Sexual dysfunction in outpatients with schizophrenia

Abstract

Background: Schizophrenia is a chronic mental illness affecting young subjects who are sexually active. Social disability and sexual dysfunction were higher in those patients compared to general population [1]. In the literature the frequency of sexual dysfunctions in these patients varies between 50 and 85% [1-3]. The aim of this study was to assess the prevalence of sexual dysfunction in outpatients with schizophrenia and investigate associated sociodemographic and clinical factors. Methods: It's a descriptive study held in psychiatric department in Farhat Hached university hospital of Sousse (Tunisia). One hundred outpatients with schizophrenia had participated. The study was conducted between First September and 15 November 2013. Participants were recruited on the following criteria: fulfilling the diagnosis of schizophrenia according to the DSM-IV-TR criteria, having a duration of illness of at least three years and meeting the remission criterion offered by 'The Working Group Remission in schizophrenia' with a score less than or equal to 90 at PANSS and no history of hospitalization during the last 6 months. Exclusion criteria were mental retardation, personal or family history of any neurological disorder, history of head injury, alcohol or substance abuse in the preceding 6 months. We administered to our patients a record exploring the sociodemographic and clinical characteristics, Positive and Negative Syndrome Scale (PANSS) and Arizona Sexual Experience Scale (ASEX) to assess sexual dysfunction. ASEX scale was translated and validated into Arabic language. Comparison was performed between two groups: - Group I: outpatients with schizophrenia having sexual dysfunction - Group II: outpatients with schizophrenia without sexual dysfunction Results: The average age of our sample was 37.6±10.2 years. 70% were male and 57% were single. Only 27% of them had professional activity. The mean age of onset of the illness was 24.8±6.1 years. The average PANSS total score and ASEX total score were respectively 51.8±12.8 and 17.7±5.6. The average equivalent dose chlorpromazine was 475±279 mg/day. Sexual dysfunction was present in 55% of outpatients with schizophrenia (total score ≥19 or ASEX Item ≥5 or ≥3 items 4). We didn't found relationship between sexual dysfunction and sociodemographic characteristics except gender. Female had higher ASEX total score (p = 0.002). Arousal and orgasm disorders were more frequent in women (p = 0.005 and p = 0.001). For clinical factors, patients with continuous evolution of schizophrenia had higher ASEX total score (p = 0.049). There was a relationship between the ASEX total score and dose of treatment (r = 0.36, p = 0.001) and with the severity of symptoms (r = 0.31, p = 0.005). Conclusions: More than half of our outpatients with schizophrenia had sexual dysfunction. Women had more sexual dysfunctions. Sexual dysfunction is correlated to symptoms severity, continuous evolution and dose treatment.