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Sheoran C, Nayar N, Kumar A, Kumar K, Sharma S, Maan N. Assessment of sexual beliefs among "drug naive male" patients attending psychiatry OPD in a teaching institution: A cross-sectional study. J Family Med Prim Care 2024; 13:1238-1242. [PMID: 38827658 PMCID: PMC11141969 DOI: 10.4103/jfmpc.jfmpc_673_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 06/04/2024] Open
Abstract
Background The basic objective of any civilization is to preserve a happy family. The quality of one's sexual encounters is crucial to a happy marriage. Couples' dissatisfaction in this area may be the cause of several social, psychological, and medical issues. The way reality is interpreted, which shapes behaviors and emotions, is established by beliefs. These beliefs, which are among the most frequent causes of male sexual problems, include those relating to high performance, women's sexual enjoyment, and sexual conservatism. Aims To identify the misconceptions about sexuality among psychiatry patients. Method This cross-sectional study was carried out at the School of Medical Sciences and Research, Sharda University. We enrolled 200 samples and it is assessed through Sexual Beliefs Questionnaire (Male version). Result Sexual beliefs were assessed in different domains as well as overall sexual belief score was also estimated. The different domains in which the sexual beliefs were scored were sexual conservatism, female sexual power, macho belief, beliefs about women's sexual satisfaction, restrictive attitude toward sex, and sex as an abuse of men's power. Conclusion The development of both psychiatric and sexological care will benefit from the early identification of the intricate relationships between psychopathology, the adverse effects of antipsychotic medicines, and sexuality. However, longitudinal studies are needed to anticipate the relationship more accurately between sexual dysfunction and sexual beliefs at a larger sample size. Sexual beliefs are significant contributors to sexual dysfunction.
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Affiliation(s)
- Chaitanya Sheoran
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Nikhil Nayar
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Abhinit Kumar
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Kunal Kumar
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Shruti Sharma
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Nikita Maan
- Department of Psychiatry, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
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Chyou TE, Ou H, Huang SY. Clozapine-Associated Hypersexuality. Am J Ther 2024; 31:e52-e53. [PMID: 37184514 DOI: 10.1097/mjt.0000000000001638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Te-En Chyou
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsun Ou
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - San-Yuan Huang
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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Vijayalakshmi S, Rajagopal K, Govindan R, Ganjekar S, Prathyusha PV, Chacko LK. Sexual and reproductive health problems among women with mental illness attending tertiary care psychiatric outpatient clinic in India: A cross-sectional study. J Neurosci Rural Pract 2023; 14:644-649. [PMID: 38059232 PMCID: PMC10696317 DOI: 10.25259/jnrp_62_2023] [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: 02/06/2023] [Accepted: 06/29/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Sexual and reproductive health (SRH) is a vital concern among women with mental illness (WMI) due to the increased risk for unplanned pregnancy, sexually transmitted infections (STIs), and poor obstetric outcomes. Objective of the study was to explore the current use of family planning (FP) methods, symptoms of STIs and sexual dysfunction among WMI. Materials and Methods This descriptive study involved 404 WMI of reproductive age (18-49 years) attending tertiary care psychiatric outpatient clinics in India. During face-to-face interviews, centers for disease control and prevention (CDC)-reproductive health assessment toolkit-FP questionnaire, STI questionnaire and Female sexual function index (FSFI) were used to collect the data. Results Of 404 WMI, 261(64.6%) were users, and 137 (33.9%) were non-users of FP methods. About 6(1.5%) WMI did not respond FP methods question. Female sterilization was the highest among the users, 244(93%). Among non-users, 100 (73%) were unaware of choosing the effective method of FP. Most of the WMI, 377(93.3%), were unaware of STIs. The symptoms of STI reported include unusual genital discharge 62(15.3%) and genital ulcers/ sores 58(14.4 %). Most of them, 76(63.3%), were not on any treatment. The most common reason for not taking treatment was feeling ashamed 70(92.1%). Female sexual dysfunction was reported in 176(43.6%). Most of the WMI had difficulties in the arousal domain 288(71.3%), followed by low desire 233(57.7%) and dissatisfaction 186(46%). Conclusion Most WMI underwent sterilization. Non-users of FP methods were not aware of choosing the effective method. Awareness about STIs was poor, and feeling ashamed was the primary reason for not availing of medical help. Nearly half of the WMI reported sexual dysfunction, among which arousal difficulties, low desire and dissatisfaction were common. Health professionals need to increase awareness about FP methods and symptoms of STIs among WMIs. Women require appropriate counselling regarding SRH and treatment for sexual dysfunction.
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Affiliation(s)
- Sundaram Vijayalakshmi
- College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Kaipangala Rajagopal
- Department of Obstetrics and Gynaecology, Kanachur Institute of Medical Science, Mangaluru, Karnataka, India
| | - Radhakrishnan Govindan
- Department of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sundarnag Ganjekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - P. V. Prathyusha
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Leena Kunnath Chacko
- Department of Community Health Nursing, Yenepoya Nursing College, Yenepoya Deemed to be University, Mangaluru, Karnataka, India
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Angelaki M, Alexiou E, Igoumenou A, Alevizopoulos G. Frequency of sexual dysfunction in outpatients with severe mental illness in Greece. Front Psychiatry 2023; 14:1227218. [PMID: 37720899 PMCID: PMC10503055 DOI: 10.3389/fpsyt.2023.1227218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/14/2023] [Indexed: 09/19/2023] Open
Abstract
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.
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Affiliation(s)
- Maria Angelaki
- Department of Education, 251 Hellenic Air Force Hospital, Athens, Greece
| | - Eirini Alexiou
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Ethics, Law, and Mental Health (CELAM), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Artemis Igoumenou
- Division of Psychiatry, University College London, London, United Kingdom
| | - Giorgos Alevizopoulos
- Department of Psychiatry, Agioi Anargyroi Hospital, Faculty of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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Barker LC, Vigod SN, Hussain Z, France J, Rodriguez A, Lubotzky-Gete S, Berkhout S, Dmytryshyn R, Dunn S, Gupta R, Hosseiny F, Sirotich F, Soklaridis S, Voineskos A, Zaheer J. Sexual health experiences of women and non-binary people with early psychosis: qualitative study. BJPsych Open 2023; 9:e146. [PMID: 37551106 PMCID: PMC10594085 DOI: 10.1192/bjo.2023.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Women and gender-diverse people with early psychosis are at risk for suboptimal sexual health outcomes, yet little research has explored their sexual health experiences. AIMS This study explored sexual health experiences and related priorities among women and gender-diverse people with early psychosis, to identify opportunities for improvements in sexual health and well-being. METHOD Semi-structured individual qualitative interviews explored how patient participants (n = 19, aged 18-31 years, cisgender and transgender women and non-binary individuals) receiving clinical care from early psychosis programmes in Ontario, Canada, experienced their sexual health, including sexual function and behaviour. Thematic analysis was conducted, with triangulation from interviews/focus groups with clinicians (n = 36) who provide sexual and mental healthcare for this population. RESULTS Three key themes were identified based on patient interviews: theme 1 was the impact of psychotic illness and its treatments on sexual function and activity, including variable changes in sex drive, attitudes and behaviours during acute psychosis, vulnerability to trauma and medications; theme 2 related to intimacy and sexual relationships in the context of psychosis, with bidirectional effects between relationships and mental health; and theme 3 comprised autonomy, identity and intersectional considerations, including gender, sexuality, culture and religion, which interplay with psychosis and sexual health. Clinicians raised each of these priority areas, but emphasised risk prevention relative to patients' more holistic view of their sexual health and well-being. CONCLUSIONS Women and non-binary people with early psychosis have wide-ranging sexual health priorities, affecting many facets of their lives. Clinical care should incorporate this knowledge to optimise sexual health and well-being in this population.
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Affiliation(s)
- Lucy C. Barker
- Department of Psychiatry, Women's College Hospital, Canada; Department of Psychiatry, University of Toronto, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Simone N. Vigod
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Zakia Hussain
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
| | - Julia France
- Department of Psychiatry, Women's College Hospital, Toronto, Canada
| | - Ananka Rodriguez
- Slaight Centre Early Intervention Service, Centre for Addiction and Mental Health, Toronto, Canada
| | | | - Suze Berkhout
- Department of Psychiatry, University of Toronto, Canada; and Department of Psychiatry, University Health Network, Toronto, Canada
| | - Robert Dmytryshyn
- Family Practice Health Centre, Women's College Hospital, Toronto, Canada; and Department of Family and Community Medicine, University of Toronto, Canada
| | - Sheila Dunn
- Family Practice Health Centre, Women's College Hospital, Toronto, Canada; and Department of Family and Community Medicine, University of Toronto, Canada
| | - Renu Gupta
- Department of Psychiatry, Women's College Hospital, Toronto, Canada; and Department of Psychiatry, University of Toronto, Canada
| | - Fardous Hosseiny
- Canadian Mental Health Association, Toronto, Canada; Atlas Institute for Veterans and Families, Ottawa, Canada; and University of Ottawa Institute of Mental Health Research at The Royal, Ottawa, Canada
| | - Frank Sirotich
- Canadian Mental Health Association, Toronto, Canada; and Factor-Inwentash Faculty of Social Work, University of Toronto, Canada
| | - Sophie Soklaridis
- Department of Psychiatry, University of Toronto, Canada; Department of Family and Community Medicine, University of Toronto, Canada; and Education, Centre for Addiction and Mental Health, Toronto, Canada
| | - Aristotle Voineskos
- Department of Psychiatry, University of Toronto, Canada; and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Juveria Zaheer
- Department of Psychiatry, University of Toronto, Canada; and Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Canada
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Vickers ML, Choi YK, Eriksson L, Polyakova-Nelson Y, Jokovic Z, Parker SD, Moudgil V, Dean JA, Debattista J, Scott JG. Sexual and Reproductive Health in Adolescents and Young Adults With Psychotic Disorders: A Scoping Review. Schizophr Bull 2023; 49:108-135. [PMID: 36065153 PMCID: PMC9810019 DOI: 10.1093/schbul/sbac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND HYPOTHESIS The sexual and reproductive health (SRH) of young people with psychosis has been largely overlooked. We hypothesised that there are key deficiencies in the existing literature on the SRH of adolescents and young adults with psychotic disorders. STUDY DESIGN We conducted a systematic scoping review using Pubmed, Web of Science, Embase, PsycINFO, and CINAHL. We included empirical studies and case reports focused on SRH issues in young people (aged 14-24 years) with psychotic disorders. A qualitative synthesis was completed. Joanna Briggs Institute Critical Appraisal Tools were utilized to assess study quality. STUDY RESULTS Seventeen empirical studies and 52 case reports met inclusion criteria. Most focused on sexual dysfunction which was identified as common among this cohort and associated with both psychotic disorders and antipsychotics. The study population was more likely to engage in sexual risk-taking behavior and was at higher risk of sexually transmissible infections than those without psychosis. SRH topics of clinical relevance in older patients with psychosis such as pregnancy, abortion, sexual violence, coercion, sexual identity, and gender were poorly addressed in this younger group. We found empirical studies generally lacked identification and controlling of confounders whilst case reports provided limited description of mental health and SRH outcomes following clinical intervention. CONCLUSION Research and clinical practice addressing sexual and reproductive health is needed for young people living with psychosis. To address research gaps future studies should focus on women's health, sexual violence, gender, and sexuality in young people with psychosis.
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Affiliation(s)
- Mark L Vickers
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Faculty of Health, Queensland University of Technology, Brisbane, Australia
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Yoon Kwon Choi
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Lars Eriksson
- Herston Health Sciences Library, University of Queensland, Brisbane, Australia
| | | | - Zorica Jokovic
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Stephen D Parker
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Vikas Moudgil
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro North Mental Health Service, Herston, Brisbane, Australia
| | - Judith A Dean
- School of Public Health, University of Queensland, Brisbane, Australia
| | - Joseph Debattista
- Metro North Public Health Unit, Metro North Hospital and Health Service, Brisbane, Australia
| | - James G Scott
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Metro North Mental Health Service, Herston, Brisbane, Australia
- QIMR Berghofer, Medical Research Institute, Brisbane, Australia
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7
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Brand E, Tham C, Ratsch A, Heffernan E. Sexual knowledge of Queensland forensic mental health patients: A cross-sectional quantitative study. Front Psychiatry 2023; 14:1160277. [PMID: 37113546 PMCID: PMC10126372 DOI: 10.3389/fpsyt.2023.1160277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/29/2023] Open
Abstract
Forensic patients with serious mental illnesses (SMI) encounter significant challenges including active symptomatology, associated social and interpersonal impairments, psychotropic medication side effects and institutionalization, all of which negatively affect sexual functioning and possibly their acquirement of sexual knowledge. Evidence shows an increased prevalence of high-risk sexual behavior by this group however, there is an absence of literature examining the sexual knowledge of forensic patients. This quantitative cross-sectional study enrolled N = 50 patients currently under the treatment requirements of a Forensic Order and utilized the validated General Sexual Knowledge Questionnaire (GSKQ) to quantify the participants' sexual knowledge over the domains of physiology, sexual intercourse, pregnancy, contraception, sexually transmitted diseases, and sexuality. Male forensic patients scored lower than females on all domains of sexual knowledge. All participants had reasonable knowledge of physiology, sexual intercourse and sexuality; of concern were poor scores on pregnancy, contraception and sexually transmitted diseases. Thirty-five (70%) of the respondents indicated that they had some limited sex education, mostly at school. Only six (12%) received any sexual education from a health professional despite extensive contact with the forensic mental health services across many years. There is a need to assess the deficit in sexual knowledge of forensic patients in order to develop sexual health education, intervention and rehabilitative programmes that cater to the specific needs of this group to improve their sexual knowledge, encourage safe and positive sexual experiences, and enhance their quality of life.
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Affiliation(s)
- Elnike Brand
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- *Correspondence: Elnike Brand,
| | - Ching Tham
- Metro South Hospital and Health Services, Queensland Health, Brisbane, QLD, Australia
| | - Angela Ratsch
- Wide Bay Hospital and Health Service, Research Services, Hervey Bay Hospital, Hervey Bay, QLD, Australia
- Rural Clinical School, The University of Queensland, Brisbane, QLD, Australia
| | - Edward Heffernan
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Pehlivan N, Brown E, Sanchez AYA, McMillan F, Moore D, Bhaduri A, Monson K, Badcock P, Thompson K, Killackey E, Chanen A, O'Donoghue B. What impact does illness severity have on the sexual health of young people affected by mental health disorders? A comparison of inpatients and outpatients. Australas Psychiatry 2022; 30:705-711. [PMID: 33118366 DOI: 10.1177/1039856220960373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Young people affected by mental health disorders have greater sexual health needs compared to their peers. Less is known about this need across illness severity. METHOD A cross-sectional survey of the sexual health of those attending outpatients or inpatients within a youth mental health service was conducted. Statistical differences between groups were explored. RESULTS One hundred and seven young people (18-25 years) participated and of these, 37.7% were inpatients who had more severe psychiatric symptoms than outpatients. While inpatients were as likely to be sexually active as outpatients, they were significantly less likely to have a regular sexual partner (25% vs 64.5%). Additionally, they used amphetamines more frequently during sex (28.6% vs 5.8%). Sexual dysfunction was experienced by 55.6% of inpatients and 37.9% of outpatients. CONCLUSIONS High-risk sexual behaviours and sexual dysfunction were highly prevalent in both groups. For some behaviours and dysfunction, this prevalence was higher in the inpatient population. Holistic clinical services that address the mental, physical and sexual health needs of consumers are needed both within inpatient and outpatient settings.
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Affiliation(s)
| | - Ellie Brown
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | | | | | - Danielle Moore
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | | | | | - Paul Badcock
- Centre for Youth Mental Health, University of Melbourne, Australia
| | | | - Eoin Killackey
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Andrew Chanen
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, Australia; and Centre for Youth Mental Health, University of Melbourne, Australia
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Thatikonda NS, Ram D, Rao TSS, Thatikonda PS. Sexual Dysfunction in Women with Nonpsychotic Disorders: A Cross-sectional Hospital-based Study. Indian J Psychol Med 2022; 44:445-451. [PMID: 36157021 PMCID: PMC9460010 DOI: 10.1177/02537176211057399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Sexual dysfunction among female psychiatric patients is zcommon and can be affected by various bio-psycho-social factors. The clinician's or patient's reluctance to actively inquire or spontaneously report these sexual difficulties creates a lacuna in our understanding of this association. This study aimed to assess the proportion of women with nonpsychotic psychiatric disorders reporting sexual dysfunction and evaluate its association with sociodemographic and clinical variables. METHODS This cross-sectional study conducted over six months included 113 women attending the psychiatry outpatient department of a tertiary care hospital. Sociodemographic and clinical variables, including diagnosis based on International Classification of Diseases 10th version (ICD 10) criteria, were assessed using a specially designed proforma. Sexual functioning was measured by Female Sexual Functioning Index (FSFI) and the Change in Sexual Functioning Questionnaire-Female Version (CSFQ-FV). RESULTS Sexual dysfunction was reported by 67.3% of patients. Among patients on psychotropics, 49% reported worsening of sexual dysfunction after treatment initiation. Sexual dysfunction was associated with increasing age (χ2 = 7.86, P = 0.04), lower educational qualification (χ2 =3.41, P = 0.04), skilled occupation (χ2 = 4.49, P = 0.03), lower socioeconomic status (χ2 = 4.27, P = 0.03) and presence of ongoing psychosocial stressor (χ2 = 4.49, P = 0.03). CONCLUSIONS Difficulties in different domains of sexual functioning are prevalent among women with nonpsychotic disorders. Sociodemographic and relational factors, along with treatment status, can influence sexual dysfunction in these patients. Clinicians should be vigilant of this association and should plan treatment to enhance compliance and outcome.
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Affiliation(s)
| | - Dushad Ram
- Dept. of Psychiatry, College of Medicine, Shaqra University, Shaqra, Riyadh Province, Saudi Arabia
| | | | - Padma Sudhakar Thatikonda
- Dept. of Psychiatry, Apollo Institute of Medical Sciences and Research, Chittoor, Andhra Pradesh, India
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10
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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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11
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Jannini TB, Sansone A, Rossi R, Di Lorenzo G, Toscano M, Siracusano A, Jannini EA. Pharmacological strategies for sexual recovery in men undergoing antipsychotic treatment. Expert Opin Pharmacother 2022; 23:1065-1080. [PMID: 35470768 DOI: 10.1080/14656566.2022.2071124] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
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.
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Affiliation(s)
- Tommaso B Jannini
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Sansone
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio Di Lorenzo
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Alberto Siracusano
- Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Emmanuele A Jannini
- Chair of Endocrinology and Medical Sexology (ENDOSEX), Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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12
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Brand BA, Haveman YRA, de Beer F, de Boer JN, Dazzan P, Sommer IEC. Antipsychotic medication for women with schizophrenia spectrum disorders. Psychol Med 2022; 52:649-663. [PMID: 34763737 PMCID: PMC8961338 DOI: 10.1017/s0033291721004591] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/13/2021] [Accepted: 10/22/2021] [Indexed: 12/24/2022]
Abstract
There are significant differences between men and women in the efficacy and tolerability of antipsychotic drugs. Here, we provide a comprehensive overview of what is currently known about the pharmacokinetics and pharmacodynamics of antipsychotics in women with schizophrenia spectrum disorders (SSDs) and translate these insights into considerations for clinical practice. Slower drug absorption, metabolism and excretion in women all lead to higher plasma levels, which increase the risk for side-effects. Moreover, women reach higher dopamine receptor occupancy compared to men at similar serum levels, since oestrogens increase dopamine sensitivity. As current treatment guidelines are based on studies predominantly conducted in men, women are likely to be overmedicated by default. The risk of overmedicating generally increases when sex hormone levels are high (e.g. during ovulation and gestation), whereas higher doses may be required during low-hormonal phases (e.g. during menstruation and menopause). For premenopausal women, with the exceptions of quetiapine and lurasidone, doses of antipsychotics should be lower with largest adjustments required for olanzapine. Clinicians should be wary of side-effects that are particularly harmful in women, such as hyperprolactinaemia which can cause oestrogen deficiency and metabolic symptoms that may cause cardiovascular diseases. Given the protective effects of oestrogens on the course of SSD, oestrogen replacement therapy should be considered for postmenopausal patients, who are more vulnerable to side-effects and yet require higher dosages of most antipsychotics to reach similar efficacy. In conclusion, there is a need for tailored, female-specific prescription guidelines, which take into account adjustments required across different phases of life.
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Affiliation(s)
- Bodyl A. Brand
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Yudith R. A. Haveman
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Franciska de Beer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Janna N. de Boer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Paola Dazzan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Iris E. C. Sommer
- Department of Biomedical Sciences of Cells & Systems, Section Cognitive Neurosciences, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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13
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Sexual Habits and Sexual Dysfunctions in a Sample of Patients with Psychotic Disorders Compared to a Group of Healthy Adults. J Clin Med 2022; 11:jcm11030505. [PMID: 35159957 PMCID: PMC8836347 DOI: 10.3390/jcm11030505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Background: There is a growing body of literature on the association between psychosis and sexual dysfunction. However, most studies have focused on sexual dysfunction and have not investigated the sexual lives of patients with psychosis across a broader range. Material and Methods: Consecutive patients with a diagnosis of acute psychosis or schizophrenia were recruited to the study after obtaining informed consent (n = 46). In addition, healthy control subjects were recruited (n = 52). Sociodemographic and clinical data, psychopathology, and sexual functioning were assessed. Independent sample t-test to determine group differences was obtained. Results: In both the male and female groups, there are significant differences between psychotic individuals and healthy controls in several areas of their sexual functioning: the control group seemed to better perceive Couple sexuality, Self-eroticism, and overall appeared to have a higher Quality of sexual life; on the other hand, the group of patients with psychosis displayed higher scores in Sexual dysfunction. Conclusions: A poor sexual quality of life may be found in patients with psychotic disorders. Assessment of sexual function in these patients is necessary to identify and manage issues and provide support and help to patients in this important area of life.
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14
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Exploration dimensionnelle des interactions sexualité/handicap psychique. Exemple d’application dans le champ de la psychose schizophrénique. SEXOLOGIES 2022. [DOI: 10.1016/j.sexol.2021.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Chaudhury S, Dhamija S, Davis S, Gupta N, Mujawar S, Saldanha D. Prevalence of sexual dysfunction in women with schizophrenia: A prospective study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_917_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Soler F, Granados R, Arcos-Romero AI, Calvillo C, Álvarez-Muelas A, Sánchez-Fuentes MDM, Moyano N, Sierra JC. Association between Psychopathological Dimensions and Sexual Functioning/Sexual Arousal in Young Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073584. [PMID: 33808329 PMCID: PMC8038005 DOI: 10.3390/ijerph18073584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 12/11/2022]
Abstract
Psychological-psychiatric factors have a different effect on sexual functioning in men and women. This research aimed to examine the association between psychopathological dimensions and dimensions of sexual functioning in Spanish young adults in two studies. Study 1 examined sexual functioning and psychopathological dimensions in 700 women and 516 men. Study 2 conducted an experimental laboratory task to evaluate subjective sexual arousal and genital sensations when watching visual sexual stimuli in a subsample of participants from Study 1 (143 women and 123 men). As a result, the first study showed that depression and anxiety-related symptoms had a negative effect, both in men and women, and having a partner had a positive influence on the dimensions of sexual functioning. The second study showed that anxiety symptoms were positively associated with subjective sexual arousal in both men and women, and anxiety was associated with the assessment of genital sensations in men. The differences between the results of anxiety may be explained because sexual arousal was evaluated in general terms in Study 1, whereas it was evaluated as a state in Study 2. These findings confirm that the presence of psychopathological symptoms contributes to sexual functioning, as well as the necessity of strengthening mental illness prevention programs that include sexual health components.
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Affiliation(s)
- Franklin Soler
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia
- Correspondence:
| | - Reina Granados
- Facultad de Ciencias de la Salud, Universidad de Granada, 18016 Granada, Spain;
| | | | - Cristóbal Calvillo
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, 18011 Granada, Spain; (C.C.); (A.Á.-M.); (J.C.S.)
| | - Ana Álvarez-Muelas
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, 18011 Granada, Spain; (C.C.); (A.Á.-M.); (J.C.S.)
| | | | - Nieves Moyano
- Facultad de Humanidades y Ciencias de la Educación, Universidad de Jaén, 23071 Jaén, Spain;
| | - Juan Carlos Sierra
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, 18011 Granada, Spain; (C.C.); (A.Á.-M.); (J.C.S.)
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17
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Angelaki M, Galanis P, Igoumenou A, Alexiou E, Alevizopoulos G. Translation and Validation of the Greek Version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). Sex Med 2021; 9:100334. [PMID: 33722475 PMCID: PMC8240157 DOI: 10.1016/j.esxm.2021.100334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction Sexual dysfunction in patients with psychoses may be associated with the psychiatric illness itself (negative symptoms, such as apathy, and avolition), comorbid somatic health, psychosocial factors (stigmatization, discrimination), and the use of psychotropic drugs. In Greece, research into the study of antipsychotic-induced sexual dysfunction is not sufficient. Aim This study was conducted to translate and validate the Greek version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ) in a sample of patients receiving antipsychotic treatment. Methods A “forward-backward translation” method was applied. A pilot study was conducted with 15 outpatients with schizophrenia and bipolar disorder under antipsychotics treatment. Patients also completed the “Subjects’ Response to Antipsychotics (SRA)” questionnaire in order to assess the validity of the ASFQ. The ASFQ and the SRA questionnaire were completed twice within 2 weeks. Main outcome measures Reliability (internal consistency and test-retest) and validity were assessed. Results The Greek translation of ASFQ was reliable, with excellent internal consistency (Cronbach's a = 0.90 for men and 0.95 for women in both measurements). In addition, the Spearman correlation coefficient was 1 (P< .001) in all Likert-type questions in both assessments. Finally, Spearman correlation coefficients between ASFQ and SRA were moderately positive to strongly positive (between 0.25 and 1) in both assessments, demonstrating moderate to high validity. Conclusions The Greek version of the ASFQ has proved to be a reliable and valid clinical instrument, hence it can be used in further studies in the Greek population. Angelaki M, Galanis P, Igoumenou A, et al. Translation and Validation of the Greek Version of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). J Sex Med 2021;9:100334.
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Affiliation(s)
- Maria Angelaki
- Department of Education, 251 Hellenic Airforce Hospital, Athens, Greece; Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece.
| | - Petros Galanis
- Center for Health Services Management and Evaluation, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Eirini Alexiou
- Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden; Center for Ethics, Law, and Mental Health (CELAM), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Giorgos Alevizopoulos
- Department of Mental Health and Behavioral Sciences, Department of Nursing, National and Kapodistrian University of Athens, Athens, Greece
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18
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Vargas-Cáceres S, Cera N, Nobre P, Ramos-Quiroga JA. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021; 18:457-466. [PMID: 33504468 DOI: 10.1016/j.jsxm.2020.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 10/27/2020] [Accepted: 12/14/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Sexual dysfunction among psychotic patients is highly prevalent. However, most research has focused on antipsychotic side effects on sexual functioning. AIM To provide evidence by means of a systematic review of the literature about the impact of psychosis on sexual functioning among unmedicated patients. METHODS Systematic search of MEDLINE (PubMed), Scopus, and Google Scholar for studies that reported sexual functioning among psychotic patients, who were drug-naïve or drug-free for at least 3 weeks before the study. Studies were published in English language between January 1994 and October 2019. We used the approach recommended by PRISMA, and the selection process was carried out by 2 reviewers. OUTCOMES The outcome measures were sexual function and sexual dysfunctions. RESULTS A total of 734 articles were obtained, 658 were obtained after duplicates were removed, 612 were excluded after reading the title and abstract, and 46 were included for a complete review of the articles. 5 papers were finally included. A total of 770 cases were included in the systematic review. The prevalence of sexual dysfunction in psychosis varied from 16.8% to 70% and in ultra-high state was 50%. It is noteworthy that those ultra-high-risk (prodromal) patients who develop psychosis had higher rates of sexual impairment. Therefore, we found higher rates of sexual dysfunction among untreated patients, both psychotic and ultra-high risk patients, than healthy controls. CLINICAL IMPLICATIONS The assessment of sexual behavior should be a part of routine psychiatric examination not only in psychotic but also in ultra-high-risk patients. STRENGTHS & LIMITATIONS This is the first systematic review about the impact of psychosis on sexual functioning among unmedicated patients. However, scarce and heterogeneous studies were identified. CONCLUSIONS Impaired sexual functioning is common in the onset of psychosis (or during ultra-high-risk state) and prior to the beginning of treatment. This suggests that psychotic symptoms and sexual dysfunction may have common etiological pathways at the psychosocial and neurobiological levels. Vargas-Cáceres S, Cera N, Nobre P, et al. The Impact of Psychosis on Sexual Functioning: A Systematic Review. J Sex Med 2021;18:457-466.
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Affiliation(s)
| | - Nicoletta Cera
- CPUP. Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Pedro Nobre
- CPUP. Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - J Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addiction, Vall d'Hebron Research Institut, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Catalonia, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
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19
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Ciocca G, Jannini TB, Ribolsi M, Rossi R, Niolu C, Siracusano A, Jannini EA, Di Lorenzo G. Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature. Front Psychiatry 2021; 12:750033. [PMID: 34777053 PMCID: PMC8579023 DOI: 10.3389/fpsyt.2021.750033] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.
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Affiliation(s)
- Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Tommaso B Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Michele Ribolsi
- Unit of Neurology, Neurobiology, Neurophysiology and Psychiatry, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | - Rodolfo Rossi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS - Fondazione Santa Lucia, Rome, Italy
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20
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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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21
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Gaber HD, El-Beeh KAM, Abd Al-Naser FAZW, Hosny A. Erectile dysfunction in patients with first-episode psychosis. Andrologia 2020; 52:e13793. [PMID: 32833250 DOI: 10.1111/and.13793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/21/2020] [Accepted: 07/12/2020] [Indexed: 11/28/2022] Open
Abstract
Sexual dysfunction is more prevalent in psychotic patients than in the nonpsychotic population. The objective of this study was to identify correlations between serum prolactin levels, testosterone levels and erectile dysfunction in patients with first-episode psychosis (n = 40) compared to age-matched healthy controls (n = 40). All subjects underwent clinical evaluation, international index of erectile function (IIEF5) score assessment and measurement of serum prolactin and total testosterone levels. In first-episode psychotic patients, the IIEF-5 score and total testosterone levels were significantly lower, while serum prolactin levels were higher. We concluded that men with first-episode psychosis are at an increased risk for development of erectile dysfunction, and increased duration of untreated psychosis leads to a higher incidence of erectile dysfunction and hyperprolactinemia.
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Affiliation(s)
- Hisham D Gaber
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Khalid A M El-Beeh
- Psychological & Neurological Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | | | - Ahmed Hosny
- Department of Dermatology and Andrology, Faculty of Medicine, Helwan University, Helwan, Egypt
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22
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Kazour F, Obeid S, Hallit S. Sexual desire and emotional reactivity in chronically hospitalized Lebanese patients with schizophrenia. Perspect Psychiatr Care 2020; 56:502-507. [PMID: 31750549 DOI: 10.1111/ppc.12455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/11/2019] [Accepted: 11/15/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To study the level of emotional reactivity of Lebanese patients with schizophrenia who have a high level of sexual desire. DESIGN/METHODS It is a cross-sectional study, enrolling 30 men and 30 women, between April and June 2017. The sexual behavior questionnaire (SBQ) was used to explore the desire, sexual arousal, orgasm, ejaculation, pleasure, and satisfaction with sexuality. FINDINGS A significantly higher mean emotional score, higher cognitive functioning score, higher motivation score, higher motor deficit score, higher sensory perception score, higher SBQ score, and higher emotional reactivity were found in patients who masturbate compared with those who did not. PRACTICE IMPLICATIONS All these improvements in patients who masturbate might be associated with better social relations, which might improve patient integration in society. KEY POINTS Sustained sexual activity of patients with schizophrenia is associated with improved emotional and cognitive functioning. The same applies to higher levels of motivation, motor skills, and sensoriality. Sustained sexual activity of patients who have schizophrenia would indicate a better prognosis of schizophrenia.
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Affiliation(s)
- Francois Kazour
- Departments of Psychiatry, Psychology and Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon.,INSERM U930, François Rabelais University, Tours, France
| | - Sahar Obeid
- Departments of Psychiatry, Psychology and Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.,Faculty of Arts and Science, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.,INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon
| | - Souheil Hallit
- INSPECT-LB: Institut National de Sante Publique, Epidemiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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23
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Del Cacho N, Vila-Badia R, Butjosa A, Cuadras D, Rubio-Abadal E, Rodriguez-Montes MJ, Muñoz-Samons D, Dolz M, Usall J. Sexual dysfunction in drug- naïve first episode nonaffective psychosis patients. Relationship with prolactin and psychotic symptoms. Gender differences. Psychiatry Res 2020; 289:112985. [PMID: 32438209 DOI: 10.1016/j.psychres.2020.112985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/01/2020] [Accepted: 04/01/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim is to examine differences in sexual functioning (SF) between patients with drug-naïve first episode psychosis (FEP) and healthy controls (HC). We will also examine correlations between prolactin levels, testosterone levels and psychotic symptomatology with SF from a gender perspective. METHODS Cross-sectional study. We included 68 FEP patients and 50 HC. A blood sample was extracted. We used the Positive and Negative Syndrome Scale to assess symptom severity, using the five factor structure according to Emsley. The Changes in Sexual Function Questionnaire (CSFQ) was administered. RESULTS We found significantly better SF in HC than in patients (in CSFQ total score (p = 0.032) and in CSFQ Desire (p = 0.032)). A significant correlation between prolactin or testosterone and SF was not observed. We found a negative significant correlation between the disorganised subscale of the EMSLEY and total CSFQ (p = 0.027; r = -0.329), CSFQ Desire (p = 0.028; r = -0.329) and CSFQ Arousal (p = 0.026; r = -0.332) in the patient sample. In a regression model, we found sex (p = 0.003) and disorganized symptoms (p = 0.034) as significant predictors. CONCLUSIONS We found evidence for better SF in HC than in FEP patients. We could not confirm an association between prolactin or testosterone and SF. Disorganized symptomatology could be a relevant factor in SF.
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Affiliation(s)
- N Del Cacho
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain; Universitat de Barcelona, Spain.
| | - R Vila-Badia
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - A Butjosa
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain; Hospital Materno- Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - D Cuadras
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - E Rubio-Abadal
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - M J Rodriguez-Montes
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - D Muñoz-Samons
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain; Hospital Materno- Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - M Dolz
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain; Hospital Materno- Infantil Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
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- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
| | - J Usall
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Catalonia, Spain; Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Catalonia, Spain
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Kantipudi SJ, Suresh N, Ayyadurai P, Ramanathan S. Sexual Dysfunction and Marital Relationship in Women With Schizophrenia in Comparison with Caregivers: A Hospital-based Study. JOURNAL OF PSYCHOSEXUAL HEALTH 2020. [DOI: 10.1177/2631831820918133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Sexual dysfunction is common in females with schizophrenia and is attributed to multiple causes, including individual psychopathology and antipsychotics. Understanding the impact of relationship satisfaction on sexual functioning is not widely studied in schizophrenia. Women caregivers also experience sexual problems and were not studied in the past. Aim: To assess the nature and occurrence of sexual dysfunction in women with schizophrenia in comparison to caregivers of males without severe mental disorder. Methods: A cross-sectional study was conducted. A total of 30 women with schizophrenia were recruited as cases and 26 age-matched controls were recruited from female caregivers. All subjects were assessed using standardized tools such as Female Sexual Function Index (FSFI) and Relationship Assessment Scale along with sociodemographic questionnaire. Results: There was a significant difference in FSFI scores and relationship scores between women with schizophrenia and caregiver control subjects. The relationship quality was better in patients with schizophrenia when compared to caregivers unlike sexual functioning. Conclusion: Sexual functioning in women is a complex phenomenon. A holistic biopsychosocial approach is necessary to understand women’s sexual function.
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Affiliation(s)
- Suvarna Jyothi Kantipudi
- Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Navina Suresh
- Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Poornima Ayyadurai
- Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
| | - Sathianathan Ramanathan
- Department of Psychiatry, Sri Ramachandra Institute of Higher Education and Research, Porur, Chennai, Tamil Nadu, India
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Zhao S, Wang X, Qiang X, Wang H, He J, Shen M, Zheng C, Kang R. Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. J Sex Med 2020; 17:1476-1488. [PMID: 32299716 DOI: 10.1016/j.jsxm.2020.03.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/17/2020] [Accepted: 03/10/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mounting clinical studies have reported patients with schizophrenia are at high risk of developing sexual dysfunction (SD), but a directly calculated prevalence of SD is currently lacking. AIM To further quantify the association between schizophrenia and SD. METHODS MEDLINE (PubMed), Embase (OVID), the Cochrane Library databases, and the PsycINFO were systematically searched for eligible studies reporting the sexual functioning in patients with schizophrenia. This meta-analysis has been registered on PROSPERO (ID: CRD42019121720, http://www.crd.york.ac.uk/PROSPERO). OUTCOMES The relationship between schizophrenia and SD was detected by calculating the relative risk (RR) with a 95% confidence interval (CI). The GRADE-profiler was employed to rank the quality of the evidence. RESULTS 10 observational studies (3 case-control studies and 7 cross-sectional studies) were finally included, enrolling a total of 3,570 participants (mean age 28.6-46.2 years), of whom 1,161 had schizophrenia and the remainders were the healthy control subjects. Synthetic results indicated that schizophrenia was significantly associated with an increased risk of SD regardless of gender (3 studies reporting both sexes: RR = 2.24, 95%CI: 1.66-3.03, P < .001, heterogeneity: I2 = 0.0%, P = .431; 7 studies reporting men: RR = 2.63, 95%CI: 1.68-4.13, P < .001, heterogeneity: I2 = 82.7%, P < .001; 5 studies reporting women: RR = 2.07, 95%CI: 1.46-2.94, P < .001; heterogeneity: I2 = 79.7%, P = .001). In accordance with the GRADE-profiler, the quality of the evidence of primary outcomes was LOW, MODERATE, and LOW in studies including both sexes, men, and women, respectively. CLINICAL IMPLICATIONS Our findings confirmed the potential link between schizophrenia and SD. Clinicians should routinely assess the sexual functioning for those patients with schizophrenia and further recommend the preferred antipsychotics for them. STRENGTHS & LIMITATIONS This is the first meta-analysis investigating the association between schizophrenia and the risks of SD in both sexes. Nonetheless, substantial heterogeneities were identified across the selected studies. CONCLUSION Robust data from this meta-analysis showed increased rates of SD in patients with schizophrenia compared with the general populations. Therefore, more specific psychological and pharmaceutical interventions are needed to help patients with schizophrenia gain a better sexual life. Zhao S, Wang X, Qiang X, et al. Is There an Association Between Schizophrenia and Sexual Dysfunction in Both Sexes? A Systematic Review and Meta-Analysis. J Sex Med 2020;17:1476-1488.
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Affiliation(s)
- Shankun Zhao
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Xiaolan Wang
- Reproductive Center of Medicine, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China
| | - Xie Qiang
- Department of Reproduction, Southern Medical University Affiliate Dongguan People's Hospital, Dongguan, China
| | - Hui Wang
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Jian He
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Maolei Shen
- Department of Urology, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Changjun Zheng
- Department of Orthopedics, Taizhou Central Hospital (Taizhou University Hospital), Taizhou, Zhejiang, China
| | - Ran Kang
- Department of Urology, The First Affiliated Hospital of University of South China, Hengyang, Hunan, China.
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Abdelatti SI, Ismail RM, Hamed RA. Sexual dysfunctions in a sample of male psychiatric patients compared to medically ill patients. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-020-00022-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Many of the psychiatric disorders and other medical conditions may affect the sexual function of the patients. The present study aims to investigate the frequency of sexual dysfunctions in male psychiatric patients compared to other medically ill patients.
Results
Sexual dysfunction among psychiatric patients (51.2%) was significantly higher than among other medical patients (21%). Among the psychiatric patients, those with schizophrenia (75%) had the highest prevalence rate of sexual dysfunctions. The patients with bipolar disorders, depressive disorders, and anxiety disorders had the following rates respectively: 55%, 45%, and 30%. Among the other medical patients, those with the cardiac diseases (35%) had the highest prevalence rate of sexual dysfunctions. The patients with hepatic diseases, diabetes, urologic diseases, and respiratory diseases had the following rates respectively: 25%, 20%, 15%, and 10%. Prolactin level among psychiatric patients was significantly higher than among the other medical patients, while there was no significant difference between the psychiatric and other medical patients regarding total testosterone level.
Conclusion
Considering the significant relative frequency of sexual dysfunctions in psychiatric patients, more emphasis is recommended to be placed on the prevention and proper treatment of these disorders.
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Barker LC, Vigod SN. Sexual health of women with schizophrenia: A review. Front Neuroendocrinol 2020; 57:100840. [PMID: 32298687 DOI: 10.1016/j.yfrne.2020.100840] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Women with schizophrenia experience low rates of sexual satisfaction and high rates of sexual dysfunction. They are at high risk for adverse sexual health outcomes including unplanned pregnancies, induced abortions, and human immunodeficiency virus (HIV), and face higher rates of sexual violence and various forms of intimate partner violence. This review explores the complex and intersecting biopsychosocial risk factors that explain these outcomes among women with schizophrenia, including factors related to the illness itself, antipsychotic medications, medical and psychiatric comorbidities, stigma, childhood trauma, and social determinants of health including poverty and housing instability. Sexual health interventions designed to help women with schizophrenia achieve pleasurable and safe sexual experiences, free of coercion, discrimination and violence are few and far between, suggesting opportunities for future development in this area.
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Affiliation(s)
- Lucy C Barker
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada
| | - Simone N Vigod
- Women's College Hospital and Research Institute, 76 Grenville St, Toronto, Ontario M5S 1B2, Canada; Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, Ontario M5T 1R8, Canada.
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Theleritis C, Bonaccorso S, Habib N, Stahl D, Gaughran F, Vitoratou S, Atakan Z, Kolliakou A, Gardner Sood P, Dazzan P, Marques T, McGuire P, Greenwood K, Eberhard J, Breedvelt J, Ferracuti S, Di Forti M, Murray R, Smith S. Sexual dysfunction and central obesity in patients with first episode psychosis. Eur Psychiatry 2020; 42:1-7. [DOI: 10.1016/j.eurpsy.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 12/18/2022] Open
Abstract
AbstractBackgroundIn recent years the association between sexual dysfunction (SD) and obesity in the general population has drawn major attention. Although sexual dysfunction is common in psychosis, its relationship with weight gain and obesity remains unclear.AimsTo investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis.MethodSexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist–hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients.ResultsA total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β = 0.36, P = 0.01), higher leptin levels (Std. β = 0.34, P = 0.02), higher waist–hip ratio (Std. β = 0.32, P = 0.04) and lower testosterone levels (Std. β = −0.44, P = 0.002). In contrast, in females, SFQ scores were not associated with any of these factors.ConclusionsWhile sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist–hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.
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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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Allen K, Baban A, Munjiza J, Pappa S. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. J Sex Med 2019; 16:1978-1987. [PMID: 31585803 DOI: 10.1016/j.jsxm.2019.08.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 08/17/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Sexual dysfunction is one of the most frequently occurring side-effects of antipsychotic medication, impacting both quality of life and adherence to treatment. Despite this, limited evidence-based guidance on treatment options is available. AIM To synthesize and analyze the evidence on management of antipsychotic-related sexual dysfunction, specifically taking note of the more recently developed antipsychotics that have been incorporated in studies over the past decade. METHODS EMBASE, Medline, and PsychINFO databases were searched using search terms related to sexual or erectile dysfunction, treatments, and antipsychotics. 2 reviewers independently assessed papers for the inclusion criteria for randomized controlled trials (RCTs) of treatments for antipsychotic-related sexual dysfunction, including adjunctive medications and a switch of antipsychotic. Studies were excluded if participants did not have recorded sexual dysfunction at baseline. MAIN OUTCOME MEASURE The primary outcome measure was any change in sexual function. RESULTS 6 RCTs were identified, all of which investigated different interventions; hence, it was not possible to synthesize the data quantitatively. Results were overall limited by small sample size, brief treatment duration, and the potential for bias. 2 studies, one assessing adjunctive sildenafil and the other adjunctive aripiprazole, reported a reduction in antipsychotic-related sexual dysfunction. CLINICAL IMPLICATIONS Due to the lack of high-quality data, no clinical recommendations can be made. STRENGTHS & LIMITATIONS A comprehensive search strategy was used with an extensive number of relevant search terms including "erectile dysfunction" and newer antipsychotics such as aripiprazole. In light of evidence that prolactin is not a reliable marker for sexual dysfunction, this review focused its inclusion criteria on participants presenting with sexual dysfunction rather than with hyperprolactinemia, which should give its recommendations more validity. However, only 6 RCTs were identified, and results were overall limited by small sample size, brief treatment duration, and the potential for bias. CONCLUSION Our findings highlight the paucity of high-quality research in this area, and conjecture that it may be difficult to recruit participants with antipsychotic-related sexual dysfunction. Future research may be necessary to unlock and address these difficulties. Furthermore, fully powered future studies should focus on the management of sexual dysfunction rather than the surrogate marker of hyperprolactinemia. Allen K, Baban A, Munjiza J, et al. Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review. J Sex Med 2019;16:1978-1987.
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Affiliation(s)
| | - Alan Baban
- Central and North West London NHS Foundation Trust, London, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK; Centre for Psychiatry, Faculty of Medicine, Imperial College London, London, UK
| | - Sofia Pappa
- West London NHS Trust, London, UK; Centre for Psychiatry, Faculty of Medicine, Imperial College London, London, UK
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Ravichandran D, Gopalakrishnan R, Kuruvilla A, Jacob KS. Sexual Dysfunction in Drug-Naïve or Drug-Free Male Patients with Psychosis: Prevalence and Risk Factors. Indian J Psychol Med 2019; 41:434-439. [PMID: 31548766 PMCID: PMC6753710 DOI: 10.4103/ijpsym.ijpsym_1_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 05/16/2019] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There is a growing body of literature on the high prevalence of sexual dysfunction in patients with psychotic disorders. However, most studies have focused on medication-related sexual side effects. MATERIAL AND METHODS Consecutive males with a diagnosis of acute psychosis or schizophrenia who were either drug-naïve or drug-free for six months were recruited to the study after obtaining informed consent. Sociodemographic and clinical data, psychopathology (using Positive and Negative Syndrome Scale), and sexual functioning (using The International Index of Erectile Functioning and DSM-IV TR criteria) were assessed. Bivariate and multivariate statistics were obtained. RESULTS One hundred males were recruited. The overall prevalence of sexual dysfunction by DSM IV-TR criteria in this population was 17%. The factors that were associated with sexual dysfunction were older age and later age of onset of illness. The rate was higher on excluding those who said that they were not sexually active (25%). CONCLUSIONS Sexual dysfunction may be found in patients with psychotic disorders even prior to commencing antipsychotic medications. It is possible that this is contributed to by several factors including the disease process. Assessment of sexual function in these patients will help in early identification and appropriate management.
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Affiliation(s)
- Dhananjayan Ravichandran
- Wide Bay Hospital and Health Service, Hervey Bay and Maryborough Hospitals, Queensland, Australia
| | | | - Anju Kuruvilla
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
| | - K S Jacob
- Department of Psychiatry, Christian Medical College, Vellore, Tamil Nadu, India
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Huang YH, Hou CL, Ng CH, Chen X, Wang QW, Huang ZH, Jia FJ. Sexual dysfunction in Chinese rural patients with schizophrenia. BMC Psychiatry 2019; 19:218. [PMID: 31299942 PMCID: PMC6624902 DOI: 10.1186/s12888-019-2205-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 07/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sexual dysfunction is common in patients with schizophrenia, however it is poorly studied in China, especially in primary health care institutions in rural areas. We investigated the prevalence of sexual dysfunction and its correlates including quality of life (QoL), in schizophrenia patients treated in primary care in a rural area in China. METHOD By using a random numbers table, 21 small town primary care service centers (from 63 totally) were selected in the study. Data of 720 community-dwelling patients with schizophrenia in rural area with diagnoses according to DSM -IV or ICD-10 were collected by interviews. Data on socio-demographic and clinical characteristics including sexual dysfunction and quality of life (QoL) were collected using a standardized protocol and data collection procedure. Data were analyzed using chi-square tests, t-tests, U-tests, ANCOVA and multiple logistic regression as appropriate by SPSS 21.0.The level of significance was set at 0.05 (two-tailed). RESULTS In this sample, sexual dysfunction was found in 71.3% of the whole sample, 82.7% of female patients and 64.5% of male patients. Multiple logistic regression analysis showed that older age (OR = 1.06, P<0.001, 95%CI: 1.04-1.09) and higher Brief Psychotic Rating Scale (negative domain) score (OR = 1.16, P = 0.01, 95%CI: 1.02-1.31) were significantly associated with sexual dysfunction. Contrary to previous findings, sexual dysfunction was not associated with quality of life after controlling for confounding variables. CONCLUSIONS More than 2/3 of schizophrenia patients living in a rural area complained of sexual dysfunction, which was associated with older age and more negative psychotic symptoms. Primary care physicians should pay attention to sexual dysfunction during the assessment and treatment of patients with schizophrenia in rural areas in China.
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Affiliation(s)
- Ying-Hua Huang
- Shantou University Medical College, Shantou, Guangdong Province China
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Cai-Lan Hou
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - C. H. Ng
- Department of Psychiatry, The University of Melbourne, Melbourne, Victoria Australia
| | - Xie Chen
- Shantou University Medical College, Shantou, Guangdong Province China
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Qian-Wen Wang
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
| | - Zhuo-Hui Huang
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong Province China
| | - Fu-Jun Jia
- Guangdong Provincial People’s Hospital, Guangdong Mental Health Center, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong Province China
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Düring SW, Nielsen MØ, Bak N, Glenthøj BY, Ebdrup BH. Sexual dysfunction and hyperprolactinemia in schizophrenia before and after six weeks of D 2/3 receptor blockade - An exploratory study. Psychiatry Res 2019; 274:58-65. [PMID: 30780063 DOI: 10.1016/j.psychres.2019.02.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/15/2019] [Accepted: 02/06/2019] [Indexed: 12/19/2022]
Abstract
Sexual side-effects along with antipsychotic treatment may be linked to hyperprolactinemia and dopamine D2 receptor blockade. High prevalence of sexual dysfunction in un-medicated patients challenges the notion of sexual dysfunction as merely a side-effect of antipsychotic medication. Sexual dysfunction was assessed in fifty-six initially antipsychotic-naïve patients with schizophrenia using the UKU (Udvalget for Kliniske Undersøgelser) questionnaire. Serum-prolactin was obtained before and after six weeks of D2/3 receptor blockade with amisulpride. At baseline 68% of patients reported one or more items of sexual dysfunction (males > females,), but the cumulative load of sexual dysfunction was similar in males and females. After 6 weeks treatment with amisulpride (mean dose 279 mg/day), 65% of patients reported one or more items of sexual dysfunctions (females > males). There was a significant sex*time interaction on mean sexual dysfunction load. All patients developed hyperprolactinaemia, and a significant effect of time and sex was found on s-prolactin (females > males). The results support that patients with schizophrenia report high levels of sexual dysfunction before antipsychotic exposure. After treatment, sexual side-effects were more frequent in females, coinciding with pronounced serum-prolactin increases. These findings suggest sex differences in sexual dysfunction before and after antipsychotic treatment.
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Affiliation(s)
- Signe W Düring
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Denmark
| | - Mette Ø Nielsen
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Denmark.
| | - Nikolaj Bak
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark
| | - Birte Y Glenthøj
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Denmark
| | - Bjørn H Ebdrup
- Center for Neuropsychiatric Schizophrenia Research (CNSR) & Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Denmark; University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Denmark
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Sexualité de la femme schizophrène en Tunisie : étude cas–témoins. SEXOLOGIES 2018. [DOI: 10.1016/j.sexol.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Sexual Expression and It's Determinants, in People Diagnosed with Psychotic Disorders. Community Ment Health J 2018; 54:1082-1088. [PMID: 29777331 DOI: 10.1007/s10597-018-0285-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 05/08/2018] [Indexed: 01/10/2023]
Abstract
This qualitative study aims to explore the difficulties people with a psychotic disorder have in sexual expression, and associated determinants. Twenty-eight semi-structured interviews were conducted and analyzed using the Grounded Theory method. Almost all participants experienced unfulfilled needs in sexual expression. These unfulfilled needs were associated with a range of factors, including antipsychotic medication, psychotic symptoms, sexual abuse, social skills and stigma, all of which may converge on a pathway involving (sexual) self-esteem. Further research is required to better understand the role of self-esteem in relation to sexual needs and expression in people with psychotic disorders.
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Trovão JN, Serefoglu EC. Neurobiology of male sexual dysfunctions in psychiatric disorders: the cases of depression, anxiety, mania and schizophrenia. Int J Impot Res 2018; 30:279-286. [PMID: 30228317 DOI: 10.1038/s41443-018-0077-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 08/16/2018] [Accepted: 09/03/2018] [Indexed: 01/09/2023]
Abstract
While the pathophysiology of several psychiatric disorders has become modestly elucidated in the last decade, comorbid sexual dysfunctions in such patients are frequently left apart from clinical and research interest. We aimed to address the malfunctioning neurocircuitry underlying sexual dysfunctions in depression, anxiety, schizophrenia and mania. We performed a comprehensive literature review, addressing any combination of the topics of "neurobiology"/"neural", "sexual"/"desire"/"arousal"/"orgasm"/"ejaculation" and "depression"/"anxiety"/"schizophrenia"/"mania"/"bipolar". Altered neurotransmitter levels or connectivity in patients are reported in sexual dysfunctions (either desire, arousal, orgasm and ejaculation) and main psychiatric disorders (depression, anxiety, mania and schizophrenia). Neuronal pathways responsible for the occurrence of sexual dysfunctions in psychiatric disorders can be figured out by overlap of their acknowledged pathophysiology. However, specific research in that group is scant, so future tailored studies are warranted to elucidate actual mechanisms.
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Affiliation(s)
- José Nuno Trovão
- Department of Psychiatry of Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
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Abstract
Antipsychotics acting as antagonists at dopamine D2 receptors concentrated in the striatum are the cornerstone of effective treatment of psychosis. Substantial progress in treating persons with schizophrenia could be achieved by the identification of biomarkers which reliably determine the lowest efficacious dose of antipsychotics. Prolactin levels have been considered a promising treatment-response biomarker due to dopamine’s regulation of serum prolactin levels through D2 receptors in the hypothalamic-pituitary pathway. Prolactin secretion in response antipsychotic administration is associated with the antipsychotics affinity for D2 receptors. This review assesses the available literature on the use of serum prolactin levels as an antipsychotic-response biomarker. Articles were identified through PubMed as well as the reference lists of full text articles available online. Relevant publications were summarized briefly to define the limitations and utility of serum prolactin levels as a tool for improving antipsychotic dosing. Serum prolactin levels in combination with prolactin-inducing potencies for each antipsychotic may help identify the lowest effective dose of antipsychotic medications. , In addition to the fact that prolactin secretion is dependent on serum antipsychotic levels and not brain levels, recent findings show that prolactin release is independent of the β-arrestin-2 pathway and GSK3β regulation, one branch of the pathway that has been implicated in antipsychotic efficacy. Therefore, serum prolactin is an indirect biomarker for treatment response. Further investigations are warranted to characterize prolactin-antipsychotic dose-response curves and systematically test the utility of measuring prolactin levels in patients to identify a person’s lowest efficacious dose.
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Affiliation(s)
- Judith M Gault
- Departments of Psychiatry, University of Colorado Denver, Anschutz Medical Campus, USA.,Departments of Neurosurgery, University of Colorado Denver, USA
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Esan O, Esan A. Sexual Dysfunction Among Patients With Schizophrenia in Southwest Nigeria. JOURNAL OF SEX & MARITAL THERAPY 2018; 44:657-666. [PMID: 29509076 DOI: 10.1080/0092623x.2018.1447055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Sexual functioning has received little attention as an important aspect of patient care for those suffering from schizophrenia. In Nigeria, cultural and religious factors often prevent patients from talking with their clinician about their sexual life. The aim of our study was to assess the frequency and nature of sexual dysfunction in patients with schizophrenia and assess the determinants of sexual dysfunction in such patients. Sexual dysfunction was assessed with the Arizona Sexual Experience Scale in 90 patients with schizophrenia. Demographic and clinical characteristics including quality of life, the severity of schizophrenia, and perceived stigma were recorded using a standardized protocol and data collection. The prevalence of sexual dysfunction was 36.7%. Higher scores on the negative subscale of the Positive and Negative Syndrome Scale (PANSS), the general subscale of the PANSS, the total scores on the PANSS, and a family history of mental illness were significantly associated with sexual dysfunction. The only significant predictor of sexual dysfunction was the severity of the negative subscale of the PANSS. This study highlights the high prevalence of sexual dysfunction among patients with schizophrenia. Efforts should be made to identify and address this problem.
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Affiliation(s)
- Oluyomi Esan
- a Department of Psychiatry , University of Ibadan, University College Hospital , Ibadan , Nigeria
| | - Arinola Esan
- b Department of Medicine , University College Hospital , Ibadan , Nigeria
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Montejo AL, Montejo L, Baldwin DS. The impact of severe mental disorders and psychotropic medications on sexual health and its implications for clinical management. World Psychiatry 2018; 17:3-11. [PMID: 29352532 PMCID: PMC5775119 DOI: 10.1002/wps.20509] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Sexual dysfunction often accompanies severe psychiatric illness and can be due to both the mental disorder itself and the use of psychotropic treatments. Many sexual symptoms resolve as the mental state improves, but treatment-related sexual adverse events tend to persist over time, and are unfortunately under-recognized by clinicians and scarcely investigated in clinical trials. Treatment-emergent sexual dysfunction adversely affects quality of life and may contribute to reduce treatment adherence. There are important differences between the various compounds in the incidence of adverse sexual effects, associated with differences in mechanisms of action. Antidepressants with a predominantly serotonergic activity, antipsychotics likely to induce hyperprolactinaemia, and mood stabilizers with hormonal effects are often linked to moderate or severe sexual dysfunction, including decreased libido, delayed orgasm, anorgasmia, and sexual arousal difficulties. Severe mental disorders can interfere with sexual function and satisfaction, while patients wish to preserve a previously satisfactory sexual activity. In many patients, a lack of intimate relationships and chronic deterioration in mental and physical health can be accompanied by either a poor sexual life or a more frequent risky sexual behaviour than in the general population. Here we describe the influence of psychosis and antipsychotic medications, of depression and antidepressant drugs, and of bipolar disorder and mood stabilizers on sexual health, and the optimal management of patients with severe psychiatric illness and sexual dysfunction.
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Affiliation(s)
- Angel L Montejo
- Department of Nursing and Institute of Biomedicine of Salamanca, Neurosciences Area, University Hospital of Salamanca, Salamanca, Spain
| | - Laura Montejo
- Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Basson R, Gilks T. Women's sexual dysfunction associated with psychiatric disorders and their treatment. WOMEN'S HEALTH (LONDON, ENGLAND) 2018; 14:1745506518762664. [PMID: 29649948 PMCID: PMC5900810 DOI: 10.1177/1745506518762664] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/08/2017] [Accepted: 01/28/2018] [Indexed: 12/13/2022]
Abstract
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.
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Affiliation(s)
| | - Thea Gilks
- The University of British Columbia, Vancouver, BC, Canada
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Ciocca G, Ochoa S, Jannini EA. Epidemiology of Sexual Dysfunctions in Persons Suffering from Psychiatric Disorders. TRENDS IN ANDROLOGY AND SEXUAL MEDICINE 2018. [DOI: 10.1007/978-3-319-68306-5_4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Sexual dysfunctions in drug-naive male patients with first-episode schizophrenia. MIDDLE EAST CURRENT PSYCHIATRY 2017. [DOI: 10.1097/01.xme.0000520063.00808.3d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Krüger THC, Egli M, Leeners B. Prolaktin und Sexualität. GYNAKOLOGISCHE ENDOKRINOLOGIE 2017. [DOI: 10.1007/s10304-017-0147-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Gopal S, Lane R, Nuamah I, Copenhaver M, Singh J, Hough D, Bach M, Savitz A. Evaluation of Potentially Prolactin-Related Adverse Events and Sexual Maturation in Adolescents with Schizophrenia Treated with Paliperidone Extended-Release (ER) for 2 Years: A Post Hoc Analysis of an Open-Label Multicenter Study. CNS Drugs 2017; 31:797-808. [PMID: 28660406 DOI: 10.1007/s40263-017-0437-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Elevated prolactin levels (hyperprolactinemia) are a frequent adverse effect of antipsychotic medications, especially in young populations. Prolonged hyperprolactinemia may affect sexual functioning and the onset and progression of puberty. OBJECTIVE This study assessed potentially prolactin-related treatment-emergent adverse events (PPRL-TEAEs) and sexual maturation during long-term treatment of adolescents with paliperidone extended-release (ER). METHODS This post hoc analysis of a 2-year open-label multicenter study (NCT00488319) included patients of either sex aged 12-17 years at study enrollment, diagnosed with schizophrenia (Diagnostic and Statistical Manual of Mental Disorders, 4th edition [DSM-IV]) for ≥1 year, who had received one or more adequate antipsychotic treatment prior to enrollment but had not responded sufficiently. Patients were initially treated with 6 mg/day paliperidone ER and further titrated between 1.5 and 12 mg/day based on clinical response and tolerability. The primary objective was to determine the relationship between characteristics (including sex, age at study entry, ethnicity, geographic region, age at diagnosis, duration of illness, number of prior hospitalizations, serum prolactin, and baseline Tanner stages) and onset or risk of PPRL-TEAEs. The secondary objective was to assess sexual maturation during long-term treatment with paliperidone ER. RESULTS In total, 400 patients were enrolled in the study and 184 patients completed the 2-year study; the majority were boys (61%), White (66%), and aged >14 years at study enrolment (73%) with mean (standard deviation [SD]) body mass index (BMI) of 21.96 (4.375) kg/m2 at baseline. Girls (18.5%) had a higher incidence of PPRL-TEAEs than did boys (3.3%). Most of these events were mild to moderate in severity, and none were serious; four patients discontinued the study due to PPRL-TEAEs. Mean prolactin levels in the total population of boys and girls increased early during treatment then stabilized with time. Mean ± SD maximum changes in prolactin levels from baseline were higher in girls and boys with PPRL-TEAEs than in those without (Girls: 74.7 ± 32.3 ng/ml [n = 28] vs. 50.5 ± 44.9 ng/ml [n = 114]; p = 0.008. Boys: 33.6 ± 23.7 ng/ml [n = 8] vs. 31.0 ± 24.5 ng/ml [n = 205]; p = 0.77). No clinically significant mean changes from baseline in growth-adjusted z-score for weight, height, or BMI were observed. Overall, ~90% of the patients who completed the 2-year study achieved Tanner stages 4-5 by study endpoint. Female sex, age at diagnosis (13-14 years), girls of Hispanic ethnicity, and region (EU and North America) were associated with a greater risk for PPRL-TEAEs; higher baseline Tanner stages for pubic hair (boys and girls) and breast development (stage 3 vs. 4 or 5) also seemed to be associated with a higher incidence of PPRL-TEAEs. CONCLUSIONS Female sex appeared to be associated with an increased risk for PPRL-TEAEs. Other potential predictors, such as ethnicity, region, age at diagnosis, and Tanner stage 4 or 5, all seemed to be related to sex. Evidence from this study was insufficient to definitively conclude that prolactin values at baseline and change during treatment were predictive of PPRL-TEAEs, although there is a signal that this may be the case in girls. These results are exploratory in nature, and confirmatory studies are needed to confirm these observations. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT00488319.
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Affiliation(s)
- Srihari Gopal
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA.
| | - Rosanne Lane
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Isaac Nuamah
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Margaret Copenhaver
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | | | - David Hough
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
| | - Mark Bach
- Janssen Pharmaceutical KK, Tokyo, Japan
| | - Adam Savitz
- Neurosciences, Janssen Research & Development, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, USA
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McMillan E, Adan Sanchez A, Bhaduri A, Pehlivan N, Monson K, Badcock P, Thompson K, Killackey E, Chanen A, O'Donoghue B. Sexual functioning and experiences in young people affected by mental health disorders. Psychiatry Res 2017; 253:249-255. [PMID: 28395230 DOI: 10.1016/j.psychres.2017.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/10/2017] [Accepted: 04/02/2017] [Indexed: 10/19/2022]
Abstract
The majority of mental disorders have their onset in late adolescence and early adulthood and this coincides with important stages of sexual development. Although sexual dysfunction is highly prevalent among people with mental health disorders, little is known about this topic among youth. This study aimed to evaluate the sexual functioning and subjective experience of sex in young people aged between 15 and 26 years attending a youth mental health service. One hundred and three participants were assessed with the Sexual Health Questionnaire, Sexual Functioning Questionnaire, Brief Psychiatric Rating Scale, Scale for the Assessment of Negative Symptoms and the Medication Adherence Rating Scale. There were 43 males, 52 females, and 8 transgender and gender diverse participants with a range of mental health disorders. Eighty (77.7%) had experienced consensual sexual intercourse. Ninety-nine (95.8%) endorsed at least one item of sexual dysfunction and clinical sexual dysfunction was present in 37 (38.9%) cases. Sexual dysfunction was associated with greater severity of general psychopathology, negative symptoms, antipsychotic use, lower antipsychotic medication adherence, and negative subjective experiences around sex. Addressing this sexual dysfunction in young people could lead to both an improvement in subjective experiences of sexual relationships and potentially improvement in adherence to treatment.
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Affiliation(s)
- Elizabeth McMillan
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Asiel Adan Sanchez
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Amit Bhaduri
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
| | | | | | - Paul Badcock
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Katherine Thompson
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Andrew Chanen
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, the National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Orygen Youth Health, Parkville, Melbourne, Australia
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46
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Berner M. [Sexual dysfunction associated with psychotropic drugs and treatment options]. DER NERVENARZT 2017; 88:459-465. [PMID: 28321467 DOI: 10.1007/s00115-017-0307-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Sexual dysfunction associated with psychotropic drugs is a threat to patient quality of life and a major reason for non-compliance. Psychotropic agents can impair the sexual response in different ways due to their neurobiological mode of action. OBJECTIVE Presentation of the frequencies of sexual functional disorders for selected psychopharmacological groups and the available treatment modalities. METHODS Literature search, selection and review of relevant studies. RESULTS The most relevant groups for impairments are antidepressants and antipsychotics due to the serotonin agonistic and anti-dopaminergic properties as well as the prolactin increasing characteristics. Agents with a favorable side effects profile are now available. All phases of the sexual response are affected. DISCUSSION The treatment of psychiatric disorders should follow a comprehensive treatment plan that anticipates a likely sexual dysfunction at the initiation of treatment. The main aim is improvement of the underlying primary disorder. Some limited evidence-based treatment strategies are available.
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Affiliation(s)
- M Berner
- Klinik für Psychiatrie und Psychotherapeutische Medizin, Städtisches Klinikum Karlsruhe, Kaiserallee 10, 76133, Karlsruhe, Deutschland. .,Medizinische Fakultät, Albert-Ludwigs-Universität, Breisacher Str. 153, 79110, Freiburg, Deutschland.
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47
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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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Kopeykina I, Kim HJ, Khatun T, Boland J, Haeri S, Cohen LJ, Galynker II. Hypersexuality and couple relationships in bipolar disorder: A review. J Affect Disord 2016; 195:1-14. [PMID: 26851616 DOI: 10.1016/j.jad.2016.01.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 01/23/2023]
Abstract
BACKGROUND Although change in sexual behavior is recognized as an integral part of bipolar disorder, most of the relevant literature on sexual issues in patients with this illness concerns medication side effects and does not differentiate bipolar disorder from other serious mental disorders. Surprisingly, little has been published on mania-induced hypersexuality and the effects of mood cycling on couple relationships. In this review, we examine the extant literature on both of these subjects and propose a framework for future research. METHODS A search of PsycINFO and PubMed was conducted using keywords pertaining to bipolar disorder, hypersexuality and couple relationships. A total of 27 articles were selected for review. RESULTS Despite lack of uniformity in diagnosis of bipolar disorder and no formal definition of hypersexuality, the literature points to an increased incidence of risky sexual behaviors in bipolar patients during manic episodes compared to patients with other psychiatric diagnoses. Further, it appears that bipolar patients are more similar to healthy controls than to other psychiatric patients when it comes to establishing and maintaining couple relationships. Nonetheless, the studies that examined sexuality in couples with one bipolar partner found decreased levels of sexual satisfaction associated with the diagnosis, varying levels of sexual interest across polarities, increased incidence of sexual dysfunction during depressive episodes, and disparate levels of satisfaction in general between patients and their partners. LIMITATIONS Due to changes in diagnostic criteria over time, there is a lack of uniformity in the definition of bipolar disorder across studies. Hypersexuality is not systematically defined and therefore the construct was not consistent across studies. Some of the older articles date back more than 30 years, making them subject to the biases of sexual and gender norms that have since become outdated. Finally, the heterogeneity of the samples, which include patients with comorbid substance use as well as inpatient, outpatient, symptomatic and euthymic patients, may limit the generalizability of results. CONCLUSIONS Although bipolar patients experience disease-specific sexual problems of mania-induced hypersexuality and specific effects of mood cycling on couple relationships, the existing literature is mostly outdated and lacks a consistent definition of hypersexuality. Novel research is needed to address sexual symptomatology in bipolar disorder within the context of current sexual, cultural and gender norms.
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Affiliation(s)
- Irina Kopeykina
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Hae-Joon Kim
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Tasnia Khatun
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Jennifer Boland
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Sophia Haeri
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Lisa J Cohen
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
| | - Igor I Galynker
- Mount Sinai Beth Israel Medical Center Department of Psychiatry and Behavioral Sciences 317 East 17th Street, New York, NY 10003 USA.
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Malt EA, Juhasz K, Malt UF, Naumann T. A Role for the Transcription Factor Nk2 Homeobox 1 in Schizophrenia: Convergent Evidence from Animal and Human Studies. Front Behav Neurosci 2016; 10:59. [PMID: 27064909 PMCID: PMC4811959 DOI: 10.3389/fnbeh.2016.00059] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/11/2016] [Indexed: 12/22/2022] Open
Abstract
Schizophrenia is a highly heritable disorder with diverse mental and somatic symptoms. The molecular mechanisms leading from genes to disease pathology in schizophrenia remain largely unknown. Genome-wide association studies (GWASs) have shown that common single-nucleotide polymorphisms associated with specific diseases are enriched in the recognition sequences of transcription factors that regulate physiological processes relevant to the disease. We have used a “bottom-up” approach and tracked a developmental trajectory from embryology to physiological processes and behavior and recognized that the transcription factor NK2 homeobox 1 (NKX2-1) possesses properties of particular interest for schizophrenia. NKX2-1 is selectively expressed from prenatal development to adulthood in the brain, thyroid gland, parathyroid gland, lungs, skin, and enteric ganglia, and has key functions at the interface of the brain, the endocrine-, and the immune system. In the developing brain, NKX2-1-expressing progenitor cells differentiate into distinct subclasses of forebrain GABAergic and cholinergic neurons, astrocytes, and oligodendrocytes. The transcription factor is highly expressed in mature limbic circuits related to context-dependent goal-directed patterns of behavior, social interaction and reproduction, fear responses, responses to light, and other homeostatic processes. It is essential for development and mature function of the thyroid gland and the respiratory system, and is involved in calcium metabolism and immune responses. NKX2-1 interacts with a number of genes identified as susceptibility genes for schizophrenia. We suggest that NKX2-1 may lie at the core of several dose dependent pathways that are dysregulated in schizophrenia. We correlate the symptoms seen in schizophrenia with the temporal and spatial activities of NKX2-1 in order to highlight promising future research areas.
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Affiliation(s)
- Eva A Malt
- Department of Adult Habilitation, Akershus University HospitalLørenskog, Norway; Institute of Clinical Medicine, Ahus Campus University of OsloOslo, Norway
| | - Katalin Juhasz
- Department of Adult Habilitation, Akershus University Hospital Lørenskog, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of OsloOslo, Norway; Department of Research and Education, Institution of Oslo University HospitalOslo, Norway
| | - Thomas Naumann
- Centre of Anatomy, Institute of Cell Biology and Neurobiology, Charite Universitätsmedizin Berlin Berlin, Germany
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Chen CY, Yeh YW, Kuo SC, Ho PS, Liang CS, Yen CH, Lu RB, Huang SY. Catechol-O-methyltransferase gene variants may associate with negative symptom response and plasma concentrations of prolactin in schizophrenia after amisulpride treatment. Psychoneuroendocrinology 2016; 65:67-75. [PMID: 26724569 DOI: 10.1016/j.psyneuen.2015.12.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Revised: 12/01/2015] [Accepted: 12/04/2015] [Indexed: 01/04/2023]
Abstract
Catechol-O-methyltransferase (COMT) enzyme is involved in the pathogenesis of psychotic symptoms and may be associated with a therapeutic response to antipsychotic drugs. The aim of this study was to examine the relationship between COMT variants, plasma prolactin level, and the therapeutic effectiveness of amisulpride treatment in patients with schizophrenia. A 12-week naturalistic study of amisulpride treatment was carried out in 185 Han Chinese patients with schizophrenia. The patients were screened for 14 single-nucleotide polymorphisms of the COMT gene. The Positive and Negative Syndrome Scale (PANSS) was used to assess the improvement of psychopathological symptoms from the baseline to the end point in each subject. For better presentation of time-course changes in response status, a mixed model for repeated-measures (MMRM) analysis of symptom improvement during the 12-week treatment period was conducted. The change in plasma prolactin level after amisulpride treatment was also examined (n=51). No significant differences in the genotype frequencies of the COMT variants investigated were observed between responders and non-responders. Moreover, an MMRM analysis of psychopathological symptom improvement during the 12-week treatment course showed that it depended significantly on COMT variants (rs4680, rs4633, and rs6267), particularly regarding changes in negative symptoms. The increase in plasma prolactin levels observed was influenced by the COMT rs4680 variant and was positively correlated with a reduction in PANSS negative scores. Our results suggest that variation of the COMT gene is associated with treatment response regarding negative symptoms and prolactin changes after amisulpride treatment in patients with schizophrenia.
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Affiliation(s)
- Chun-Yen Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Wei Yeh
- Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shin-Chang Kuo
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Pei-Shen Ho
- Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Sung Liang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Che-Hung Yen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ru-Band Lu
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - San-Yuan Huang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan; Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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