A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia
Keywords:
Schizophrenia, Antipsychotic agents, Sexual and gender disorders, LibidoAbstract
INTRODUCTION: Sexual dysfunction frequently occurs in patients with schizophrenia under an- tipsychotic therapy, and the presence of sexual side effects may affect compliance. The aim of this study was to review and describe clinical findings relating to the appropriate management of such dysfunctions. MATERIAL AND METHODS: The research was carried out through Medline (from 1966 to March 2005), PsycInfo (from 1974 to March 2005), and Cochrane Library (from 1965 to March 2005) and included any kind of study, from case reports to randomized trials. RESULTS: The most common sexual dysfunctions found in the literature were libido decrease, dif- ficulties in achieving and maintaining erection, ejaculatory dysfunction, orgasmic dysfunction, and menstrual irregularities. Thirteen papers were found: eight of them were open-label studies, four were descriptions of cases, and only one was a randomized clinical trial. All of them were short-term and had small sample sizes. The agents used were: bromocriptine, cabergoline, cyproheptadine, amantadine, shakuyaku-kanzo- to, sildenafil and selegiline. DISCUSSION: There was no evidence that those agents had proper efficacy in treating the antipsychotic-induced sexual dysfunction. An algorithm for managing sexual dysfunction induced by antipsychotics is suggested as a support for clinical decisions. Since the out- come from schizophrenia treatment is strongly related to compliance with the antipsychotics, prevention of sexual dysfunction is better than its treatment, since there is a scarcity of data available regarding the efficacy of intervention to deal with these problems.
Downloads
References
Duggan L, Fenton M, Dardennes RM, El-Dosoky A, Indran S. Olanzapine for schizophrenia. Cochrane Database Syst Rev. 2003; 1):CD001359.
Waraich PS, Adams CE, Roque M, Hamill KM, Marti J. Haloperidol dose for the acute phase of schizophrenia. Cochrane Database Syst Rev. 2002;(3):CD001951.
Mota NE, Lima MS, Soares BG. Amisulpride for schizophrenia. Cochrane Database Syst Rev. 2002;(2):CD001357.
Fenton M, Coutinho ES, Campbell C. Zuclopenthixol acetate in the treatment of acute schizophrenia and similar serious mental illnesses. Cochrane Database Syst Rev. 2001;(3):CD000525.
Bagnall A, Lewis RA, Leitner ML. Ziprasidone for schizophrenia and severe mental illness. Cochrane Database Syst Rev. 2000;(4): CD001945.
Gilbody SM, Bagnall AM, Duggan L, Tuunainen A. Risperidone versus other atypical antipsychotic medication for schizophrenia. Cochrane Database Syst Rev. 2000;(3):CD002306.
Srisurapanont M, Disayavanish C, Taimkaew K. Quetiapine for schizophrenia. Cochrane Database Syst Rev. 2000;(3): CD000967.
Teusch L, Scherbaum N, Bohme H, Bender S, Eschmann-Mehl G, Gastpar M. Different patterns of sexual dysfunctions asso- ciated with psychiatric disorders and psychopharmacological treatment. Results of an investigation by semistructured inter- view of schizophrenic and neurotic patients and methadone-sub- stituted opiate addicts. Pharmacopsychiatry. 1995;28(3):84-92.
Hansen TE, Casey DE, Hoffman WF. Neuroleptic intolerance. Schizophr Bull. 1997;23(4):567-82.
Finn SE, Bailey JM, Schultz RT, Faber R. Subjective utility ratings of neuroleptics in treating schizophrenia. Psychol Med. 1990;20(4):843-8.
Macdonald S, Halliday J, MacEWAN T, et al. Nithsdale Schizo- phrenia Surveys 24: sexual dysfunction. Case-control study. Br J Psychiatry. 2003;182:50-6.
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 Suppl. 1987;334:1-100.
Beau Y, Guillard P. Essai de traitement par la bromocriptine des effets secondaires endocriniens des traitements psychotropes. [Trial therapy with bromocriptine of secondary endocrine ef- fects after psychotropic treatment]. Ann Med Psychol (Paris). 1980;138(2):179-86.
Matsuoka I, Nakai T, Miyake M, Hirai M, Ikawa G. Effects of bromocriptine on neuroleptic-induced amenorrhea, galactorrhea and impotence. Jpn J Psychiatry Neurol. 1986;40(4):639-46.
Tollin SR. Use of the dopamine agonists bromocriptine and cabergoline in the management of risperidone-induced hyper- prolactinemia in patients with psychotic disorders. J Endocrinol Invest. 2000;23(11):765-70.
Jeffries JJ, Walker C. Cyproheptadine and drug-induced anor- gasmia. Can J Psychiatry. 1987;32(1):79.
Aizenberg D, Shiloh R, Zemishlany Z, Weizman A. Low-dose imipramine for thioridazine-induced male orgasmic disorder. J Sex Marital Ther. 1996;22(3):225-9.
Correa N, Opler LA, Kay SR, Birmaher B. Amantadine in the treatment of neuroendocrine side effects of neuroleptics. J Clin Psychopharmacol. 1987;7(2):91-5.
Valevski A, Modai I, Zbarski E, Zemishlany Z, Weizman A. Effect of amantadine on sexual dysfunction in neuroleptic- treated male schizophrenic patients. Clin Neuropharmacol. 1998;21(6):355-7.
Benatov R, Reznik I, Zemishlany Z. Sildenafil citrate (Viagra) treatment of sexual dysfunction in a schizophrenic patient. Eur Psychiatry. 1999;14(6):353-5.
Lare SB, Labbate LA. Sildenafil and erectile dysfunction. Am J Psychiatry. 2000;157(12):2055-6.
Atmaca M, Kuloglu M, Tezcan E. Sildenafil use in patients with olanzapine-induced erectile dysfunction. Int J Impot Res. 2002;14(6):547-9.
Aviv A, Shelef A, Weizman A. An open-label trial of sildenafil addition in risperidone-treated male schizophrenia patients with erectile dysfunction. J Clin Psychiatry. 2004;65(1):97-103.
Yamada K, Kanba S, Yagi G, Asai M. Effectiveness of herbal medicine (shakuyaku-kanzo-to) for neuroleptic-induced hyper- prolactinemia. J Clin Psychopharmacol. 1997;17(3):234-5.
Angrist B, Gershon S. Clinical effects of amphetamine and L-DOPA on sexuality and aggression. Compr Psychiatry. 1976;17(6):715-22.
Aizenberg D, Zemishlany Z, Weizman A. Cyproheptadine treatment of sexual dysfunction induced by serotonin reuptake inhibitors. Clin Neuropharmacol. 1995;18(4):320-4.
Siever LJ. The effect of amantadine on prolactin levels and galac- torrhea on neuroleptic-treated patients. J Clin Psychopharmacol. 1981;1(1):2-7.
Yamada K, Kanba S, Yagi G, Asai M. Herbal medicine (Shakuyaku-kanzo-to) in the treatment of risperidone-induced amenorrhea. J Clin Psychopharmacol. 1999;19(4):380-1.
Berry MD, Juorio AV, Paterson IA. Possible mechanisms of action of (-)deprenyl and other MAO-B inhibitors in some neurologic and psychiatric disorders. Prog Neurobiol. 1994;44(2):141-61.
Kodesh A, Weizman A, Aizenberg D, Hermesh H, Gelkopf M, Zemishlany Z. Selegiline in the treatment of sexual dysfunction in schizophrenic patients maintained on neuroleptics: a pilot study. Clin Neuropharmacol. 2003;26(4):193-5.
Micromedex® Healthcare Series. Thomson Micromedex. Avail- able from URL: http://www.micromedex.com/products/hcs/. Accessed in 2006 (Aug 23).
Beumont P, Bruwer J, Pimstone B, Vinik A, Utian W. Brom- ergocryptine in the treatment of phenothiazine-induced galactorrhea. Br J Psychiatry. 1975;126:285-8.
Varia IM, Cavenar JO Jr, Taska RJ, Maltbie AA. Bromocriptine in the treatment of haloperidol-induced galactorrhea. N C Med J. 1982;43(11):769-70.
Smith S. Neuroleptic-associated hyperprolactinemia. Can it be treated with bromocriptine? J Reprod Med. 1992; 37(8):737-40.
Popli A, Gupta S, Rangwani SR. Risperidone-induced galactor- rhea associated with a prolactin elevation. Ann Clin Psychiatry. 1998;10(1):31-3.
Cohen LG, Biederman J. Treatment of risperidone-induced hyperprolactinemia with a dopamine agonist in children. J Child Adolesc Psychopharmacol. 2001;11(4):435-40.
Blumenthal M, Busse WR, Goldberg A, et al. The Complete Com- mission E Monographs: Therapeutic Guide to Herbal Medicines. Boston: Integrative Medicine Communications; 1998.
Armanini D, Bonanni G, Palermo M. Reduction of serum testosterone in men by licorice. N Engl J Med. 1999;341(15):1158.
Negrete JC. Clinical aspects of substance abuse in persons with schizophrenia. Can J Psychiatry. 2003;48(1):14-21.
Marinow A. Diabetes in chronic schizophrenia. Dis Nerv Syst. 1971;32(11):777-8.
McKee HA, D’Arcy PF, Wilson PJ. Diabetes and schizophrenia-a preliminary study. J Clin Hosp Pharm. 1986;11(4):297-9.
Tsuang MT, Perkins K, Simpson JC. Physical diseases in schizophrenia and affective disorder. J Clin Psychiatry. 1983;44(2):42-6.
Davidson M. Risk of cardiovascular disease and sudden death in schizophrenia. J Clin Psychiatry. 2002;63(Suppl 9):5-11.
Blair JH, Simpson GM. Effect of antipsychotic drugs on reproductive functions. Dis Nerv Syst. 1966;27(10):645-7.
Kotin J, Wilbert DE, Verburg D, Soldinger SM. Thioridazine and sexual dysfunction. Am J Psychiatry. 1976;133(1):82-5.
Laughren TP, Brown WA, Petrucci JA. Effects of thioridazine on serum testosterone. Am J Psychiatry. 1978;135(8):982-4.
Schnieden H. Effect of psychoactive drugs on the motil- ity of human spermatozoa. ICRS J Int Res Commun. 1974;2(5):1322.
Kleinberg DL, Davis JM, de Coster R, Van Baelen B, Brecher M. Prolactin levels and adverse events in patients treated with risperidone. J Clin Psychopharmacol. 1999;19(1):57-61.
Ghadirian AM, Chouinard G, Annable L. Sexual dysfunction and plasma prolactin levels in neuroleptic-treated schizophrenic outpatients. J Nerv Ment Dis. 1982;170(8):463-7.
Windgassen K, Wesselmann U, Schulze Monking H. Galac- torrhea and hyperprolactinemia in schizophrenic patients on neuroleptics: frequency and etiology. Neuropsychobiology. 1996;33(3):142-6.
Gruen PH, Sachar EJ, Langer G, et al. Prolactin responses to neuroleptics in normal and schizophrenic subjects. Arch Gen Psychiatry. 1978;35(1):108-16.
Langer G, Sachar EJ, Gruen PH, Halpern FS. Human prolactin responses to neuroleptic drugs correlate with antischizophrenic potency. Nature. 1977;266(5603):639-40.
Rubin RT. Prolactin and schizophrenia. In: Meltzer HY, Coyle JT, Kopin IJ, editors. Psychopharmacology: the third generation of progress. New York: Raven Press; 1987. p. 803-6.
Harrison WM, Rabkin JG, Ehrhardt AA, et al. Effects of anti- depressant medication on sexual function: a controlled study. J Clin Psychopharmacol. 1986;6(3):144-9.
Kinon BJ, Lieberman JA. Mechanisms of action of atypical antipsychotic drugs: a critical analysis. Psychopharmacology (Berl). 1996;124(1-2):2-34.
Aizenberg D, Modai I, Landa A, Gil-Ad I, Weizman A. Com- parison of sexual dysfunction in male schizophrenic patients maintained on treatment with classical antipsychotics versus clozapine. J Clin Psychiatry. 2001;62(7):541-4.
Knegtering H, Blijd C, Boks M. Sexual dysfunction and prolactin levels in patients using classical antipsychotics, ris- peridone or olanzapine. Schizophr Res. 1999;36(1-3):355-6. [abstract].
David S, Crawford AM, Breier A. Prolactin levels in olanzap- ine versus typical and atypical antipsychotics. Schizophr Res. 1998;29(1-2):153. [abstract].
Montejo AL, Llorca G, Izquierdo JA. Switching to olanzapine in patients with antipsychotic-induced sexual dysfunction: a prospective and naturalistic study. Program and abstracts from the 153rd annual meeting of the American Psychiatric Associa- tion; 2000 May 13-18. Chicago; 2000.
Bobes J, Garc A-Portilla MP, Rejas J, et al. Frequency of sexual dysfunction and other reproductive side-effects in patients with schizophrenia treated with risperidone, olanzapine, quetiapine, or haloperidol: the results of the EIRE study. J Sex Marital Ther. 2003;29(2):125-47.
Knegtering R, Castelein S, Bous H, et al. A randomized open-label study of the impact of quetiapine versus risperidone on sexual functioning. J Clin Psychopharmacol. 2004;24(1):56-61.
Sandison RA, Whitelaw E, Currie JD. Clinical trials with melleril (TP21) in the treatment of schizophrenia. A two-year study. J Ment Sci. 1960;106:732-41.
Sullivan G, Lukoff D. Sexual side effects of antipsychotic medication: evaluation and interventions. Hosp Community Psychiatry. 1990;41(11):1238-41.
Shiwach RS, Carmody TJ. Prolactogenic effects of risperidone in male patients--a preliminary study. Acta Psychiatr Scand. 1998;98(1):81-3.
Peacock L, Solgaard T, Lublin H, Gerlach J. Clozapine versus typical antipsychotics. A retro- and prospective study of extrapyramidal side effects. Psychopharmacology (Berl). 1996;124(1-2):188-96.
Knegtering H, van der Moolen AE, Castelein S, Kluiter H, van den Bosch RJ. What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning? Psychoneuroendocri- nology. 2003;28(Suppl 2):109-23.
Kaplan HS. The new sex therapy. New York: Routledge; 1974.
Kane JM. Antipsychotic drug side effects: their relationship to dose. J Clin Psychiatry. 1985;46(5 Pt 2):16-21.
Gross MD. Reversal by bethanechol of sexual dysfunction caused by anticholinergic antidepressants. Am J Psychiatry. 1982;139(9):1193-4.
Segraves T. Effects of psychotropic drugs on human erection and ejaculation. Arch Gen Psychiatry. 1989;46(3):275-84.
