EBP-_Article_1

Background

• Antipsychotic-induced sexual dysfunction commonly occurs in patients with psychotic disorders.

  • Very few studies have examined its impact on treatment adherence.

Study Aims

• Determine the prevalence of sexual dysfunction in patients with schizophrenia and schizoaffective disorder.

• Assess the impact of sexual dysfunction on treatment adherence.

Methods

• Participants: 95 outpatients receiving antipsychotics for at least four weeks.

• Assessment Tools:

  • Sexual dysfunction measured using a questionnaire based on the UKU Side Effect Rating Scale and the Psychotropic-Related Sexual Dysfunction Questionnaire (PRSexDQ).

  • Medication Adherence Rating Scale (MARS) for adherence.

• Results:

  • Prevalence of sexual dysfunction: 57.9%, with 65.5% attributing it to treatment.

  • Most common dysfunction reported was reduced desire in both genders.

  • No significant correlation between number, dose, and duration of antipsychotics and sexual dysfunction.

  • MARS scores significantly related to sexual dysfunction presence (p = 0.0001) and attribution to medication (p = 0.0003).

  • Attributed medication dysfunction was an independent variable associated with adherence (p = 0.001).

Conclusions

• Sexual dysfunction is prevalent among schizophrenia and schizoaffective disorder patients on antipsychotics and should be discussed by clinicians to improve adherence.

Introduction

• Schizophrenia requires lifelong antipsychotic treatment, but antipsychotics can cause several adverse effects that impact adherence.

• 30-80% of schizophrenic patients experience sexual dysfunction, a rate higher than in other populations.

• First-generation antipsychotics (FGAs) are linked with higher risks for sexual dysfunction compared to second-generation antipsychotics (SGAs).

Mechanisms of Dysfunction

• Sexual dysfunction may result from:

  • Antipsychotic blockade of D2 receptors, leading to increased prolactin levels.

  • Hyperprolactinemia causing hypogonadism and decreased testosterone, which can lead to various sexual dysfunctions.

  • Other factors such as sedation, weight gain, and other neurotransmitter receptor antagonisms.

  • D2 receptor polymorphisms have been linked with dysfunction in male patients.

Clinical Practice Challenges

• There's a reluctance among clinicians to discuss sexual issues due to embarrassment or misconceptions about psychotic patients' sexual activities.

• Limited discussion time: 50% of psychiatrists rarely address sexual problems with patients.

Study Design and Sample

• Setting: Outpatient clinic at the Psychiatric Hospital of the Cross, Lebanon, between May and August 2013.

• Eligibility: Patients aged 18-65 with schizophrenia or schizoaffective disorder on antipsychotics for at least four weeks. Excluded patients with:

  • Comorbid psychiatric conditions or medical issues affecting sexuality.

  • Prior surgeries causing sexual dysfunction.

  • Substance misuse history except nicotine.

Assessment Procedures

• Collected socio-demographic parameters and clinical data.

• Sexual functioning was evaluated through a newly designed questionnaire validated by psychiatrists.

• MARS, translated into Arabic, also assessed treatment adherence with high reliability and validity.

Results – Participants Characteristics

• Sample: 95 patients (13.7% females, 86.3% males).

• Age range: 24 – 65 years; average age: 41.4 years.

• Predominantly single (81.1%) and unemployed (57.9%).

  • Most took medication independently (80% of patients).

• FGAs included haloperidol, chlorpromazine; SGAs included olanzapine and clozapine.

Results – Prevalence of Dysfunction

• Overall sexual dysfunction prevalence: 57.9% (57.3% males, 61.5% females).

• No significant gender differences reported.

• Common issues:

  • Reduced desire (46.3% males, 53.8% females).

• No association between the number, dose of antipsychotics, or treatment duration with sexual dysfunction.

Results – Treatment Adherence

• Sexual dysfunction significantly impacts treatment adherence as shown by MARS scores:

  • Patients with dysfunction had a lower mean MARS score (8.0) than those without (9.2) (p = 0.0001).

• Attribution of sexual issues to antipsychotics correlated with decreased adherence (p = 0.0003).

• Multivariate regression confirms attribution as an independent factor affecting adherence.

Discussion

• This is the first study directly associating sexual dysfunction with treatment adherence.

• Effective clinician-patient communication about potential medication side effects is essential for adherence.

• The high prevalence of sexual dysfunction highlights the need for healthcare professionals to routinely inquire about these concerns and discuss potential solutions with patients.

Conclusion

• The study indicates a high prevalence of sexual dysfunction in schizophrenia patients on antipsychotics.

• Training healthcare providers to address these issues could enhance treatment adherence and patient outcomes.