A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics.
ABSTRACT The aim of this meta-analysis was to quantify sexual dysfunction (SD) in patients treated with antipsychotics on the basis of selected papers that specifically investigated this type of adverse events by means of adequate instruments. A literature research was conducted using three electronic databases. Studies providing measures of SD in patients taking antipsychotics and providing separate data on single drugs were considered for inclusion. Our primary outcome measure was the rate of total SD, and our secondary outcome measures were the rates of desire, arousal, and orgasm dysfunction. We found that significant differences exist across different antipsychotics in terms of total SD, such that, partially consistent with the traditional dichotomy between prolactin-raising and prolactin-sparing antipsychotics, quetiapine, ziprasidone, perphenazine, and aripiprazole were associated with relatively low SD rates (16-27%), whereas olanzapine, risperidone, haloperidol, clozapine, and thioridazine were associated with higher SD rates (40-60%). Apart from a few exceptions, secondary analyses substantially confirmed the primary outcome measure. However, sensitivity analyses showed a significant impact of several variables on SD rates. In addition, taking into account several limitations, including the difficulty to disentangle SD related to drugs from SD related to illness itself, further studies are needed to determine more thorough evidence concerning antipsychotic-induced SD.
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ABSTRACT: Resumen El cambio de antipsicóticos es un hecho frecuente en la práctica clínica y está sujeto a potenciales complicaciones clínicamente relevantes. Un grupo de expertos seleccionados por la Sociedad Española de Psiquiatría y la Sociedad Española de Psiquiatría Biológica ha revisado y discutido las pruebas provenientes de los ensayos clínicos y otros artículos relevantes para llegar a unas recomendaciones de consenso sobre el cambio de antipsicóticos. En este artículo se revisa toda la información que ha dado lugar a esas recomendaciones y que incluye: indica-ciones y contraindicaciones del cambio de antipsicóticos, aspectos farmacológicos, estrategias de cambio, el cambio por motivos de eficacia, el cambio por motivos de tolerabilidad (inclu-yendo los síntomas extrapiramidales y la discinesia tardía, el aumento de peso, los trastornos metabólicos, la hiperprolactinemia, la disfunción sexual, la sedación persistente y la prolon-gación del QT), el cambio por problemas de cumplimiento y el cambio de antipsicóticos en el trastorno bipolar. © 2011 SEP y SEPB. Publicado por Elsevier España, S.L. Todos los derechos reservados. Los miembros del Grupo RECAP aparecen al final del artículo. * Autor para correspondencia.Revista de Psiquiatría Biológica y Salud Mental 07/2011; DOI:10.1016/j.rpsm.2011.07.003 · 0.31 Impact Factor
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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.Schizophrenia Bulletin 02/2015; 41(3). DOI:10.1093/schbul/sbv001 · 8.61 Impact Factor
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ABSTRACT: Hyperprolactinemia (HPRL) has until recently been considered an unavoidable side effect inherent to antipsychotic treatment and probably this has been the reason why its clinical effects are underestimated in daily clinical practice. In this review we evaluate the different prolactin (PRL) raising potential of the antipsychotic (AP) drugs as well as the clinical and individual situations where special precautions must be taken when using these medications. The most common and better known clinical consequences of HPRL-induced by APs are sexual and reproductive symptoms, with different characteristics depending on gender, but recently more evidence has been provided of also an involvement in bone mineral density, carcinogenesis and cardiovascular system. Though these effects still require more evidence, they are important to be taken into account when prescribing APs drugs in susceptible patients. It is essential to prevent and minimize the effect of HPRL-induced by APs and, once established, to consider its severity and clinical effects and to provide a proper management, treatment and consideration of other disciplines.Psiquiatria Biologica 07/2013; 20(3):27-34. DOI:10.1016/j.psiq.2013.06.011