Prevalence of Sexual Dysfunction in Schizophrenic Patients Taking Antipsychotic Drugs

Sun Hwa Jeong; Shi Hyun Kang; Dong Yeon Park; Hai Joo Yoon; Eun Kyung Park; Jong Il Lee

doi:10.16946/kjsr.2016.19.2.60

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Jeong, Kang, Park, Yoon, Park, and Lee: Prevalence of Sexual Dysfunction in Schizophrenic Patients Taking Antipsychotic Drugs

Original Article

Korean J Schizophr Res 2016;19(2):60-67.

Published online: 20 January 2016

DOI: https://doi.org/10.16946/kjsr.2016.19.2.60

Prevalence of Sexual Dysfunction in Schizophrenic Patients Taking Antipsychotic Drugs

Sun Hwa Jeong, MD¹, Shi Hyun Kang, MD, PhD¹, Dong Yeon Park, MD, PhD¹, Hai Joo Yoon, MA², Eun Kyung Park, RN³, Jong Il Lee, MD, PhD^1,

¹Department of Psychiatry, National Center for Mental Health, Seoul, Korea

²Department of Clinical Psychology, National Center for Mental Health, Seoul, Korea

³Department of Clinical Trial Center, National Center for Mental Health, Seoul, Korea

Address for correspondence: Jong-Il Lee, Department of Psychiatry, National Center for Mental Health, 127, Yongmasan-ro, Gwangjin-gu, Seoul 04933, Korea Tel: 02-2204-0114, Fax: 02-2204-0389 E-mail: lji7542@naver.com

Received 20 June 2016 Revised 7 September 2016 Accepted 20 September 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objectives

Sexual dysfunction is said to affect the compliance of drug and quality of life. This study is a research to investigate the prevalence of sexual dysfunction and affecting factors that can occur when schizophrenic and schizoaffective patients have taken drugs.

Methods

Subjects were 300 patients who have been taken inpatient or outpatient treatment in national seoul hospital. We used UKU-S, ASEX scale for evaluating the prevalence of sexual dysfunction and CGI-S, PANSS negative scale and CES-D for investigating the influence of psychopathology and depressive symptoms on sexual dysfunction.

Results

: It was reported sexual dysfunction 82.7% in male and 92.2% in female with 7 items of UKU-S. The prevalence of sexual dysfunction with criteria of ASEX was 47.72% in male and 65.05% in female. Sexual dysfunction was more prevalent in patients taking prolactin-elevation drugs. In the factor analysis for the sexual dysfunction it was investigated that age, onset time, CGI-S, PANSS negative scale, and CES-D can affect the sexual dysfunction in both male and female.

Conclusion

This study reported that many patients complained of sexual dysfunction. On considering the influence of sexual dysfunction to compliance and quality of life, clinicians evaluate sexual side effects more actively because patients are more likely not spontaneously tell the sexual side effects in comparison to others.

Keywords: Sexual dysfunction, Schizophrenia, Antipsychotic agent.

References

1. McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD, et al. Risk factors for sexual dysfunction among women and men: a consensus statement from the fourth international consultation on sexual medicine 2015. Journal of Sexual Medicine. 2016; 13:153–167.

2. Fric M, Laux G. Prolactin levels and symptoms of hyperprolactinaemia in patients treated with amisulpride, risperidone, olanzapine and quetiapine. Psychiatr Prax. 2003; 30:97–101.

3. Smith SM, O'Keane V, Murray R. Sexual dysfunction in patients taking conventional antipsychotic medication. Br J Psychiatry. 2002; 181:49–55.

4. Richard GP. Prolactin and antipsychotic medications: mechanism of action. Schizophr Res. 1999; 35:67–73.

5. Compton MT, Miller AH. Antipsychotic-induced hyperprolactinemia and sexual dysfunction. Psychopharmacol Bull. 2001; 36:143–164.

6. Yasui-Furukori N, Fujii A, Sugawara N, Tsuchimine S, Saito M, Hashimoto K, et al. No association between hormonal abnormality and sexual dysfunction in Japanese schizophrenia patients treated with antipsychotics. Hum Psychopharmacol. 2012; 27:82–89.

7. Dossenbach M, Hodge A, Anders M, Molnár B, Peciukaitiene D, Krupka-Matuszczyk I, et al. Prevalence of sexual dysfunction in patients with schizophrenia: international variation and underestimation. Int J Neuropsychopharmacol. 2005; 8:195–201.

8. Uçok A, Incesu C, Aker T, Erkoç S. Sexual dysfunction in patients with schizophrenia on antipsychotic medication. Eur Psychiatry. 2007; 22:328–333.

9. Fujii A, Yasui-Furukori N, Sugawara N, Sato Y, Nakagami T, Saito M, et al. Sexual dysfunction in Japanese patients with schizophrenia treated with antipsychotics. Prog Neuropsychopharmacol Biol Psychiatry. 2010; 34:288–293.

10. Choi YT, Cheon JS, Oh BH. Review of sexual dysfunction in male schizophrenics. J Korean Soc Biol Psychiatry. 2000; 7:85–98.

11. Lee KH, Kang SH, Kang GY, Kim KH, Kim KK, Soh M, et al. The prevalence of hyperprolactinemia and amenorrhea and the association with sexual dysfunction in schizophrenic patients with antipsychotics. J Korean Neuropsychiatr Assoc. 2009; 48:423–429.

12. Olfson M, Uttaro T, Carson WH. Male sexual dysfunction and quality of life in schizophrenia. J Clin Psychiatry. 2005; 66:331–338.

13. Costa AM, Lima MS, Mari Jde J. A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia. Sao Paulo Med J. 2006; 124:291–297.

14. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-IV-TR. 4th ed., text revision. Washington, DC: American Psychiatric Association;2000.

15. Byerly M, Suppes T, Tran QV, Baker RA. Clinical implications of antipsychotic-induced hyperprolactinemia in patients with schizophrenia spectrum or bipolar spectrum disorders: recent developments and current perspectives. J Clin Psychopharmacol. 2007; 27:639–661.

16. Kane JM, Meltzer HY, Carson WH, McQuade RD, Marcus RN, Sanchez R. Aripiprazole for treatment-resistant schizophrenia: results of a multicenter, randomized, double-blind, comparison study versus perphenazine. J Clin Psychiatry. 2007; 68:213–223.

17. Tauscher-Wisniewski S, Kapur S, Tauscher J, Jones C, Daskalakis ZJ, Papatheodorou G, et al. Quetiapine: an effective antipsychotic in first-episode schizophrenia despite only transiently high dopamine-2 receptor blockade. J Clin Psychiatry. 2002; 63:992–997.

18. Bushe C, Yeomans D, Floyd T, Smith SM. Categorical prevalence and severity of hyperprolactinaemia in two UK cohorts of patients with severe mental illness during treatment with antipsychotics. J Psychopharmacol. 2008; 22:56–62.

19. Crawford AM, Beasley CM Jr, Tollefson GD. The acute and longterm effect of olanzapine compared with placebo and haloperidol on serum prolactin concentrations. Schizophr Res. 1997; 26:41–54.

20. Woods SW. Chlorpromazine equivalent doses for the newer atypical antipsychotics. J Clin Psychiatry. 1899; 64:663–667.

21. Harrison WM, Rabkin JG, Ehrhardt AA, Stewart JW, McGrath PJ, Ross D, et al. Effects of antidepressant medication on sexual function: a controlled study. J Clin Psychopharmacol. 1986; 6:144–149.

22. Montejo AL, Llorca G, Izquierdo JA, Rico-Villademoros F. Incidence of sexual dysfunction associated with antidepressant agents: a prospective multicenter study of 1022 outpatients. J Clin Psychiatry. 2001; 62:10–21.

23. Guy W. Clinical Global Impressions (CGI) Scale. Modified From: Rush J, et al.: Psychiatric Measures, APA, Washington DC;2000.

24. Kay SR, Fiszbein A, Opler LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull. 1987; 13:261–276.

25. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977; 1:385–401.

26. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. J Sex Marital Ther. 2000; 26:25–40.

27. Martha S, Luis FR. Rating scales in mental health. Revised. 2nd ed.Lexi-comp;2006. p. 376–378.

28. Lingjaerde O, Ahlfors UG, Bech P, Dencker SJ, Elgen K. The UKU side effect rating scale: a new comprehensive rating scale for psychotropic drugs and a cross-sectional study of side effects in neuroleptic-treated patients. Acta Psychiatr Scand. 1987; 76:1–100.

29. Schwartz MF, Bauman JE, Masters WH. Hyperprolactinemia and sexual disorders in men. Biol Psychiatry. 1982; 17:861–876.

30. Mah PM, Webster J. Hyperprolactinemia: etiology, diagnosis, and management. Semin Reprod Med. 2002; 20:365–374.

31. Westheide J, Cohen S, Bender S, Cooper-Mahkorn D, Erfurth A, Gastpar M, et al. Sexual dysfunction in psychiatric inpatients the role of antipsychotic medication. Pharmacopsychiatry. 2007; 40:140–145.

32. Harley EW, Boardman J, Craig T. Sexual problems in schizophrenia: prevalence and characteristics. A cross sectional survey. Soc Psychiatry Psychiatr Epidemiol. 2010; 45:759–766.

33. Rettenbacher MA, Hofer A, Ebenbichler C, Baumgartner S, Edlinger M, Engl J, et al. Prolactin levels and sexual adverse effects in patients with schizophrenia during antipsychotic treatment. J Clin Psychopharmacol. 2010; 30:711–715.

34. Smith S, Gillam A. Sexual dysfunction-the forgotten taboo. Mental Health Nurs. 2005; 25:6–9.

35. Gopalakrishnan R, Jacob KS, Kuruvilla A, Vasantharaj B, John JK. Sildenafil in the treatment of antipsychotic-induced erectile dysfunction: a randomized, double-blind, placebocontrolled, flexible-dose, two-way crossover trial. Am J Psychiatry. 2006; 163:494–499.

36. Seeman MV. Loss of libido in a woman with schizophrenia. Am J Psychiatry. 2013; 170:471–475.

37. Hou CL, Zang Y, Rosen RC, Cai MY, Li Y, Jia FJ, et al. Sexual dysfunction and its impact on quality of life in Chinese patients with schizophrenia treated in primary care. Comprehensive Psychiatry. 2016; 65:116–121.

Table 1.

Characteristics of demographic and psychiatric parameters of total subjects

		Mean (SD)	N (%)
Sex	Male		197 (65.7)
	Female		103 (34.3)
Age (year)		41.00 (7.21)
Onset age (year)		22.51 (4.94)
Illness duration (year)		19.10 (6.82)
Education (year)		12.63 (2.24)
Marital status	Unmarried		228 (76.0)
	Married		43 (14.3)
	Divorce		29 (9.7)
Sexual partner	Yes		55 (18.3)
Sexual partner	Yes		55 (18.3)
	No		245 (81.7)
Diagnosis	Schizophrenia disorder		294 (98.0)
	Schizoaffective disorder		6 (2.0)
Antipsychotics (mg/day)	Prolactin-elevating drug	537.21 (412.27)	183 (61.0)
	Haloperidol	501.35 (420.45)	57 (19.0)
	Risperidone	483.27 (421.10)	89 (29.7)
	Paliperidone	450.93 (394.57)	43 (14.3)
	Amisulpiride	620.42 (512.09)	31 (10.3)
	Prolactin-sparing drug	579.45 (495.52)	117 (39.0)
	Aripiprazole	489.37 (389.90)	61 (20.3)
	Olanzapine	607.88 (493.67)	53 (17.7)
	Quetiapine	599.06 (470.21)	76 (25.3)
	Clozapine	459.70 (375.61)	31 (10.3)
	Polypharmacy		76 (25.3)
Mood stabilizer			56 (18.7)
Antidepressant			42 (14.0)
ASEX-Male		17.78 (4.98)
ASEX-Female		20.93 (5.83)
CES-D		19.71 (10.36)
PANSS-N		22.43 (3.39)
CGI-S		3.71 (0.66)

ASEX: Arizona Sexual Experience Scale, CES-D: Center for Epidemiological Studies Depression Scale, PANSS-N: Positive and Negative Syndrome Scale-Negative Scale, CGI-S: Clinical Global Impression-Severity

Table 2.

Disorders in sexual function according to the UKU-S

	None	Mild	Moderate	Severe
Galactorrhea	284 (94.6%)	11 (3.7%)	4 (1.3%)	1 (0.3%)
Increased sexual desire	274 (91.3%)	20 (6.7%)	6 (2.0%)	0 (0.0%)
Decreased sexual desire	122 (40.7%)	62 (20.7%)	84 (28.0%)	32 (10.7%)
Orgasmic dysfunction	154 (51.3%)	61 (20.4%)	53 (17.7%)	32 (10.7%)
Gynecomastia^a	184 (93.4%)	11 (5.6%)	2 (1.0%)	0 (0.0%)
Erectile dysfunction^a	87 (44.2%)	53 (26.9%)	40 (20.3%)	17 (8.6%)
Ejaculatory dysfunction^a	106 (53.8%)	39 (19.8%)	35 (17.8%)	17 (8.6%)
Menorrhagia^b	78 (75.7%)	15 (14.6%)	7 (6.8%)	3 (2.9%)
Amenorrhea^b	61 (59.1%)	13 (12.6%)	8 (7.8%)	21 (20.4%)
Dry vagina^b	62 (60.2%)	13 (12.6%)	18 (17.5%)	10 (9.7%)

a: only men, b: only women. UKU-S: udvalg for Kliniske Undersogelser side effects rating scale-sexual function subscale

Table 3.

Group difference of sexual dysfunction according to the UKU-S

	Prolactin-elevating group		Prolactin-sparing group		p value
	n (total)	%	n (total)	%	p value
Galactorrhea	11 (183)	6.0	5 (117)	4.3	0.606
ncreased sexual desire	13 (183)	7.1	13 (117)	11.1	0.214
Decreased sexual desire	124 (183)	67.8	54 (117)	46.2	0.000
Orgasmic dysfunction	103 (183)	56.3	44 (117)	37.6	0.001
Gynecomastia^a	13 (123)	10.6	0 (74)	0.0	0.002
Erectile dysfunction^a	73 (123)	59.4	37 (74)	48.6	0.137
Ejaculatory dysfunction^a	70 (123)	56.9	22 (74)	29.7	0.000
Menorrhagia^b	11 (60)	18.3	14 (43)	32.6	0.109
Amenorrhea^b	31 (60)	51.7	11 (43)	25.6	0.009
Dry vagina^b	26 (60)	43.3	15 (43)	34.9	0.421

a: Only men, b: Only women. UKU-S: Udvalg for Kliniske Undersogelser side effects rating scale – sexual function subscale

Table 4.

Group difference of clinical variables and various rating scales

Male	Prolactin-elevating group (n=123)			Prolactin-sparing group (n=74)			p value
Male	Mean	SD	n (%)	Mean	SD	n (%)	p value
Age (year)	42.98	6.60		39.50	7.85		0.001
Education (year)	12.71	2.49		12.19	1.94		0.126
Onset age (year)	25.09	7.07		23.31	7.06		0.089
ASEX	18.66	5.39		16.29	3.81		0.001
CGI-S	3.8	0.57		3.69	0.68		0.236
PANSS-N	23.02	3.05		22.11	3.58		0.059
CES-D	20.95	11.32		16.38	9.03		0.004
Sexual dysfunction			63 (51.2)			23 (31.1)	0.007
AD			33 (26.8)			17 (23.0)	0.547
Female	Prolactin-elevating group (N=60)			Prolactin-sparing group (n=43)			p value
Female	Mean	SD	n (%)	Mean	SD	n (%)	p value
Age (year)	44.57	6.14		40.21	7.62		0.002
Education (year)	12.93	2.24		12.77	1.89		0.693
Onset age (year)	24.48	6.22		25.26	6.02		0.530
ASEX	21.78	5.81		19.86	5.81		0.101
CGI-S	3.76	0.65		3.42	0.76		0.016
PANSS-N	22.98	3.11		20.51	3.69		0.000
CES-D	20.98	9.80		20.16	9.41		0.671
Sexual dysfunction			41 (68.3)			26 (60.5)	0.409
AD			15 (25.0)			8 (18.6)	0.442

ASEX: Arizona Sexual Experience Scale, CGI-S: Clinical Global Impression-Severity, PANSS-N: Positive and Negative Syndrome Scale-Negative scale, CES-D: Center for Epidemiological Studies Depression Scale, AD: Antidepressant

Table 5.

Pearson correlations between ASEX score and clinical variables

	ASEX_male		ASEX_female
	Pearson's coefficient	p value	Pearson's coefficient	p value
Age (year)	0.164	0.220	0.018	0.857
Onset age (year)	0.880	0.220	0.009	0.931
CGI-S	0.272	0.000	0.135	0.171
PANSS-N	0.239	0.001	0.151	0.122
CES-D	0.122	0.910	0.027	0.784

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