; escitalopram, 6.00 and 7.55; agomelatine, 4.26 and 5.65; paroxetine, 5.24 and 3.25; sertraline, 4.97 and 5.11; reboxetine, 3.54 and 2.19; and bupropion, 4.85 and 3.46, in each case. In conclusion, some antidepressant agents exhibited potential risks of inducing HMB. Therefore, a combined prescription of antidepressant agents and valproate should be carefully considered for young women with HMB.
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Affiliation(s)
- Chuanjun Zhuo
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China.,Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China.,Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Laboratory of Psychiatric-Neuroimaging-Genetic and Comorbidity, Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Guangdong Chen
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Chongguang Lin
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jing Ping
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Jingjing Zhu
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Lina Wang
- Laboratory of Psychiatric-Neuroimaging-Genetic and Comorbidity, Tianjin Anding Hospital, Tianjin Mental Health Center of Tianjin Medical University, Tianjin, China
| | - Shili Jin
- Inpatient Department, Shandong Daizhuang Hospital, Jining, China
| | - Chuanxin Liu
- College of Mental Disorder, Jining Medical University, Jining, China
| | - Qiuyu Zhang
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Lei Yang
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Qianchen Li
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Chunhua Zhou
- Department of Pharmacology, The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Langlang Cheng
- Department of Psychiatry, Wenzhou Seventh Peoples Hospital, Wenzhou, China
| | - Hongjun Tian
- Key Laboratory of Multiple Organs Damage in Patients With Metal Disorder, Tianjin Fourth Center Hospital, Nankai University Affiliated Tianjin Fourth Center Hospital, Tianjin, China
| | - Xueqin Song
- Department of Psychiatry, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Yoshida K, Takeuchi H. Dose-dependent effects of antipsychotics on efficacy and adverse effects in schizophrenia. Behav Brain Res 2021; 402:113098. [PMID: 33417992 DOI: 10.1016/j.bbr.2020.113098] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/02/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Antipsychotics are a cornerstone of pharmacological treatment of schizophrenia. Improved understanding of the dose-response relationship of antipsychotics in terms of efficacy, adverse effects, and mortality can help to optimize the pharmacological treatment of schizophrenia. METHODS This narrative literature review summarizes current evidence on the relationship of antipsychotic dose with efficacy, adverse effects, and mortality in patients with schizophrenia. RESULTS The efficacy of antipsychotics generally appeared to be highly dose-dependent in the acute phase of schizophrenia, with each antipsychotic having a specific dose-response curve. The presence or absence of dose-dependency and its extent varied according to the type of adverse effect. Parkinsonism, hyperprolactinemia, weight gain, and neurocognitive impairment appeared to be dose-related. The following adverse effects might be at least somewhat dose-dependent: akathisia, tardive dyskinesia, osteoporosis, sexual dysfunction, diabetes mellitus, myocardial infarction, stroke, thromboembolism, QT interval prolongation, anticholinergic adverse effects, somnolence, pneumonia, hip fracture, and neuroleptic malignant syndrome. In contrast, the relationships of antipsychotic dose with dyslipidemia, hypotension, seizure, sialorrhea, and neutropenia and agranulocytosis remained unclear due to mixed findings and/or limited data. Although a higher lifetime cumulative antipsychotic dose might contribute to higher mortality, it is still difficult to conclude whether mortality increases in a dose-dependent manner. CONCLUSION These findings could help clinicians to optimize antipsychotic treatment in patients with schizophrenia by balancing risks and benefits in clinical practice. However, further investigations with larger sample sizes and more robust study designs that focus on each antipsychotic agent are needed.
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Affiliation(s)
- Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, ON, Canada; Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Hiroyoshi Takeuchi
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan; Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, ON, Canada.
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9
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Liu D, Liu S, Xiu M, Deng H, Guo H, Liu W, Zhang D, Mao Z, Huang D, Huang D, Miao Q, Qiu L, Zhao NO, Wu HE, Zhang X. Sexual Dysfunction in Chronically Medicated Male Inpatients With Schizophrenia: Prevalence, Risk Factors, Clinical Manifestations, and Response to Sexual Arousal. Front Psychiatry 2021; 12:761598. [PMID: 35095591 PMCID: PMC8795612 DOI: 10.3389/fpsyt.2021.761598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sexual dysfunction is a common symptom in patients with schizophrenia, especially in chronically medicated patients. However, the relationship between sexual dysfunction and emotional response to sexual arousal in male patients with schizophrenia remains unclear. This study aimed to assess the incidence, risk factors of sexual dysfunction in males, and their clinical correlations to sexual arousal in male patients with schizophrenia in China. METHODS A total of 162 male patients, aged 18-50 years, with schizophrenia were recruited from a psychiatric hospital in Ganzhou. The clinical symptoms were assessed by the Positive and Negative Syndrome Scale (PANSS). The Arizona Sexual Experience Scale was utilized to evaluate sexual dysfunction. Erotic images were selected from International Affective Picture System (IAPS). Sixty-eight out of the 162 subjects completed the erotic pictures reactivity task. RESULTS Overall, 48 (29.6%) patients were measured as having global sexual dysfunction, 72 (44.4%) patients as having strength of sex drive dysfunction, 51 (31.5%) patients as having sexual arousal dysfunction, 55 (34.0%) patients as having penile erection dysfunction, 60 (37.0%) patients as having reached orgasm dysfunction, and 60 (37.0%) patients as having satisfaction with orgasm dysfunction. The sexual dysfunction patients had significantly higher scores on the negative symptoms of the PANSS. The only important predictor of sexual dysfunction was the severity of PANSS negative factor. The sense of pleasure and arousal post viewing erotic images in the sexual dysfunction group were lower compared to the non-sexual dysfunction group. The sense of pleasure and approach motivation were significantly negatively correlated with the severity of sexual dysfunction. CONCLUSIONS This study shows that nearly one-third of young and middle-aged chronically medicated male inpatients with schizophrenia suffer from sexual dysfunction. The negative factor of the PANSS can be regarded as the risk factor of sexual dysfunction. Schizophrenia patients with sexual dysfunction experienced lower pleasure and higher avoidance motivation than non-sexual dysfunction patients when exposed to erotic stimuli.
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Affiliation(s)
- Dianying Liu
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Shaohua Liu
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Meihong Xiu
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, China
| | - Hongdong Deng
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Huiyun Guo
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Wanglin Liu
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Delong Zhang
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Zhongzhen Mao
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Dan Huang
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Donghua Huang
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Qiumei Miao
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Lijuan Qiu
- Ganzhou City Key Laboratory of Mental Health, The Third People's Hospital of Ganzhou City, Ganzhou, China
| | - Ning Olivia Zhao
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Hanjing Emily Wu
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Xiangyang Zhang
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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10
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Dumontaud M, Korchia T, Khouani J, Lancon C, Auquier P, Boyer L, Fond G. Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review. Prog Neuropsychopharmacol Biol Psychiatry 2020; 98:109804. [PMID: 31711954 DOI: 10.1016/j.pnpbp.2019.109804] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/10/2019] [Accepted: 11/05/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual dysfunctions (SD) in schizophrenia are frequent with strong impact on adherence and quality of life. Current recommendations stipulate to switch to prolactin-sparing antipsychotic in case of SD. OBJECTIVES To synthetize in a systematic review data on the SD prevalence and the associated risk factors in schizophrenia (SZ). METHODS Medline, Google Scholar, PsychInfo, and Cochrane were explored, without any year or language restriction. RESULTS Overall, 89 studies and 25,490 participants were included in the present review. SZ subjects aged 18-70 reported high SD frequency [30%-82%] (men [33%- 85%]; women [25%- 85%]). For SZ men erectile dysfunction [31%-95%] was the most frequent SD vs. loss of libido for women [31%-100%]. The following risk factors were associated with increased SD: 1. Illness severity (including psychotic symptomatology, early age at SZ onset, negative symptomatology, and continuous illness course), 2. Depressive symptomatology 3. Antipsychotics (especially first generation antipsychotics, risperidone and antipsychotic polytherapy). Switching to prolactin-sparing antipsychotics has shown effectiveness in some studies (especially aripiprazole). Antidepressants were not found to be associated with SD in SZ subjects. CONCLUSION The prevalence of SD is high in SZ subjects. In addition to the current guidelines, the present review suggests that treating depressive symptoms may be a major intervention to improve SD in SZ subjects. Sociodemographic variables, physical illnesses, metabolic syndrome and peripheral inflammation have been poorly or never explored and should be included in future studies.
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Affiliation(s)
- Marion Dumontaud
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Théo Korchia
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Jérémy Khouani
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Christophe Lancon
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Sainte-Marguerite Hospital, Marseille, France
| | - Pascal Auquier
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Laurent Boyer
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France
| | - Guillaume Fond
- Aix-Marseille Univ, CEReSS-Health Service Research and Quality of Life Center, School of Medicine-La Timone Medical, Marseille, France; Aix-Marseille Univ, APHM, Department of Medical Information and Public Health, Marseille, France.
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11
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Misiak B, Frydecka D, Loska O, Moustafa AA, Samochowiec J, Kasznia J, Stańczykiewicz B. Testosterone, DHEA and DHEA-S in patients with schizophrenia: A systematic review and meta-analysis. Psychoneuroendocrinology 2018; 89:92-102. [PMID: 29334627 DOI: 10.1016/j.psyneuen.2018.01.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 01/04/2018] [Accepted: 01/08/2018] [Indexed: 12/19/2022]
Abstract
Neuroactive steroids, including testosterone, dehydroepiandrosterone (DHEA) and its sulfate (DHEA-S) might play an important role in the pathophysiology of schizophrenia. Therefore, we performed a systematic review and meta-analysis of studies comparing the levels of testosterone, DHEA and DHEA-S in patients with schizophrenia and healthy controls. We searched electronic databases from their inception until Oct 29, 2017. Effect size (ES) estimates were calculated as Hedges' g. Data analysis was performed using random-effects models. Our analysis included 34 eligible studies, representing 1742 patients and 1604 controls. Main analysis revealed elevated DHEA-S levels in the whole group of patients (ES = 0.75, 95%CI: 0.23-1.28, p = 0.005). In subgroup analyses, patients with first-episode psychosis (FEP) had significantly higher levels of free testosterone (ES = 1.21, 95%CI: 0.30-2.12, p = 0.009) and DHEA-S (ES = 1.19, 95%CI: 0.66-1.71, p < 0.001). Acutely relapsed schizophrenia patients presented significantly higher levels of total testosterone (ES = 0.50, 95%CI: 0.21-0.70, p < 0.001). Total testosterone levels were also elevated in stable multi-episode schizophrenia (sMES) females (ES = 0.56, 95%CI: 0.33-0.80, p < 0.001) and reduced in sMES males (ES = -0.62, 95%CI: -1.07 to 0.18, p = 0.006). Increased levels of biologically active, free testosterone and DHEA-S in FEP suggest that these alterations might appear as a response to stress that becomes blunted during subsequent exacerbations of schizophrenia. Differential changes in total testosterone levels in male and female sMES patients might represent medication effects related to prolactin-releasing effects of antipsychotics.
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Affiliation(s)
- Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Olga Loska
- Department of Forensic Medicine, Wroclaw Medical University, Mikulicza-Radeckiego 4 Street, 50-345 Wroclaw, Poland; Department of Laboratory Diagnostics, 4th Military Hospital, Weigla 5 Street, 50-981 Wroclaw, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Justyna Kasznia
- Inpatient Psychiatric Unit, Municipal General Hospital, Limanowskiego 20/22 Street, 63-400 Ostrów Wielkopolski, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
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12
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Hatano M, Kamei H, Kato A, Takeuchi I, Hanya M, Uno J, Yamada S, Fujita K, Iwata N. Assessment of the Latent Adverse Events of Antipsychotic Treatment Using a Subjective Questionnaire in Japanese Patients with Schizophrenia. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2017; 15:132-137. [PMID: 28449560 PMCID: PMC5426495 DOI: 10.9758/cpn.2017.15.2.132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/26/2016] [Accepted: 09/10/2016] [Indexed: 11/23/2022]
Abstract
Objective The adverse effects of antipsychotic agents can have a marked influence on medication adherence. In this study, we investigated the adverse events of antipsychotics that are less likely to be reported by patients and the reasons why such symptoms remain latent. Methods Data were collected by interviewing patients using a subjective questionnaire, and the associations between unreported symptoms and background factors were investigated. Results A total of 306 patients with schizophrenia or schizoaffective disorder were examined. Their major symptoms were daytime sleepiness (50.0%), weight gain (42.2%), and sexual dysfunction (38.9%). Sexual dysfunction was nominal significantly more common among the patients that had been treated with antipsychotic agent polypharmacy (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.07 to 4.30), and was nominal significantly more common among outpatients (OR, 1.78; 95% CI, 1.02 to 3.13). Only approximately 30% of the patients had reported their symptoms to their physicians. Conclusion Patients receiving antipsychotic treatment tolerate some symptoms and do not feel able to report them to their physicians. The most common reason for this is an insufficient patient-physician relationship. Sexual dysfunction is especially hard to identify because it is a delicate problem, and our findings demonstrate that subjective questionnaires are helpful for detecting such symptoms.
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Affiliation(s)
- Masakazu Hatano
- Department of Psychiatry, Fujita Health University School of Medicine, Nagoya, Japan.,Department of Clinical Pharmacy, Fujita Health University School of Medicine, Nagoya, Japan.,Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Hiroyuki Kamei
- Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Azusa Kato
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Nagoya, Japan
| | - Ippei Takeuchi
- Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan.,Department of Psychiatry, Okehazama Hospital, Toyoake, Japan
| | - Manako Hanya
- Office of Clinical Pharmacy Practice and Health Care Management, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Junji Uno
- Department of Psychiatry, Okehazama Hospital, Toyoake, Japan
| | - Shigeki Yamada
- Department of Clinical Pharmacy, Fujita Health University School of Medicine, Nagoya, Japan
| | - Kiyoshi Fujita
- Department of Psychiatry, Okehazama Hospital, Toyoake, Japan
| | - Nakao Iwata
- Department of Psychiatry, Fujita Health University School of Medicine, Nagoya, Japan
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13
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Yunilaynen OA, Starostina EG, Dzeranova LK, Kudryashkina GN, Kesselman LG, Baranov PA, Dedov II. [Hyperprolactinemia associated with neuroleptic treatment: clinical characteristics and an impact on sexual function]. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 116:17-25. [PMID: 28091497 DOI: 10.17116/jnevro201611611117-25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM To study clinical characteristics of antipsychotic-induced hyperprolactinemia (AIH) and an impact of AIH on sexual function in patients with mental disorders treated with neuroleptics for a long time. MATERIAL AND METHODS A cross-sectional study of 244 consecutive psychiatric in-patients (F/M=140/104) with mental disorders currently taking antipsychotics was carried out. The patients were screened for serum prolactin, sex hormones and gonadotropin levels. The UKU Side effects rating scale (UKU) was used to assess side-effects. For assessment of sexual dysfunction, the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ) was administered. RESULTS AND CONCLUSION Asymptomatic AIH was found in 16% of females and in 37% of males. AIH caused menstrual disorders (oligomenorrhea and amenorrhea), galactorrhea in females. AIH was associated with libido decrease and life quality impairment due to sexual dysfunctions in patients of both genders. AIH was associated with orgasm delay and vaginal dryness during sexual intercourse in females. In men, AIH was associated with erectile dysfunction. In contrast to pituitary tumor and idiopathic hyperprolactinemia, there was no association between AIH and weight gain and/or obesity, and hypogonadism in patients of both genders.
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Affiliation(s)
| | - E G Starostina
- Vladimirsky Moscow Regional Research Clinical Institute, Moscow, Russia; Moscow Institute of Psychiatry - Branch of Serbsky Federal Medical Research Center for Psychiatry and Narcology, Moscow, Russia
| | | | | | | | - P A Baranov
- Russian Medical Academy of Postgraduate Education, Moscow, Russia
| | - I I Dedov
- Mental Health Research Center, Moscow, Russia
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14
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Hou CL, Zang Y, Rosen RC, Cai MY, Li Y, Jia FJ, Lin YQ, Ungvari GS, Ng CH, Chiu HFK, Xiang YT. Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care. Compr Psychiatry 2016; 65:116-21. [PMID: 26773999 DOI: 10.1016/j.comppsych.2015.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 11/10/2015] [Accepted: 11/11/2015] [Indexed: 01/23/2023] Open
Abstract
PURPOSE Sexual dysfunction in schizophrenia patients is common. In China, maintenance treatment for clinically stable patients with schizophrenia is usually provided by primary care physicians. Illness- or treatment-related sexual dysfunction in this patient population has been never studied. This study describes the prevalence and correlates of sexual dysfunction and its impact on quality of life (QOL) in patients with schizophrenia treated in primary care in China. METHOD A total of 607 patients with schizophrenia treated in 22 randomly selected primary care services in China formed the study sample. Patients' socio-demographic and clinical characteristics including sexual function and QOL were recorded using a standardized protocol and data collection. RESULTS Sexual dysfunction was present in 69.9% of all patients; 60.7% in males and 80.6% in females. Multiple logistic regression analysis revealed that female gender, being single, older age and use of first-generation antipsychotics were independently and significantly associated with more sexual dysfunction accounting for 23.5% of its variance (P<0.001). Unexpectedly, sexual dysfunction was not associated with lower QOL. CONCLUSIONS High rate of sexual dysfunction was reported in the majority of patients with schizophrenia treated in primary care in China. Given its negative impact on social adjustment, QOL and treatment adherence, efforts should be made to address sexual dysfunction in this patient population.
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Affiliation(s)
- Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - R C Rosen
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - Yan Li
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of WA, Perth, Australia
| | - Chee H Ng
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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15
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Ågmo A. Animal models of female sexual dysfunction: Basic considerations on drugs, arousal, motivation and behavior. Pharmacol Biochem Behav 2014; 121:3-15. [DOI: 10.1016/j.pbb.2013.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 10/04/2013] [Indexed: 12/19/2022]
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16
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De Hert M, Detraux J, Peuskens J. Second-generation and newly approved antipsychotics, serum prolactin levels and sexual dysfunctions: a critical literature review. Expert Opin Drug Saf 2014; 13:605-24. [PMID: 24697217 DOI: 10.1517/14740338.2014.906579] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Using antipsychotic (AP) medication can increase prolactin (PRL) levels and place the patient at risk of sexual dysfunction (SD). AREAS COVERED The aim of this review is to describe the PRL propensity of the different second-generation and newly approved APs. It then considers the prevalence rates of SDs associated with these compounds in patients with schizophrenia and treatment strategies for the management of SDs and/or hyperprolactinemia (HPRL). Furthermore, we address the lingering question regarding the association between SDs and PRL. EXPERT OPINION SD (particularly long-term) data remain scarce for several APs. A wide variety of assessment techniques used in SD research make reliable comparisons between APs impossible. The majority of these reports do not equally allow us to distinguish between treatment (AP and co-medication)-emergent SDs and illness-related SDs. This makes it difficult to assess the degree to which these side effects are associated with 'PRL-raising' APs, and what part of this fraction is directly reducible to serum PRL levels. Also, few evidence-based treatment strategies for HPRL and associated side effects are available. Therefore, longer-term randomized controlled trials, using reliable and valid structured interviews or questionnaires, are necessary to establish the precise relationship between APs, PRL levels and SDs rates and develop valuable treatment options.
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Affiliation(s)
- Marc De Hert
- UPC KU Leuven, Department of Neurosciences KU Leuven , Kortenberg , Belgium
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17
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Cookson J, Hodgson R, Wildgust HJ. Prolactin, hyperprolactinaemia and antipsychotic treatment: a review and lessons for treatment of early psychosis. J Psychopharmacol 2012; 26:42-51. [PMID: 22472310 DOI: 10.1177/0269881112442016] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Hyperprolactinaemia is a common side effect of antipsychotics; markedly raised levels are less common. Higher levels of prolactin result from longer exposure to higher doses, especially with older antipsychotics or with risperidone, sulpiride or amisulpride. Galactorrhoea, gynaecomastia, menstrual abnormalities and sexual dysfunction including hypogonadism and fertility problems are consequences of raised prolactin, and in the longer-term bone demineralisation. Younger patients may be more susceptible to hyperprolactinaemia. Trial reports often fail to state the frequency of raised levels.
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