|
1
|
Seeman MV. Schizophrenia in Women: Clinical Considerations. Psychiatr Clin North Am 2023; 46:475-486. [PMID: 37500245 DOI: 10.1016/j.psc.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Men and women, for biologic and sociocultural reasons, differ in the nature of their risks for schizophrenia and also in their care needs. Women with schizophrenia have several reproduction-associated risks and care needs that require special clinical consideration. They also have several specific risks related to antipsychotics and gender-associated needs not necessarily related to biology. These require clinicians' diagnostic acumen, treatment skills, cultural sensitivity, and advocacy know-how. Although this does not pertain to everyone, awareness on the part of clinicians is essential. This article addresses the current evidence for difference.
Collapse
Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Toronto, Ontario M5P3L6, Canada.
| |
Collapse
|
|
2
|
Chung MH, Chao JK, Ma MC, Lin RW. Sexuality and Quality of Life in Eastern Taiwan People With Schizophrenia. Psychiatry Investig 2023; 20:1-8. [PMID: 36721880 PMCID: PMC9890041 DOI: 10.30773/pi.2022.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/05/2022] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE Patients with schizophrenia are living at the border of society and their sexuality is often neglected. The aim of the study is to explore the association among The Brief Psychiatric Rating Scale (BPRS), quality of life (QoL), Taiwanese Depression Questionnaire, and Sexual Desire Inventory in people with schizophrenia (PwS). METHODS This study used a cross-sectional design with 277 psychiatric inpatients. A descriptive analysis, difference analysis, and logistic regression model were presented to identify relevant variables that may affect the probability of good QoL. RESULTS The study showed that male PwS had higher scores of standard deviation (SD) than females in PwS. The study also showed that smoking, early illness onset age, and shorter illness duration demonstrated a significantly higher SD. The logistic regression analysis showed that BPRS, depression, and SD significantly affected the probability of QoL. By structural equation model, SD would be positively correlated with mental status and SD would indirectly influence QoL. CONCLUSION Our results showed psychological and sociological factors interactions may contribute to the QoL and SD for PwS. This study also demonstrated a close relationship between SD, depression, and BPRS. These factors may predict the probability of good life quality for the PwS.
Collapse
Affiliation(s)
- Mei Hua Chung
- Graduate Institute of Bioresources, National Pingtung University of Science & Technology, Pingtung, Taiwan
| | - Jian-Kang Chao
- Department of Psychiatry, Yuli Branch, Taipei Veterans General Hospital, Hualien, Taiwan.,Graduate School of Human Sexuality, Shu-Te University, Kaohsiung, Taiwan
| | - Mi Chia Ma
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Ru Wei Lin
- Department of Plant Industry, National Pingtung University of Science & Technology, Pingtung, Taiwan
| |
Collapse
|
|
3
|
Abstract
A first step towards personalized medicine is to consider whether, for some disorders, the safest and most effective treatment of women needs to differ from standard guideline recommendations developed on the basis of clinical trials conducted, for the most part, in men. A second step is to consider how women’s reproductive stages—pre-pubertal years, menstrual phases, pregnancy trimesters, lactation and postpartum periods, menopausal and postmenopausal/aging status—affect the optimal choice of treatment. This review focuses on these two steps in the treatment of psychosis, specifically schizophrenia. It discusses genetics, precursors and symptoms of schizophrenia, reproductive and associated ethical issues, antipsychotic drug response and adverse effects, substance abuse, victimization and perpetration of violence, and issues of immigration and of co-morbidity. The conclusions, while often based on clinical experience and theoretical considerations rather than strictly on the evidence of randomized controlled trials, are that clinical recommendations need to consider clinical and role differences that exist between men and women and make appropriate correction for age and reproductive status.
Collapse
|
|
4
|
Bianco CL, Pratt SI, Ferron JC. Deficits in Sexual Interest Among Adults With Schizophrenia: Another Look at an Old Problem. Psychiatr Serv 2019; 70:1000-1005. [PMID: 31401908 DOI: 10.1176/appi.ps.201800403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Despite the important impact of sexuality on quality of life in adults, there is a paucity of research on this topic for people with schizophrenia. This study examined predictors of sexual interest among adults with schizophrenia. METHODS Using data from three studies with similar measures and participants with similar characteristics (N=231), the authors conducted a secondary analysis to examine the relationships among sexual interest, demographic characteristics (gender, age, living situation, and marital status), and clinical factors (sexual self-efficacy, symptom severity, and medications). Sexual interest was measured by using one item from the Scale to Assess Negative Symptoms. Binomial logistic regressions were conducted to explore factors most associated with level of sexual interest. RESULTS Separately, cardiovascular medications, gender, age, sexual self-efficacy, and negative symptoms were associated with sexual interest. In a logistic regression model that included all of these factors, only sexual self-efficacy and gender were significantly associated with sexual interest. Higher levels of sexual self-efficacy were associated with lower levels of impairment in sexual interest (odds ratio [OR]=0.98, 95% confidence interval [CI]=0.98-0.99, p<0.001), and males were less likely than females to have impaired sexual interest (OR=0.38, 95% CI=0.20-0.73, p=0.004). CONCLUSIONS The strength of the relationship between sexual self-efficacy and sexual interest warrants development of interventions to address sexuality among people with serious mental illness, at least for those who are interested in developing or maintaining intimate relationships. An intervention that teaches skills needed to successfully pursue and navigate intimate relationships could positively influence overall quality of life for many.
Collapse
Affiliation(s)
- Cynthia L Bianco
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Sarah I Pratt
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| | - Joelle C Ferron
- Department of Psychiatry Research, Dartmouth-Hitchcock, Lebanon, New Hampshire, and Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
| |
Collapse
|
|
5
|
Zhang Y, Tang Z, Ruan Y, Huang C, Wu J, Lu Z, Li W, Tang Y, Liu J, She J, Wang TT, Zhu Y, Teng ZW, Zeng Y. Prolactin and Thyroid Stimulating Hormone (TSH) Levels and Sexual Dysfunction in Patients with Schizophrenia Treated with Conventional Antipsychotic Medication: A Cross-Sectional Study. Med Sci Monit 2018; 24:9136-9143. [PMID: 30554232 PMCID: PMC6319142 DOI: 10.12659/msm.913759] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background This study aimed to investigate the relationship between serum profiles of prolactin and thyroid stimulating hormone (TSH) and sexual dysfunction in patients with schizophrenia treated with conventional antipsychotic medication. Material/Methods A hospital-based cross-sectional study included 118 patients, age range 18–57 years (55 men, 63 women), with a confirmed diagnosis of schizophrenia. All patients were stable after antipsychotic treatment. Serum levels of hormones, including prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), progesterone, testosterone, thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), free triiodothyronine (FT3) and free thyroxine (FT4), were detected in venous blood. The Positive and Negative Syndrome Scale (PANSS) score was used to measure symptom severity of patients with schizophrenia. The Mandarin Chinese version of the Arizona Sexual Experience Scale (ASEX), a 5-item scale, was used to measure sexual function. Results There were 66 patients (55.9%) who had hyperprolactinemia, the prevalence of hyperprolactinemia was markedly higher in the sexual dysfunction group than the non-sexual dysfunction group (91.8% vs. 17.5%) (P<0.001). Mean prolactin levels were significantly increased in patients with sexual dysfunction compared with the patients without sexual dysfunction (P<0.001), with a higher incidence in female patients. Subclinical hypothyroidism and hyperprolactinemia were found to be independently associated with sexual dysfunction, and an increased PANSS negative score was an independent risk factor for the development of sexual dysfunction. Conclusions The incidence of sexual dysfunction was significantly increased in patients with schizophrenia. Hyperprolactinemia and subclinical hypothyroidism were associated with sexual dysfunction, especially in female patients.
Collapse
Affiliation(s)
- Yunqiao Zhang
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Zhen Tang
- Xiangya Third Hospital, Central South University, Changsha, Hunan, China (mainland)
| | - Ye Ruan
- Affiliated Mental Health Center, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Chaohong Huang
- Affiliated Mental Health Center, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Jie Wu
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Zixiang Lu
- Department of Psychiatry, Honghe Second People's Hospital, Honghe, Yunnan, China (mainland)
| | - Wang Li
- Affiliated Ganmei Hospital, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Yan Tang
- Affiliated Mental Health Center, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Jianping Liu
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Jixiang She
- Affiliated Mental Health Center, Kunming Medical University, Kunming, Yunnan, China (mainland)
| | - Ting Ting Wang
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Yu Zhu
- School of Public Health, Wannan Medical College, Wuhu, Anhui, China (mainland)
| | - Zhao Wei Teng
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| | - Yong Zeng
- Sixth Affiliated Hospital, Kunming Medical University, Yuxi, Yunnan, China (mainland)
| |
Collapse
|
|
6
|
Seeman MV. Women who suffer from schizophrenia: Critical issues. World J Psychiatry 2018; 8:125-136. [PMID: 30425943 PMCID: PMC6230925 DOI: 10.5498/wjp.v8.i5.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/24/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Many brain diseases, including schizophrenia, affect men and women unequally - either more or less frequently, or at different times in the life cycle, or to varied degrees of severity. With updates from recent findings, this paper reviews the work of my research group over the last 40 years and underscores issues that remain critical to the optimal care of women with schizophrenia, issues that overlap with, but are not identical to, the cares and concerns of men with the same diagnosis. Clinicians need to be alert not only to the overarching needs of diagnostic groups, but also to the often unique needs of women and men.
Collapse
Affiliation(s)
- Mary V Seeman
- Department of Psychiatry, University of Toronto, Institute of Medical Science, Toronto, ON M5P 3L6, Canada
| |
Collapse
|
|
7
|
Chen KP, Lung FW. Reliability and Validity of the Short Version of Udvalg for Kliniske Undersogelser in Antipsychotic Treatment. Psychiatr Q 2017; 88:787-796. [PMID: 28150091 DOI: 10.1007/s11126-017-9494-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aim of this study was to develop a reliable and valid short version of the Udvalg for Kliniske Undersogelser (UKU) to efficiently evaluate the side effects of antipsychotics in patients with schizophrenia. This multi-site study included 10 hospitals, which included 331 inpatients and outpatients diagnosed with schizophrenia. UKU, Clinical Global Impression-Severity (CGI-S), Personal and Social Performance (PSP) and dosage of paliperidone were collected. The predictive validity of the UKU-short version, as well as that of the CGI-S, PSP and paliperidone dosages, was analyzed using structural equation modeling (SEM), latent growth models (LGM), and confirmatory factor analysis to test its content and construct validity. The UKU-short included nine-items of sedation, reduced sleep, rigidity, tremor, akathisia, headache, reduced salivation, constipation and orthostatic dizziness, and has good construct and content validity over time. Confirmatory factor analysis showed good construct validity, with the psychic, neurological and autonomic side effect dimensions having correlations between 0.60 and 0.71. The predictive validity of the short-version UKU for psychiatric symptoms (CGI-S), quality of life (PSP) and dosage showed that the effects of drug dosage were negligible, and only neurological side effects were associated with psychiatric symptoms and quality of life. The UKU-short showed good content, construct and predictive validity. It is a more time-efficient instrument than the original UKU. This study only included patients treated with paliperidone, larger scale studies is needed to validate the UKU-short in detection of side effects in routine clinical practice to prevent non-adherence in patients with schizophrenia.
Collapse
Affiliation(s)
- Kun-Po Chen
- Taipei City Hospital, Songde Branch, Taipei, Taiwan.,Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan
| | - For-Wey Lung
- Calo Psychiatric Center, No.12-200, Jinhua Rd., Xinpi Township, Pingtung County, 925, Taiwan. .,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan. .,Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan.
| |
Collapse
|
|
8
|
Hamilton I, Pringle R, Hemingway S. Psychotropic induced sexual dysfunction for people with a dual diagnosis. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-09-2015-0021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Purpose
– The purpose of this paper is: first, to consider the reported problems in sexual function caused by psychotropic medication. Second, the complex undertaking of completing an assessment of sexual functioning. Third, the role of the pharmaceutical industry is explored. Finally, implications for future research and practice are suggested.
Design/methodology/approach
– As a commentary this paper draws on the available literature to synthesise what is already known about the relationship between psychoactive substances and sexual functioning.
Findings
– The limited literature and lack of research attention given to psychotropic induced sexual dysfunction limits our collective understanding of how many people are affected and in what way.
Research limitations/implications
– A greater focus on psychotropic induced sexual dysfunction is needed for people with a dual diagnosis. There has been an over reliance on single case studies and self-reporting. Large scale epidemiological investigation would help understand the extent and nature of the problem more fully. The demographic shift particularly in relation to an ageing population should be considered as psychotropic substances effect individuals in different ways as they grow older.
Practical implications
– There is scope for workers to engage more fully in a conversation with clients about their experience of using psychotropic substances and how this has impacted their sexual functioning. The literature suggests that clients want to talk about this issue but staff are unwilling or unable to discuss the topic.
Originality/value
– To the authors’ knowledge this is the first paper that draws on the available literature to explore the known and likely implications of psychotropic induced sexual dysfunction for this client group.
Collapse
|
|
9
|
Seeman MV. Sexual Minority Women in Treatment for Serious Mental Illness: A Literature Review. JOURNAL OF GAY & LESBIAN MENTAL HEALTH 2015; 19:303-319. [DOI: 10.1080/19359705.2015.1026016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
|
10
|
Hocaoglu C, Celik FH, Kandemir G, Guveli H, Bahceci B. Sexual dysfunction in outpatients with schizophrenia in Turkey: a cross-sectional study. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:347-56. [PMID: 25642109 PMCID: PMC4311108 DOI: 10.11919/j.issn.1002-0829.214101] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 12/14/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Sexual dysfunction is one of several factors related to medication compliance in patients taking antipsychotic medication but the magnitude of this problem is unknown. AIM Compare the self-reported sexual functioning of clinically stable patients with schizophrenia taking antipsychotic medication to that of healthy controls using the Turkish version of the 5-item Arizona Sexual Experience Scale (ASEX). This scale, which has previously been validated in Turkey, assesses 5 components of sexual function: sex drive, sexual arousal, vaginal lubrication/penile erection, ability to achieve orgasm, and satisfaction with orgasm. METHODS The Scale for the Assessment of Positive Symptoms, the Scale for Assessment of Negative Symptoms, and ASEX were administered to 101 clinically stable outpatients with schizophrenia (38 females and 63 males). The ASEX was also administered to 89 control subjects (41 females and 48 males) without a history of mental illness. Respondents were classified as having sexual dysfunction if ASEX total score (range 5-30) >18, if any ASEX item score (range 1-6) ≥ 5, or if 3 or more ASEX items ≥4. RESULTS Male patients with schizophrenia have significantly more self-reported sexual dysfunction than healthy controls (46% vs. 8%). The prevalence of sexual dysfunction is higher in female patients than in male patients (68% vs. 46%), but it was also very high in healthy female controls (68%), so the sexual dysfunction of female patients cannot be attributed to their illness or to the medications they are taking. Within the patient group, there was no significant relationship between the severity of positive or negative symptoms and the severity of sexual dysfunction, and the severity of sexual function was not different between patients taking first-generation or second-generation antipsychotic medications. CONCLUSIONS The very different findings by gender in Turkey highlights the importance of assessing location-specific and gender-specific sexual norms when trying to assess the role of mental illness and medications on sexual functioning. Prospective studies are needed to distinguish the relative importance of cultural norms, the schizophrenic illness, and the use of antipsychotic medication in the etiology and course of sexual dysfunction among individuals with schizophrenia.
Collapse
Affiliation(s)
- Cicek Hocaoglu
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Fatmagul H Celik
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Gokhan Kandemir
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| | - Hulya Guveli
- Istanbul University Oncology Enstitude, Department of Psychiatry, Istanbul, Turkey
| | - Bulent Bahceci
- Department of Psychiatry,Recep Tayyip Erdogan University, Rize, Turkey
| |
Collapse
|