Download PDF
Psychiatr Prax 2009; 36(4): 160-168
DOI: 10.1055/s-0028-1090206
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Sexuelle Störungen bei Menschen mit einer schizophrenen Erkrankung

Sexual Problems in Patients with SchizophreniaDaniel  Schöttle1 , Dürten  Kammerahl1 , Johannes  Huber2 , Peer  Briken3 , Martin  Lambert1 , Christian  G.  Huber1
  • 1Psychosen-Ersterkennungs- und Behandlungsprojekt (PEB), Zentrum für Psychosoziale Medizin, Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf
  • 2Urologische Universitätsklinik, Heidelberg
  • 3Institut für Sexualforschung und Forensische Psychiatrie, Zentrum für Psychosoziale Medizin, Universitätsklinikum Hamburg-Eppendorf
Further Information

Publication History

Publication Date:
07 May 2009 (online)

Also available at
    Permissions and Reprints

Zusammenfassung

Anliegen Überblick über den aktuellen Kenntnisstand zu sexuellen Störungen bei Menschen mit einer schizophrenen Erkrankung. Methode Selektive Literaturübersicht zu Klassifikation, Vorkommen, Auswirkungen und Therapie. Ergebnisse Sexuelle Störungen bei Menschen mit einer schizophrenen Erkrankung werden in ihrer Häufigkeit und subjektiven Bedeutung weitgehend unterschätzt. Schlussfolgerungen Sexualität sollte im Rahmen eines integrativen Behandlungsansatzes stärker berücksichtigt werden. Dies könnte eine umfassendere psychische Stabilisierung der Betroffenen fördern.

Abstract

Objective Overview on the current knowledge concerning sexual dysfunctions in patients with schizophrenia and implications for treatment, compliance, quality of life and partnership. Method Selective literature research on classification, occurrence, effects and therapy. Results Frequency and subjective distress of sexual problems in patients with schizophrenia are widely underestimated. Pharmacogenic and morbogenic causes of the sexual problems are often difficult to differentiate. The low awareness of health care professionals for sexual problems and their persistence have significant negative impact on patients' satisfaction with the treatment, compliance, quality of life and partnership. Conclusions It is important to consider patients' sexuality as an integral part of a treatment approach to achieve compliance and mental stabilization as well as an improvement in quality of life.

Schlüsselwörter

Sexualität - sexuelle Nebenwirkungen - Lebensqualität - Partnerschaft - Compliance - psychotische Ersterkrankung

Key words

sexuality - sexual side effects - quality of life - partnership - compliance - first-episode psychosis

Literatur

  • 1 Kelly D L, Conley R R. Sexuality and schizophrenia: a review.  Schizophr Bull. 2004;  30 767-779
    CrossrefPubMedGoogle Scholar
  • 2 Grube M, Weigand-Tomiuk H. Sexual dysfunctions in a group of psychiatric in-patients.  Psychiat Prax. 2002;  29 194-200
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Sigusch V. Sexuelle Störungen und ihre Behandlung. Stuttgart, New York; Thieme 2007: 107-141
    Google Scholar
  • 4 Meston C M, Bradford A. Sexual dysfunctions in women.  Annual review of clinical psychology. 2007;  3 233-256
    CrossrefPubMedGoogle Scholar
  • 5 WHO .ICD-10: The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines. Geneva; World Health Organisation (WHO) 1992
    Google Scholar
  • 6 APA .Diagnostic Criteria from DSM-IV. Washington, DC; American Psychiatric Publishing 1994
    Google Scholar
  • 7 Beutel M E, Stöbel-Richter Y, Daig I. et al . Sexuelles Verlangen und sexuelle Aktivität von Männern und Frauen über die Lebensspanne – Ergebnisse einer repräsentativen deutschen Bevölkerungsumfrage.  J Reproduktionsmed Endokrinol. 2008;  5 203-211
    PubMedGoogle Scholar
  • 8 Dunn K M, Jordan K, Croft P R. et al . Systematic review of sexual problems: epidemiology and methodology.  J Sex Marital Ther. 2002;  28 399-422
    CrossrefPubMedGoogle Scholar
  • 9 Nazareth I, Boynton P, King M. Problems with sexual function in people attending London general practitioners: cross sectional study.  BMJ. 2003;  327 423
    CrossrefPubMedGoogle Scholar
  • 10 Laumann E O, Paik A, Rosen R C. Sexual dysfunction in the United States: prevalence and predictors.  JAMA. 1999;  281 537-544
    CrossrefPubMedGoogle Scholar
  • 11 Fortier P, Mottard J P, Trudel G. et al . Study of sexuality-related characteristics in young adults with schizophrenia treated with novel neuroleptics and in a comparison group of young adults.  Schizophr Bull. 2003;  29 559-572
    CrossrefPubMedGoogle Scholar
  • 12 Hartmann U. Depression and sexual dysfunction: aspects of a multi-faceted relationship.  Psychiat Prax. 2007;  34 (Suppl. 3) S314-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 13 Kinzl J F. Sexuality and antipsychotics.  Neuropsychiatr. 2008;  22 49-50
    PubMedGoogle Scholar
  • 14 Bhui K, Puffet A, Herriot P. A survey of sexual problems amongst psychiatric inpatients.  Soc Psychiatry Psychiatr Epidemiol. 1995;  30 73-77
    CrossrefPubMedGoogle Scholar
  • 15 Smith S M, O'Keane V, Murray R. Sexual dysfunction in patients taking conventional antipsychotic medication.  Br J Psychiatry. 2002;  181 49-55
    CrossrefPubMedGoogle Scholar
  • 16 Kammerahl D, Schottle D, Huber C G. Sexualität und Schizophrenie. Eine Übersicht.  Z Sexualforsch. 2008;  21 165-180
    Google Scholar
  • 17 Ferguson J M. The effects of antidepressants on sexual functioning in depressed patients: a review.  J Clin Psychiatry. 2001;  62 (Suppl. 3) 22-34
    PubMedGoogle Scholar
  • 18 Dossenbach M, Hodge A, Anders M. et al . Prevalence of sexual dysfunction in patients with schizophrenia: international variation and underestimation.  Int J Neuropsychopharmacol. 2005;  8 195-201
    CrossrefPubMedGoogle Scholar
  • 19 Cohen S, Scholz P. Sexualstörungen in der Behandlung depressiver Erkrankungen.  Psychoneuro. 2004;  30 164-168
    Article in Thieme ConnectPubMedGoogle Scholar
  • 20 Pinderhughes C A, Grace E B, Reyna L J. Psychiatric disorders and sexual functioning.  Am J Psychiatry. 1972;  128 1276-1283
    PubMedGoogle Scholar
  • 21 Akhtar S, Thomson Jr J A. Schizophrenia and sexuality: a review and a report of twelve unusual cases – Part II.  J Clin Psychiatry. 1980;  41 166-174
    PubMedGoogle Scholar
  • 22 Lewis J, Scott E. The sexual education needs of those disabled by mental illness.  Psychiatric Rehabilitation. 1997;  21 164-167
    PubMedGoogle Scholar
  • 23 Miller L J, Finnerty M. Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders.  Psychiatr Serv. 1996;  47 502-506
    PubMedGoogle Scholar
  • 24 McCann E. The expression of sexuality in people with psychosis: breaking the taboos.  J Adv Nurs. 2000;  32 132-138
    CrossrefPubMedGoogle Scholar
  • 25 Buddeberg C, Furrer H, Limacher B. Sexual problems in schizophrenic patients treated by ambulatory care.  Psychiat Prax. 1988;  15 187-191
    PubMedGoogle Scholar
  • 26 Lukoff D, Gioia-Hasick D, Sullivan G. et al . Sex education and rehabilitation with schizophrenic male outpatients.  Schizophr Bull. 1986;  12 669-677
    CrossrefPubMedGoogle Scholar
  • 27 Kelly D L, Conley R R. Evaluating sexual function in patients with treatment-resistant schizophrenia.  Schizophr Res. 2003;  63 195-196
    CrossrefPubMedGoogle Scholar
  • 28 Raja M, Azzoni A. Sexual behavior and sexual problems among patients with severe chronic psychoses.  Eur Psychiatry. 2003;  18 70-76
    CrossrefPubMedGoogle Scholar
  • 29 Pfeiffer W, Kockott G, Fischl B. et al . Adverse effects of long-term psychopharmacologic therapy on sexual functions.  Psychiat Prax. 1991;  18 92-98
    PubMedGoogle Scholar
  • 30 Aizenberg D, Zemishlany Z, Dorfman-Etrog P. et al . Sexual dysfunction in male schizophrenic patients.  J Clin Psychiatry. 1995;  56 137-141
    PubMedGoogle Scholar
  • 31 Kinzel U, Weig W. Medikamente und ihre Nebenwirkungen auf die Sexualität.  Psychoneuro. 2003;  30 53-56
    Article in Thieme ConnectPubMedGoogle Scholar
  • 32 Darves-Bornoz J M, Lemperiere T, Degiovanni A. et al . Sexual victimization in women with schizophrenia and bipolar disorder.  Soc Psychiatry Psychiatr Epidemiol. 1995;  30 78-84
    CrossrefPubMedGoogle Scholar
  • 33 Friedman S, Harrison G. Sexual histories, attitudes, and behavior of schizophrenic and „normal” women.  Arch Sex Behav. 1984;  13 555-567
    CrossrefPubMedGoogle Scholar
  • 34 Lysaker P H, Meyer P S, Evans J D. et al . Childhood sexual trauma and psychosocial functioning in adults with schizophrenia.  Psychiatr Serv. 2001;  52 1485-1488
    CrossrefPubMedGoogle Scholar
  • 35 Rosenberg S D, Lu W, Mueser K T. et al . Correlates of adverse childhood events among adults with schizophrenia spectrum disorders.  Psychiatr Serv. 2007;  58 245-253
    CrossrefPubMedGoogle Scholar
  • 36 Perkins D O. Predictors of noncompliance in patients with schizophrenia.  J Clin Psychiatry. 2002;  63 1121-1128
    CrossrefPubMedGoogle Scholar
  • 37 Peuskens J, Sienaert P, De Hert M. Sexual dysfunction: the unspoken side effect of antipsychotics.  Eur Psychiatry. 1998;  13 (Suppl. 1) 23s-30s
    CrossrefPubMedGoogle Scholar
  • 38 Nestoros J N, Lehmann H E, Ban T A. Sexual behavior of the male schizophrenic: the impact of illness and medications.  Arch Sex Behav. 1981;  10 421-442
    CrossrefPubMedGoogle Scholar
  • 39 Bitter I, Basson B R, Dossenbach M R. Antipsychotic treatment and sexual functioning in first-time neuroleptic-treated schizophrenic patients.  Int Clin Psychopharmacol. 2005;  20 19-21
    CrossrefPubMedGoogle Scholar
  • 40 Dossenbach M, Dyachkova Y, Pirildar S. et al . Effects of atypical and typical antipsychotic treatments on sexual function in patients with schizophrenia: 12-month results from the Intercontinental Schizophrenia Outpatient Health Outcomes (IC-SOHO) study.  Eur Psychiatry. 2006;  21 251-258
    PubMedGoogle Scholar
  • 41 Kelly D L, Conley R R. A randomized double-blind 12-week study of quetiapine, risperidone or fluphenazine on sexual functioning in people with schizophrenia.  Psychoneuroendocrinology. 2006;  31 340-346
    CrossrefPubMedGoogle Scholar
  • 42 Ghadirian A M, Chouinard G, Annable L. Sexual dysfunction and plasma prolactin levels in neuroleptic-treated schizophrenic outpatients.  J Nerv Ment Dis. 1982;  170 463-467
    CrossrefPubMedGoogle Scholar
  • 43 Fakhoury W K, Wright D, Wallace M. Prevalence and extent of distress of adverse effects of antipsychotics among callers to a United Kingdom National Mental Health Helpline.  Int Clin Psychopharmacol. 2001;  16 153-162
    CrossrefPubMedGoogle Scholar
  • 44 Macdonald S, Halliday J, MacEwan T. et al . Nithsdale Schizophrenia Surveys 24: sexual dysfunction. Case-control study.  Br J Psychiatry. 2003;  182 50-56
    CrossrefPubMedGoogle Scholar
  • 45 Demyttenaere K, De Fruyt J, Sienaert P. Psychotropics and sexuality.  Int Clin Psychopharmacol. 1998;  13 (Suppl. 6) S35-S41
    PubMedGoogle Scholar
  • 46 Hartmann U, Ruffer-Hesse C. Sexuality and pharmacotherapy. Medication-induced disorders of sexual response and pharmacotherapeutic options for the treatment of sexual dysfunctions.  Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2007;  50 19-32
    Google Scholar
  • 47 Mancini T, Casanueva F F, Giustina A. Hyperprolactinemia and prolactinomas.  Endocrinol Metab Clin North Am. 2008;  37 67-99, viii
    CrossrefPubMedGoogle Scholar
  • 48 Mah P M, Webster J. Hyperprolactinemia: etiology, diagnosis, and management.  Semin Reprod Med. 2002;  20 365-374
    Article in Thieme ConnectPubMedGoogle Scholar
  • 49 Bushe C, Shaw M. Prevalence of hyperprolactinaemia in a naturalistic cohort of schizophrenia and bipolar outpatients during treatment with typical and atypical antipsychotics.  J Psychopharmacol. 2007;  21 768-773
    PubMedGoogle Scholar
  • 50 Marken P A, Haykal R F, Fisher J N. Management of psychotropic-induced hyperprolactinemia.  Clin Pharm. 1992;  11 851-856
    PubMedGoogle Scholar
  • 51 Haddad P M, Hellewell J S, Wieck A. Antipsychotic induced hyperprolactinaemia: a series of illustrative case reports.  J Psychopharmacol. 2001;  15 293-295
    CrossrefPubMedGoogle Scholar
  • 52 Kim K S, Pae C U, Chae J H. et al . Effects of olanzapine on prolactin levels of female patients with schizophrenia treated with risperidone.  J Clin Psychiatry. 2002;  63 408-413
    PubMedGoogle Scholar
  • 53 Knegtering H, van der Moolen A E, Castelein S. et al . What are the effects of antipsychotics on sexual dysfunctions and endocrine functioning?.  Psychoneuroendocrinology. 2003;  28 (Suppl. 2) 109-123
    CrossrefPubMedGoogle Scholar
  • 54 Weig W, Cohen S, Kuhn K U. et al .Sexualstörungen bei stationär psychiatrisch behandelten Patienten – eine multizentrische Prävalenzstudie. (in Vorbereitung)
    Google Scholar
  • 55 Brunelleschi S, Zeppegno P, Risso F. et al . Risperidone-associated hyperprolactinemia: evaluation in twenty psychiatric outpatients.  Pharmacol Res. 2003;  48 405-409
    CrossrefPubMedGoogle Scholar
  • 56 Cutler A J. Sexual dysfunction and antipsychotic treatment.  Psychoneuroendocrinology. 2003;  28 (Suppl. 1) 69-82
    PubMedGoogle Scholar
  • 57 Howes O D, Wheeler M J, Pilowsky L S. et al . Sexual function and gonadal hormones in patients taking antipsychotic treatment for schizophrenia or schizoaffective disorder.  J Clin Psychiatry. 2007;  68 361-367
    CrossrefPubMedGoogle Scholar
  • 58 Fric M, Laux G. Prolactin Levels and Symptoms of Hyperprolactinemia in Patients Treated with Amisulpride, Risperidone, Olanzapine and Quetiapine.  Psychiat Prax. 2003;  30 97-101
    Article in Thieme ConnectPubMedGoogle Scholar
  • 59 Kleinberg D L, Davis J M, de Coster R. et al . Prolactin levels and adverse events in patients treated with risperidone.  J Clin Psychopharmacol. 1999;  19 57-61
    CrossrefPubMedGoogle Scholar
  • 60 Chue P, Kovacs C S. Safety and tolerability of atypical antipsychotics in patients with bipolar disorder: prevalence, monitoring and management.  Bipolar Disord. 2003;  5 (Suppl. 2) 62-79
    PubMedGoogle Scholar
  • 61 Jamerson B, Ashton A K, Houser T. et al .Antidepressant compliance and side effects: Results from a patient survey. New Orleans, LA; Paper presented at the annual meeting of the American Psychiatric Association 2001
    Google Scholar
  • 62 Olfson M, Uttaro T, Carson W H. et al . Male sexual dysfunction and quality of life in schizophrenia.  J Clin Psychiatry. 2005;  66 331-338
    CrossrefPubMedGoogle Scholar
  • 63 Finn S E, Bailey J M, Schultz R T. et al . Subjective utility ratings of neuroleptics in treating schizophrenia.  Psychol Med. 1990;  20 843-848
    CrossrefPubMedGoogle Scholar
  • 64 Lambert M, Conus P, Eide P. et al . Impact of present and past antipsychotic side effects on attitude toward typical antipsychotic treatment and adherence.  Eur Psychiatry. 2004;  19 415-422
    CrossrefPubMedGoogle Scholar
  • 65 Hellewell J S, Kalali A H, Langham S J. Patient satisfaction and acceptability of long-term treatment wih quetiapine.  Int J Psychiatry Clin Prae. 1999;  3 105-113
    PubMedGoogle Scholar
  • 66 Fleischhacker W W, Meise U, Gunther V. et al . Compliance with antipsychotic drug treatment: influence of side effects.  Acta Psychiatr Scand Suppl. 1994;  382 11-15
    PubMedGoogle Scholar
  • 67 Rosenberg K P, Bleiberg K L, Koscis J. et al . A survey of sexual side effects among severely mentally ill patients taking psychotropic medications: impact on compliance.  J Sex Marital Ther. 2003;  29 289-296
    CrossrefPubMedGoogle Scholar
  • 68 Strauss B, Gross J. Psychotropic drug-induced changes in sexuality – frequency and relevance in psychiatric practice.  Psychiat Prax. 1984;  11 49-55
    PubMedGoogle Scholar
  • 69 Waldinger M D, Hengeveld M W, Zwinderman A H. et al . Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline.  J Clin Psychopharmacol. 1998;  18 274-281
    CrossrefPubMedGoogle Scholar
  • 70 Gregorian R S, Golden K A, Bahce A. et al . Antidepressant-induced sexual dysfunction.  Ann Pharmacother. 2002;  36 1577-1589
    CrossrefPubMedGoogle Scholar
  • 71 Mallis D, Moisidis K, Kirana P S. et al . Moderate and severe erectile dysfunction equally affects life satisfaction.  J Sex Med. 2006;  3 442-449
    CrossrefPubMedGoogle Scholar
  • 72 Laumann E O, Paik A, Rosen R C. The epidemiology of erectile dysfunction: results from the National Health and Social Life Survey.  Int J Impot Res. 1999;  11 (Suppl. 1) S60-S64
    CrossrefPubMedGoogle Scholar
  • 73 Byerly M J, Nakonezny P A, Fisher R. et al . An empirical evaluation of the Arizona sexual experience scale and a simple one-item screening test for assessing antipsychotic-related sexual dysfunction in outpatients with schizophrenia and schizoaffective disorder.  Schizophr Res. 2006;  81 311-316
    CrossrefPubMedGoogle Scholar
  • 74 Schimmelmann B G, Paulus S, Schacht M. et al . Subjective distress related to side effects and subjective well-being in first admitted adolescents with early-onset psychosis treated with atypical antipsychotics.  J Child Adolesc Psychopharmacol. 2005;  15 249-258
    Google Scholar
  • 75 Fan X, Henderson D C, Chiang E. et al . Sexual functioning, psychopathology and quality of life in patients with schizophrenia.  Schizophr Res. 2007;  94 119-127
    CrossrefPubMedGoogle Scholar
  • 76 Baldwin D S. Sexual dysfunction associated with antidepressant drugs.  Expert Opin Drug Saf. 2004;  3 457-470
    CrossrefPubMedGoogle Scholar
  • 77 Targum S D, Dibble E D, Davenport Y B. et al . The Family Attitudes Questionnaire. Patients' and spouses' views of bipolar illness.  Arch Gen Psychiatry. 1981;  38 562-568
    PubMedGoogle Scholar
  • 78 Ablon S L, Davenport Y B, Gershon E S. et al . The married manic.  Am J Orthopsychiatry. 1975;  45 854-866
    PubMedGoogle Scholar
  • 79 Rust J, Golombok S, Collier J. Marital problems and sexual dysfunction: how are they related?.  Br J Psychiatry. 1988;  152 629-631
    CrossrefPubMedGoogle Scholar
  • 80 Harvey K V, Balon R. Clinical implications of antidepressant drug effects on sexual function.  Ann Clin Psychiatry. 1995;  7 189-201
    CrossrefPubMedGoogle Scholar
  • 81 Raboch J. Sexual development and life of psychiatric female patients.  Arch Sex Behav. 1986;  15 341-353
    CrossrefPubMedGoogle Scholar
  • 82 Kockott G, Pfeiffer W. Sexual disorders in nonacute psychiatric outpatients.  Compr Psychiatry. 1996;  37 56-61
    CrossrefPubMedGoogle Scholar
  • 83 Weisman A G, Nuechterlein K H, Goldstein M J. et al . Controllability perceptions and reactions to symptoms of schizophrenia: a within-family comparison of relatives with high and low expressed emotion.  J Abnorm Psychol. 2000;  109 167-171
    CrossrefPubMedGoogle Scholar
  • 84 Weig W. Diagnostics and therapy of sexual disorders.  Fortschr Neurol Psychiatr. 2006;  74 665-671; quiz 672–674
    Article in Thieme ConnectPubMedGoogle Scholar
  • 85 Clayton A H, McGarvey E L, Clavet G J. The Changes in Sexual Functioning Questionnaire (CSFQ): development, reliability, and validity.  Psychopharmacol Bull. 1997;  33 731-745
    PubMedGoogle Scholar
  • 86 Zajecka J. Strategies for the treatment of antidepressant-related sexual dysfunction.  J Clin Psychiatry. 2001;  62 (Suppl. 3) 35-43
    PubMedGoogle Scholar
  • 87 Weig W. Sexual dysfunctions from a neuropsychiatric perspective.  Nervenarzt. 2006;  77 101-108; quiz 109
    CrossrefPubMedGoogle Scholar
  • 88 Malik P. Sexual dysfunction in schizophrenia.  Curr Opin Psychiatry. 2007;  20 138-142
    CrossrefPubMedGoogle Scholar
  • 89 Gitlin M. Sexual dysfunction with psychotropic drugs.  Expert Opin Pharmacother. 2003;  4 2259-2269
    CrossrefPubMedGoogle Scholar
  • 90 Taylor M J, Rudkin L, Hawton K. Strategies for managing antidepressant-induced sexual dysfunction: systematic review of randomised controlled trials.  J Affect Disord. 2005;  88 241-254
    Google Scholar
  • 91 Assem-Hilger E, Kasper S. Psychopharmaka und sexuelle Dysfunktion.  J Neurol Neurochir Psychiatr. 2005;  6 30-36
    PubMedGoogle Scholar
  • 92 Haddad P M, Wieck A. Antipsychotic-induced hyperprolactinaemia: mechanisms, clinical features and management.  Drugs. 2004;  64 2291-2314
    CrossrefPubMedGoogle Scholar
  • 93 Kockott G. Psychotherapie sexueller Funktions- und Erlebensstörungen.  Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz. 2007;  50 11-18
    PubMedGoogle Scholar
  • 94 Hauch M. Paartherapie bei sexuellen Störungen. Stuttgart; Thieme 2006
    Google Scholar

Dr. Daniel Schöttle

Psychosen-Ersterkennungs- und Behandlungsprojekt (PEB), Zentrum für Psychosoziale Medizin, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf

Martinistraße 52

20246 Hamburg

Email: d.schoettle@uke.uni-hamburg.de

      >