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.

Determine the prevalence of sexual dysfunction in patients with schizophrenia and schizoaffective disorder.
Assess the impact of sexual dysfunction on treatment adherence.

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).

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

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).

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.

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.

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.

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.

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.

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.

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.

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.

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.