Serretti A, Chiesa A. A meta-analysis of sexual dysfunction in psychiatric patients taking antipsychotics
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.
Available from: Ian Hamilton
- "A gender lens is useful to apply to this topic as there is a distinct link between gender, sexual experience and response to substances, prescribed or otherwise. For example the three phases of sexual response are affected in differing ways by each gender in relation to selective serotonin reuptake inhibitors (SSRI's), with females more likely to be effected in the arousal phase, while for males it is during the desire and orgasm response (Serretti et al 2011b). "
Available from: PubMed Central
- "Recently, several studies outlined that SD is rated as one of the most distressing side effects of antipsychotics [5, 6] and a major cause of a poor quality of life , and that it is associated with a negative attitude toward therapy and noncompliance to treatment . Furthermore, strong evidence has been presented suggesting that both typical and some atypical antipsychotics, such as risperidone, are often associated with a significant impairment of sexual function . Suggested mechanisms for these unwanted effects include a disturbance of one or more of the three areas of the normal sexual–response cycle: sexual interest (libido), arousal (including vaginal lubrication in women and erection in men), and orgasm (along with further endocrine disturbances), to a higher or lesser extent depending on the pharmacological properties of each single compound [10, 11]. "
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ABSTRACT: Sexual dysfunction (SD) is common in patients taking antipsychotics, and is the most bothersome symptom and adverse drug effect compromising treatment compliance. Mechanisms involved in psychotropics-induced SD are either largely unknown or poorly understood. The aim of this review is to present an updated analysis of SD associated with the use of psychotropic drugs in psychiatric patients.
Contemporary evidence from available studies demonstrates that SD rates are drug-related rather than drug-class specific, and that these rates vary widely. Mechanisms involved in psychotropics-induced SD are either largely unknown or poorly understood. Our understanding of psychotropics-induced SD is limited by the inability to differentiate whether these effects are really drug-induced or due to different inclusion criteria.
Rigorous research, basic and clinical, is needed to understand the exact incidence, severity and mechanisms involved in the development of SD induced by various psychotropic treatment regimens.
Available from: Marrit K. De Boer
- "Several questionnaires on the sexual side effects of antipsychotics have been used in previous studies (Serretti & Chiesa, 2011), but psychometric properties have been reported for only a few instruments. Because of the scarcity of validation and standardization studies, a gold standard method to evaluate antipsychotic-induced changes in sexual functioning is lacking. "
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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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