Introduction

Long term treatment is indicated for all patients with schizophrenia¹. Antipsychotic   drugs can be of great benefit for a wide range of psychotic disorders, although   treatment can be associated with potential and unpleasant adverse effects².

  Antipsychotic drugs may restore sexual desire lost for patients with schizophrenia,  but they can also impair the patient’s sexual performance^3-5. Antipsychotics   can cause sexual dysfunction through multiple mechanisms, including sedation,  hyperprolactinaemia (wich can cause sexual dysfunction directly and indirectly   by causing secondary hypogonadism) and antagonism of α-adrenergic,  dopaminergic, histaminic and muscarinic receptors². Moreover, there   are many other factors that may cause sexual problems for patients with schizophrenia,  including concomitant medications, the effect of the disease itself, comorbidity   with other psychiatric disorders and various endocrine, vascular or genitourinary   diseases⁶. Negative symptoms of the disorder, such as anhedonia,  avolition and blunted affect related to hypodopaminergic activity in the frontal   cortex, severely harm the ability to enjoy sexual life. These patients face   difficulties in establishing relationships due to recurrent psychotic episodes,  obesity and low self-steem⁷.

It is noteworthy   that a recent study conducted by Plevin et al.⁸ reported that 73%  of men presented complaints in at least one area of antipsychotic-induced sexual   dysfunction: a) erectile, ejaculatory, and orgasmic dysfunction^9-16  b) low sexual desire^11,13-16 and c) priapism¹². Although   fewer studies have been conducted with females, there is evidence of sexual   dysfunctions in the following areas: a) lack of orgasm^11,13,17,18  b) low lubrification^13,19 c) loss of libido^14,19 and d)  amenorrhea¹¹. Sexual dysfunctions induced by antipsychotic treatment   can be responsible for non-adherence to treatment²⁰ and non compliance   is one of the main obstacles to an adequate control of the symptoms present   in patients with schizophrenia². Moreover, sexual dysfunction is   rated as one of the most distressing adverse effects of antipsychotic treatment^22,23  and experienced by patients as significantly more distressing than sedation,  or extrapyramidal side effects²².

At present, there   are three scales available to asses sexual dysfunctions in patients under antipsychotic   treatment: a) the Dickson and Glazer Scale for the Assessment of Sexual Functioning   Inventory (DGSFi)²⁴; b) the Arizona Sexual Experience Scale (ASEX)²⁵,  c) the Psychotropic-Related Sexual Dysfunction (PRSexDQ-SALSEX)²⁶.

  Unlike the more traditional and lengthy scales for assessing sexual dysfunctions,  the ASEX can be completed in approximately 5 minutes²⁷ and it was   designed to be self- or clinician-administered. In addition, the ASEX questionnaire   can be used for heterossexual and homossexual populations, as well as for those   without sexual partners²⁸.

  Antipsychotic-induced   sexual dysfunctions are poorly recognized, and not properly investigated by   most clinicians²⁹. Thus, it is very important to have accurate tools   to aid clinicians in the diagnosis of antipsychotic-induced sexual dysfunctions²⁸.

  The main aims of this paper are threefold: a) to evaluate the accuracy of the   ASEX to identify sexual dysfunction; b) to assess the frequency of sexual dysfunction in a sample of outpatients with schizophrenia and schizoaffective disorder under   antipsychotic therapy; and c) to investigate the effect of different antipsychotics   on sexual function.

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  Luciana Vargas Alves Nunes^I; Luiz Henrique Junqueira Dieckmann^II; Fernando
  Sargo Lacaz^II; Rodrigo Bressan^III; Tiemi Matsuo^IV; Jair de Jesus Mari

  ^IM.D, MSc. Student, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
  ^IIM.D., Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
  ^IIM.D, PhD., Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
  ^IVPhD, Department of Statistics, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
  ^VM.D., PhD, Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil. Honorary Visiting Professor, Health Services and Population Research Department, Institute of Psychiatry, King’s College, University of London

Full article

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