A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia

Abstract

INTRODUCTION: Sexual dysfunction frequently occurs in patients with schizophrenia under antipsychotic therapy, and the presence of sexual side effects may affect compliance. The aim of this study was to review and describe clinical findings relating to the appropriate management of such dysfunctions. MATERIAL AND METHODS: The research was carried out through Medline (from 1966 to March 2005), PsycInfo (from 1974 to March 2005), and Cochrane Library (from 1965 to March 2005) and included any kind of study, from case reports to randomized trials. RESULTS: The most common sexual dysfunctions found in the literature were libido decrease, difficulties in achieving and maintaining erection, ejaculatory dysfunction, orgasmic dysfunction, and menstrual irregularities. Thirteen papers were found: eight of them were open-label studies, four were descriptions of cases, and only one was a randomized clinical trial. All of them were short-term and had small sample sizes. The agents used were: bromocriptine, cabergoline, cyproheptadine, amantadine, shakuyaku-kanzo-to, sildenafil and selegiline. DISCUSSION: There was no evidence that those agents had proper efficacy in treating the antipsychotic-induced sexual dysfunction. An algorithm for managing sexual dysfunction induced by antipsychotics is suggested as a support for clinical decisions. Since the outcome from schizophrenia treatment is strongly related to compliance with the antipsychotics, prevention of sexual dysfunction is better than its treatment, since there is a scarcity of data available regarding the efficacy of intervention to deal with these problems.

A Randomized, Crossover Comparison of Herbal Medicine and Bromocriptine Against Risperidone-Induced Hyperprolactinemia in Patients With Schizophrenia

“…7 The formula called Peony-Glycyrrhiza Decoction (PGD) made from Paeoniae and Glycyrrhiza radices (Shaoyao-Gancao-Tang in Chinese and Shakuyaku-Kanzo-To in Japanese, TJ-68) is such agent that has been introduced into the treatment of various conditions associated with hyperprolactinemia by medical professionals in China and Japan. [8][9][10][11][12][13] Peony-Glycyrrhiza Decoction was originally recorded in the ancient Chinese pharmacopoeia called Treatise on Exogenous Febrile Diseases (written by Zhang ZhongJing, 200-400 B.C.) and used for alleviating muscle spasm.…”

“…Today, numerous studies have confirmed the antispasmodic effects of this herbal formula and its major constituents on various spasmodic conditions. 14-16 Furthermore, a large number of studies have shown that PGD is also effective in treating disorders associated with sexual and reproductive hormone dysfunctions, including infertility, 17 ovulation disorders, 18,19 menopause, 20 hyperprolactinemia-induced impotence, 13 and neuroleptic-induced hyperprolactinemia in schizophrenic individuals, [8][9][10][11] as evidenced by a significant suppression of elevated PRL levels and resumption of sexual desire and menstrual cycle, without incidence of severe adverse events. [8][9][10][11] Animal studies further demonstrated that PGD and its major constituents possess a capacity of modulating synthesis and release of several sexual and reproductive hormones, including PRL.…”

Strategies for the Treatment of Antipsychotic-Induced Sexual Dysfunction and/or Hyperprolactinemia Among Patients of the Schizophrenia Spectrum: A Review

“…There was a lack of randomized controlled trials on the clinical management of antipsychoticinduced sexual dysfunction in the literature, and no proper comparisons of the efficacy of agents (Costa, Lima, & Mari, 2006).…”

Práticas baseadas em evidências publicadas no Brasil: identificação e análise de suas vertentes e abordagens metodológicas

“…In the childhood and adolescence specialty, for example, EBP ranged from anxiety disorder, whether for treatment (18) or assessment (19) , vaccination (24)(25) , safety during nebulization (28) , ICU death (29) , physical exercise measure (33) , nutritional interventions and child growth (70) , prenatal and weight at birth (71) , among others. Another quite diversified example comes from psychiatry/mental health: medication treatments (15,18,20,76,80,89) , physical exercise (16) , cognitive therapy (17) , anxiety assessment instrument (19) , quality of life and food disorders (35) , psychological stress x hypertension (40) , family intervention in schizophrenia (50) etc.…”