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Meta-Analysis
. 2012 Nov 14;11(11):CD003546.
doi: 10.1002/14651858.CD003546.pub3.

Management of sexual dysfunction due to antipsychotic drug therapy

Hannah M Schmidt  1 , Mathias Hagen, Levente Kriston, Karla Soares-Weiser, Nicola Maayan, Michael M Berner
Affiliations
Meta-Analysis

Management of sexual dysfunction due to antipsychotic drug therapy

Hannah M Schmidt et al. Cochrane Database Syst Rev. .

Abstract

Background: Psychotropic drugs are associated with sexual dysfunction. Symptoms may concern penile erection, lubrication, orgasm, libido, retrograde ejaculation, sexual arousal, or overall sexual satisfaction. These are major aspects of tolerability and can highly affect patients' compliance.

Objectives: To determine the effects of different strategies (e.g. dose reduction, drug holidays, adjunctive medication, switching to another drug) for treatment of sexual dysfunction due to antipsychotic therapy.

Search methods: An updated search was performed in the Cochrane Schizophrenia Group's Trials Register (3 May 2012) and the references of all identified studies for further trials.

Selection criteria: We included all relevant randomised controlled trials involving people with schizophrenia and sexual dysfunction.

Data collection and analysis: We extracted data independently. For dichotomous data we calculated random effects risk ratios (RR) with 95% confidence intervals (CI), for crossover trials we calculated Odds Ratios (OR) with 95% CI. For continuous data, we calculated mean differences (MD) on the basis of a random-effects model. We analysed cross-over trials under consideration of correlation of paired measures.

Main results: Currently this review includes four pioneering studies (total n = 138 , duration two weeks to four months), two of which are cross-over trials. One trial reported significantly more erections sufficient for penetration when receiving sildenafil compared with when receiving placebo (n = 32, MD 3.20 95% CI 1.83 to 4.57), a greater mean duration of erections (n = 32, MD 1.18 95% CI 0.52 to 1.84) and frequency of satisfactory intercourse (n = 32, MD 2.84 95% CI 1.61 to 4.07). The second trial found no evidence for selegiline as symptomatic treatment for antipsychotic-induced sexual dysfunction compared with placebo (n = 10, MD change on Aizenberg's sexual functioning scale -0.40 95% CI -3.95 to 3.15). No evidence was found for switching to quetiapine from risperidone to improve sexual functioning (n = 36, MD -2.02 95% CI -5.79 to 1.75). One trial reported significant improvement in sexual functioning when participants switched from risperidone or an typical antipsychotic to olanzapine (n = 54, MD -0.80 95% CI -1.55 to -0.05).

Authors' conclusions: We are not confident that cross-over studies are appropriate for this participant group as they are best for conditions that are stable and for interventions with no physiological and psychological carry-over. Sildenafil may be a useful option in the treatment of antipsychotic-induced sexual dysfunction in men with schizophrenia, but this conclusion is based only on one small short trial. Switching to olanzapine may improve sexual functioning in men and women, but the trial assessing this was a small, open label trial. Further well designed randomised control trials that are blinded and well conducted and reported, which investigate the effects of dose reduction, drug holidays, symptomatic therapy and switching antipsychotic on sexual function in people with antipsychotic-induced sexual dysfunction are urgently needed.

PubMed Disclaimer

Conflict of interest statement

Michael Berner ‐ has received tuition fees from Pfizer, Germany, manufacturer of the PDE V‐inhibitor Sildenafil and tuition fees from Astra Zeneca, Germany, manufacturer of the antipsychotic agent quetiapine.

All other review authors: none.

Figures

1
1
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 1 Sexual function (objective assessment): Number of erections sufficient for penetration (over 2 weeks).
1.2
1.2. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 2 Sexual function (objective assessment): Mean duration of erections (minutes).
1.3
1.3. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 3 Sexual function (objective assessment): Frequency of satisfactory intercourse (over 2 weeks).
1.4
1.4. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 4 Sexual function (subjective assessment): Improved erections ('yes') (GEQ).
1.5
1.5. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 5 Sexual function (subjective assessment): Would take drug in future ('yes') (GEQ).
1.6
1.6. Analysis
Comparison 1 ADJUNCTIVE TREATMENT ‐ SPECIFIC: SILDENAFIL versus PLACEBO, Outcome 6 Leaving the study early.
2.1
2.1. Analysis
Comparison 2 ADJUNCTIVE TREATMENT ‐ NON‐SPECIFIC: SELEGILINE versus PLACEBO, Outcome 1 Sexual function (objective assessment): Average change in score (ASF, high=good).
2.2
2.2. Analysis
Comparison 2 ADJUNCTIVE TREATMENT ‐ NON‐SPECIFIC: SELEGILINE versus PLACEBO, Outcome 2 Leaving the study early.
2.3
2.3. Analysis
Comparison 2 ADJUNCTIVE TREATMENT ‐ NON‐SPECIFIC: SELEGILINE versus PLACEBO, Outcome 3 Adverse effects: Extrapyramidal symptoms ‐ average change in score (SAS, high=poor).
2.4
2.4. Analysis
Comparison 2 ADJUNCTIVE TREATMENT ‐ NON‐SPECIFIC: SELEGILINE versus PLACEBO, Outcome 4 Adverse effects: Psychopathology ‐ average change in scores (PANSS, high=poor).
3.1
3.1. Analysis
Comparison 3 SWITCHING ANTIPSYCHOTIC: TO QUETIAPINE versus MAINTENANCE RISPERIDONE, Outcome 1 Sexual function (subjective assessment): Average endpoint score (ASEX, high=bad).
3.2
3.2. Analysis
Comparison 3 SWITCHING ANTIPSYCHOTIC: TO QUETIAPINE versus MAINTENANCE RISPERIDONE, Outcome 2 Sexual function (surrogate assessment): Prolactin levels, average endpoint (ng/ml).
3.3
3.3. Analysis
Comparison 3 SWITCHING ANTIPSYCHOTIC: TO QUETIAPINE versus MAINTENANCE RISPERIDONE, Outcome 3 Leaving the study early.
3.4
3.4. Analysis
Comparison 3 SWITCHING ANTIPSYCHOTIC: TO QUETIAPINE versus MAINTENANCE RISPERIDONE, Outcome 4 Adverse effects: Psychopathology ‐ average endpoint score (PANSS, high=poor).
4.1
4.1. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 1 Sexual function (subjective assessment): Average change in score (GISF, high=poor).
4.2
4.2. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 2 Sexual function (surrogate assessment): Prolactin levels, average change (ng/ml).
4.3
4.3. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 3 Leaving the study early.
4.4
4.4. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 4 Adverse effects: Psychopathology ‐ average change in score (PANSS, high=poor).
4.5
4.5. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 5 Adverse effects: Psychopathology ‐ average change in score (BPRS, high=poor).
4.6
4.6. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 6 Adverse effects: Psychopathology ‐ average change in score (CGI‐Severity, high=poor).
4.7
4.7. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 7 Adverse effects: Psychopathology ‐ average change in score (MMSE, high=good).
4.8
4.8. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 8 Adverse effects: Extrapyramidal symptoms ‐ average change in score (BAS, high=poor).
4.9
4.9. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 9 Adverse effects: Extrapyramidal symptoms ‐ average change in score (SAS, high=poor).
4.10
4.10. Analysis
Comparison 4 SWITCHING ANTIPSYCHOTIC: TO OLANZAPINE versus MAINTENANCE RISPERIDONE/FGA, Outcome 10 Adverse effects: Extrapyramidal symptoms ‐ average change in score (AIMS, high=poor).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Byerly 2008 {published data only}
    1. Byerly M J, Nakonezny P, Bugno R, Boles J. A randomized, double‐blind pilot trial of switching to quetiapine vs. risperidone continuation in outpatients with risperidone‐associated sexual dysfunction. Proceedings of the 159th Annual Meeting of the American Psychiatric Association; 2006 May 20‐25; Toronto, Canada. 2006.
    1. Byerly MJ, Nakonezny PA. A pilot study to determine a prolactin threshold that identifies improved sexual functioning when switching from a prolactin‐elevating to a prolactin‐neutral antipsychotic. Clinical Schizophrenia and Related Psychoses 2010;3:209‐16.
    1. Byerly MJ, Nakonezny PA, Rush AJ. Sexual functioning associated with quetiapine switch vs risperidone continuation in outpatients with schizophrenia or schizoaffective disorder: a randomized double‐blind pilot trial. Psychiatry Research 2008; Vol. 159:115‐20. - PubMed
    1. Nakonezny PA, Byerly MJ, Rush AJ. The relationship between serum prolactin level and sexual functioning among male outpatients with schizophrenia or schizoaffective disorder: a randomized double‐blind trial of risperidone vs quetiapine. Journal of Sex and Marital Therapy 2007;33:203‐16. - PubMed
Gopalakrishnan 2006 {published data only}
    1. Gopalakrishnan R, Jacob KS, Kuruvilla A, Vasantharaj B, John JK. Sildenafil in the treatment of antipsychotic‐induced erectile dysfunction: a randomized, double‐blind, placebo‐controlled, flexible‐dose, two‐way crossover trial. American Journal of Psychiatry 2006;163(3):494‐9. - PubMed
Kinon 2006 {published data only}
    1. Kinon BJ, Ahl J, Liu‐Seifert H, Maguire GA. Improvement in hyperprolactinemia and reproductive comorbidities in patients with schizophrenia switched from conventional antipsychotics or risperidone to olanzapine. Psychoneuroendocrinology 2006;31:577‐88. - PubMed
    1. Kinon BJ, Liu H, Ahl J. Sexual dysfunction associated with neuroleptic‐induced hyperprolactinemia improves with reduction in prolactin levels. Proceedings of the 156th Annual Meeting of the American Psychiatric Association; 2003 May 17‐22; San Francisco, California, USA. 2003. - PubMed
Kodesh 2003 {published data only}
    1. Kodesh A, Weizman A, Aizenberg D, Hermesh H, Gelkopf M, Zemishlany Z. Selegiline in the treatment of sexual dysfunction in schizophrenic patinets maintained on neuroleptics: a pilot study. Clinical Neuropharmacology 2003;26(4):193‐5. - PubMed

References to studies excluded from this review

Aizenberg 1995 {published data only}
    1. Aizenberg D, Zemishlany Z, Dorfman‐Ettrog P, Weizman A. Sexual dysfunction in male schizophrenic patients. Journal of Clinical Psychiatry 1995;56:137‐41. - PubMed
Aizenberg 1996 {published data only}
    1. Aizenberg D, Shiloh R, Zemishlany Z, Weizman A. Low‐dose imipramine for thioridazine‐induced male orgasmic disorder. Journal of Sex & Marital Therapy 1996;22(3):225‐9. - PubMed
Atmaca 2002 {published data only}
    1. Atmaca M, Kuloglu M, Tezcan E. Sildenafil use in patients with olanzapine‐induced erectile dysfunction. International Journal of Impotence Research 2002;14(6):547‐9. - PubMed
Aviv 2004 {published data only}
    1. Aviv A, Shelef A, Weizman A. An open‐label trial of sildenafil addition in risperidone‐treated male schizophrenia patients with erectile dysfunction. Journal of Clinical Psychiatry 2004;65(1):97‐103. - PubMed
Bastecky 1980 {published data only}
    1. Bastecky J, Kalvach Z, Halkova E, Tosovsky J. High doses of clorotepin in chronic schizophrenia (preliminary report). Agressologie 1980;21(A):31‐5. - PubMed
Benatov 1999 {published data only}
    1. Benatov R, Reznik I, Zemishlany Z. Sildenafil citrate (Viagra) treatment of sexual dysfunction in a schizophrenic patient. European Psychiatry 1999;14:353‐5. - PubMed
Beuzen 2007 {published data only}
    1. Beuzen JN, L'Italien G, Hanssens L, Marcus RN, mcquade RD, Carson WH. Changes in prolactin levels and arizona sexual experience scale (ASEX) scores among patients switched from risperidone to aripiprazole in the schizophrenia trial of aripiprazole (STAR) study. Schizophrenia Bulletin 2007;33:421‐2.
Blin 1996 {published data only}
    1. Blin O, Azorin JM, Bouhours P. Antipsychotic and anxiolytic properties of risperidone, haloperidol and methotrimeprazine in schizophrenic patients. Journal of Clinical Psychopharmacology 1996;16(1):38‐44. - PubMed
Bruggeman 2002 {published data only}
    1. Bruggeman R, Knegtering H, Castelein S, Linde J, Bous J. Risperidone versus quetiapine: preliminary results of a comparative study on sexual dysfunctioning and prolactin elevation. Nordic Journal of Psychiatry 2002;2:14.
Byerly 2004 {published data only}
    1. Byerly M, Lescouflair E, Weber M, Bugno R, Fisher R, Carmody T, et al. An open‐label trial of quetiapine for antipsychotic‐induced sexual dysfunction. Journal of Sex & Marital Therapy 2004;30(5):325‐32. - PubMed
Claghorn 1987 {published data only}
    1. Claghorn J, Honigfeld G, Abuzzahab FS, Wang R, Steinbook R, Tuason V, et al. The risks and benefits of clozapine versus chlorpromazine. Journal of Clinical Psychopharmacology 1987;7(6):377‐84. - PubMed
Correa 1987 {published data only}
    1. Correa N, Opler LA, Kay SR, Birmaher B. Amantadine in the treatment of neuroendocrine side effects of neuroleptics. Journal of Clinical Psychopharmacology 1987;7(2):91‐5. - PubMed
Costa 2007 {published data only}
    1. Costa AMN, Lima MS, Faria M, Filho SR, Oliveira IR, Jesus MJ. A naturalistic, 9‐month follow‐up, comparing olanzapine and conventional antipsychotics on sexual function and hormonal profile for males with schizophrenia. Journal of Psychopharmacology 2007;21(2):165‐70. - PubMed
Covington 2000 {published data only}
    1. Covington L, Cola PA. Clozapine vs. haloperidol: antipsychotic effects on sexual function in schizophrenia. Sexuality and Disability 2000;18(1):41‐8.
De Boer 2011 {published data only}
    1. Boer MK, Wiersma D, Bous J, Sytema S, Moolen AEGM, Wilffert B, et al. A randomized open‐label comparison of the impact of aripiprazole versus risperidone on sexual functioning (ras study). Journal of Clinical Psychopharmacology 2011;31:523‐5. - PubMed
Degen 1982 {published data only}
    1. Degen K. Sexual dysfunction in women using major tranquilizers. Psychosomatics 1982;23(9):959‐61. - PubMed
Dufresene 1988 {published data only}
    1. Dufresene RL, Kass DJ, Becker RE. Bupropion and thiothixene versus placebo and thiothixene in the treatment of depression in schizophrenia. Drug Development Research 1988;12(259):266.
Hanssens 2008 {published data only}
    1. Hanssens L, L'Italien G, Loze JY, Marcus RN, Pans M, Kerselaers W. The effect of antipsychotic medication on sexual function and serum prolactin levels in community‐treated schizophrenic patients: results from the Schizophrenia Trial of Aripiprazole (STAR) study (NCT00237913). BMC Psychiatry 2008;8:95. - PMC - PubMed
Hoyberg 1993 {published data only}
    1. Hoyberg OJ, Fensbo C, Remvig J, Lingjaerde O, Sloth‐Nielsen M. Risperidone versus perphenazine in the treatment of chronic schizophrenic patients with acute exacerbation. Acta Psychiatrica Scandinavica 1993;88:395‐402. - PubMed
Huang 2008 {published data only}
    1. Huang ZY, Li PC. Effects of olanzapine, risperidone and chlorpromazine on prolactin and erectile function in male patients with schizophrenia. Modern Medicine and Health [现代医药卫生] 2008;24:2077‐8.
Kaneda 2001 {published data only}
    1. Kaneda Y. Effects of risperidone on gonadal axis hormones in schizophrenia. Annals of Pharmacotherapy 2001;35:1523‐7. - PubMed
Keller 2002 {published data only}
    1. Keller R, Mongini F. Switch to quetiapine in antipsychotic agent‐related hyperprolactinemia. Neurological Sciences 2002;23(5):233‐5. - PubMed
Kelly 2006 {published data only}
    1. Kelly DL, Conley RR. A randomized double‐blind 12‐week study of quetiapine, risperidone or fluphenazine on sexual functioning in people with schizophrenia. Psychoneuroendocrinology 2006; Vol. 31:340‐6. - PubMed
Kim 2002 {published data only}
    1. Kim K‐S, Pae C‐U, Chae J‐H, Bahk W‐M, Jun T‐Y, Kim D‐J, Dickson RA. Effects of olanzapine on prolactin levels of female patients with schizophrenia treated with risperidone. Journal of Clinical Psychiatry 2002;63(5):408‐13. - PubMed
Kleinberg 1999 {published data only}
    1. Kleinberg DL, Davis JM, Coster R, Baelen B, Brecher M. Prolactin‐levels and adverse events in patients treated with risperidone. Journal of Clinical Psychopharmacology 1999;19(1):57‐61. - PubMed
Knegtering 2000 {published data only}
    1. Knegtering R, Boks M, Wiersma D, Blijd C, Bruggeman R, Oer RBV. Sexual dysfunctions in patients on antipsychotics. Proceedings of the 155th Annual Meeting of the American Psychiatric Association; 2002 May 18‐23; Philadelphia, Pennsylvania, USA. 2002.
    1. Knegtering R, Boks M, Wiersma D, Blijd C, Bruggeman R, Oer RB. Sexual dysfunctions in patients on antipsychotics. Proceedings of the 153rd Annual Meeting of the American Psychiatric Association; 2000 May 13‐18; Chicago, Illinois, USA. 2000.
    1. Knegtering R, Castelein S, Bous H, Linde J, Bruggeman R, Kluiter H, et al. A randomized open‐label study of the impact of quetiapine versus risperidone on sexual functioning. Journal of Clinical Psychopharmacology 2004;24(1):56‐61. - PubMed
    1. Knegtering R, Castelein S, Bous H, Linde J, Bruggeman R, Kluiter H, et al. A randomized open‐label study of the impact of quetiapine versus risperidone on sexual functioning. Proceedings of the Bi‐annual Winter Workshop on Schizophrenia Research; 2002 Feb 24 ‐ Mar 1; Davos, Switzerland. 2002. - PubMed
Knegtering 2002a {published data only}
    1. Knegtering H, Castelein S, Linde J Van‐der, Bous J. Sexual dysfunctions and serum prolactin levels in patients using risperidone or quetiapine: a randomised trial. Schizophrenia Research 2002;53(3 Suppl 1):163.
Knegtering 2006 {published data only}
    1. Knegtering H, Boks M, Blijd C, Castelein S, Bosch RJ, Wiersma D. A randomized open‐label comparison of the impact of olanzapine versus risperidone on sexual functioning. Journal of Sex and Marital Therapy 2006;32(4):315‐26. - PubMed
Kockott 1996 {published data only}
    1. Kockott G, Pfeiffer W. Sexual disorders in nonacute psychiatric outpatients. Comprehensive Psychiatry 1996;37(1):56‐61. - PubMed
Kubacki 1984 {published data only}
    1. Kubacki A, Bathurst NB. Sexual disinhibition and antipsychotics. Nova Scotia Medical Bulletin 1984;6:81‐2.
Mahmoud 2011 {published data only}
    1. Mahmoud A, Hayhurst KP, Drake RJ, Lewis SW. Second generation antipsychotics improve sexual dysfunction in schizophrenia: A randomised controlled trial. Schizophrenia Research and Treatment 2011:596898. Epub 2011 Jan 16. - PMC - PubMed
    1. Mahmoud A, Hayhurst KP, Lewis SW. Antipsychotic drugs and sexual dysfunctions. Proceedings of the 8th World Congress of Psychiatry; 2005 Sep 10‐15; Cairo, Egypt. 2005.
    1. Mahmoud A, Hayhurst KP, Lewis SW. Antipsychotic drugs and sexual function. Schizophrenia Research 2004;67:189.
Malik 2011 {published data only}
    1. Malik P, Kemmler G, Hummer M, Riecher‐Roessler A, Kahn RS, Fleischhacker WW, et al. Sexual dysfunction in first‐episode schizophrenia patients results from european first episode schizophrenia trial. Journal of Clinical Psychopharmacology 2011;31:274‐80. - PubMed
Matsuoka 1986 {published data only}
    1. Matsuoka I, Nakai T, Miyake M, Hirai M, Ikawa G. Effects of bromocriptine on neuroleptic‐induced amenorrhea, galactorrhea and impotence. Japanese Journal of Psychiatry and Neurology 1986;40(4):639‐46. - PubMed
McCreadie 1988 {published data only}
    1. McCreadie RG, Todd N, Livingston M, Eccleston D, Watt JAG, Tait D, et al. A double‐blind comparative study of remoxipride and thioridazine in the acute phase of schizophrenia. Acta Psychiatrica Scandinavica 1988;78:49‐56. - PubMed
Mir 2006 {published data only}
    1. Mir A, Shivakumar K, Mcallister V, O Keane V, Mccrone P, Aitchinson KJ. Change in sexual dysfunction on switching to aripiprazole. Proceedings of the 13th Biennial Winter Workshop on Schizophrenia Research; 2006 Feb 4‐10; Davos, Switzerland. 2006.
    1. Mir A, Shivakumar K, Williamson RJ, Mcallister V, O'Keane V, Aitchison KJ. Change in sexual dysfunction with aripiprazole: A switching or add‐on study. Journal of Psychopharmacology 2008;22:244‐53. - PubMed
Mullen 2001 {published data only}
    1. Mullen B, Brar JS, Vagnucci AH, Ganguli R. Frequency of sexual dysfunctions in patients with schizophrenia on haloperidol, clozapine or risperidone. Schizophrenia Research 2001;48:155‐8. - PubMed
Rosenberg 2001 {published data only}
    1. Rosenberg K P, Bleiberg K, Kocsis J H. Psychotropic‐induced sexual dysfunction among outpatients. Proceedings of the 154th Annual Meeting of the American Psychiatric Association; 2001 May 5‐10; New Orleans, Louisiana, USA. 2001.
    1. Rosenberg KP, Bleiberg K, Kocsis JH. Psychotropic‐induced sexual dysfunction among outpatients. Proceedings of the 155th Annual Meeting of the American Psychiatric Association; 2002 May 18‐23; Philadelphia, Pennsylvania, USA. Philadelphia, Pennsylvania, USA, 2002.
Sechter 2002 {published data only}
    1. Sechter D, Peuskens J, Fleurot O, Rein W, Lecrubier Y. Amisulpride versus risperidone in chronic schizophrenia: results of a 6‐month double‐blind study. Neuropsychopharmacology 2002;27(6):1071‐81. - PubMed
Segraves 1999 {published data only}
    1. Segraves RT. Two additional uses for sildenafil in psychiatric patients. Journal of Sex & Marital Therapy 1999;25:265‐6. - PubMed
Tsai 2000 {published data only}
    1. Tsai S‐J, Hong C‐J. Haloperidol‐induced impotence improved by switching to olanzapine. General Hospital Psychiatry 2000;22(5):391‐2. - PubMed
Valevski 1998 {published data only}
    1. Valevski A, Modai I, Zbarski E, Zemishlany Z, Weizman A. Effect of amantadine on sexual dysfunction in neuroleptic‐treated male schizophrenic patients. Clinical Neuropharmacology 1998;21(6):355‐7. - PubMed
Wesby 1996 {published data only}
    1. Wesby R, Bullmore E, Earle J, Heavey A. A survey of psychosexual arousability in male patients on depot neuroleptic medication. European Psychiatry 1996;11:81‐6. - PubMed
Wirshing 1999 {published data only}
    1. Wirshing DA, Perkins V, Marder SR, Wirshing WC. Sexual side effects of atypical antipsychotic medications. Proceedings of the 152nd Annual Meeting of the American Psychiatric Association; 1999 May 15‐20; Washington DC, USA. 1999.
Zhang 2002 {published data only}
    1. Zhang X, Pang L, Huang Y. Sexual dysfunction of 220 schizophrenics. Health Psychology Journal 2002;10:247‐8.
周云 2009 {published data only}
    1. 周云. Hydrogen benzene that clozapine induced salivation Immunotherapy Clinical [Google Translate] [氢苯那敏治疗氯氮平所致的流涎临床观察]. Linchuang Jingshen Yixue Zazhi [临床精神医学杂志] 2009;19(2):132‐3.
张东卫 2008 {published data only}
    1. 张东卫, 甘景梨, 高存友, 段惠峰. A pilot study on the sexual hormones level of male patients with schizophrenia [抗精神病药物对男性精神分裂症患者性激素水平的影响]. 实用医药杂志 2008;25(9):1117‐20.
肖攀攀 2009 {published data only}
    1. 肖攀攀, 林伟成, 宋宁, 高镇松. Effect of quetiapine on PRL secretion and sexual function of male schizophrenic patients [喹硫平对男性精神分裂症患者催乳素及性功能的影响]. Chinese Journal of Health Psychology [中国健康心理学杂志] 2009; Vol. 17, issue 8:897‐9.
谢新年 2008 {published data only}
    1. 谢新年, 舒人九, 钦桃桃. Aripiprazole and risperidone in the treatment of male schizophrenia efficacy and sexual function [Google translate] [阿立哌唑及利培酮治疗男性精神分裂症的疗效及对性功能的影响]. Hunan Medical Journal 2008; Vol. 25, issue 6:1111‐3.
靳西龙 2010 {published data only}
    1. 靳西龙. Aripiprazole on male sexual function in patients with schizophrenia study Google Translate. Journal of Qiqihar Medical College [Qiqihar Yixueyuan xuebao] 2010;31(18):2883‐4.
黄粱镔 2010 {published data only}
    1. 黄粱镔, 龙欣, 王臬茂. Quetiapine and risperidone on sex hormone levels in patients with schizophrenia Google Translate. China Pharmaceuticals 2010;19(13):20‐1.

Additional references

Aizenberg 1997
    1. Aizenberg D, Gur S, Zemishlany Z, Granek M, Jeczmien P, Weizman A. Mianserin, a 5‐HT2a/c and alpha2 antagonist in the treatment of sexual dysfunction induced by serotonin reuptake inhibitors. Clinical Neuropsychopharmacology 1997;30:210‐4. - PubMed
Althof 2005
    1. Althof SE, Leiblum SR, Chevret‐Measson M, Hartmann U, Levine SB, McCabe M, et al. Psychological and interpersonal dimensions of sexual function and dysfunction. Journal of Sexual Medicine 2005;2(6):793‐800. - PubMed
Altman 1996
    1. Altman DG, Bland JM. Detecting skewness from summary information. BMJ 1996;313(7066):1200. - PMC - PubMed
Apantaku‐Olajide 2011
    1. Apantaku‐Olajide T, Gibbons P, Higgins A. Drug‐induced sexual dysfunction and mental health patients' attitude to psychotropic medications. Sexual & Relationship Therapy 2011;26(2):145‐55.
Barnes 1989
    1. Barnes TR. A rating scale for drug‐induced akathisia. British Journal of Psychiatry 1989;154:672‐6. - PubMed
Bland 1997
    1. Bland JM, Kerry SM. Trials randomised in clusters. BMJ 1997;315:600. - PMC - PubMed
Boissel 1999
    1. Boissel JP, Cucherat M, Li W, Chatellier G, Gueyffier F, Buyse M, et al. The problem of therapeutic efficacy indices. 3. Comparison of the indices and their use [Apercu sur la problematique des indices d'efficacite therapeutique, 3: comparaison des indices et utilisation. Groupe d'etude des indices d'efficacite]. Therapie 1999;54(4):405‐11. [PUBMED: 10667106] - PubMed
Chalmers 1983
    1. Chalmers TC, Celano P, Sacks HS, Smith HJr. Bias in treatment assignment in controlled clinical trials. New England Journal of Medicine 1983;309(22):1358‐61. - PubMed
Clayton 1998
    1. Clayton DO, Shen WW. Psychotropic drug‐induced sexual dysfunction. Drug Safety 1998;19(4):299‐312. - PubMed
Clayton 2006
    1. Clayton A, Keller A, McGarvey EL. Burden of phase‐specific sexual dysfunction with SSRIs. Journal of Affective Disorders 2006;91:27‐32. - PubMed
Curtin 2002a
    1. Curtin F, Altman DG, Elbourne D. Meta‐analysis combining parallel and cross‐over clinical trials. I: Continuous outcomes. Statistics in Medicine 2002;21:2131‐44. - PubMed
Curtin 2002b
    1. Curtin F, Elbourne D, Altman DG. Meta‐analysis combining parallel and cross‐over clinical trials. II: Binary outcomes. Statistics in Medicine 2002;21:2145‐59. - PubMed
Deeks 2000
    1. Deeks J. Issues in the selection for meta‐analyses of binary data. Proceedings of the 8th International Cochrane Colloquium; 2000 Oct 25‐28; Cape Town. Cape Town: The Cochrane Collaboration, 2000.
Divine 1992
    1. Divine GW, Brown JT, Frazer LM. The unit analysis error in studies about physicians' patient care behavior. Journal of General Internal Medicine 1992;7:623‐9. - PubMed
Donner 2002
    1. Donner A, Klar N. Issues in the meta‐analysis of cluster randomized trials. Statistics in Medicine 2002;21:2971‐80. - PubMed
DSM‐IV
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM‐IV). 4th Edition. Washington DC: American Psychiatric Association, 1994.
Egger 1997
    1. Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta‐analysis detected by a simple, graphical test. BMJ 1997;315:629‐34. - PMC - PubMed
El Kissi 2011
    1. Kissi Y, Mannai J, Laroussi M, Gaabout S, Ayachi M, Hadj Ali B. P03‐209 ‐ Sexual function in untreated then treated schizophrenic patients: a prospective study. European Psychiatry 2011; Vol. 26:1378.
Elbourne 2002
    1. Elbourne D, Altman DG, Higgins JPT, Curtina F, Worthingtond HV, Vaile A. Meta‐analyses involving cross‐over trials: methodological issues. International Journal of Epidemiology 2002;31(1):140‐9. - PubMed
Folstein 1975
    1. Folstein MF, Folstein SE, McHugh PR. Mini mental state: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research 1975;12:189‐98. - PubMed
Furukawa 2006
    1. Furukawa TA, Barbui C, Cipriani A, Brambilla P, Watanabe N. Imputing missing standard deviations in meta‐analyses can provide accurate results. Journal of Clinical Epidemiology 2006;59(7):7‐10. - PubMed
Gitlin 1994
    1. Gitlin MJ. Psychotropic medications and their effect on sexual function: diagnosis, biology and treatment approaches. Journal of Clinical Psychiatry 1994;55:406‐13. - PubMed
Goldstein 1998
    1. Goldstein I, Lue TF, Padma‐Nathan H, Rosen RC, Steers WD, Wicker PA. Oral sildenafil in the treatment of erectile dysfunction. New England Journal of Medicine 1998;338:1397‐404. - PubMed
Gulliford 1999
    1. Gulliford MC, Ukoumunne OC, Chinn S. Components of variance and intraclass correlations for the design of community‐based surveys and intervention studies: data from the health survey for england 1994. American Journal of Epidemiology 1999;149:876‐83. - PubMed
Guy 1976
    1. Guy U. Early Clinical Drug Evaluation (ECDEU) Assessment Manual for Psychopharmacology. National Institute of Mental Health, 1976.
Hashimoto 2012a
    1. Hashimoto Y, Uno J, Miwa T, Kurihara M, Tanifuji H, Tensho M. Effects of antipsychotic polypharmacy on side‐effects and concurrent use of medications in schizophrenic outpatients. Psychiatry & Clinical Neurosciences 2012;66(5):405‐10. - PubMed
Herman 1990
    1. Herman JB, Brotman AW, Pollack MH, Falk WE. Fluoxetine‐induced sexual dysfunction. Journal of Clinical Psychiatry 1990;51:25‐7. - PubMed
Higgins 2003
    1. Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta‐analyses. BMJ 2003;327:557‐60. - PMC - PubMed
Higgins 2005
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions. Vol. 2, Chichester UK: John Wiley & Sons, 2005.
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2011]. The Cochrane Collaboration, 2011. Available from www.cochrane‐handbook.org.
ICD‐10
    1. World Health Organization. The ICD‐10 Classification of Mental and Behavioural Disorders. Geneva: World Health Organization, 1992.
Kay 1986
    1. Kay SR, Opler LA, Fiszbein A. Positive and Negative Syndrome Scale (PANSS) Manual. North Tonawanda, NY: Multi‐Health Systems, 1986.
Kay 1987
    1. Kay SR, Fiszbein A, Opler LA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 1987;13:261‐76. - PubMed
Kelly 2004
    1. Kelly DL, Conley RR. Sexuality and schizophrenia: a review. Schizophrenia bulletin 2004;30(4):767‐79. - PubMed
Laumann 1999
    1. Laumann EO, Paik A, Rosen RC. Sexual dysfunction in the United States: prevalence and predictors. JAMA 1999;281(6):537‐44. - PubMed
Leucht 2005
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR. What does the PANSS mean?. Schizophrenia Research 2005;79(2‐3):231‐8. [PUBMED: 15982856] - PubMed
Leucht 2005a
    1. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel R. Clinical implications of brief psychiatric rating scale scores. British Journal of Psychiatry 2005;187:366‐71. [PUBMED: 16199797] - PubMed
Leucht 2007
    1. Leucht S, Engel RR, Bauml J, Davis JM. Is the superior efficacy of new generation antipsychotics an artifact of LOCF?. Schizophrenia Bulletin 2007;33(1):183‐91. [PUBMED: 16905632] - PMC - PubMed
Malik 2007
    1. Malik P. Sexual dysfunction in schizophrenia. Current Opinion in Psychiatry 2007;20(2):138‐42. - PubMed
Marshall 2000
    1. Marshall M, Lockwood A, Bradley C, Adams C, Joy C, Fenton M. Unpublished rating scales: a major source of bias in randomised controlled trials of treatments for schizophrenia. British Journal of Psychiatry 2000;176:249‐52. - PubMed
McGahuey 2000
    1. McGahuey CA, Gelenberg AJ, Laukes CA, Moreno FA, Delgado PL, McKnight KM, et al. The Arizona Sexual Experience Scale (ASEX): reliability and validity. Journal of Sex and Marital Therapy 2000;26:25‐40. - PubMed
Michelson 2001
    1. Michelson D, Schmidt M, Lee J, Tepner R. Changes in sexual function during acute and six‐month fluoxetine therapy: a prospective assessment. Journal of Sex and Marital Therapy 2001;27:289‐302. - PubMed
Moher 2010
    1. Moher D, Hopewell S, Schulz KF, Montori V, Gøtzsche PC, Devereaux PJ, et al. CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials. BMJ 2010;340:c869. - PMC - PubMed
Montejo 2010
    1. Montejo ÁL, Majadas S, Rico‐Villademoros F, LLorca G, Gándara J, Franco M, et al. Frequency of sexual dysfunction in patients with a psychotic disorder receiving antipsychotics. Journal of Sexual Medicine 2010;7(10):3404‐13. - PubMed
Nicolaou 2012
    1. Nicolaou L. Sexual dysfunction in people with schizophrenia. Mental Health Practice 2012;15(10):20‐4.
Overall 1962
    1. Overall JE, Gorham DR. The brief psychiatric rating scale. Psychological Reports 1962;10:799‐812.
Oxman 1992
    1. Oxman AD, Guyatt GH. A consumer's guide to subgroup analyses. Annals of Internal Medicine 1992;116(1):78‐84. - PubMed
Schultz 1995
    1. Schultz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA 1995;273(5):408‐12. - PubMed
Schünemann 2008
    1. Schünemann HJ, Oxman AD, Vist GE, Higgins JPT, Deeks JJ, Glasziou P, et al. Chapter 12: Interpreting results and drawing conclusions. In: Higgins JPT, Green S editor(s). Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration, 2008:359‐83.
Segraves 1998
    1. Segraves RT. Antidepressant‐induced sexual dysfunction. Journal of Clinical Psychiatry 1998;59(Suppl 4):48‐54. - PubMed
Simpson 1970
    1. Simpson GM, Angus JW. A rating scale for extrapyramidal side effects. Acta Psychiatrica Scandinavica 1970;212(Suppl):11‐9. - PubMed
Tharyan 2006
    1. Tharyan P, Gopalakrishan G. Erectile dysfunction. BMJ Clinical Evidence 2006;15:1227‐51. - PubMed
Ukoumunne 1999
    1. Ukoumunne OC, Gulliford MC, Chinn S, Sterne JAC, Burney PGJ. Methods for evaluating area‐wide and organistation‐based intervention in health and health care: a systematic review. Health Technology Assessment 1999;3(5):1‐75. - PubMed
Williams 2006
    1. Williams VS, Baldwin DS, Hogue SL, Fehnel SE, Hollis KA, Edin HM. Estimating the prevalence and impact of antidepressant‐induced sexual dysfunction in 2 European countries: a cross‐sectional patient survey. Jounral of Clinical Psychiatry 2006;67:204‐10. - PubMed
Xia 2009
    1. Xia J, Adams CE, Bhagat N, Bhagat V, Bhoopathi P, El‐Sayeh H, et al. Loss to outcomes stakeholder survey: the LOSS study. Psychiatric Bulletin 2009;33(7):254‐7.
Xiang 2011
    1. Xiang YT, Wang CY, Si TM, Lee EHM, He YL, Ungvari GS, et al. The low frequency of reported sexual dysfunction in Asian patients with schizophrenia (2001‐2009): low occurrence or ignored side effect?. Human Psychopharmacology 2011; Vol. 26, issue 4/5:352‐7. - PubMed
Zemishlany 2012
    1. Zemishlany Z. AS01‐02 ‐ The impact of psychiatric disorders on sexual dysfunction: an update. European Psychiatry 2012; Vol. 27:1‐1.
Üçok 2007
    1. Üçok A, İncesu C, Aker T, Erkoç Ş. Sexual dysfunction in patients with schizophrenia on antipsychotic medication. European Psychiatry 2007;22(5):328‐33. - PubMed

References to other published versions of this review

Berner 2006
    1. Berner MM, Hagen M, Kriston L. A systematic review of research on strategies for the management of antipsychotic‐induced sexual dysfunction: high‐level evidence is needed. Journal of Clinical Psychiatry 2006;67(10):1649‐50. - PubMed
Berner 2007
    1. Berner MM, Hagen M, Kriston L, Omar H. Management of sexual dysfunction due to antipsychotic drug therapy. Cochrane Database of Systematic Reviews 2007, Issue 1. [DOI: 10.1002/14651858.CD003546.pub2] - DOI - PubMed

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