Sexual Dysfunction in Schizophrenia

Purpose of Review: Sexual dysfunctions have been described as being common in schizophrenia patients. The pathophysiology behind their development remains unclear. They can be secondary to the disease itself or an adverse event of antipsychotic medication. Therapeutic interventions are also not well studied.

Recent Findings: Earlier work has suggested that second-generation antipsychotics bear fewer risks for developing sexual dysfunction because of a lower propensity to elevate prolactin levels, although the latter does not apply to amisulpride and risperidone. Only a few controlled trials with larger patient samples have been performed in the past.

Summary: The review covers studies published from March 2005 to June 2006 focusing on sexual dysfunctions in schizophrenia patients, as well as their possible causes. Treatment options and the impact of sexual dysfunction on quality of life are also covered. The reviewed papers show no clear consistency regarding potential advantages of one drug over another. Many trials suffer from small sample sizes. The field badly needs more and larger studies on this topic.

Introduction

Sexual dysfunctions, such as erectile dysfunction, decreased libido or disturbances in ejaculation/orgasm are frequent in both men and women suffering from schizophrenia.[1,2] Whether a disturbance of the menstrual cycle is also considered under this umbrella is a matter of debate, but we have also searched for studies dealing with this issue. Sexual dysfunctions represent an important factor both with regard to adherence to medication, which is highly influenced by side effects of antipsychotics,[3,4] and other outcome variables such as quality of life.

An elevation of plasma prolactin levels through D2 receptor antagonism is considered a possible pathophysiological explanation for these adverse events.[5,6] Apart from D2 blockade, sedation due to antihistaminergic or adrenergic effects, as well as serotonergic blockade, are alternative pathways potentially leading to sexual dysfunction.[7]

As sexual dysfunction can also be observed in untreated schizophrenia patients,[8] other factors may play an important role as well: decreased libido through negative symptoms could be one of them. Previous studies have focused primarily on chronically ill patients, and thus little is known about sexual functioning among more recent onset, acutely ill patients.

In this review, last year's published papers on sexual dysfunction in schizophrenia patients are discussed. As an in-depth literature search through Medline has yielded only a few studies focusing solely on sexual dysfunction, reports with other main aims that, nevertheless, describe findings on sexual dysfunction are also reviewed.

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Peter Malik, Department of Biological Psychiatry, Medical University Innsbruck, AustriaPosted: 02/20/2007; Curr Opin Psychiatry. 2007;20(2):138-142. © 2007 Lippincott Williams & Wilkins