Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

Abstract

A considerable body of literature reports that individuals with psychotic disorders often suffer from sexual dysfunctions (SDs), with these representing a major unmet need. Long-term antipsychotic drug treatment may be the main cause for SDs in psychotic patients, through a plethora of different mechanisms, including prolactin dyscrasia, histamine-mediated sedation, and serotonin-induced sexual demotivation. However, a few pieces of evidence treat sexuality in patients at risk or the onset of psychosis. For this purpose, we systematically reviewed literature of the last 10 years in order to investigate sexuality in ultra-high risk (UHR) for psychosis and first-episode psychosis (FEP). We included in our review 34 articles fitting our research criteria on SDs in UHR and FEP. Evidence of SDs in the transition from UHR to FEP emerges through the selected studies. In FEP, sexuality is affected by the severity of the psychotic symptoms and, in some cases, by the iatrogenic effects of psychopharmacological treatment. Further experimental and clinical studies should systematically investigate the role of sexual functioning in the transition from UHR to FEP and, consequently, clarify whether or not SDs could be considered a possible marker for the onset of psychosis in at-risk populations. Moreover, psychiatrists and clinical psychologists should take into consideration the role of sexual life in young people with prodromal mental symptoms or at the onset of psychosis. Focusing on a thorough sexual evaluation might be a major challenge that could break down barriers of mental health promotion among young people with schizophrenia-spectrum disorders and therefore achieve better clinical outcomes.

The Italian Society of Andrology and Sexual Medicine (SIAMS), along with ten other Italian Scientific Societies, guidelines on the diagnosis and management of erectile dysfunction

“…In men with diabetes and depression, a significantly higher prevalence of ED is observed [ 60 , 134 ], with depressive symptoms showing an independent and positive association with the severity of ED [ 135 ]. Moreover, it has been demonstrated that young people in the early stages of psychosis have higher rates of ED [ 136 ] and that men suffering from bipolar disorder and post-traumatic stress disorder may also have a higher risk of ED [ 137 , 138 ], not associated with the use of psychotropic medications.…”

Structural Features Predict Sexual Trauma and Interpersonal Problems in Borderline Personality Disorder but Not in Controls: A Multi-Voxel Pattern Analysis

“…The most frequent of these is childhood sexual abuse, reported by 40-71% of patients linked to the severity of the abuse itself (Shearer et al, 1990;Paris et al, 1994;Zanarini et al, 2002). Consistent evidence show as sexual abuse during childhood is a reliable predictor of chronic PTSD (Müller et al, 2018), is strongly linked to ultra-high risk of psychosis (UHR), first -episode psychosis (FEP; Ciocca et al, 2021). Sexual trauma is particularly relevant for the development of addiction (Poppa et al, 2019) and it is often associated with the ineffectiveness of pharmacological treatment of anxiety disorders (Kim et al, 2021).…”

Validity of self-reported male sexual function scales in a young Chinese population: a comparative study with clinician-assisted evaluation

“…Psychometric scales are scientifically and clinically relevant tools used by physicians and psychologists to quantitatively assess patients’ sexual health 1 2 3 by means of patient-reported outcomes (PROs). 4 Male sexual function can be assessed by several psychometric scales: the 6-item International Index for Erectile Function (IIEF-6), the Erection Hardness Scale (EHS), and the Masturbation Erection Index (MEI) can be used to assess aspects related to erectile function; moreover, the Premature Ejaculation Diagnostic Tool (PEDT) can be used to assess the presence of premature ejaculation (PE) and its clinical consequences.…”