195 - Effects of psychosis

Effects of psychosis

Schizophrenia and related psychoses CHAPTER 1 Sexual dysfunction and antipsychotics A 2023 meta-­analysis found the global prevalence of sexual dysfunction in people with schizophrenia to be 56% in men and 60% in women.1 Problems are not always reported by patients. In one study of patients with psychosis, 37% spontaneously reported sexual problems but 46% were found to be experiencing difficulties when directly questioned.2 Baseline sexual functioning should be determined if possible (questionnaires may be useful) because sexual function can affect both quality of life3 and compliance with medication (sexual dysfunction is one of the major causes of treatment dropout).4,5 Complaints of sexual dysfunction may also indicate progression or inadequate treatment of underlying medical or psychiatric conditions.6,7 Sexual problems may also be caused by drug treatment and are associated with early discontinuation of antipsychotics.8 Intervention may greatly improve quality of life.9 The human sexual response There are four phases of the human sexual response, as detailed in Table 1.44.10–12 Effects of psychosis Sexual dysfunction is a well-­established phenomenon in first-episode schizophrenia.13,14 Up to 82% of men and 96% of women report problems, with associated reductions in quality of life.3 Antipsychotic adverse effects are not solely responsible, because prevalence is also high (17–70%) in patients who are unmedicated.15 Men complain of reduced desire,16 inability to achieve an erection and premature ejaculation,1 whereas women complain of lowered libido and orgasm dysfunction.1 Women with psychosis also have reduced fertility.17 Table 1.44  The human sexual response. Desire ■ ■Related to testosterone levels in men ■ ■Possibly increased by dopamine and decreased by prolactin ■ ■Psychosocial context and conditioning significantly affect desire Arousal ■ ■Influenced by testosterone in men and oestrogen in women ■ ■Other potential mechanisms include central dopamine stimulation, modulation of the cholinergic/adrenergic balance, peripheral α1 agonism and nitric oxide pathways ■ ■Physical pathology such as hypertension or diabetes can have a significant effect Orgasm ■ ■May be related to oxytocin ■ ■Inhibition of orgasm may be caused by an increase in serotonin activity and raised prolactin, as well as α1 blockade Resolution ■ ■Occurs passively after orgasm Note: Many other hormones and neurotransmitters may interact in a complex way at each phase.