Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study

Prevalence and correlates of sexual dysfunction among patients with schizophrenia spectrum disorder on antipsyhotic medications in Maiduguri, Northeastern Nigeria

OBJECTIVES

Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale.

METHODOLOGY

This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction.

RESULTS

The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030).

CONCLUSION

Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.

Sexual Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis

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.

Frequency of sexual dysfunction in outpatients with severe mental illness in Greece

Introduction

Patients with psychosis can develop sexual dysfunction, which may be related to the disease itself, psychosocial factors, somatic comorbidities, and the use of psychotropic medication.

Objective

We aimed to investigate the type and frequency of sexual dysfunction in patients diagnosed with schizophrenia or bipolar disorder in order to assess the side effects of antipsychotics in sexual function.

Methods

This is a multicenter, cross-sectional study, involving patients diagnosed with schizophrenia (79.3%) or bipolar disorder (20.7%) treated in the Department of Psychiatry and Community Mental Health Centers from November 2018 to December 2019. Patients were enrolled in the study after signed informed consent. Demographic and clinical data were collected from patients through a semi-structured interview. The Antipsychotics and Sexual Functioning Questionnaire (ASFQ) was administered to assess sexual function.

Results

A total of 87 outpatients on antipsychotics were recruited in the study. The mean age was 43.6 years, while the mean duration of the disease was 16.9 years. Overall, only 9.1% of patients spontaneously reported sexual dysfunction. Patients treated with oral first-generation antipsychotics had more difficulties in achieving orgasm and decreased erection capacity. In contrast, patients treated with oral second-generation antipsychotics had decreased ejaculation capacity. Patients on antipsychotic combination therapy were associated with higher rates of sexual anhedonia.

Discussion

These results suggest that sexual dysfunction is a side effect of antipsychotic treatment, which was spontaneously rarely reported by patients. It seems essential to obtain a psychosexual clinical history before initiating antipsychotic treatment to evaluate following changes and adopt an individualized strategy to manage sexual dysfunction induced by antipsychotics.

Risperidone-Induced Sexual Dysfunction Case Report

Treatment-emergent sexual dysfunctions are a common and distressing adverse effect of antipsychotic medication, particularly risperidone, which can result in medication noncompliance among patients with psychiatric disorders. In this case report, we present a 55-year-old male patient with a history of bipolar disorder type 1 who was admitted to an inpatient psychiatric facility due to a severe manic episode with psychotic features. The patient reported having previously taken risperidone for his bipolar symptoms but stopped taking it two months prior to hospitalization due to sexual side effects, including reduced libido and anejaculation. Comprehensive medical and psychiatric evaluations were performed during the patient's hospitalization, and his symptoms were treated with lurasidone instead of resuming risperidone. The patient's symptoms improved, and he was discharged with close outpatient follow-up for six months without symptoms of sexual dysfunction, depressive or manic symptoms, or adverse medication effects. This case adds to the growing body of literature on the adverse effects of risperidone, which is known to stimulate prolactin and contribute to sexual dysfunction in as many as 50-70% of patients, and highlights the potential benefits of switching to lurasidone, which has limited literature but as of this publication has not been associated with sexual dysfunction in clinical trials. However, more research is needed to fully understand the impact of antipsychotic switching on sexual side effects and the reluctance of patients to switch medications due to discomfort discussing these sensitive issues.

Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment

INTRODUCTION

: First- and second-generation antipsychotics are highly accountable for causing a plethora of medical side effects, ranging from metabolic imbalances to sexual dysfunction (SD), that frequently undermine patient-doctor relationships. Nevertheless, to date antipsychotics are one of the best treatment options for dealing with numerous either acute or chronic conditions like agitation, suicidality, depression, dementia, and of course psychosis. For these reasons, clinicians need to handle them wisely to preserve patients' sexual health, avoid poor therapeutic adherence and prevent high rates of therapy drop-out.

AREAS COVERED

: This article reviews the literature on pharmacologic approaches for management strategies in men who are administered with antipsychotics and developed SD. The etiology of antipsychotic-induced SD is also discussed.

EXPERT OPINION

: Clinicians must consider sexual life as a major health domain. To do so, a first step would be to measure and monitor sexual function by means of psychometric tools. Secondly, primary prevention should be conducted when choosing antipsychotics, i.e., picking sex-sparing compounds like aripiprazole or brexpiprazole. Thirdly, if sexolytic compounds cannot be dismissed, such as first-generation antipsychotics, risperidone, paliperidone, or amisulpride, then aripiprazole 5-20 mg/day adjunctive therapy has proven to be most effective in normalizing prolactin levels and consequently treating antipsychotic-induced SD.

A Qualitative Study on Sexuality and Sexual Experiences in Community Forensic Mental Health Patients in Queensland, Australia

This qualitative study reports on the sexuality and sexual experiences of community-based forensic mental health participants. The findings indicate that these participants feel the need for intimacy and want to engage in sexual activity more often than their neurotypical Australian peers. Participants identified their mental health and the side effects of compliance with prescribed psychotropic medications were barriers to achieving their desired level of sexual activity. Participants supported the notion that mental health teams were positioned to assist patients navigate the psychological, cultural, education and physical barriers to achieving sexual health and wellbeing. We propose several interventions to support these participants and other community forensic mental health patients in attaining healthy relationships, understanding their sexual health, and gaining more fulfilling sexual experiences. These interventions, which include sex education, upskilling in socialization and communication, and regular medication reviews, could be delivered as part of the holistic care provided by mental health teams. Mental health clinicians should be offered appropriate training to assess patients and have discussions related to sexuality, sexual experiences and sexual health needs.

The role of dopaminergic and serotonergic transmission in the processing of primary and monetary reward

Natural rewards such as erotic stimuli activate common neural pathways with monetary rewards. In human studies, the manipulation of dopamine and serotonin play an important role in the processing of monetary rewards with less understood on its role on erotic stimuli. In this study, we investigate the neuromodulatory effects of dopaminergic and serotonergic transmission in the processing of erotic versus monetary visual stimuli. We scanned one hundred and two (N = 102) healthy volunteers using functional magnetic resonance imaging while performing a modified version of the well-validated monetary incentive delay task consisting of erotic, monetary and neutral visual stimuli. We show a role for enhanced central dopamine and lowered central serotonin levels in increasing activity in the right caudate and left anterior insula during anticipation of erotic relative to monetary rewards in healthy controls. We further show differential activation in the anticipation of natural versus monetary rewards with the former associated with ventromesial and dorsomesial activity and the latter with dorsal cingulate, striatal and anterior insular activity. These findings are consistent with preclinical and clinical findings of a role for dopaminergic and serotonergic mechanisms in the processing of natural rewards. Our study provides further insights into the neural substrates underlying reward processing for natural primary erotic rewards and yields importance for the neurochemical systems of addictive disorders including gambling disorder.

Fertility trends of women with serious mental illness in the United Kingdom 1992-2017: A primary care cohort study using the clinical practice research datalink

BACKGROUND

Changes in care may mean women with serious mental illness (SMI) are more fertile. We investigated 1) the live-birth and pregnancy rate of women with and without SMI over time, 2) the likelihood of pregnancy when using second or first-generation antipsychotics.

METHOD

Retrospective cohort study of women (15-45 years) registered in Clinical Practice Research Datalink (CPRD) general practices between 1992 and 2017. Each analysis year, women with SMI (affective and non-affective psychotic disorder) were matched with up to four women with no record of SMI on age, calendar year and general practice. Pregnancy and live-birth rates and the rate ratio (RR) comparing women with and without SMI were estimated. The stability of the RR between years was tested. For women with SMI, the pregnancy rates when on or off first or second-generation antipsychotics were calculated and compared using Poisson regression models.

RESULTS

In total, 12,524 women with SMI were matched to 50,074 women without SMI, median age 34 [IQR 28-39] years. Between 1992 and 2017 women with SMI had 50% fewer live-births than women without SMI (RR 0..50, 95%CI 0.45-0.55). The pregnancy rate ratio increased from 0.64 (95%CI 0.48-0.86) (1992-1994) to 1.00 (95%CI 0.81-1.22) (2016-2017), (p < 0.0001), but this change was only seen in women with affective disorders. Women are most likely to become pregnant after discontinuing either a second-generation or first-generation antipsychotic (RR 1.74, 95%CI 1.42-2.13).

CONCLUSIONS

Women with SMI are increasingly experiencing pregnancy but not live-birth, which suggests the reproductive health needs of these women are unmet.

Pharmacological Augmentation in Unipolar Depression: A Guide to the Guidelines

BACKGROUND

Pharmacological augmentation is a recommended strategy for patients with treatment-resistant depression. A range of guidelines provide advice on treatment selection, prescription, monitoring and discontinuation, but variation in the content and quality of guidelines may limit the provision of objective, evidence-based care. This is of importance given the side effect burden and poorer long-term outcomes associated with polypharmacy and treatment-resistant depression. This review provides a definitive overview of pharmacological augmentation recommendations by assessing the quality of guidelines for depression and comparing the recommendations made.

METHODS

A systematic literature search identified current treatment guidelines for depression published in English. Guidelines were quality assessed using the Appraisal of Guidelines for Research and Evaluation II tool. Data relating to the prescription of pharmacological augmenters were extracted from those developed with sufficient rigor, and the included recommendations compared.

RESULTS

Total of 1696 records were identified, 19 guidelines were assessed for quality, and 10 were included. Guidelines differed in their quality, the stage at which augmentation was recommended, the agents included, and the evidence base cited. Lithium and atypical antipsychotics were recommended by all 10, though the specific advice was not consistent. Of the 15 augmenters identified, no others were universally recommended.

CONCLUSIONS

This review provides a comprehensive overview of current pharmacological augmentation recommendations for major depression and will support clinicians in selecting appropriate treatment guidance. Although some variation can be accounted for by date of guideline publication, and limited evidence from clinical trials, there is a clear need for greater consistency across guidelines to ensure patients receive consistent evidence-based care.

Sexual dysfunction in patients with schizophrenia on antipsychotic medication

Objective

The objective of this study was to determine the prevalence of sexual dysfunction in patients with schizophrenia under antipsychotic therapy and to investigate the effect of various parameters on sexual dysfunction.

Method

A total of 827 stabilized outpatients who met DSM-IV criteria for schizophrenia, were recruited in the study. Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.

Results

In total, 52.6% of the patients had sexual dysfunction, 54.2% reported a low sexual desire and 41.7% reported problems in having an orgasm. Erectile dysfunction and ejaculation problems were seen in 48.1% and 64.2% of the men, respectively; amenorrhea was seen in 24.9% of the women. ASEX score and severity of disease were found to be correlated (p = 0.02). Higher ASEX scores were observed in patients who smoked (p = 0.01). Men receiving atypical monotherapy had lower ASEX scores than those receiving a combination of atypical and conventional antipsychotics (p = 0.017). Patients on combination therapy had more ejaculation problems than the atypical group (p = 0.001). Low sexual desire was more prevalent among women using conventional drugs than those on atypical drugs (p = 0.004). In linear regression analyses, ASEX was affected significantly and independently by the severity of the disease only in men (p = 0.005).

Conclusion

Our results show that sexual dysfunction is widespread among patients with schizophrenia on antipsychotic medications.

The Schizophrenia Outpatient Health Outcomes (SOHO) study: 3-year results of antipsychotic treatment discontinuation and related clinical factors in Spain

Introduction

This article presents the long-term results in terms of antipsychotic medication maintenance and factors influencing it in a representative sample of patients with schizophrenia recruited in the SOHO study within Spain.

Methods

The SOHO was a prospective, 3-year observational study of the outcomes of schizophrenia treatment in outpatients who initiated therapy or changed to a new antipsychotic performed in 10 European countries with a focus on olanzapine. The Kaplan–Meier method was used to analyse the time to treatment discontinuation and the Cox proportional hazards model to investigate correlates of discontinuation.

Results and conclusions

In total, 1688 patients were included in the analyses. Medication maintenance at 3 years varied with the antipsychotic prescribed, being highest with clozapine (57.6%, 95% CI 39.2–74.5), followed by olanzapine (48.3%, 95% CI 45.1–51.5); and lowest with quetiapine (19.0%, 95% CI 13.0–26.3). Treatment discontinuation was significantly less frequent with olanzapine than with risperidone (p = 0.015), depot typical (p = 0.001), oral typical antipsychotics (p < 0.001) or quetiapine (p < 0.001); but not than with clozapine (p = 0.309). Longer maintenance was also associated with higher social abilities and better cognitive status at baseline; in contrast, a shorter time to discontinuation was associated with the need for mood stabilisers during follow-up. This study emphasises the different value of antipsychotics in day-to-day clinical practice, as some of them were associated with longer medication maintenance periods than others. This study has some limitations because of possible selection and information biases derived from the non-systematic, non-randomised allocation to treatments and the existence of unobserved covariates that may influence the outcome.

Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review

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.

Sexual Dysfunction in Male Canadian Armed Forces Members and Veterans Seeking Mental Health Treatment

INTRODUCTION

There is mixed evidence regarding how posttraumatic stress disorder (PTSD) symptom clusters are associated with sexual dysfunction (SD), and most studies to date have failed to account for potentially confounding variables. Our study sought to explore the unique contribution of PTSD symptom clusters on (a) lack of sexual desire or pleasure, and (b) pain or problems during sexual intercourse, after adjusting for comorbidities and medication usage.

MATERIALS AND METHODS

Participants included 543 male treatment-seeking veterans and Canadian Armed Forces (CAF) personnel (aged <65 years), referred for treatment between September 2006 and September 2014. Each participant completed self-report measures of demographic variables, depressive symptom severity, chronic pain, alcohol misuse, and psychotropic medication usage as part of a standard clinical intake protocol. Hierarchical ordinal logistic regression analyses were used to determine the incremental contribution of PTSD symptom clusters on sexual dysfunction.

RESULTS

Nearly three-quarters (71.5%) of participants reported a lack of sexual desire or pleasure and 40.0% reported pain or problems during intercourse. Regression analyses suggested that avoidant/numbing symptoms were the only symptoms to be independently associated with lacking sexual desire or pleasure (AOR = 1.10; 95% CI 1.05-1.15). None of the PTSD symptom clusters were independently associated with pain or problems during intercourse.

CONCLUSIONS

Sexual dysfunction is prevalent among male treatment-seeking CAF personnel and veterans. Results suggest that PTSD symptoms are differentially associated with sexual desire or pleasure concerns. Assessing sexual function among CAF personnel and veterans seeking treatment for PTSD is critical in order to treat both conditions and improve overall functioning.

Serotonergic, Dopaminergic, and Noradrenergic Modulation of Erotic Stimulus Processing in the Male Human Brain

Human sexual behavior is mediated by a complex interplay of cerebral and spinal centers, as well as hormonal, peripheral, and autonomic functions. Neuroimaging studies identified central neural signatures of human sexual responses comprising neural emotional, motivational, autonomic, and cognitive components. However, empirical evidence regarding the neuromodulation of these neural signatures of human sexual responses was scarce for decades. Pharmacological functional magnetic resonance imaging (fMRI) provides a valuable tool to examine the interaction between neuromodulator systems and functional network anatomy relevant for human sexual behavior. In addition, this approach enables the examination of potential neural mechanisms regarding treatment-related sexual dysfunction under psychopharmacological agents. In this article, we introduce common neurobiological concepts regarding cerebral sexual responses based on neuroimaging findings and we discuss challenges and findings regarding investigating the neuromodulation of neural sexual stimulus processing. In particular, we summarize findings from our research program investigating how neural correlates of sexual stimulus processing are modulated by serotonergic, dopaminergic, and noradrenergic antidepressant medication in healthy males.

Sexual dysfunction in patients with schizophrenia and schizoaffective disorder and its association with adherence to antipsychotic medication

Background: Antipsychotic-induced sexual dysfunction is a common complaint among patients with psychotic disorders. However, few papers have discussed its impact on treatment adherence.Aims: The aim of the study was to determine the prevalence of antipsychotic induced sexual dysfunction in patients with schizophrenia and schizoaffective disorder and assess its impact on treatment adherence.Methods: Nighty-five outpatients treated with antipsychotics for at least four weeks were recruited. Sexual dysfunction was assessed using a questionnaire inspired from the Udvalg for Kliniske Undersøgelser (UKU) Side Effect Rating Scale and the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). An Arabic version of the Medication Adherence Rating Scale (MARS) was used to assess treatment adherence.Results: The prevalence of sexual dysfunction was 57.9%, of which 65.5% attributed it to treatment. Reduced desire was the mostly reported sexual dysfunction in males and females. Number, dose and duration of antipsychotics were not associated with sexual dysfunction. MARS score was associated with the presence of sexual dysfunction (p = 0.0001) and its attribution to antipsychotic medication (p = 0.0003), the latter being an independent associated variable (p = 0.001).Conclusion: Sexual dysfunction is prevalent in patients with schizophrenia and schizoaffective disorder treated with antipsychotic drugs. Clinicians should ask about sexual dysfunction and discuss its different causes with patients in order to improve adherence.

Women's sexual dysfunction associated with psychiatric disorders and their treatment

Impairment of mental health is the most important risk factor for female sexual dysfunction. Women living with psychiatric illness, despite their frequent sexual difficulties, consider sexuality to be an important aspect of their quality of life. Antidepressant and antipsychotic medication, the neurobiology and symptoms of the illness, past trauma, difficulties in establishing relationships and stigmatization can all contribute to sexual dysfunction. Low sexual desire is strongly linked to depression. Lack of subjective arousal and pleasure are linked to trait anxiety: the sensations of physical sexual arousal may lead to fear rather than to pleasure. The most common type of sexual pain is 10 times more common in women with previous diagnoses of anxiety disorder. Clinicians often do not routinely inquire about their patients' sexual concerns, particularly in the context of psychotic illness but careful assessment, diagnosis and explanation of their situation is necessary and in keeping with patients' wishes. Evidence-based pharmacological and non-pharmacological interventions are available but poorly researched in the context of psychotic illness.

Effects of long-term treatment with haloperidol, clozapine and aripiprazole on mice isolated vas deferens

PURPOSE

Sexual dysfunction is a common condition in patients taking antipsychotics and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. Pharmacology research into human ejeculatory disorders is limited to clinical studies with registered drugs affecting the ejaculation process; therefore, animal research has become the need. We aimed to investigate the effects of haloperidol, clozapine and aripiprazole on serotonin, noradrenaline, adenosine triphosphate (ATP) and potassium chloride (KCl)-induced contractions of the vas deferens in order to evaluate the effect of haloperidol, clozapine and aripiprazole on the contraction of the vas deferens.

METHODS

Male inbred BALB/c ByJ mice aged 7 weeks upon arrival to the laboratory were used in this study. Haloperidol, clozapine, aripiprazole, serotonin, noradrenaline, ATP and KCl were dissolved in 0.9% physiological saline. The mice were randomly divided into experimental groups as follows: saline; haloperidol 0.125 mg/kg; haloperidol 0.25 mg/kg; clozapine 1.25 mg/kg; clozapine 2.5 mg/kg; aripiprazole 3 mg/kg; aripiprazole 6 mg/kg. Mice were treated by ip injection of drugs during 21 days. Mice receiving only the vehicle ip (0.9% saline) during 21 days served as control group (n = 7). Each experimental group consisted of 7 mice. After 21 days of treatment, epididymal and prostatic portions of vas deferens were surgically dissected free and immersed in 20-mL organ baths containing Krebs' solution. The effects of chronic treatment with haloperidol (0.125 and 0.25 mg/kg), clozapine(1.25 and 2.5 mg/kg) and aripiprazole (3 and 6 mg/kg) were investigated on serotonin [10 (-8) to 10 (-4) M], noradrenaline [10 (-8) to 10 (-4) M], ATP [10 (-8) to 10 (-4) M] and 80 mM KCl-induced contractile responses in the epididymal and prostatic portions of mice isolated vas deferens strips. Statistical comparison between the groups was performed using ANOVA supported by Dunnett's post hoc test.

RESULTS

Serotonin-induced contractile responses were significantly increased in the epididymal and prostatic portions of the vas deferens obtained from the haloperidol-treated group and clozapine-treated group. However, aripiprazole treatment had no effect on serotonin responses in both epididymal and prostatic portions of mice vas deferens. On the other hand, haloperidol and clozapine treatments significantly inhibited both noradrenaline and ATP-induced contractions of the prostatic and epididymal portions of the mice vas deferens, but had no effect on KCl-induced contractions of the vas deferens in both portions. There were no significant differences in KCl-induced contractile responses among the groups.

CONCLUSIONS

These results revealed that induced contractions of vas deferens were affected after chronic treatment with haloperidol and clozapine but not aripiprazole. Serotonergic, noradrenergic and purinergic receptors may, at least in part, contribute to changes in vas deferens contractions in mice with chronic treatment of haloperidol and clozapine but not aripiprazole.

Original research paper. Switching antipsychotics: Results of 16-month non-interventional, prospective, observational clinical research of inpatients with schizophrenia spectrum disorders

The study aims to identify prescribing and switching patterns of antipsychotics in clinical practice. A 16-month, prospective study was conducted at the Psychiatric Hospital Idrija, Slovenia. Inpatients (N = 311) with schizophrenia spectrum disorders were observed. The causes for switching antipsychotics and switching strategies were analyzed. Analyzing a total of 3954 prescriptions, the collected data confirmed that treatment strategies in this psychiatric hospital are very complex. It was found that 37 percent of inpatients had at least one switch. Moreover, switches that included three or more antipsychotics were detected. The most common causes for switching antipsychotics were adverse reactions and inefficacy or lack of efficacy. Among switching options, abrupt switch was recorded several times. As some patients are receiving several antipsychotics at the same time, it is possible that unusual switching occurs in clinical practice. It seems that the choice of switching strategy is also affected by the cause and urgency for switching an antipsychotic.

Sexual dysfunction among women with Schizophrenia-A cross sectional study from India

Sexual dysfunction among women usually has a multifactorial etiology and is also difficult to study in cultures where open discussions about sexuality are not common. Not much is known about sexual function in women with schizophrenia even though it may have a significant impact on their quality of life and maybe influenced by several factors.

AIMS AND OBJECTIVES

This study aimed to assess the frequency and nature of sexual dysfunction in women with schizophrenia and study its association with marital quality, illness, treatment, and socio-demographic factors.

METHODOLOGY

This was a cross sectional, hospital-based study conducted among 63 women with schizophrenia attending the outpatient services of a tertiary care psychiatric hospital. Sexual dysfunction was assessed using the Female Sexual Function Index (FSFI). Side effects of medications, psychopathology, and marital quality were assessed using standard scales.

RESULTS

Among the 63 women assessed, 44 (70%) reported sexual dysfunction. Impaired desire was reported by all women, impaired arousal by 58 (92.1%), poor lubrication by 30 (47.6%), impaired orgasm by 48(76.2%) poor satisfaction by 44(69.8%) and pain by 23(36.5%). Poor Marital quality ('p' value-0.001), higher scores on general psychopathology of the Positive and Negative symptoms scale of schizophrenia (PANSS) ('p' value-0.049) and side effects such as weight gain, menstrual disturbances, galactorrohea and dry vagina were significantly associated with Female Sexual Dysfunction (FSD) in univariate analysis. However, multivariate analysis found marital quality alone to be significantly related to FSD.

Sexual Dysfunction Due to Psychotropic Medications

Sexual functioning is important to assess in patients with psychiatric illness as both the condition and associated treatment may contribute to sexual dysfunction (SD). Antidepressant medications, mood stabilizers, antipsychotics, and antianxiety agents may be associated with SD related to drug mechanism of action. Sexual adverse effects may be related to genetic risk factors, impact on neurotransmitters and hormones, and psychological elements. Effective strategies to manage medication-induced sexual dysfunction are initial choice of a drug unlikely to cause SD, switching to a different medication, and adding an antidote to reverse SD. Appropriate interventions should be determined on a clinical case-by-case basis.

Psychotropic induced sexual dysfunction for people with a dual diagnosis

Purpose

– The purpose of this paper is: first, to consider the reported problems in sexual function caused by psychotropic medication. Second, the complex undertaking of completing an assessment of sexual functioning. Third, the role of the pharmaceutical industry is explored. Finally, implications for future research and practice are suggested.

Design/methodology/approach

– As a commentary this paper draws on the available literature to synthesise what is already known about the relationship between psychoactive substances and sexual functioning.

Findings

– The limited literature and lack of research attention given to psychotropic induced sexual dysfunction limits our collective understanding of how many people are affected and in what way.

Research limitations/implications

– A greater focus on psychotropic induced sexual dysfunction is needed for people with a dual diagnosis. There has been an over reliance on single case studies and self-reporting. Large scale epidemiological investigation would help understand the extent and nature of the problem more fully. The demographic shift particularly in relation to an ageing population should be considered as psychotropic substances effect individuals in different ways as they grow older.

Practical implications

– There is scope for workers to engage more fully in a conversation with clients about their experience of using psychotropic substances and how this has impacted their sexual functioning. The literature suggests that clients want to talk about this issue but staff are unwilling or unable to discuss the topic.

Originality/value

– To the authors’ knowledge this is the first paper that draws on the available literature to explore the known and likely implications of psychotropic induced sexual dysfunction for this client group.

Factors associated with self-rated sexual function in Korean patients with schizophrenia receiving risperidone monotherapy

OBJECTIVE

This study aims to investigate the factors associated with sexual function in Korean patients with schizophrenia.

METHODS

This study evaluated 169 patients with schizophrenia who were receiving risperidone monotherapy. The Visual Analog Scale was used to assess sexual function in terms of sexual desire, sexual arousal, and sexual satisfaction. The Positive and Negative Syndrome Scale, the Beck Depression Inventory, the Korean version of the Subjective Well-being under Neuroleptic Treatment-Brief Form (SWN-K) scale, and the Drug Attitude Inventory (DAI) were also administered.

RESULTS

Sexual function was negatively associated with age, duration of illness, gender (female), marital status (single), the presence of tardive dyskinesia, and Beck Depression Inventory score, but positively associated with the SWN-K and DAI scores. A linear regression analysis revealed that being male and married had significant positive associations with sexual arousal, sexual satisfaction, and/or sexual desire, while the presence of tardive dyskinesia and a longer duration of illness were associated with poor sexual arousal and/or sexual desire. Additionally, sexual function was significantly associated with the SWN-K and DAI scores in multivariate analysis.

CONCLUSIONS

The acknowledgement and management of sexual dysfunction in patients with schizophrenia by clinicians may be important for improvement of their quality of life and adherence to medication.

Psychiatric disorders and sexual dysfunction

Sexual problems are highly prevalent among patients with psychiatric disorders. They may be caused by the psychopathology of the psychiatric disorder but also by its pharmacotherapy. Both positive symptoms (e.g., psychosis, hallucinations) as well as negative symptoms (e.g., anhedonia) of schizophrenia may negatively interfere with interpersonal and sexual relationships. Atypical antipsychotics have fewer sexual side-effects than the classic antipsychotics. Mood disorders may affect libido, sexual arousal, orgasm, and erectile function. With the exception of bupropion, agomelatine, mirtazapine, vortioxetine, amineptine, and moclobemide, all antidepressants cause sexual side-effects. Selective serotonin reuptake inhibitors (SSRIs) may particularly delay ejaculation and female orgasm, but also can cause decreased libido and erectile difficulties. SSRI-induced sexual side-effects are dose-dependent and reversible. Very rarely, their sexual side-effects persist after SSRI discontinuation. This is often preceded by genital anesthesia. Some personality characteristics are a risk factor for sexual dysfunction. Also patients with eating disorders may suffer from sexual difficulties. So far, research into psychotropic-induced sexual side-effects suffers from substantial methodologic limitations. Patients tend not to talk with their clinician about their sexual life. Psychiatrists and other doctors need to take the initiative to talk about the patient's sexual life in order to become informed about potential medication-induced sexual difficulties.

Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study

BACKGROUND

Sexual dysfunction is one of several factors related to medication compliance in patients taking antipsychotic medication but the magnitude of this problem is unknown.

AIM

Compare the self-reported sexual functioning of clinically stable patients with schizophrenia taking antipsychotic medication to that of healthy controls using the Turkish version of the 5-item Arizona Sexual Experience Scale (ASEX). This scale, which has previously been validated in Turkey, assesses 5 components of sexual function: sex drive, sexual arousal, vaginal lubrication/penile erection, ability to achieve orgasm, and satisfaction with orgasm.

METHODS

The Scale for the Assessment of Positive Symptoms, the Scale for Assessment of Negative Symptoms, and ASEX were administered to 101 clinically stable outpatients with schizophrenia (38 females and 63 males). The ASEX was also administered to 89 control subjects (41 females and 48 males) without a history of mental illness. Respondents were classified as having sexual dysfunction if ASEX total score (range 5-30) >18, if any ASEX item score (range 1-6) ≥ 5, or if 3 or more ASEX items ≥4.

RESULTS

Male patients with schizophrenia have significantly more self-reported sexual dysfunction than healthy controls (46% vs. 8%). The prevalence of sexual dysfunction is higher in female patients than in male patients (68% vs. 46%), but it was also very high in healthy female controls (68%), so the sexual dysfunction of female patients cannot be attributed to their illness or to the medications they are taking. Within the patient group, there was no significant relationship between the severity of positive or negative symptoms and the severity of sexual dysfunction, and the severity of sexual function was not different between patients taking first-generation or second-generation antipsychotic medications.

CONCLUSIONS

The very different findings by gender in Turkey highlights the importance of assessing location-specific and gender-specific sexual norms when trying to assess the role of mental illness and medications on sexual functioning. Prospective studies are needed to distinguish the relative importance of cultural norms, the schizophrenic illness, and the use of antipsychotic medication in the etiology and course of sexual dysfunction among individuals with schizophrenia.

Comparison of Sexual Function and Hormonal Parameters Between Mood Stabilizer Treatment Modalities in Bipolar Disorder

INTRODUCTION

The aim of this study was to determine the differences between lithium and atypical antipsychotics (quetiapine and olanzapine) with regard to their effects on sexual functions and hormonal variables and to assess the findings in term of gender differences, in patients with bipolar disorder.

METHOD

28 female and 29 male patients diagnosed as having bipolar disorder type I according to the DSM-IV, using lithium or quetiapine and quetiapine+lithium or olanzapine and olanzapine+lithium were evaluated consecutively. Being in remission period and given informed consent were set as inclusion criteria in these cases. Interviews with the patients were carried out using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and SKIP-TURK. Sexual functions and satisfaction were evaluated with the Arizona Sexual Experiences Scale (ASEX) and the Golombok Rust Inventory of Sexual Satisfaction (GRISS). Blood samples of the patients were taken in order to determine prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and free testosterone (T) levels.

RESULTS

GRISS scores in male patients were higher than in female patients (p=.001). The number of manic, depressive and total episodes, and functionality levels were similar between the treatment groups, both in female and male patients. No differences were found between treatment modalities in terms of hormone levels both in female and male patients. Among females, ASEX scores of the patients treated with lithium monotherapy were less than the ones treated with quetiapine and olanzapine. Among patients with quetiapine monotherapy, GRISS scores in male patients were higher than in female patients.

CONCLUSION

There are some evidences showing gender-based differences in the side effects of atypical antipsychotic drugs. Future studies with a specific focus on this topic are needed in order to have a better understanding of the basic mechanisms of gender differences.

Second-generation and newly approved antipsychotics, serum prolactin levels and sexual dysfunctions: a critical literature review

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.

Non-neurological and metabolic side effects in the Cost Utility of the Latest Antipsychotics in Schizophrenia Randomised Controlled Trial (CUtLASS-1)

The impact of non-neurological and metabolic side effects (NNSEs) on the prescription of antipsychotics in real clinical practice remains unclear. We conducted an intention-to-treat, secondary analysis of data from a randomised, controlled trial (CUtLASS-1; n=227) to examine NNSEs emergent at 12 weeks and 52 weeks. A clinically significant difference was defined as double or half the symptoms in groups prescribed first- versus second-generation antipsychotics, represented by odds ratios greater than 2.0 (indicating advantage for first-generation drugs) or less than 0.5 (indicating advantage for the newer drugs). There were no differences between the treatment groups at baseline. At both 12 and 52 weeks follow-up, patients on second-generation drugs were more likely than their first-generation counterparts to experience cardiovascular problems and anticholinergic side effects, as well as increased sexual side effects in men. Objective weight gain was equivalent between the two groups at 12 weeks, but by one year fewer patients in the second-generation arm experienced weight gain and there was no significant difference with regard to percent change in BMI. These results suggest that there may be clinically significant increases in anticholinergic, cardiovascular, and sexual side effects for patients on second-generation drugs. The expected increased weight gain in the second-generation arm did not occur. This study provides evidence that clinicians should take a more nuanced approach toward expert antipsychotic prescription, rather than viewing the drugs as distinct classes.

Subjective quality of life and sexual dysfunction in outpatients with schizophrenia or schizoaffective disorder

The objective of this research was to examine the association between sexual dysfunction and subjective quality of life in outpatients with schizophrenia and schizoaffective disorder. The authors evaluated a sample of 238 adult outpatients with diagnoses of schizophrenia or schizoaffective disorder who took quetiapine, olanzapine, or risperidone at study entry with a 1-time rating of the Arizona Sexual Experience Scale and the general life satisfaction scale item of the quality of life index. The authors used multiple linear robust regression and Spearman partial correlation coefficient to examine the relation between subjective quality of life (measured by the general life satisfaction scale item) and sexual functioning (measured by the Arizona sexual experience scale). The authors found a significant negative linear relation between the Arizona Sexual Experience Scale total score and the general life satisfaction scale item for the overall sample (r(s) = -0.16, p = .01), but not separately for men or women. Sexual dysfunction in men and women with schizophrenia and schizoaffective disorder is associated with decreased subjective quality of life, although the magnitude of the effect size was relatively small. Improving clinicians' awareness of the importance of sexual dysfunction in patients may improve tolerability and subsequent treatment outcomes.

Antipsychotic-induced sexual dysfunction and its management

Sexual dysfunction is a common condition in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect, resulting in a negative effect on treatment compliance. It is known that hyperprolactinemia is a major cause of sexual dysfunction. Based on the blockade of dopamine D2 receptors, haloperidol, risperidone, and amisulpride are classed as prolactin-elevating antipsychotics, while olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole are classed as prolactin-sparing drugs. Risperidone and the other typical antipsychotics are associated with a high rate of sexual dysfunction as compared to olanzapine, clozapine, quetiapine, and aripiprazole. With regard to treatment in patients suffering from sexual dysfunction, sildenafil was associated with significantly more erections sufficient for penetration as compared to a placebo. Subsequent studies are needed in order to provide physicians with a better understanding of this problem, thereby leading toward efficacious and safe solutions.

A study of the efficacy and safety of switching from oral risperidone to risperidone long-acting injection in older patients with schizophrenia

OBJECTIVE

We investigated the clinical efficacy and safety of switching to risperidone long-acting injection (RLAI) in older patients with schizophrenia receiving oral risperidone.

METHODS

The subjects were 48 inpatients who had been diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. Their clinical symptoms were assessed using the Positive and Negative Syndrome Scale and the Clinical Global Impression - Severity of Illness scale, and their safety was assessed using the Drug-Induced Extrapyramidal Symptoms Scale (DIEPSS), body weight, body mass index, and blood biochemistry tests.

RESULTS

No significant differences in clinical symptom improvement efficacy were seen between the group switched to RLAI and the control group. The mean changes from baseline on the DIEPSS total score and prolactin level were significantly greater in the older group switched to RLAI than in the control group. Furthermore, in older patients, RLAI allowed the dosage of the concomitant medication to be significantly reduced compared with the control group.

CONCLUSION

The results of this study suggest that switching older patients from oral risperidone to RLAI may result in superior efficacy and safety, and may also make it possible to reduce the dosage of the concomitant medication.

Effectiveness of antipsychotic maintenance therapy with quetiapine in comparison with risperidone and olanzapine in routine schizophrenia treatment: results of a prospective observational trial

Objective of this observational trial is to examine the effects of quetiapine in comparison with olanzapine and risperidone on clinical outcomes and quality of life in patients with schizophrenia and schizoaffective disorder in routine care. 374 adult persons with schizophrenia or schizoaffective disorder prescribed antipsychotic maintenance therapy with quetiapine, olanzapine, or risperidone at discharge from inpatient treatment were included. Clinical and psychosocial outcomes were assessed before discharge and at 6, 12, 18, and 24 months. Statistical analyses were conducted by mixed-effects regression models for longitudinal data. The propensity score method was used to control for selection bias. Patients discharged on olanzapine had significantly lower hospital readmissions than those receiving quetiapine or risperidone. The average chlorpromazine equivalent dose of quetiapine was higher than in patients treated with olanzapine or risperidone. No further significant differences between treatment groups were found. Quetiapine and risperidone are less effective in preventing the need for psychiatric inpatient care than olanzapine, and higher chlorpromazine equivalent doses of quetiapine are needed to obtain clinical effects similar to those of olanzapine and risperidone.

One-year outcomes in schizophrenia after switching from typical antipsychotics to olanzapine in Japan: an observational study

Background

The purpose of this study was to assess the 1-year clinical, functional, and safety-related outcomes following a switch to olanzapine of at least one typical antipsychotic drug in the previous regimen in the treatment of patients of schizophrenia in Japan.

Methods

Using data from a large 1-year prospective, multicenter, naturalistic study of olanzapine for the treatment of schizophrenia in Japan, patients who were switched from any oral typical antipsychotic to olanzapine were identified. Mixed models for repeated measures, controlling for baseline demographics, were utilized to assess outcomes for clinical and functional measures.

Results

Of the 262 patients who switched from typical antipsychotics to olanzapine, 41% were outpatients and 59% were inpatients. Most of these patients were switched due to poor medication efficacy (71.0%) or medication intolerability (25.6%). Most patients (71.4%) completed the 1-year study. Clinically and statistically significant (P < 0.01) improvements were observed in patient illness severity and health-related quality of life, including improvements in global symptom severity and in positive, negative, depressive, and cognitive symptoms. Over half of the patients (58.3%) demonstrated a treatment response to olanzapine and 47.4% achieved symptom remission. Mean weight gain from baseline to endpoint was 2.31 ± 4.72 kg, with 30.4% of patients experiencing clinically significant weight gain (at least 7% of baseline weight).

Conclusion

During this 1-year naturalistic treatment of schizophrenia patients in Japan, switching from typical antipsychotics to olanzapine resulted in significant improvements in patients’ clinical and functional outcomes. Approximately one-third of patients had clinically significant weight gain. These findings highlight the favorable benefit to risk profile of switching to olanzapine following failure on typical antipsychotics.

Comparative effectiveness of atypical antipsychotics in schizophrenia: what have real-world trials taught us?

Real-world, effectiveness studies add an important new dimension to the evaluation of the benefits of individual antipsychotics. Efficacy studies have already shown the unique effectiveness of clozapine, and suggested improved outcomes for olanzapine compared with some atypical antipsychotics and a reduced tendency to produce acute and chronic movement disorders for atypical compared with typical drugs. Recent effectiveness studies largely confirm these prior observations. The CATIE (Clinical Antipsychotic Trials of Intervention Effectiveness), CUtLASS (Cost Utility of the Latest Antipsychotic Drugs in Schizophrenia Study) and SOHO (Schizophrenia Outpatient Health Outcomes) programmes confirmed the superiority of clozapine over other antipsychotics; CATIE and SOHO also confirmed olanzapine as probably the second most effective antipsychotic. Effectiveness studies have confirmed the high incidence of adverse metabolic effects with clozapine, olanzapine and (with less certainty) quetiapine but the ZODIAC (Ziprasidone Observational Study of Cardiac Outcomes) study found no excess cardiovascular events or deaths for olanzapine compared with ziprasidone. Prior observations on reduced frequency of movement disorders for second-generation versus first-generation antipsychotics were also largely (but not uniformly) supported. Overall, recent real-world studies have done much to confirm prior observations from efficacy-based randomized, controlled trials.

Sexual function of patients with schizophrenia receiving first-generation (FGA) or second-generation antipsychotic (SGA) treatment

OBJECTIVES

The aim of the study was to investigate sexual function in patients with schizophrenia receiving treatment with a first-generation antipsychotic (FGA) or a second-generation antipsychotic (SGA) drug. Sexual function is an important aspect of human experience, which can be affected by antipsychotic drug treatment. Sexual dysfunction in patients with schizophrenia may be less prevalent with SGA than with FGA drug treatment.

METHODS

A cross-sectional prevalence study assessed sexual function in a sample of 144 patients with DSM-IV schizophrenia aged between 18 and 65, using the Derogatis Interview for Sexual Functioning (self-report version: DISF-SR). Two equal-sized groups (N = 72) received treatment with an FGA or an SGA drug for at least 12 weeks.

RESULTS

No significant differences were seen on DISF-SR total score or subscale score between the two treatment groups.

CONCLUSIONS

There are no differences in measured sexual function of non-randomised patients with schizophrenia treated with an FGA compared with SGA-treated patients.

Sexual dysfunction in male subjects receiving trifluoperazine, risperidone, or olanzapine: rates vary with assessment questionnaire

OBJECTIVE

To assess the rate and typology of sexual dysfunction in male subjects receiving trifluoperazine, risperidone, or olanzapine using the Arizona Sexual Experience Scale (ASEX), the Psychotropic Related Sexual Dysfunction Questionnaire (PRSexDQ), and the sexual function section of the modified Udvalg for Kliniske Undersøgelser Side Effect Rating Scale (UKU).

METHOD

The sample included 100 men with psychotic disorders (F2 category of the ICD-10) and receiving trifluoperazine (n = 20), risperidone (n = 30), or olanzapine (n = 50) for at least 3 months' duration. Subjects with a history of sexual dysfunction prior to antipsychotic intake or chronic medical illness were excluded. A cross-sectional design was employed, and data were collected over a 1½-year period from March 2009 to August 2010.

RESULTS

The rate of sexual dysfunction varied from scale to scale among the 100 subjects. The rate of sexual dysfunction was 25% on the ASEX, 37% on the PRSexDQ, and 40% on the UKU. Sexual dysfunction in the trifluoperazine, risperidone, and olanzapine groups was 20%, 43%, and 16%, respectively, on the ASEX; 35%, 50%, and 30%, respectively, on the PRSexDQ; and 40%, 50%, and 34%, respectively, on the UKU. The most common sexual dysfunction as assessed on all scales was decreased libido, except for the risperidone group on the ASEX.

CONCLUSIONS

Sexual dysfunction is quite prevalent in subjects receiving antipsychotic medications. In our study, rate of sexual dysfunction was highest for risperidone, followed by trifluoperazine and olanzapine. However, the rate of sexual dysfunction varied from scale to scale. Hence, there is a need for a comprehensive instrument to assess sexual dysfunction in patients receiving antipsychotics.

Association of common genetic variants with risperidone adverse events in a Spanish schizophrenic population

Risperidone non-compliance is often high due to undesirable side effects, whose development is in part genetically determined. Studies with genetic variants involved in the pharmacokinetics and pharmacodynamics of risperidone have yielded inconsistent results. Thus, the aim of this study was to investigate the putative association of genetic markers with the occurrence of four frequently observed adverse events secondary to risperidone treatment: sleepiness, weight gain, extrapyramidal symptoms and sexual adverse events. A series of 111 schizophrenia inpatients were genotyped for genetic variants previously associated with or potentially involved in risperidone response. Presence of adverse events was the main variable and potential confounding factors were considered. Allele 16Gly of ADRB2 was significantly associated with a higher risk of sexual adverse events. There were other non-significant trends for DRD3 9Gly and SLC6A4 S alleles. Our results, although preliminary, provide new candidate variants of potential use in risperidone safety prediction.

Sexual self-perception in schizophrenic and depressive patients

BACKGROUND

Sexual self-perception is just one of the items of the complex system of self, which has rarely been researched in the population of mental health patients.

OBJECTIVE

Our goal was to establish whether the differences in sexual self-perception exist between schizophrenic and depressive patients compared with the healthy control group.

PARTICIPANTS AND METHODS

This research was performed on 100 schizophrenic patients, 100 depressive patients and 100 phenotypically healthy volunteers. In order to diagnose schizophrenia and depression, DSM-IV classification was used. Bezinovic's questionnaire for sexual self-perception was used in order to assess seven aspects of sexual self-perception.

RESULTS

Results revealed that schizophrenic and depressive patients, compared with healthy individuals, scored significantly higher on the aspects of negative emotionality and sexual incompetence, and significantly lower on the aspect of sexual satisfaction. No statistically significant differences were established between schizophrenic and depressive patients.

CONCLUSION

We can conclude that patients suffering from schizophrenia or depression differ from healthy individuals in all of the aspects of sexual self-perception.

Sexual dysfunction in male schizophrenia: influence of antipsychotic drugs, prolactin and polymorphisms of the dopamine D2 receptor genes

Aim: Sexual dysfunction induced by antipsychotic drug treatment is under investigated and under reported. This study aimed to determine the influence of genetic polymorphisms in the D2 dopamine receptor (DRD2) and endothelial nitric oxide synthase (eNOS) genes, and the possible role of blood prolactin concentrations on sexual function in schizophrenic patients. Materials & methods: Male remitted schizophrenic patients (n = 100), who were living with a sexual partner and receiving antipsychotic drug monotherapy for at least 6 months, were assessed for sexual and erectile dysfunction using the Arizona Sexual Experience Scale and the five-item version of the International Index of Erectile Function. Blood samples were taken for plasma prolactin determination and genotyped for four polymorphisms: DRD2 (-141C Ins/Del and Taq1A) and eNOS gene (G894T and T-786C). Results: The -141C Ins/Del, but not Taq1A, polymorphism of the DRD2 gene was significantly associated with sexual dysfunction with the del allele being less frequent in sexual dysfunction subjects. Neither of the eNOS polymorphisms, G894T or T-786C, was significantly associated with sexual or erectile dysfunction. Prolactin concentrations were significantly higher in patients with erectile dysfunction but did not reach significance in those with sexual dysfunction. Prolactin was also reduced in -141C Del allele carriers. The frequency and severity of sexual dysfunction in the patients receiving typical antipsychotics was significantly greater than those receiving risperidone or clozapine, while prolactin concentrations were significantly higher in subjects receiving risperidone compared with those receiving clozapine or typical antipsychotics. Conclusion: This is the first evidence indicating that antipsychotic drug treatment in men is associated with a variant in the DRD2 gene in which the -141C Del allele might be a protective factor. While this may, in part, be mediated by effects on prolactin, other factors are likely to contribute to the greater sexual dysfunction in patients receiving typical antipsychotics.

Original submitted 25 January 2011; Revision submitted 21 March 2011

Sexual dysfunction in first-episode schizophrenia patients: results from European First Episode Schizophrenia Trial

Sexual dysfunctions (SDs) occur frequently in schizophrenia patients and have a huge impact on quality of life and compliance. They are often associated with antipsychotic medication. Nicotine consumption, negative or depressive symptoms, and physical illness are also discussed as contributing factors. Data on SD in first-episode schizophrenia patients are scarce.As part of the European First Episode Schizophrenia Trial, first-episode schizophrenia patients were randomly assigned to 5 medication groups. We assessed SD by analyzing selected items from the Udvalg for Kliniske Undersugelser at baseline and at 5 following visits.Differences between antipsychotics were small for all SDs, and fairly little change in the prevalence of SDs was seen over the course of the study. A significantly larger increase of amenorrhea and galactorrhea was seen with amisulpride than with the other medications. In men, higher age, more pronounced Positive and Negative Syndrome Scale general psychopathology symptoms, and higher plasma prolactin levels predicted higher rates of erectile and ejaculatory dysfunctions. Positive and Negative Syndrome Scale negative symptoms and higher age were predictors for decreased libido.In women, higher prolactin plasma levels were identified as a predictor of amenorrhea. Positive and Negative Syndrome Scale negative symptoms predicted decreased libido.All evidence taken together underscores the influence of the disease schizophrenia itself on sexual functioning. In addition, there is a strong correlation between the prolactin-increasing properties of amisulpride and menstrual irregularities.

Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care

The lifespan of people with severe mental illness (SMI) is shorter compared to the general population. This excess mortality is mainly due to physical illness. We report prevalence rates of different physical illnesses as well as important individual lifestyle choices, side effects of psychotropic treatment and disparities in health care access, utilization and provision that contribute to these poor physical health outcomes. We searched MEDLINE (1966 - August 2010) combining the MeSH terms of schizophrenia, bipolar disorder and major depressive disorder with the different MeSH terms of general physical disease categories to select pertinent reviews and additional relevant studies through cross-referencing to identify prevalence figures and factors contributing to the excess morbidity and mortality rates. Nutritional and metabolic diseases, cardiovascular diseases, viral diseases, respiratory tract diseases, musculoskeletal diseases, sexual dysfunction, pregnancy complications, stomatognathic diseases, and possibly obesity-related cancers are, compared to the general population, more prevalent among people with SMI. It seems that lifestyle as well as treatment specific factors account for much of the increased risk for most of these physical diseases. Moreover, there is sufficient evidence that people with SMI are less likely to receive standard levels of care for most of these diseases. Lifestyle factors, relatively easy to measure, are barely considered for screening; baseline testing of numerous important physical parameters is insufficiently performed. Besides modifiable lifestyle factors and side effects of psychotropic medications, access to and quality of health care remains to be improved for individuals with SMI.

Antipsychotics and hyperprolactinaemia: mechanisms, consequences and management

Hyperprolactinaemia is a common side effect in people receiving antipsychotics. The propensity to cause hyperprolactinaemia differs markedly between antipsychotics as a result of differential dopamine D(2) receptor-binding affinity and ability to cross the blood-brain barrier. Sexual dysfunction is common and under-recognized in people with severe mental illness and is in part caused by hyperprolactinaemia. There are a number of long-term consequences of hyperprolactinaemia, including osteoporosis. Regular monitoring before and during treatment will help identify those developing antipsychotic-induced hyperprolactinaemia. The treatment includes dose reduction and change in antipsychotic. Where this is not possible because of the risk of relapse of the mental illness, sex steroid replacement may be helpful in improving symptoms secondary to hypogonadism and reducing the risk of osteoporosis. Tertiary prevention of complications should also be considered.

Second generation antipsychotics improve sexual dysfunction in schizophrenia: a randomised controlled trial

The impact of antipsychotic drug treatment on sexual function was investigated during a randomised trial comparing first generation antipsychotics (FGAs) to (nonclozapine) second generation antipsychotics (SGAs). Sexual function and quality of life were (rater-blind) assessed in 42 patients with DSM-IV schizophrenia (aged 18-65) using the self-report version of the Derogatis Interview for Sexual Function (DISF-SR) and the Heinrichs Quality of Life Scale (QLS), prior to, and 12 weeks following, a change in medication from an FGA drug to either an FGA or SGA drug. SGAs significantly improved sexual function compared to FGAs. Change in sexual function was associated with change in quality of life. Where impaired sexual functioning is a distressing adverse effect of treatment with an FGA agent, consideration should be given to switching to an SGA.