Sexual dysfunctions in schizophrenia: Beyond antipsychotics. A systematic review

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 prolactinsparing 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.

The Relationships Between Hyperprolactinemia, Metabolic Disturbance, and Sexual Dysfunction in Patients With Schizophrenia Under Olanzapine Treatment

“…The prevalence of sexual dysfunction among people with schizophrenia is higher than that among the rest of the population. Sexual dysfunction has been reported in 30–82% of patients with psychiatric disorders who use antipsychotics, due to hyperprolactinemia as well as α1 and dopamine D 2 receptor blockades ( De Boer et al, 2015 ; Dumontaud et al, 2020 ). A meta-analysis reported that olanzapine users had a higher rate of sexual dysfunction (approximately 40%) as compared with the prolactin-sparing antipsychotics quetiapine, ziprasidone, and aripiprazole (16–27%) ( Serretti and Chiesa, 2011 ).…”

“…Some studies have suggested a relationship between the disorders ( Ahl et al, 2004 ; Rubio-Abadal et al, 2016 ), but other studies have discovered no such relationship ( Johnsen et al, 2011 ; Kikuchi et al, 2012 ). Other factors that have been suggested to be related to sexual dysfunction in patients with schizophrenia include sex, age, disease psychopathology, effects of other medications, substance use, and medical comorbidities ( Martin et al, 2018 ; Dehelean et al, 2020 ; Dumontaud et al, 2020 ). Antipsychotic-induced sexual dysfunction can significantly distress patients and subsequently reduce drug compliance ( Souaiby et al, 2019 ); accordingly, evaluating sexual dysfunction and managing it properly are essential.…”

Experiences and opinions of nurses working in psychiatric wards on assessing patients' sexual health: A qualitative study

“…5,6,7 Sexual dysfunctions, to which clinicians pay little attention, are among the most important causes of poor quality of life and treatment noncompliance. 8 Effectively managing the side effects that occur during mental health treatment, facilitating drug compliance and achieving the best possible results are important for patients' sexual health. 9 Patients' inability to express their sexual problems, healthcare professionals' belief that individuals with mental illnesses do not have sex lives and clinicians' avoiding talking about these issues with patients further increase patients' problems.…”

“…Compared with the general population, individuals with serious mental disorders exhibit lower rates of contraceptive use and have a higher risk of engaging in risky sexual acts and being exposed to harassment and rape, unwanted pregnancies, and sexually transmitted diseases 5,6,7 . Sexual dysfunctions, to which clinicians pay little attention, are among the most important causes of poor quality of life and treatment noncompliance 8 . Effectively managing the side effects that occur during mental health treatment, facilitating drug compliance and achieving the best possible results are important for patients' sexual health 9 .…”

Complex Gastrointestinal and Endocrine Sources of Inflammation in Schizophrenia

“…The endocrine system is another postulated source for the chronic inflammation associated with schizophrenia. Especially implicated are certain conditions including metabolic syndrome, obesity, and diabetes as well as basic differences in disease pathophysiology between males and females (11)(12)(13). These conditions are often the result of antipsychotics that slow metabolism and contribute to weight gain and a disrupted metabolic state.…”