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Tijdschrift voor Psychiatrie 49 (2007) 10, 733 - 742

State-of-the-art-article

Antipsychotics and sexual functioning in persons with psychoses

H. Knegtering, R. Bruggeman , S. Castelein, D. Wiersma

summary
background
So far little research has been done into sexual dysfunctions that develop during the use of antipsychotics. However, over the last 10 years a great deal of new and clinically useful information has become available.
aim To provide information about the frequency, nature and pathogenesis of sexual dysfunctions that arise during treatment with antipsychotics and to suggest some ways of tackling such problems in clinical practice.
results In 30 to 60% of cases the use of antipsychotics is linked to sexual dysfunctions such as loss of libido, erectile and/or lubrication problems and orgasm and ejaculation disorders. If sexual dysfunctions are not actively addressed by clinicians they are likely to be underreported. The most frequent sexual dysfunctions are a result of treatment with antipsychotics with a high affinity for dopamine receptors and/or that cause a marked rise in the prolactin level. Antipsychotic-induced sexual dysfunctions are probably linked to a lower quality of life and lower treatment compliance. Possible mechanisms that underlie the influence of antipsychotics on sexual functioning are discussed. Also discussed are possible interventions designed to reduce sexual dysfunction.
conclusions During treatment with antipsychotics sexual dysfunctions occur frequently, depending on the type of antipsychotics prescribed. If clinicians actively address the problems of sexual dysfunction, they may often be able to arrive at a solution by giving information, by prescribing a different antipsychotic, by reducing the dose and/or by prescribing appropriate supplementary medication.

keywords adverse effects, antipsychotic agents, dopamine, sexual dysfunction, prolactin