A systematic review on clinical management of antipsychotic-induced sexual dysfunction in schizophrenia.
BACKGROUND
Sexual dysfunction frequently occurs in patients with schizophrenia under antipsychotic 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.


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, difficulties 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.


CONCLUSIONS
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 outcome 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.
Costa
Anna Maria Niccolai
AM
Universidade Federal de São Paulo, Rua Samia Haddad 150, CEP 05709-050, São Paulo(SP), Brazil. annamariac@globo.com
Lima
Mauricio Silva de
MS
Mari
Jair de Jesus
Jde J
D000465:Algorithms; D014150:Antipsychotic Agents / Q000009:adverse effects*; D018491:Dopamine Agonists / Q000627:therapeutic use; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007989:Libido / Q000187:drug effects; D008297:Male; D008599:Menstruation Disturbances / Q000150:complications; D009948:Orgasm / Q000187:drug effects; D010410:Penile Erection / Q000187:drug effects; D010726:Phosphodiesterase Inhibitors / Q000627:therapeutic use; D012559:Schizophrenia / Q000188:drug therapy*; D012702:Serotonin Antagonists / Q000627:therapeutic use; D012735:Sexual Dysfunction, Physiological / Q000139:chemically induced* / Q000188:drug therapy
D014150:Antipsychotic Agents; D018491:Dopamine Agonists; D010726:Phosphodiesterase Inhibitors; D012702:Serotonin Antagonists