Sexual dysfunctions in schizophrenia: beyond antipsychotics. A systematic review

Marion Dumontaud (1, 2) , Théo Korchia (1, 2) , Jérémy Khouani (1, 2) , Christophe Lançon (1, 3) , Pascal Auquier (1, 2) , Laurent Boyer (1, 2) , Guillaume Fond (2, 1)

1 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
2 APHM - Assistance Publique - Hôpitaux de Marseille
3 Hôpitaux Sud - Hôpital Sainte-Marguerite [CHU - APHM]

Background Sexual dysfunctions (SD) in schizophrenia are frequent with strong impact on adherence and quality of life. Current recommendations stipulate to switch to prolactin-sparing antipsychotic in case of SD. Objectives To synthetize in a systematic review data on the SD prevalence and the associated risk factors in schizophrenia (SZ). Methods Medline, Google Scholar, PsychInfo, and Cochrane were explored, without any year or language restriction. Results Overall, 89 studies and 25,490 participants were included in the present review. SZ subjects aged 18–70 reported high SD frequency [30%–82%] (men [33%- 85%]; women [25%- 85%]). For SZ men erectile dysfunction [31%–95%] was the most frequent SD vs. loss of libido for women [31%–100%]. The following risk factors were associated with increased SD: 1. Illness severity (including psychotic symptomatology, early age at SZ onset, negative symptomatology, and continuous illness course), 2. Depressive symptomatology 3. Antipsychotics (especially first generation antipsychotics, risperidone and antipsychotic polytherapy). Switching to prolactin-sparing antipsychotics has shown effectiveness in some studies (especially aripiprazole). Antidepressants were not found to be associated with SD in SZ subjects. Conclusion The prevalence of SD is high in SZ subjects. In addition to the current guidelines, the present review suggests that treating depressive symptoms may be a major intervention to improve SD in SZ subjects. Sociodemographic variables, physical illnesses, metabolic syndrome and peripheral inflammation have been poorly or never explored and should be included in future studies.

Mots clés: Sexual dysfunctions; Schizophrenia; Psychotropic drugs; Addiction; Prolactin; Depression

Domaines: Psychiatrie et santé mentale

Marion Dumontaud, Théo Korchia, Jérémy Khouani, Christophe Lançon, Pascal Auquier, et al.. Sexual dysfunctions in schizophrenia: beyond antipsychotics. A systematic review. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 2020, 98, pp.109804. ⟨10.1016/j.pnpbp.2019.109804⟩. ⟨hal-02473196⟩