Sexual dysfunction in women with psychosis

INTRODUCTION: Human sexual function is complex and affected by many different factors. In patients with mental and emotional disorders such as schizophrenia, biological and psychosocial factors associated with sexual functioning are further complicated by illness and medication effects. Antipsychotic medication, the main modality of treatment in schizophrenia, is known to produce sexual side effects in addition to others such as weight gain and the metabolic syndrome. Because of the sensitive nature of the problem, many patients may not report this side effect to the therapist, though distressing to them, unless specifically asked for it. These sexual side-effects may subsequently lead to nonadherence, distress in patient and /or partner and marital dysharmony. Therefore effective management of this problem is essential. While prevention is most desirable, early identification and effective management of these sexual side effects could improve compliance and quality of life. OBJECTIVES: To study the nature, prevalence and risk factors for sexual dysfunction in neuroleptic-naïve women with psychosis, and to evaluate the incidence of antipsychotic induced sexual dysfunction in these individuals. METHODS: Consecutive antipsychotic drug naïve women with schizophrenia or acute psychosis who met eligibility criteria were rated on the Positive and Negative Symptom Scale for symptom severity and the Female Sexual Function Index for sexual functioning. Weight, blood sugar and prolactin levels were measured. Socio-demographic details were recorded. After six weeks and six months of treatment with antipsychotic medication, the assessments were repeated. Using SPSS for Windows (version 16.0.1), mean and standard deviation were calculated for continuous variables and frequency distributions for categorical data. Pearson’s correlation and chi square were calculated to assess relationships between continuous and categorical variables respectively. RESULTS: Among the 104 subjects recruited, prevalence rates of sexual dysfunction were 67.3, 82.8 and 72.22% at baseline, six weeks and six months respectively. Incidence of sexual dysfunction at six weeks was 60%. The most common type of dysfunction was hypoactive sexual desire and orgasmic disorder. Factors associated with sexual dysfunction at different points of time included age, education, age of onset and duration of illness, negative and general psychopathology scores and type of antipsychotic used. Weight, prolactin level and dose of antipsychotic medication were not significantly associated with sexual dysfunction