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Fentahun S, Melkam M, Tadesse G, Rtbey G, Andualem F, Wassie YA, Geremew GW, Alemayehu TT, Haile TD, Godana TN, Mengistie BA, Kelebie M, Nakie G, Tinsae T, Takelle GM. Sexual dysfunction among people with mental illness in Africa: A systematic review and meta-analysis study. PLoS One 2024; 19:e0308272. [PMID: 39083558 PMCID: PMC11290669 DOI: 10.1371/journal.pone.0308272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/18/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Sexual dysfunction is the most frequent health problem among psychiatric patients. This could be the result of both the nature of the illness itself and the side effects of prescribed psychotropic medications. It also significantly affects an individual's general well-being, interpersonal relationships, self-esteem, and treatment outcomes. Therefore, the current systematic review and meta-analysis was conducted to determine the combined prevalence of sexual dysfunction and its correlated factors among people with mental illness. METHODS We retrieved eligible primary studies using various search databases like PubMed, EMBASE, Science Direct, African Journal Online, Google Scholar, and Psychiatry Online. The report of this systematic review was reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. We used standardized data extraction checklists and STATA version 14 for data extraction and analysis, respectively. The I-squared statistics test was used to check statistical heterogeneity within the included articles. Publication bias was assessed using a funnel plot and the Egger test. To estimate the overall prevalence and correlated factors of sexual dysfunction, a random effects model meta-analysis was employed. RESULTS In this meta-analysis, a total of 15 primary studies with 2849 psychiatric patients were included. The overall pooled prevalence of sexual dysfunction among psychiatric patients in Africa was 58.42% (95% CI: 49.55, 67.28). Having older age (OR = 1.92, 95% CI: 1.28, 2.87), longer duration of illness (OR = 2.60, 95% CI: 1.14, 5.93), history of relapse (OR = 3.51, 95% CI: 1.47, 8.43), poor quality of life (OR = 3.89, 95% CI: 2.15, 7.05), and antipsychotic medications (OR = 2.99, 95% CI: 1.84, 4.86) were significantly associated with sexual dysfunction. CONCLUSION This meta-analysis revealed that approximately two-thirds of psychiatric patients in Africa are affected by sexual dysfunction. Therefore, the findings of this study recommend that when evaluating psychiatric patients, health professionals should focus more on sexual dysfunction. It is also essential to promote awareness and incorporate sexual health assessment and intervention into mental health services to reduce the overall burden of the problem.
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Affiliation(s)
- Setegn Fentahun
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gebresilassie Tadesse
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Gidey Rtbey
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Fantahun Andualem
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Yilkal Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Gebremariam Wulie Geremew
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tekletsadik Tekleslassie Alemayehu
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Denekew Haile
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmaceutical Chemistry
| | - Tilahun Nega Godana
- Department of Internal Medicine, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar Ethiopia
| | - Berihun Agegn Mengistie
- Department of General Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulualem Kelebie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girum Nakie
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Techilo Tinsae
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Girmaw Medfu Takelle
- Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Shettima FB, Wakil MA, Sheikh TL, Abdulaziz M, Rabbebe IB, Wakawa IA, Placidus O. Prevalence and correlates of sexual dysfunction among patients with schizophrenia spectrum disorder on antipsyhotic medications in Maiduguri, Northeastern Nigeria. Int J Psychiatry Med 2024; 59:373-392. [PMID: 37616598 DOI: 10.1177/00912174231196612] [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: 08/26/2023]
Abstract
OBJECTIVES Despite the importance of a satisfying sexual life, most patients with schizophrenia spectrum disorders do not discuss sexual issue with their clinicians. The current study seeks to determine the prevalence and socio-clinical correlates of sexual dysfunction among patients with schizophrenia spectrum disorders receiving typical and atypical antipsychotic medications. The second objective is to determine the frequency and correlates of specific sexual dysfunction (desire, arousal, erection/lubrication and orgasm) by gender and drug type using the Arizona Sexual Experience Scale. METHODOLOGY This cross-sectional study used standardized structured interviewer based survey to assess sexual dysfunction among patients with schizophrenia that are both sexually active and inactive at a tertiary hospital in Maiduguri from December 2020 to April 2021. Participants were also assayed for prolactin using ELISA Kit for a possible association with sexual dysfunction. RESULTS The overall prevalence of sexual dysfunction among patients with schizophrenia spectrum disorder receiving antipsychotics was 34% with patients on typical and atypical antipsychotics reporting rates of 36.8% and 24.6%, respectively. Among the typical and atypical antipsychotics, patients receiving haloperidol (40.3%) and risperidone (37.5%) reported a relatively higher frequency of sexual dysfunction compared to those receiving clozapine (18.2%). Independent correlates of sexual dysfunction were: female gender (OR = 1.89, 95% CI = 1.17-3.06; P = .010), being unmarried (OR = 1.51, 95% CI = 1.17-1.96; P = .001), pseudoparkinsonism (OR = 1.66, 95% CI = 1.02-2.69; P = .008), prolactin (OR = 2.15, 95% CI = 1.34-3.43; P = .001) and severity of illness (OR = 1.34, 95% CI = 1.03-1.75; P = .030). CONCLUSION Sexual dysfunction is prevalent among patients with schizophrenia spectrum disorder receiving either typical or atypical antipsychotics.
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Affiliation(s)
- Falmata Baba Shettima
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Maiduguri, Nigeria
| | - Musa Abba Wakil
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Maiduguri, Nigeria
| | | | | | - Isa Bukar Rabbebe
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Maiduguri, Nigeria
| | - Ibrahim Abdu Wakawa
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Maiduguri, Nigeria
| | - Ogualili Placidus
- Departmental of Mental Health, Federal Neuropsychiatric Hospital Maiduguri, Maiduguri, Nigeria
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Kumari P, Kumar R, Rohilla J. Sexual dysfunction, marital relationship, and subjective quality of life among women with schizophrenia: Analytical case-control study. Indian J Psychiatry 2024; 66:280-286. [PMID: 39100124 PMCID: PMC11293288 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_346_23] [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: 05/11/2023] [Revised: 09/08/2023] [Accepted: 02/26/2024] [Indexed: 08/06/2024] Open
Abstract
Background Women with schizophrenia have a high risk of adverse sexual health outcomes. The chronic course of schizophrenia draws attention to assessing the quality of life and marital relationships of patients with schizophrenia. However, there is a crunch of data in the Indian setting. This study aimed to investigate the prevalence of sexual dysfunctions (SDs) and determine the marital relationship and quality of life among women with schizophrenia. Material and Methods The study followed an analytical case-control design. The study was conducted at the inpatient psychiatric department of one of the apex tertiary healthcare centers located at the foothills of the Northern Himalayas. The study purposively included 136 participants (68 cases and 68 controls). The control group included healthy women aged 18-45 currently staying with sexual partners. Data were collected using pretested and standardized self-report questionnaires. Results The median age of the case group was 36 (interquartile range (IQR), 29-42) years, while that of the control group was 29 (IQR 26-34) years. The prevalence of SD was significantly higher (P = 0.001) in cases (95.3%) than in controls (73.4%). Compared to healthy controls, women with schizophrenia have a significantly higher rate of SD in sexual desire (P = 0.001), getting arousal (P < 0.001), lubrication (P < 0.001), achieving orgasm (P < 0.001), and sexual satisfaction (P < 0.001) (except pain). In addition, the marital relationship was better managed (P < 0.001) in healthy controls compared with cases. The healthy control group significantly expressed a better quality of life in physical (P < 0.001), psychological (P < 0.001), and maintaining social (P < 0.001) relationships (except environment domains). In multivariable logistic regression analysis, employment status significantly predicted SDs (odds ratio (OR), 25.78; 95% confidence interval (CI), 2.09, 318.10; P < 0.05) in participants. Conclusion The prevalence of SD is significantly high among female participants. Hence, treating physicians should pay attention to sexual function during the screening and treatment of patients with schizophrenia.
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Affiliation(s)
- Puja Kumari
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Rajesh Kumar
- College of Nursing, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Jitendra Rohilla
- Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Korchia T, Achour V, Faugere M, Albeash A, Yon DK, Boyer L, Fond G. Sexual Dysfunction in Schizophrenia: A Systematic Review and Meta-Analysis. JAMA Psychiatry 2023; 80:1110-1120. [PMID: 37703012 PMCID: PMC10500435 DOI: 10.1001/jamapsychiatry.2023.2696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/04/2023] [Indexed: 09/14/2023]
Abstract
Importance In individuals with schizophrenia, antipsychotic-induced dysfunctions are frequent but often underexplored in clinical practice. Objective To synthetize the data of observational studies exploring the prevalence of sexual dysfunction in individuals with schizophrenia-spectrum disorders as well as associated factors. Data Sources A systematic literature search without language or time restrictions was conducted in Google, Google Scholar, PubMed/MEDLINE, Science Direct, and Université Sorbonne Paris Cité for studies published up to June 8, 2022. Study Selection All observational studies reporting a prevalence of sexual dysfunction in schizophrenia-spectrum disorder were included. Data Extraction and Synthesis The MOOSE guidelines with independent extraction by 2 observers and random-effects models were used. Main Outcomes and Measures The prevalence of sexual dysfunction and each specific dysfunction. Results A total of 72 of 1119 studies from 33 countries on 6 continents published from inception to June 2022 were included with a total of 21 076 participants with schizophrenia. The pooled global prevalence of sexual dysfunctions was 56.4% (95% CI, 50.5-62.2), with a prevalence of 55.7% (95% CI, 48.1-63.1) for men and 60.0% (95% CI, 48.0-70.8) for women. The most frequent sexual dysfunction was erectile dysfunction in men (44%; 95% CI, 33.5-55.2), followed by loss of libido in men (41%; 95% CI, 30.7-51.4), ejaculation dysfunction in men (39%; 95% CI, 26.8-51.8), orgasm dysfunction in women (28%; 95% CI, 18.4-40.2), and amenorrhea in women (25%; 95% CI, 17.3-35.0). Factors associated with heterogeneity were study design, time and location, sociodemographic data, alcohol use disorder, psychiatric diagnosis, illness severity, and the use of antidepressants and anxiolytics. Sexual dysfunctions were more frequent in schizophrenia vs schizoaffective disorders, and erectile disorders were less frequent in individuals with longer illness duration. Antidepressant and mood stabilizer prescriptions were associated with lower rates of erection disorders (β, -6.30; 95% CI, -10.82 to -1.78); P = .006 and -13.21; 95% CI, -17.59 to -8.83; P < .001, respectively) and ejaculation disorders (β, -6.10; 95% CI, -10.68 to -1.53; P = .009 and β, -11.57; 95% CI, -16.34 to -6.80; P < .001, respectively). No obvious improvements in the rates of sexual dysfunction at other times were found, and there were conflicting results regarding antipsychotic classes. Conclusions and Relevance This systematic review and meta-analysis found a high prevalence of sexual dysfunction among individuals with schizophrenia, with considerable heterogeneity in associated factors. The findings also suggest that some dysfunctions may be explained by schizophrenia. The association between lower rates of dysfunction and antidepressant use suggests that treating comorbid depression could be an effective strategy to improve sexual health. A lack of data on metabolic parameters and physical health in general was also noted, while these issues are frequent in the care of schizophrenia.
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Affiliation(s)
- Théo Korchia
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Vincent Achour
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Mélanie Faugere
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Ali Albeash
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
| | - Dong Keon Yon
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, Republic of Korea
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, Republic of Korea
| | - Laurent Boyer
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Guillaume Fond
- Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, CEReSS - Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
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Wazni L, Gifford W, Perron A, Vandyk A. Understanding the Physical Health Problems of People with Psychotic Disorders Using Digital Storytelling. Issues Ment Health Nurs 2023; 44:690-701. [PMID: 37549316 DOI: 10.1080/01612840.2023.2229435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
People with psychotic disorders struggle to be heard and express concerns beyond their mental health, especially concerns related to the side effects of treatment. Using digital storytelling, this study aimed to uncover and expose the underlying systems that oppress people with psychotic disorders from meeting their physical health needs. The stories revealed two themes: body as a contested site and biological entity with society, and (in)visible patient and paternalism. Spivak's theory of subalternity provided the theoretical basis for a critical analysis and discussion of the experiences. More research is required to highlight the power relations and structures that lead to health disparity in psychiatry.
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Affiliation(s)
- Liquaa Wazni
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Wendy Gifford
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amélie Perron
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Amanda Vandyk
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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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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Chung MH, Chao JK, Ma MC, Lin RW. Sexuality and Quality of Life in Eastern Taiwan People With Schizophrenia. Psychiatry Investig 2023; 20:1-8. [PMID: 36721880 PMCID: PMC9890041 DOI: 10.30773/pi.2022.0097] [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] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Patients with schizophrenia are living at the border of society and their sexuality is often neglected. The aim of the study is to explore the association among The Brief Psychiatric Rating Scale (BPRS), quality of life (QoL), Taiwanese Depression Questionnaire, and Sexual Desire Inventory in people with schizophrenia (PwS). METHODS This study used a cross-sectional design with 277 psychiatric inpatients. A descriptive analysis, difference analysis, and logistic regression model were presented to identify relevant variables that may affect the probability of good QoL. RESULTS The study showed that male PwS had higher scores of standard deviation (SD) than females in PwS. The study also showed that smoking, early illness onset age, and shorter illness duration demonstrated a significantly higher SD. The logistic regression analysis showed that BPRS, depression, and SD significantly affected the probability of QoL. By structural equation model, SD would be positively correlated with mental status and SD would indirectly influence QoL. CONCLUSION Our results showed psychological and sociological factors interactions may contribute to the QoL and SD for PwS. This study also demonstrated a close relationship between SD, depression, and BPRS. These factors may predict the probability of good life quality for the PwS.
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Affiliation(s)
- Mei Hua Chung
- Graduate Institute of Bioresources, National Pingtung University of Science & Technology, Pingtung, Taiwan
| | - Jian-Kang Chao
- Department of Psychiatry, Yuli Branch, Taipei Veterans General Hospital, Hualien, Taiwan.,Graduate School of Human Sexuality, Shu-Te University, Kaohsiung, Taiwan
| | - Mi Chia Ma
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Ru Wei Lin
- Department of Plant Industry, National Pingtung University of Science & Technology, Pingtung, Taiwan
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Krishnegowda S, Udaykumar P, Yadiyal A. Association Between Sexual Dysfunction and Dose of Atypical Antipsychotics: Essential to Learn the Basics. J Clin Pharmacol 2023; 63:40-47. [PMID: 35939487 DOI: 10.1002/jcph.2131] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/29/2022] [Indexed: 12/15/2022]
Abstract
There is paucity of data on sexual dysfunction associated with atypical antipsychotics in Indian population. We estimated the prevalence of sexual dysfunction and assessed dose dependency, if any, in patients on monotherapy of atypical antipsychotics. This cross-sectional study analyzed the data from patients with F20 to F29 (International Classification of Diseases 10th Revision, ICD-10) receiving monotherapy of risperidone (group 1), olanzapine (group 2), or quetiapine (group 3) for at least 4 weeks. The sexual function of participants was assessed using Arizona sexual experiences (ASEX) scale. Chlorpromazine (CPZ) equivalent dose and doses in terms of dose years were calculated. Kruskal-Wallis test, Mann-Whitney U-test, and Pearson correlation were used for analysis. Of the 154 subjects, 65.58% were males, with 44%, 48%, and 8% receiving risperidone, olanzapine, and quetiapine, respectively. The mean duration of treatment was 20.9 weeks. Lower ASEX scores were reported with quetiapine. The differences in mean ASEX scores between groups 1 and 2 were statistically significant for sex drive (P = .016), sexual arousal (P = .025), and overall score (P = .037). Sexual dysfunction was more frequent with risperidone (48.5%) than with olanzapine (28.4%) and quetiapine (0%). In group 1, the duration of therapy positively correlated with the mean scores of sexual desire (P = .003) and arousal (P = .033), but this was not the case for group 2 (receiving olanzapine). The mean CPZ equivalent doses were comparable between the groups (P = .064); those receiving <200 mg CPZ dose equivalents showed greater sexual impairment. We conclude that the occurrence of atypical antipsychotic-induced sexual dysfunction is not dose dependent. Olanzapine has a better safety profile in terms of sexual dysfunction, whereas the data reflecting the experience with quetiapine are insufficient.
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Affiliation(s)
| | - Padmaja Udaykumar
- Department of Pharmacology, Father Muller Medical College, Kankanady, Mangalore, India
| | - Aruna Yadiyal
- Department of Pharmacology, Father Muller Medical College, Kankanady, Mangalore, India
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Thana LJ, O'Connell L, Carne-Watson A, Shastri A, Saravanamuthu A, Budhwani N, Jayacodi S, Leeson VC, Munjiza J, Pappa S, Hughes E, Reilly J, Crawford MJ. Barriers to the management of sexual dysfunction among people with psychosis: analysis of qualitative data from the REMEDY trial. BMC Psychiatry 2022; 22:545. [PMID: 35953808 PMCID: PMC9373458 DOI: 10.1186/s12888-022-04193-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 03/03/2022] [Accepted: 07/29/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND More than half of people who use antipsychotic medication for psychosis report having sexual dysfunction. The REMEDY trial aimed to find out if switching antipsychotic medication provides an effective way to reduce sexual dysfunction among people with psychosis. We set out to recruit 216 participants over a two-year period, but recruitment was stopped after an extended 12-month pilot phase, during which we recruited only 10 participants. As part of a nested process evaluation, we conducted qualitative interviews with front-line clinicians to examine barriers to recruitment to the trial. METHODS We developed a semi-structured interview schedule to explore staff views on factors that influenced whether they referred potential participants to the study. We interviewed a purposive sample of 51 staff from four National Health Service (NHS) Trusts in England, ensuring a range of different backgrounds, seniority, and levels of involvement in the trial. Audio recordings of interviews were transcribed for verbatim, and data were analysed using an inductive approach to thematic analysis. RESULTS Nine interconnected themes were generated. Six themes concerned barriers to recruitment; including; prioritising patients' mental stability, mutual discomfort and embarrassment about discussing a "taboo" subject, and concerns about unintended consequences of asking people with psychosis about their sexual functioning. Three themes, including the quality of treatment relationships and strategies for opening dialogue suggested ways to improve recognition of these "hidden" side effects. CONCLUSION The identification and management of sexual dysfunction among people with psychosis are not priorities for mental health services in England at this time. Many staff working in front-line services feel unprepared and uncomfortable asking people with psychosis about these problems. While greater use of screening tools may improve the identification of sexual dysfunction among people with psychosis, the evaluation and implementation of interventions to manage them will continue to be challenging unless NHS leaders and senior clinicians demonstrate greater commitment to changing current clinical practice. TRIAL REGISTRATION Current Controlled Trials ISRCTN12307891.
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Affiliation(s)
- Lavanya J Thana
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Lesley O'Connell
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | | | | | | | | | - Sandra Jayacodi
- Central and North West London NHS Foundation Trust, London, UK
| | - Verity C Leeson
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK
| | - Jasna Munjiza
- Central and North West London NHS Foundation Trust, London, UK
| | | | - Elizabeth Hughes
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Joe Reilly
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | - Mike J Crawford
- Division of Psychiatry, Commonwealth Building, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Prediction of quality of life in schizophrenia using machine learning models on data from Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) schizophrenia trial. NPJ SCHIZOPHRENIA 2022; 8:29. [PMID: 35314708 PMCID: PMC8938459 DOI: 10.1038/s41537-022-00236-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 02/11/2022] [Indexed: 12/22/2022]
Abstract
While research focus remains mainly on psychotic symptoms, it is questionable whether we are placing enough emphasis on improving the quality of life (QoL) of schizophrenia patients. To date, the predictive power of QoL remained limited. Therefore, this study aimed to accurately predict the QoL within schizophrenia using supervised learning methods. The authors report findings from participants of a large randomized, double-blind clinical trial for schizophrenia treatment. Potential predictors of QoL included all available and non-redundant variables from the dataset. By optimizing parameters, three linear LASSO regressions were calculated (N = 697, 692, and 786), including 44, 47, and 41 variables, with adjusted R-squares ranging from 0.31 to 0.36. Best predictors included social and emotion-related symptoms, neurocognition (processing speed), education, female gender, treatment attitudes, and mental, emotional, and physical health. These results demonstrate that machine learning is an excellent predictive tool to process clinical data. It appears that the patient’s perception of their treatment has an important impact on patients’ QoL and that interventions should consider this aspect. Trial registration: ClinicalTrials.gov Identifier: NCT00014001.
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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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Crawford MJ, Thana L, Evans R, Carne A, O'Connell L, Claringbold A, Saravanamuthu A, Case R, Munjiza J, Jayacodi S, Reilly JG, Hughes E, Hoare Z, Barrett B, Leeson VC, Paton C, Keown P, Pappa S, Green C, Barnes TR. Switching antipsychotic medication to reduce sexual dysfunction in people with psychosis: the REMEDY RCT. Health Technol Assess 2021; 24:1-54. [PMID: 32930090 DOI: 10.3310/hta24440] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Sexual dysfunction is common among people who are prescribed antipsychotic medication for psychosis. Sexual dysfunction can impair quality of life and reduce treatment adherence. Switching antipsychotic medication may help, but the clinical effectiveness and cost-effectiveness of this approach is unclear. OBJECTIVE To examine whether or not switching antipsychotic medication provides a clinically effective and cost-effective method to reduce sexual dysfunction in people with psychosis. DESIGN A two-arm, researcher-blind, pilot randomised trial with a parallel qualitative study and an internal pilot phase. Study participants were randomised to enhanced standard care plus a switch of antipsychotic medication or enhanced standard care alone in a 1 : 1 ratio. Randomisation was via an independent and remote web-based service using dynamic adaptive allocation, stratified by age, gender, Trust and relationship status. SETTING NHS secondary care mental health services in England. PARTICIPANTS Potential participants had to be aged ≥ 18 years, have schizophrenia or related psychoses and experience sexual dysfunction associated with the use of antipsychotic medication. We recruited only people for whom reduction in medication dosage was ineffective or inappropriate. We excluded those who were acutely unwell, had had a change in antipsychotic medication in the last 6 weeks, were currently prescribed clozapine or whose sexual dysfunction was believed to be due to a coexisting physical or mental disorder. INTERVENTIONS Switching to an equivalent dose of one of three antipsychotic medications that are considered to have a relatively low propensity for sexual side effects (i.e. quetiapine, aripiprazole or olanzapine). All participants were offered brief psychoeducation and support to discuss their sexual health and functioning. MAIN OUTCOME MEASURES The primary outcome was patient-reported sexual dysfunction, measured using the Arizona Sexual Experience Scale. Secondary outcomes were researcher-rated sexual functioning, mental health, side effects of medication, health-related quality of life and service utilisation. Outcomes were assessed 3 and 6 months after randomisation. Qualitative data were collected from a purposive sample of patients and clinicians to explore barriers to recruitment. SAMPLE SIZE Allowing for a 20% loss to follow-up, we needed to recruit 216 participants to have 90% power to detect a 3-point difference in total Arizona Sexual Experience Scale score (standard deviation 6.0 points) using a 0.05 significance level. RESULTS The internal pilot was discontinued after 12 months because of low recruitment. Ninety-eight patients were referred to the study between 1 July 2018 and 30 June 2019, of whom 10 were randomised. Eight (80%) participants were followed up 3 months later. Barriers to referral and recruitment included staff apprehensions about discussing side effects, reluctance among patients to switch medication and reticence of both staff and patients to talk about sex. LIMITATIONS Insufficient numbers of participants were recruited to examine the study hypotheses. CONCLUSIONS It may not be possible to conduct a successful randomised trial of switching antipsychotic medication for sexual functioning in people with psychosis in the NHS at this time. FUTURE WORK Research examining the acceptability and effectiveness of adjuvant phosphodiesterase inhibitors should be considered. TRIAL REGISTRATION Current Controlled Trials ISRCTN12307891. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 44. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | - Lavanya Thana
- Division of Psychiatry, Imperial College London, London, UK
| | - Rachel Evans
- North Wales Organisation for Randomised Trials in Health and Social Care, University of Bangor, Bangor, UK
| | - Alexandra Carne
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | | | | | - Rebecca Case
- Central and North West London NHS Foundation Trust, London, UK
| | - Jasna Munjiza
- Division of Psychiatry, Imperial College London, London, UK.,Central and North West London NHS Foundation Trust, London, UK
| | - Sandra Jayacodi
- Central and North West London NHS Foundation Trust, London, UK
| | - Joseph G Reilly
- Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, UK
| | | | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health and Social Care, University of Bangor, Bangor, UK
| | - Barbara Barrett
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | - Patrick Keown
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sofia Pappa
- Division of Psychiatry, Imperial College London, London, UK.,West London NHS Trust, London, UK
| | - Charlotte Green
- Central and North West London NHS Foundation Trust, London, UK
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Ishigooka J, Inada K, Niidome K, Aoki K, Kojima Y, Iwashita S, Yamada S. Safety of switching to brexpiprazole in Japanese patients with schizophrenia: A post-hoc analysis of a long-term open-label study. Hum Psychopharmacol 2021; 36:e2777. [PMID: 33496984 PMCID: PMC8365679 DOI: 10.1002/hup.2777] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 12/23/2020] [Accepted: 01/05/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To determine the long-term safety of switching to brexpiprazole from aripiprazole or non-aripiprazole dopamine antagonists. METHODS Post-hoc analysis of 56-week study of Japanese outpatients with schizophrenia switched to brexpiprazole 2 mg/day over 4-week switching period with further titration (1-4 mg/day) allowed during the 52-week, open-label period. Major assessment items: total/low-density lipoprotein (LDL)-/high-density lipoprotein (HDL)-cholesterol, triglycerides, blood glucose, body weight and prolactin. Secondary evaluations were related to efficacy, treatment emergent adverse events (TEAEs), extrapyramidal symptoms, and corrected QT interval (QTc). RESULTS 84/186 (45.2%) patients (aripiprazole, 32.9%; non-aripiprazole, 54.8%) discontinued treatment over 56 weeks mainly because of consent withdrawal/adverse events. From baseline to Week 56, both groups showed minimal mean changes in total/LDL-/HDL-cholesterol, triglycerides, and glucose levels and a slight increase in mean (SD) body weight (aripiprazole, 1.1 [4.4] kg; non-aripiprazole, 0.4 [4.6] kg). Mean prolactin levels increased slightly in the aripiprazole group, but decreased in the non-aripiprazole group. Symptom severity scores decreased similarly in both groups. TEAEs occurred in 161/186 (86.6%) patients (aripiprazole, 84.1% [serious, 9.8%]; non-aripiprazole, 88.5% [serious, 14.4%]). Few changes occurred in extrapyramidal symptom scales or QTc interval. CONCLUSIONS Switching to brexpiprazole is associated with a low long-term risk for metabolic abnormalities (including weight gain), hyperprolactinemia, extrapyramidal symptoms and QTc changes and minimal changes in psychiatric symptoms.
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Affiliation(s)
| | - Ken Inada
- Department of PsychiatryTokyo Women's Medical University School of MedicineTokyoJapan
| | - Kazunari Niidome
- Department of Medical AffairsOtsuka Pharmaceutical Co., Ltd.TokyoJapan
| | - Kazuo Aoki
- Department of Medical AffairsOtsuka Pharmaceutical Co., Ltd.TokyoJapan
| | - Yoshitsugu Kojima
- Department of Medical AffairsOtsuka Pharmaceutical Co., Ltd.TokyoJapan
| | - Shuichi Iwashita
- Headquarters of Clinical DevelopmentOtsuka Pharmaceutical Co., Ltd.OsakaJapan
| | - Sakiko Yamada
- Department of Medical AffairsOtsuka Pharmaceutical Co., Ltd.TokyoJapan
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14
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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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15
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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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16
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McCann E, Donohue G, de Jager J, Nugter A, Stewart J, Eustace-Cook J. Sexuality and intimacy among people with serious mental illness: a qualitative systematic review. ACTA ACUST UNITED AC 2020; 17:74-125. [PMID: 30629043 DOI: 10.11124/jbisrir-2017-003824] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The aim of this systematic review was to synthesize the best available qualitative evidence on the experiences and support needs of people with serious mental illness (SMI) regarding sexuality and intimacy within hospital and community settings. The objectives were to explore intimate relationship experiences of people with SMI, to uncover potential obstacles to the expression of sexuality and to present recommendations for mental health policy, education, research and practice. INTRODUCTION Mental health services worldwide have seen major transformations in recent years through deinstitutionalization programs and more enlightened ways of organizing and providing mental health care. However, in terms of social and emotional wellbeing, issues persist for people with SMI, particularly relating to intimacy and the expression of sexuality. This systematic review may assist service providers to determine ways that they may better support people in establishing and maintaining satisfying intimate relationships and the full expression of their sexuality. INCLUSION CRITERIA This review explored the intimacy and sexuality experiences, perceptions and concerns of people over the age of 18 years who were living with a SMI in hospital or community settings. This review considered studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research. METHODS The databases MEDLINE, CINAHL, PsycINFO, Embase and Web of Science were utilised in the review. The search included studies published from 1995 up to and including February 6, 2018 and were limited to those in the English language. Each paper was assessed by two independent reviewers for methodological quality using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Any disagreements that arose between the reviewers were resolved through discussion. Data extraction was conducted by two independent reviewers using the standardized qualitative data extraction tool from JBI. The qualitative research findings were pooled using JBI methodology. The JBI process of meta-aggregation was used to identify categories and synthesized findings. RESULTS Based on the thematic findings from the 21 studies, three synthesized findings were extracted from 10 categories and 83 findings: 1) the complexity of individual sexual experiences, 2) the clinical constructs of sexuality and 3) family and partner involvement. CONCLUSIONS Having fulfilling and satisfying sexual and relationship experiences is a fundamental human right that can enhance an individual's quality of life. Being aware of the potential stresses and challenges that having a SMI can have on a relationship and involving partners in the treatment, may help to promote intimacy and recovery. Practitioners can use these findings to guide future policy, education and developments in practice. Further research is required to develop and evaluate interventions that target the identified barriers and help people with SMI to fulfil their unmet sexuality and intimacy needs.
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Affiliation(s)
- Edward McCann
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Grainne Donohue
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.,Trinity Centre for Practice and Healthcare Innovation, Trinity College Dublin: a Joanna Briggs Institute Affiliated Group
| | - Jose de Jager
- Maastricht University, Medical Centre, Maastricht, The Netherlands
| | - Annet Nugter
- Mental Health Service Organization, GGZ Noord-Holland-Noord, The Netherlands
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17
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Uçok A, Incesu C, Aker T, Erkoç S. Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry 2020; 22:328-33. [PMID: 17344032 DOI: 10.1016/j.eurpsy.2007.01.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Revised: 01/02/2007] [Accepted: 01/03/2007] [Indexed: 11/30/2022] Open
Abstract
AbstractObjectiveThe objective of this study was to determine the prevalence of sexual dysfunction in patients with schizophrenia under antipsychotic therapy and to investigate the effect of various parameters on sexual dysfunction.MethodA total of 827 stabilized outpatients who met DSM-IV criteria for schizophrenia, were recruited in the study. Arizona Sexual Experience Scale (ASEX) and the subscale on sexual function of the UKU Side Effects Rating Scale were applied at a single interview.ResultsIn total, 52.6% of the patients had sexual dysfunction, 54.2% reported a low sexual desire and 41.7% reported problems in having an orgasm. Erectile dysfunction and ejaculation problems were seen in 48.1% and 64.2% of the men, respectively; amenorrhea was seen in 24.9% of the women. ASEX score and severity of disease were found to be correlated (p = 0.02). Higher ASEX scores were observed in patients who smoked (p = 0.01). Men receiving atypical monotherapy had lower ASEX scores than those receiving a combination of atypical and conventional antipsychotics (p = 0.017). Patients on combination therapy had more ejaculation problems than the atypical group (p = 0.001). Low sexual desire was more prevalent among women using conventional drugs than those on atypical drugs (p = 0.004). In linear regression analyses, ASEX was affected significantly and independently by the severity of the disease only in men (p = 0.005).ConclusionOur results show that sexual dysfunction is widespread among patients with schizophrenia on antipsychotic medications.
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Affiliation(s)
- Alp Uçok
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Millet Street, Capa 34390, Istanbul, Turkey.
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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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García-Blanco A, García-Portilla MP, Fuente-Tomás LDL, Batalla M, Sánchez-Autet M, Arranz B, Safont G, Arqués S, Livianos L, Sierra P. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020; 17:930-940. [PMID: 32139195 DOI: 10.1016/j.jsxm.2020.01.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 01/20/2020] [Accepted: 01/30/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND In addition to factors intrinsic to bipolar disorder (BD), sexual functioning (SF) can be affected by extrinsic causes, such as psychotropic drugs. However, the effect of mood stabilizers on SF and quality of life (QoL) is an underexplored research area. AIM To analyze SF in BD outpatients in euthymia for at least 6 months treated only with mood stabilizers and the association between SF and QoL. METHODS A multicenter cross-sectional study was conducted in 114 BD outpatients treated with (i) lithium alone (L group); (ii) anticonvulsants alone (valproate or lamotrigine; A group); (iii) lithium plus anticonvulsants (L+A group); or (iv) lithium plus benzodiazepines (L+B group). The Changes in Sexual Functioning Questionnaire Short Form (CSFQ-14) was used. Statistical analyses were performed to compare CSFQ-14 scores among the pharmacological groups. An adaptive lasso was used to identify potential confounding variables, and linear regression models were used to study the association of the CSFQ-14 with QoL. MAIN OUTCOME MEASURES Self-reports on phases of the sexual response cycle (ie, desire, arousal, and orgasm) and QoL were assessed. RESULTS The A group had better total SF scores than the L group and the L+B group. Relative to the A group, the L and L+B groups had worse sexual desire; the L group had worse sexual arousal; and the L+A group and the L+B group had worse sexual orgasm. Regarding sociodemographic factors, being female and older age were associated with worse total SF and all subscale scores. Among all subscales scores, higher sexual arousal scores were associated with better QoL. CLINICAL IMPLICATIONS Potential modified extrinsic factors such as psychotropic medication that can affect SF can be addressed and adjusted to lessen side effects on SF. STRENGTHS & LIMITATIONS Sample of patients with euthymic BD in treatment with mood stabilizers and no antipsychotics or antidepressants, substance use as an exclusion criterion, and use of a validated, gender-specific scale to evaluate SF. Major limitations were cross-sectional design, sample size, and lack of information about stability of relationship with partner. CONCLUSIONS Lithium in monotherapy or in combination with benzodiazepines is related to worse total SF and worse sexual desire than anticonvulsants in monotherapy. While the addition of benzodiazepines or anticonvulsants to lithium negatively affects sexual orgasm, sexual arousal (which plays a significant role in QoL) improves when benzodiazepines are added to lithium. Anticonvulsants in monotherapy have the least negative effects on SF in patients with BD. García-Blanco A, García-Portilla MP, Fuente-Tomás L de la, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. J Sex Med 2020;17:930-940.
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Affiliation(s)
| | - María P García-Portilla
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - Lorena de la Fuente-Tomás
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University of Oviedo, Oviedo, Spain
| | - María Batalla
- La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Belén Arranz
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Parc Sanitari Sant Joan de Deu, Barcelona, Spain
| | - Gemma Safont
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain; Department of Psychiatry, University Hospital Mutua Terrassa, University of Barcelona, Barcelona, Spain
| | | | - Lorenzo Livianos
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain; CIBERESP-17, Valencia, Spain
| | - Pilar Sierra
- La Fe University and Polytechnic Hospital, Valencia, Spain; Department of Medicine, University of Valencia, Valencia, Spain.
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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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Scoglio AAJ, Adams WE, Lincoln AK. Meaning and Management of Multiple Medications Among Public Mental Health Service Users. Community Ment Health J 2020; 56:313-321. [PMID: 31646406 PMCID: PMC6980939 DOI: 10.1007/s10597-019-00491-9] [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: 05/07/2019] [Accepted: 10/12/2019] [Indexed: 10/25/2022]
Abstract
Public mental health service users frequently manage multiple health conditions, and are often prescribed multiple medications. While medications are useful tools in treating diagnosed mental illnesses, they bring management challenges and also can carry complex meanings for the individuals taking them. This study utilized a qualitative methodological approach to examine the experience and meaning of polypharmacy among public mental health services users. This sample of service users (n = 26) who were prescribed multiple medications described three distinct types of challenges they faced in managing medications: related to information, material tasks, and self-stigma. Nevertheless, respondents reported creative and resilient strategies to manage these challenges. Findings build on previous literature and reflect the increasing need to focus on challenges related to polypharmacy. Furthermore, findings indicate that low levels of literacy and high levels of material disadvantage, which are common among public mental health service users, complicate the management and meaning of multiple medications.
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Affiliation(s)
- Arielle A J Scoglio
- Institute for Health Equity and Social Justice Research, Northeastern University, 314 International Village, 360 Huntington Ave, Boston, MA, 02115, USA
| | - Wallis E Adams
- Institute for Health Equity and Social Justice Research, Northeastern University, 314 International Village, 360 Huntington Ave, Boston, MA, 02115, USA.,Center for Psychiatric Rehabilitation, Boston University, Boston, MA, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, 314 International Village, 360 Huntington Ave, Boston, MA, 02115, USA.
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Roughley M, Lyall M. Republished: Retrograde ejaculation associated with quetiapine and treatment with low-dose imipramine. Drug Ther Bull 2019; 57:189-191. [PMID: 31558552 DOI: 10.1136/dtb.2019.228539rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- Matthew Roughley
- City and Hackney Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | - Marc Lyall
- John Howard Centre, East London NHS Foundation Trust, London, UK
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Roughley M, Lyall M. Retrograde ejaculation associated with quetiapine and treatment with low-dose imipramine. BMJ Case Rep 2019; 12:12/8/e228539. [PMID: 31383672 DOI: 10.1136/bcr-2018-228539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Sexual side-effects are common among those using antipsychotic medication and may result in poor compliance and reduced quality of life. Retrograde ejaculation (RE) has been described occurring with a number of antipsychotic medications (thioridazine, risperidone, iloperidone and clozapine) but there are no guidelines regarding management of antipsychotic-associated RE. Imipramine has been suggested as a treatment for antipsychotic-associated RE in one small study of patients prescribed thioridazine and a case series of patients prescribed iloperidone. Quetiapine is a commonly used antipsychotic and is thought to be associated with less sexual side-effects relative to other antipsychotic medications. This case report describes a 25-year-old man with first episode psychosis who developed RE during treatment with quetiapine which improved with low-dose imipramine. This is the first description of RE occurring with quetiapine and successful treatment of quetiapine-associated RE with imipramine.
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Affiliation(s)
- Matthew Roughley
- City and Hackney Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | - Marc Lyall
- John Howard Centre, East London NHS Foundation Trust, London, UK
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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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Ghormode D, Gupta P, Ratnani D, Aneja J. Evaluation of sexual dysfunction and quality of life in patients with severe mental illness: A cross-sectional study from a tertiary care center in Chhattisgarh. Ind Psychiatry J 2019; 28:75-81. [PMID: 31879451 PMCID: PMC6929216 DOI: 10.4103/ipj.ipj_16_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/15/2019] [Accepted: 08/19/2019] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Sexual dysfunctions (SDs) are common and lead to psychological distress and impair quality of life (QOL). However, little attention has been paid to explore SD in severe mental illnesses (SMIs). Hence, this study aimed to evaluate the occurrence of SD and its impact on the QOL in persons suffering from schizophrenia, bipolar disorder, and depression and compare it with healthy controls. MATERIALS AND METHODS In this cross-sectional study, 79 clinically stable patients and 50 healthy controls underwent evaluation for SD on the Arizona Sexual Experience Scale, and their QOL was measured using the WHO QOL-BREF scale. Chi-square test was used for the categorical variables, whereas comparison of continuous variables was done by t-test with post hoc corrections. RESULTS Compared to healthy controls, patients with depression had significantly higher rates of SD in the domain of obtaining penile erection (P = 0.019), ability to reach orgasm (P = 0.03), and satisfaction from orgasm (P = 0.01). Patients with schizophrenia had higher rates of problems in achieving arousal (P < 0.01), penile erection (P = 0.03), and satisfaction from orgasm (P = 0.03), whereas those with bipolar disorder only differed significantly on the domain of ability to reach orgasm (P = 0.03). However, patients fared better than the controls on various domains of QOL (except social domain). CONCLUSION A significant number of patients with SMI suffer from SD. Hence, it should be made a routine practice to evaluate and address the problem of SDs in patients with SMI.
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Affiliation(s)
- Deepak Ghormode
- Department of Psychiatry, CCM Medical College, Durg, Chhattisgarh, India
| | - Pramod Gupta
- Department of Psychiatry, Central Institute of Mental Health and Neuro-Sciences, Durg, Chhattisgarh, India
| | - Devendra Ratnani
- Department of Psychiatry, CCM Medical College, Durg, Chhattisgarh, India
| | - Jitender Aneja
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Fanta T, Haile K, Abebaw D, Assefa D, Hibdye G. Assessment of sexual dysfunction and associated factors among patients with schizophrenia in Ethiopia, 2017. BMC Psychiatry 2018; 18:158. [PMID: 29843656 PMCID: PMC5975573 DOI: 10.1186/s12888-018-1738-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 05/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexual dysfunction is remarkably prevalent amongst psychiatric patients than general population. This might be due to either the nature of the illness itself or the unwanted effect of the medication they are taking for the illness which limits the capability of forming interpersonal and sexual relationships. This issue is rarely raised in developing countries, and the aim of this study was to assess magnitude and factors contributing to sexual dysfunction among patients with Schizophrenia. METHOD Hospital based cross sectional study was conducted at Amanuel Mental Specialized Hospital from January to June 2017. The sample required for this study was determined by using single population proportion formula and the final sample size was 423; and systematic random sampling was used to select participants. We used Change in Sexual Functioning Questionnaire to measure sexual dysfunction. The collected data was cleaned, interred in to Epi data and transferred to SPSS version 20 for farther analysis. The OR with 95% CI was used to measure association and P-value < 0.05 was used as statistically significant. RESULT A total of 422 patients with Schizophrenia were involved in the study. The prevalence of General Sexual dysfunction was 82.7%; and in male and female patients the prevalence was 84.5 and 78.6% respectively. Marital status (Unmarried, Divorced and widowed, history of relapse and poor quality of life were associated significantly to global sexual dysfunction. CONCLUSION The magnitude of Sexual dysfunction was found to be high among patients with schizophrenia and it is associated with different factors like unmarried, divorced, widowed, relapse and poor quality of life. Treating physicians should be conscious to sexual dysfunction during evaluation and treatment of patients with Schizophrenia. Special attention should be given to single, divorced, widowed patients and patients with history of relapse to improve quality of life of this patients.
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Affiliation(s)
- Tolesa Fanta
- Amanuel Mental Specialized Hospital Research and Training Department, Addis Ababa, Ethiopia.
| | - Kibrom Haile
- Amanuel Mental Specialized Hospital Research and Training Department, Addis Ababa, Ethiopia
| | - Dessie Abebaw
- Amanuel Mental Specialized Hospital Research and Training Department, Addis Ababa, Ethiopia
| | - Dawit Assefa
- Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Getahun Hibdye
- Amanuel Mental Specialized Hospital Clinical Service Department, Addis Ababa, Ethiopia
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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: 79] [Impact Index Per Article: 13.2] [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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Mitchell AJ, Selmes T. Why don't patients take their medicine? Reasons and solutions in psychiatry. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.106.003194] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients' reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.
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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: 76] [Impact Index Per Article: 12.7] [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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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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Del Mar Baños-Martín M, Márquez-Hernández VV, Gutiérrez-Puertas L, Aguilera-Manrique G, Gutiérrez-Puertas V, Granados-Gámez G. Sexual Behavior in Patients with Psychosis Admitted to a Hospital Unit. Issues Ment Health Nurs 2017; 38:473-479. [PMID: 28605242 DOI: 10.1080/01612840.2017.1284967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The sexual dimension is part of a person's functionality. Patients with mental disorders have the same sexual needs as any other person, although they may not always be recognized. This is a retrospective observational study to describe the information on sexuality of patients with mental disorders, admitted to an acute short-stay inpatient unit between 2011 and 2015. We analyzed 293 clinical histories of patients, comprising diagnoses in the ICD-10 (International Classification of Diseases) between F20 and F29, inclusively. The information collected corresponded to the beginning of hospitalization, its duration and discharge. The results showed that 24% of the patients had sexual delusions. These delusions were more frequent in women, who in turn had more emotional symptoms, persecutory deception being the most common. There were few reports found on sexual dysfunction. In conclusion, the lack of data in the reports shows little recognition of sexuality in hospitalized patients with mental disorder, highlighting the need to promote the training of health personnel.
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Wang YX, Zhang P, Xin LM, Chen L, Liu YH, Su YA, Si TM. Chinese version of the Psychotropic-related Sexual Dysfunction Questionnaire (PRSexDQ -SALSEX): Validity and reliability for schizophrenic patients taking antipsychotics. Psychiatry Res 2016; 246:303-307. [PMID: 27744232 DOI: 10.1016/j.psychres.2016.05.063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 05/23/2016] [Accepted: 05/24/2016] [Indexed: 11/27/2022]
Abstract
This study was designed to examine the validity and reliability of the Chinese version of the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ-SALSEX) in patients with schizophrenia taking antipsychotics. It was conducted in a sample of 135 patients aged between 18 and 50 years old and diagnosed with schizophrenia. Demographic data and clinical features were assessed with PRSexDQ, the Positive and Negative Syndrome Scale (PANSS), the Clinical Global Impression (CGI), and the Udvalg for Kliniske Undersøgelser (UKU) Side Effects Rating Scale. The internal consistency of the Chinese version of PRSexDQ using Cronbach's α was 0.902. The test-retest and inter rater reliability was both high with p<0.001. PRSexDQ was correlated with corresponding items in the UKU Side Effects Rating Scale (Items 4.12-4.16), and showed good sensitivity, specificity, positive and negative predictive value. It could also clearly detect differences in SD rates of three monotherapy groups: patients treated with risperidone had the highest scores, followed by patients treated with olanzapine, whereas patients treated with aripiprazole had the lowest scores. The Chinese version of PRSexDQ is a reliable and valid instrument to assess patients with schizophrenia. Assessed by PRSexDQ, 53.2% of total subjects in our study reported symptoms of SD.
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Affiliation(s)
- Yu-Xi Wang
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/ Institute of Mental Health), and the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China
| | - Ping Zhang
- Hebei Mental Health Center, Baoding, Hebei Province, China
| | - Li-Min Xin
- Beijing Hui-Long-Guan Hospital,Peking University, Beijing, China
| | - Lin Chen
- Beijing Hui-Long-Guan Hospital,Peking University, Beijing, China
| | - Yan-Hong Liu
- Beijing Hui-Long-Guan Hospital,Peking University, Beijing, China
| | - Yun-Ai Su
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/ Institute of Mental Health), and the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
| | - Tian-Mei Si
- National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital/ Institute of Mental Health), and the Key Laboratory of Mental Health, Ministry of Health (Peking University), Beijing, China.
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Abstract
OBJECTIVE We aimed to study the relationship between hyperprolactinemia (HPRL) and sexual dysfunction (SED) in a sample of patients being prescribed a dose-stable antipsychotic medication, and to evaluate sex differences in the prevalence of HPRL and SED and their relationship. METHOD A cross-sectional study was carried out including patients between 18 and 55 years of age with a psychotic spectrum diagnosis who were attending community mental health services or hospitalized in medium and long stay units. Positive and Negative Syndrome scale, Calgary depression scale for schizophrenia, Personal and Social Performance scale, and Changes in Sexual Functioning questionnaire-short form were administered. Not later than 3 months, a determination of prolactin, follicle-stimulating hormone, luteinizing hormone, estrogen (only in women) and testosterone was performed. RESULTS A final sample of 101 patients (30 women and 71 men) was recruited. Seventy-two patients (71.3%) showed HPRL. Sexual dysfunction was significantly higher in HPRL patients than in non-HPRL patients (79.17% vs 51.72%) (P = 0.006), and mean prolactin values were significantly higher in case of SED (P = 0.020). No sex differences were found in prevalence of HPRL or SED. Low Personal and Social Performance scale scores and HPRL were factors independently associated with SED, whereas alcohol use was an independent protector factor. CONCLUSIONS In our study, SED was significantly related to HPRL without showing sex differences. Prevalence of HPRL and SED observed was higher than that in previous studies, which should be taken into consideration because these have been associated with higher morbimortality, and noncompliance and relapse, respectively.
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Bacconi L, Gressier F. [Efficacy and tolerance of PDE-5 in the treatment of erectile dysfunction in schizophrenic patients: A literature review]. Encephale 2016; 43:55-61. [PMID: 27658991 DOI: 10.1016/j.encep.2016.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 12/07/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Sexual dysfunction is an important public health problem in men and is associated with reduced quality of life. It is more common in patients with schizophrenia. It is well-established that antipsychotic drugs cause sexual dysfunction with consequences on the quality of life of patients, adherence to treatment, and public health costs. Phosphodiesterase type 5 inhibitors (PDE5 inhibitors) are indicated for the management of erectile dysfunction. However, there is little information on such treatment in schizophrenic patients. This literature review aimed to summarize the current data on the efficacy and tolerability of PDE-5 inhibitors in the erectile dysfunction in schizophrenic patients. MATERIAL AND METHODS PubMed, PsycInfo and Cochrane databases were searched for studies published until August 2014. RESULTS Only 6 studies met the inclusion criteria. Three were randomized, double-blind, cross-over, placebo-controlled trials and three were open studies. Various scales were used to measure erectile and orgasmic function, desire, satisfaction during intercourse, overall satisfaction, quality of life and intensity of schizophrenic symptoms. In the 3 randomized studies (one with sildenafil 25-50 mg, one with lodenafil carbonate 80 mg/j and the last one with tadalafil 10 mg), the rate of participants who completed the trial was high (around 95 %). All three included patients with schizophrenia or schizophrenia spectrum disorders. Patients reported significant improvement on sexual dysfunction. However, no statistical difference was reported between lodenafil and placebo, on different scales, suggesting a very important placebo effect in patients with schizophrenia. All three found a good tolerance of PDE-5 inhibitors. Side effects were rare and were mainly nasal congestion, headaches, nausea and dizziness. There were no major side effects or drug interactions. Considering the 3 open studies, 2 involved sildenafil and one tadalafil. All concluded in improved erectile and orgasmic function, desire, satisfaction during intercourse, overall satisfaction, and even the quality of life when it was studied. However, very few patients were included. DISCUSSION Little data are available on the use of PDE5 inhibitors in schizophrenic patients. The 6 studies included few patients which reduces the power and the scope of their conclusions. There is also an important bias due to the use of self-questionnaires. The methodologies of the studies differ in many aspects which limits the comparability. Inclusion and exclusion criteria, drugs used and scales varied among the studies. However, the management of erectile disorder seems to be a consistent target in an integrative approach for the overall well-being of schizophrenic patients. PDE-5 inhibitors appear to be safe and could improve erectile function in schizophrenic patients. CONCLUSION In total, the current data suggest efficiency and good tolerance of the use of PDE-5 inhibitors in schizophrenic patients with erectile dysfunction. However, further studies focusing on PDE-5 inhibitors are needed to more deeply assess their efficacy and safety in patients with schizophrenia.
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Affiliation(s)
- L Bacconi
- Service de psychiatrie d'adultes, pôle V(e)-VI(e) arr., CHU Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
| | - F Gressier
- Inserm UMR 1178, université Paris Sud, service de Psychiatrie d'adultes, CHU de Bicêtre, Assistance publique-hôpitaux de Paris, 78, rue du Général-Leclerc, 94275 Le Kremlin-Bicêtre, France
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.rpsmen.2016.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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36
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Montejo ÁL, Arango C, Bernardo M, Carrasco JL, Crespo-Facorro B, Cruz JJ, Del Pino J, García Escudero MA, García Rizo C, González-Pinto A, Hernández AI, Martín Carrasco M, Mayoral Cleries F, Mayoral van Son J, Mories MT, Pachiarotti I, Ros S, Vieta E. Spanish consensus on the risks and detection of antipsychotic drug-related hyperprolactinaemia. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2016; 9:158-73. [PMID: 26927534 DOI: 10.1016/j.rpsm.2015.11.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 09/28/2015] [Accepted: 11/16/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Iatrogenic hyperprolactinaemia (IHPRL) has been more frequently related to some antipsychotic drugs that provoke an intense blockade of dopamine D2 receptors. There is a wide variation in clinical practice, and perhaps some more awareness between clinicians is needed. Due to the high frequency of chronic treatment in severe mental patients, careful attention is recommended on the physical risk. IHPRL symptoms could be underestimated without routine examination. METHODOLOGY An intense scientific literature search was performed in order to draw up a multidisciplinary consensus, including different specialists of psychiatry, endocrinology, oncology and internal medicine, and looking for a consensus about clinical risk and detection of IHPRL following evidence-based medicine criteria levels (EBM I- IV). RESULTS Short-term symptoms include amenorrhea, galactorrhoea, and sexual dysfunction with decrease of libido and erectile difficulties related to hypogonadism. Medium and long-term symptoms related to oestrogens are observed, including a decrease bone mass density, hypogonadism, early menopause, some types of cancer risk increase (breast and endometrial), cardiovascular risk increase, immune system disorders, lipids, and cognitive dysfunction. Prolactin level, gonadal hormones and vitamin D should be checked in all patients receiving antipsychotics at baseline although early symptoms (amenorrhea-galactorrhoea) may not be observed due to the risk of underestimating other delayed symptoms that may appear in the medium term. Routine examination of sexual dysfunction is recommended due to possible poor patient tolerance and low compliance. Special care is required in children and adolescents, as well as patients with PRL levels >50ng/ml (moderate hyperprolactinaemia). A possible prolactinoma should be investigated in patients with PRL levels >150ng/ml, with special attention to patients with breast/endometrial cancer history. Densitometry should be prescribed for males >50 years old, amenorrhea>6 months, or early menopause to avoid fracture risk.
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Affiliation(s)
- Ángel L Montejo
- Área de Neurociencias, Instituto de Biomedicina de Salamanca (IBSAL), Universidad de Salamanca, Servicio de Psiquiatría, Hospital Universitario de Salamanca, España.
| | - Celso Arango
- Departamento de Psiquiatría Infanto-Juvenil, Hospital General Universitario Gregorio Marañón (IiSGM). Facultad de Medicina, Universidad Complutense, CIBERSAM, Madrid, España
| | - Miguel Bernardo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - José L Carrasco
- Instituto de Investigación Sanitaria, Hospital Clínico San Carlos, CIBERSAM, Madrid, España
| | - Benedicto Crespo-Facorro
- Departamento de Medicina y Psiquiatría, Universidad de Cantabria. Hospital Universitario Marqués de Valdecilla, IDIVAL, CIBERSAM, Santander, España
| | - Juan J Cruz
- Servicio de Oncología Médica, Hospital Universitario de Salamanca, Universidad de Salamanca (IBSAL), España
| | - Javier Del Pino
- Servicio Medicina Interna, Hospital Clínico Universitario, Universidad de Salamanca, España
| | | | - Clemente García Rizo
- Unidad Esquizofrenia Clínic, Instituto Clínic de Neurociencias, Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, España
| | - Ana González-Pinto
- International Mood Disorders Research Centre, CIBERSAM, Hospital Santiago Apóstol, Universidad del País Vasco, Vitoria, España
| | - Ana I Hernández
- FEA Psiquiatría, Red de Salud Mental de Guipúzcoa, San Sebastián, España
| | - Manuel Martín Carrasco
- Instituto de Investigaciones Psiquiátricas, Fundación María Josefa Recio, Bilbao, España; Clínica Psiquiátrica Padre Menni, CIBERSAM, Pamplona, España
| | - Fermin Mayoral Cleries
- UGC Salud Mental, Hospital Regional Universitario, Instituto de Biomedicina de Málaga, Málaga, España
| | | | - M Teresa Mories
- Servicio de Endocrinología y Nutrición, Hospital Universitario de Salamanca, España
| | - Isabella Pachiarotti
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
| | - Salvador Ros
- Instituto Internacional de Neurociencias Aplicadas, Barcelona, España
| | - Eduard Vieta
- Programa de Trastornos Bipolares, Departamento de Psiquiatría, Hospital Clínic, Universidad de Barcelona, IDIBAPS, CIBERSAM, Barcelona, España
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de Boer MK, Castelein S, Wiersma D, Schoevers RA, Knegtering H. The facts about sexual (Dys)function in schizophrenia: an overview of clinically relevant findings. Schizophr Bull 2015; 41:674-86. [PMID: 25721311 PMCID: PMC4393701 DOI: 10.1093/schbul/sbv001] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
A limited number of studies have evaluated sexual functioning in patients with schizophrenia. Most patients show an interest in sex that differs little from the general population. By contrast, psychiatric symptoms, institutionalization, and psychotropic medication contribute to frequently occurring impairments in sexual functioning. Women with schizophrenia have a better social outcome, longer lasting (sexual) relationships, and more offspring than men with schizophrenia. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships. Although patients consider sexual problems to be highly relevant, patients and clinicians not easily discuss these spontaneously, leading to an underestimation of their prevalence and contributing to decreased adherence to treatment. Studies using structured interviews or questionnaires result in many more patients reporting sexual dysfunctions. Although sexual functioning can be impaired by different factors, the use of antipsychotic medication seems to be an important factor. A comparison of different antipsychotics showed high frequencies of sexual dysfunction for risperidone and classical antipsychotics, and lower frequencies for clozapine, olanzapine, quetiapine, and aripiprazole. Postsynaptic dopamine antagonism, prolactin elevation, and α1-receptor blockade may be the most relevant factors in the pathogenesis of antipsychotic-induced sexual dysfunction. Psychosocial strategies to treat antipsychotic-induced sexual dysfunction include psychoeducation and relationship counseling. Pharmacological strategies include lowering the dose or switching to a prolactin sparing antipsychotic. Also, the addition of a dopamine agonist, aripiprazole, or a phosphodiesterase-5 inhibitor has shown some promising results, but evidence is currently scarce.
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Affiliation(s)
- Marrit K. de Boer
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;,*To whom correspondence should be addressed; Department of Psychiatry, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, CC43, 9700 RB Groningen, The Netherlands. tel: +31-50-3616161, fax: +31-50-3611699, e-mail:
| | - Stynke Castelein
- Lentis, Center for Mental Healthcare, Groningen, The Netherlands;,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Rob Giel Research center, Groningen, The Netherlands
| | - Durk Wiersma
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Drake RJ, Nordentoft M, Haddock G, Arango C, Fleischhacker WW, Glenthøj B, Leboyer M, Leucht S, Leweke M, McGuire P, Meyer-Lindenberg A, Rujescu D, Sommer IE, Kahn RS, Lewis SW. Modeling determinants of medication attitudes and poor adherence in early nonaffective psychosis: implications for intervention. Schizophr Bull 2015; 41:584-96. [PMID: 25750247 PMCID: PMC4393703 DOI: 10.1093/schbul/sbv015] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aimed to design a multimodal intervention to improve adherence following first episode psychosis, consistent with current evidence. Existing literature identified medication attitudes, insight, and characteristics of support as important determinants of adherence to medication: we examined medication attitudes, self-esteem, and insight in an early psychosis cohort better to understand their relationships. Existing longitudinal data from 309 patients with early Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nonaffective psychosis (83% first episode) were analyzed to test the hypothesis that medication attitudes, while meaningfully different from "insight," correlated with insight and self-esteem, and change in each influenced the others. Rosenberg Self-Esteem Scale, Birchwood Insight Scale, and Positive and Negative Syndrome Scale insight were assessed at presentation, after 6 weeks and 3 and 18 months. Drug Attitudes Inventory (DAI) and treatment satisfaction were rated from 6 weeks onward. Structural equation models of their relationships were compared. Insight measures' and DAI's predictive validity were compared against relapse, readmission, and remission. Analysis found five latent constructs best fitted the data: medication attitudes, self-esteem, accepting need for treatment, self-rated insight, and objective insight. All were related and each affected the others as it changed, except self-esteem and medication attitudes. Low self-reported insight at presentation predicted readmission. Good 6-week insight (unlike drug attitudes) predicted remission. Literature review and data modeling indicated that a multimodal intervention using motivational interviewing, online psychoeducation, and SMS text medication reminders to enhance adherence without damaging self-concept was feasible and appropriate.
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Affiliation(s)
- Richard J Drake
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK;
| | - Merete Nordentoft
- Mental Health Centre Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen NV, Denmark
| | - Gillian Haddock
- Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK; Manchester Academic Health Sciences Centre, School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Birte Glenthøj
- Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Psychiatric Hospital Center Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Marion Leboyer
- INSERM U955, Laboratoire Psychopathologie et génétique des maladies mentales, et AP-HP, DHU Pe-PSY, Pole de Psychiatrie et d'addictologie des Hôpitaux Universitaires Henri Mondor, Université Paris-Est, Créteil, France
| | - Stefan Leucht
- Department of Psychiatry and Psychotherapy, Technische Universität München, München, Germany
| | - Markus Leweke
- Central Institute of Mental Health, Mannheim, Germany
| | | | | | - Dan Rujescu
- Psychiatry, Molecular and Clinical Neurobiology, Ludwig-Maximilians University, München, München, Germany; Department of Psychiatry, University of Halle, Halle, Germany
| | - Iris E Sommer
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - René S Kahn
- Department of Psychiatry, Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - Shon W Lewis
- Manchester Academic Health Sciences Centre, Institute of Brain, Behaviour & Mental Health, University of Manchester, Manchester, UK; Manchester Academic Health Sciences Centre, Manchester Mental Health & Social Care NHS Trust, Manchester, UK
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Sexual dysfunction related to typical and atypical antipsychotics in drug naive psychotic patients. MIDDLE EAST CURRENT PSYCHIATRY 2015. [DOI: 10.1097/01.xme.0000461673.36113.c8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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van Hasselt FM, Krabbe PFM, Postma MJ, Loonen AJM. Evaluation of health promotion programmes in severe mental illness: theory and practice. Int J Methods Psychiatr Res 2015; 24:83-97. [PMID: 25488507 PMCID: PMC6878437 DOI: 10.1002/mpr.1456] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/23/2014] [Accepted: 05/20/2014] [Indexed: 12/13/2022] Open
Abstract
Health promotion programmes for patients with severe mental illness (HPP) are not uniformly evaluated. We discuss the evaluation of HPP in theory and practice, as a prerequisite for future uniform evaluation. We explored the expected outcome and mechanism of HPP in the current literature. Based on this theoretical exploration we selected measures assessing the expected outcome and mechanism in current practice. The individual properties of these measures were described. Based on our theoretical exploration the outcome of HPP can be expressed in several aspects of health. Health can be improved through several mechanisms. In the current evaluation of HPP only some of the expected outcomes were evaluated. The measures used for evaluation were not all representative for the constructs they should assess. Important aspects of HPP are currently not evaluated, based on a comparison between our theoretical exploration of expected outcome and mechanism and current practice. Additionally, not all measures in use are suitable for evaluation of HPP. Therefore, development and identification of suitable measures is necessary. Our framework offers valuable directions for the development of such measures and the future evaluation of HPP.
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Affiliation(s)
- Fenneke M van Hasselt
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, The Netherlands; GGZ WNB, Mental Health Hospital, Bergen op Zoom, The Netherlands
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Tharoor H, Kaliappan A, Gopal S. Sexual dysfunctions in schizophrenia: Professionals and patients perspectives. Indian J Psychiatry 2015; 57:85-7. [PMID: 25657463 PMCID: PMC4314923 DOI: 10.4103/0019-5545.148532] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Sexual dysfunction (SD) is not commonly reported by persons with schizophrenia unless an enquiry is made by a doctor or staff during routine clinical visits. MATERIALS AND METHODS A cross-sectional study was carried out to determine reporting of drug-induced sexual side-effects and the attitude of the treating team in clarifying or detecting this issue. RESULTS A vast majority of professionals (73.2%) did not enquire about SDs in routine clinical setting and admitted that they lack expertise based on the Attitude Survey Questionnaire. More than one-third of the patients (35.3%) attributed sexual side-effects to medications. Many patients (91.7%) reported good to fair tolerance to sexual side-effects according to the Psychotropic Related Sexual Dysfunction Questionnaire. CONCLUSION The treating team plays a crucial role. Sexual side-effects are often under-reported and need to be addressed by the treating physician.
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Affiliation(s)
- Hema Tharoor
- Department of Mental Health and Social Sciences, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Anandhalakshmi Kaliappan
- Department of Mental Health and Social Sciences, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Subhashini Gopal
- Department of Mental Health and Social Sciences, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
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Hocaoglu C, Celik FH, Kandemir G, Guveli H, Bahceci B. Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:347-56. [PMID: 25642109 PMCID: PMC4311108 DOI: 10.11919/j.issn.1002-0829.214101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/14/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sexual dysfunction is one of several factors related to medication compliance in patients taking antipsychotic medication but the magnitude of this problem is unknown. AIM Compare the self-reported sexual functioning of clinically stable patients with schizophrenia taking antipsychotic medication to that of healthy controls using the Turkish version of the 5-item Arizona Sexual Experience Scale (ASEX). This scale, which has previously been validated in Turkey, assesses 5 components of sexual function: sex drive, sexual arousal, vaginal lubrication/penile erection, ability to achieve orgasm, and satisfaction with orgasm. METHODS The Scale for the Assessment of Positive Symptoms, the Scale for Assessment of Negative Symptoms, and ASEX were administered to 101 clinically stable outpatients with schizophrenia (38 females and 63 males). The ASEX was also administered to 89 control subjects (41 females and 48 males) without a history of mental illness. Respondents were classified as having sexual dysfunction if ASEX total score (range 5-30) >18, if any ASEX item score (range 1-6) ≥ 5, or if 3 or more ASEX items ≥4. RESULTS Male patients with schizophrenia have significantly more self-reported sexual dysfunction than healthy controls (46% vs. 8%). The prevalence of sexual dysfunction is higher in female patients than in male patients (68% vs. 46%), but it was also very high in healthy female controls (68%), so the sexual dysfunction of female patients cannot be attributed to their illness or to the medications they are taking. Within the patient group, there was no significant relationship between the severity of positive or negative symptoms and the severity of sexual dysfunction, and the severity of sexual function was not different between patients taking first-generation or second-generation antipsychotic medications. CONCLUSIONS The very different findings by gender in Turkey highlights the importance of assessing location-specific and gender-specific sexual norms when trying to assess the role of mental illness and medications on sexual functioning. Prospective studies are needed to distinguish the relative importance of cultural norms, the schizophrenic illness, and the use of antipsychotic medication in the etiology and course of sexual dysfunction among individuals with schizophrenia.
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Affiliation(s)
- Cicek Hocaoglu
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Fatmagul H Celik
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Gokhan Kandemir
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Hulya Guveli
- Istanbul University Oncology Enstitude, Department of Psychiatry, Istanbul, Turkey
| | - Bulent Bahceci
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
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Ong KY, Muhd Ramli ER, Che Ismail H. Factors associated with sexual dysfunction among schizophrenia men with nicotine dependency and non-smoking schizophrenia men. ACTA ACUST UNITED AC 2014. [DOI: 10.1080/17523281.2014.940370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Efficacy of tadalafil on erectile dysfunction in male patients using antipsychotics: a double-blind, placebo-controlled, crossover pilot study. J Clin Psychopharmacol 2014; 34:380-2. [PMID: 24743725 DOI: 10.1097/jcp.0000000000000113] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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De Hert M, Detraux J, Peuskens J. Second-generation and newly approved antipsychotics, serum prolactin levels and sexual dysfunctions: a critical literature review. Expert Opin Drug Saf 2014; 13:605-24. [PMID: 24697217 DOI: 10.1517/14740338.2014.906579] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Using antipsychotic (AP) medication can increase prolactin (PRL) levels and place the patient at risk of sexual dysfunction (SD). AREAS COVERED The aim of this review is to describe the PRL propensity of the different second-generation and newly approved APs. It then considers the prevalence rates of SDs associated with these compounds in patients with schizophrenia and treatment strategies for the management of SDs and/or hyperprolactinemia (HPRL). Furthermore, we address the lingering question regarding the association between SDs and PRL. EXPERT OPINION SD (particularly long-term) data remain scarce for several APs. A wide variety of assessment techniques used in SD research make reliable comparisons between APs impossible. The majority of these reports do not equally allow us to distinguish between treatment (AP and co-medication)-emergent SDs and illness-related SDs. This makes it difficult to assess the degree to which these side effects are associated with 'PRL-raising' APs, and what part of this fraction is directly reducible to serum PRL levels. Also, few evidence-based treatment strategies for HPRL and associated side effects are available. Therefore, longer-term randomized controlled trials, using reliable and valid structured interviews or questionnaires, are necessary to establish the precise relationship between APs, PRL levels and SDs rates and develop valuable treatment options.
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Affiliation(s)
- Marc De Hert
- UPC KU Leuven, Department of Neurosciences KU Leuven , Kortenberg , Belgium
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Kheng Yee O, Muhd Ramli ER, Che Ismail H. Remitted Male Schizophrenia Patients with Sexual Dysfunction. J Sex Med 2014; 11:956-965. [DOI: 10.1111/jsm.12246] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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de Boer MK, Castelein S, Wiersma D, Schoevers RA, Knegtering H. A systematic review of instruments to measure sexual functioning in patients using antipsychotics. JOURNAL OF SEX RESEARCH 2014; 51:383-389. [PMID: 24754359 DOI: 10.1080/00224499.2013.865111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Sexual dysfunction is a frequent side effect of antipsychotics, but information is scant regarding the psychometric properties and clinical usefulness of currently existing questionnaires. This systematic review compares the psychometric properties and content of questionnaires for assessment of sexual functioning in patients using antipsychotics. A systematic literature search was performed using three electronic databases (PubMed, Embase, and PsycINFO) with predefined search terms. We identified six validated instruments for assessment of sexual functioning in patients using antipsychotics: the Antipsychotic Non-Neurological Side Effects Rating Scale (ANNSERS), the Arizona Sexual Experience Scale (ASEX), the Antipsychotics and Sexual Functioning Questionnaire (ASFQ), the Changes in Sexual Function Questionnaire-14 (CSFQ-14), the Nagoya Sexual Function Questionnaire (NSFQ), and the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ). The ASFQ, CSFQ-14, and PRSexDQ cover all stages of sexual functioning, which makes these questionnaires preferable to the other three questionnaires described. The ASFQ and PRSexDQ are clinician-administered and ask for a change in sexual functioning related to medication. The ASFQ assesses improvement as well as deterioration of sexual functioning, and includes items about hyperprolactinemia. The CSFQ-14 is useful when self-report is desired but contains more items.
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Affiliation(s)
- Marrit K de Boer
- a Department of Psychiatry , University Medical Center Groningen, University of Groningen
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de Boer MK, Castelein S, Bous J, van den Heuvel ER, Wiersma D, Schoevers RA, Knegtering H. The Antipsychotics and Sexual Functioning Questionnaire (ASFQ): preliminary evidence for reliability and validity. Schizophr Res 2013; 150:410-5. [PMID: 24064182 DOI: 10.1016/j.schres.2013.08.037] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 08/24/2013] [Accepted: 08/25/2013] [Indexed: 10/26/2022]
Abstract
The aim of this study is to describe the psychometric properties of the Antipsychotics and Sexual Functioning Questionnaire (ASFQ). Internal reliability, test-retest reliability, inter-rater reliability, validity and sensitivity to change were calculated in a sample of 30 patients with schizophrenia or a schizophrenia spectrum disorder using antipsychotics. The ASFQ is a semistructured interview, with good face validity and content validity, that takes on average about 10min to complete. The ASFQ has good internal reliability (Cronbach's alpha 0.84) and good test-retest reliability (mean Spearman's rho=.76). The inter-rater reliability is good for questions about libido, orgasm, erection and ejaculation. Correlation coefficients for calculating convergent validity were modest to good when comparing the ASFQ with the corresponding items on the Subject's Response to Antipsychotics (SRA) questionnaire and the Arizona Sexual Experience Scale (ASEX). Based on preliminary evidence, it can be concluded that the Antipsychotics and Sexual Functioning Questionnaire has reasonable reliability and is available for clinical use and research.
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Affiliation(s)
- Marrit K de Boer
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, The Netherlands.
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Kelly DL, Wehring HJ, Earl AK, Sullivan KM, Dickerson FB, Feldman S, McMahon RP, Buchanan RW, Warfel D, Keller WR, Fischer BA, Shim JC. Treating symptomatic hyperprolactinemia in women with schizophrenia: presentation of the ongoing DAAMSEL clinical trial (Dopamine partial Agonist, Aripiprazole, for the Management of Symptomatic ELevated prolactin). BMC Psychiatry 2013; 13:214. [PMID: 23968123 PMCID: PMC3766216 DOI: 10.1186/1471-244x-13-214] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 08/07/2013] [Indexed: 01/01/2023] Open
Abstract
Prolactin elevations occur in people treated with antipsychotic medications and are often much higher in women than in men. Hyperprolactinemia is known to cause amenorrhea, oligomenorrhea, galactorrhea and gynecomastia in females and is also associated with sexual dysfunction and bone loss. These side effects increase risk of antipsychotic nonadherence and suicide and pose significant problems in the long term management of women with schizophrenia. In this manuscript, we review the literature on prolactin; its physiology, plasma levels, side effects and strategies for treatment. We also present the rationale and protocol for an ongoing clinical trial to treat symptomatic hyperprolactinemia in premenopausal women with schizophrenia. More attention and focus are needed to address these significant side effects and help the field better personalize the treatment of women with schizophrenia.
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Affiliation(s)
- Deanna L Kelly
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA.
| | - Heidi J Wehring
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Amber K Earl
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Kelli M Sullivan
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | | | - Stephanie Feldman
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Robert P McMahon
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Robert W Buchanan
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Dale Warfel
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - William R Keller
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA
| | - Bernard A Fischer
- School of Medicine, Maryland Psychiatric Research Center, University of Maryland Baltimore, Baltimore, Maryland, USA,VA Capital Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), Baltimore, Maryland, USA
| | - Joo-Cheol Shim
- Department of Psychiatry and Clinical Trial Center, Busan Paik Hospital, Inje University, Busan, South Korea
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Hui CLM, Lee EHM, Chang WC, Chan SKW, Li YK, Lee JTM, Chen EYH. Sexual dysfunction in Chinese patients with first-episode psychosis: prevalence, clinical correlates and functioning. Schizophr Res 2013; 148:181-2. [PMID: 23791026 DOI: 10.1016/j.schres.2013.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 05/10/2013] [Accepted: 06/02/2013] [Indexed: 11/24/2022]
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