Sexual dysfunction with major depressive disorder and antidepressant treatments: impact, assessment, and management.

INTRODUCTION: Sexual dysfunction (SD) is a symptom of depression in ≈70% of patients presenting with major depressive disorder (MDD). Antidepressant medications (AD) and adjunctive treatments may further contribute to SD and complicate evaluation and management. AREAS COVERED: A systematic literature search of PubMed, Ovid MEDLINE and Cochrane databases for MDD, SD, classes of antidepressants, etc. was performed with a focus on 2014 to June 2021. SSRIs are associated with 70% treatment-emergent sexual dysfunction (TESD), SNRIs and tricyclics have rates of TESD of 40-45%, and antidepressant medications without SRI effects or with additional unique mechanisms of action have rates similar to placebo (<10%). Appropriate assessment at baseline and throughout treatment, consideration of patient preferences in prescribing, addressing modifiable factors (comorbid medical/psychiatric conditions, substances, relationship difficulties), and utilizing management strategies of switching to an AD with less SD, adding an antidote/adjunctive therapy or lowering the dose are discussed. EXPERT OPINION: MDD and antidepressant treatment contribute to SD in a high percentage of patients. Treating to remission reduces SD as a symptom of depression. Frequent assessment and targeted management strategies may be effective in preventing or addressing SD. Secondary outcomes like impact on adherence, relationships and self-image should also be considered.

Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese / Tradução e adaptação transcultural da Arizona Sexual Scale (ASEX) para a língua portuguesa

Abstract Introduction Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. Methods The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. Results The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. Conclusion The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Resumo Introdução A disfunção sexual é comum em indivíduos com doenças psiquiátricas e sob o uso de medicações como antidepressivos e antipsicóticos. Várias escalas foram desenvolvidas para avaliar a função sexual desses doentes. A Arizona Sexual Scale (ASEX) é uma escala de cinco itens de avaliação que quantifica desejo sexual, excitação, lubrificação vaginal/ereção peniana, capacidade para atingir o orgasmo e satisfação com o orgasmo. Este artigo descreve o processo de tradução e adaptação transcultural da escala ASEX para a língua portuguesa, com o objetivo de contribuir para a avaliação da função sexual dos doentes medicados com fármacos psicotrópicos nos vários países onde se utiliza essa língua. Métodos A tradução e a adaptação transcultural seguiram de forma detalhada os passos recomendados pelo grupo de trabalho da International Society for Pharmacoeconomics and Outcomes Research (ISPOR), nomeadamente: preparação, tradução inicial, reconciliação, retroversão, revisão da retroversão, harmonização, teste cognitivo, revisão do teste cognitivo, finalização, leitura final e versão final. Resultados O processo foi completado com sucesso, e não foram observadas diferenças grandes entre as fases de tradução, reconciliação e retroversão, tendo sido feitos apenas pequenos ajustes. Conclusão A tradução da escala ASEX foi bem-sucedida, seguindo orientações internacionais de referência. A aplicação dessas orientações é a garantia de uma versão em língua portuguesa que é qualitativa e semanticamente equivalente à versão original da escala. A existência desta nova versão da escala permitirá estudos que avaliem a função sexual dos doentes em países nos quais se fale a língua portuguesa. Estudos futuros poderão atestar a validade da escala para essas populações.

Translation and cross-cultural adaptation of the Arizona Sexual Scale (ASEX) into Portuguese.

INTRODUCTION: Sexual dysfunction is common in individuals with psychiatric disorders and under psychotropic medication such as antidepressants and antipsychotics. Several scales have been developed to assess sexual function in these patients. The Arizona Sexual Scale (ASEX) is a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. We describe the translation and cross-cultural adaptation of the ASEX into the Portuguese language, with the goal of contributing to the assessment of sexual function in Portuguese-speaking psychiatric patients under treatment with psychotropic drugs. METHODS: The translation and cross-cultural adaptation process thoroughly followed the steps recommended by the Task Force of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR), namely: preparation, forward translation, reconciliation, back-translation, back-translation review, harmonization, cognitive debriefing, review of cognitive debriefing, finalization, proofreading, and final version. RESULTS: The process was successfully completed and no major differences were found between the translation, reconciliation and back-translation phases, with only small adjustments being made. CONCLUSION: The translation of the ASEX was completed successfully, following international reference guidelines. The use of these guidelines is a guarantee of a Portuguese version that is qualitatively and semantically equivalent to the original scale. This availability of this new scale version will enable studies evaluating the sexual function of Portuguese-speaking psychiatric patients. Future studies may assess the validity of the scale for Portuguese-speaking populations.

Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.

Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.

[Hypersexuality in Parkinson's disease. Advantage of the presence of the entourage for medical assessment]. / Prise en charge de l'hypersexualité dans la maladie de Parkinson. Intérêt de la présence de l'entourage lors de l'évaluation médicale.

OBJECTIVE: To improve the management of hypersexuality caused by antiparkinsonian treatment and its psychopathological implications in patients with Parkinson's disease (PD). If hypersexuality is a classic form of impulse control disorder (ICD) observed in PD, its rate is certainly underestimated. METHODS: We have proposed to meet patients with Parkinson's disease, referred by the neurology department of Lille University Hospital, for detection or suspicion of hypersexuality, in the presence of their spouse. The session consisted of an interview conducted by our psychiatry team. This evaluation was conducted between January 1 and August 31, 2011. Nine patients were referred to our service, 7 agreed to meet us, 6 of them with their spouse. RESULTS: An interview in the presence of the spouse has improved hypersexuality screening and information given to the patient and his close contacts regarding the side effects of treatment, and particularly the occurrence of hypersexuality. It also highlighted the various expressions of these behavioral changes, often minimized by patients, as spouses had great difficulty dealing with this. It helped them to improve verbal communication and, therefore, to be more informative concerning sexual behavior changes in connection with the treatment and its management. Finally, it has enabled improved support for secondary consequences of this impulse control disorder, such as guilt, jealousy or shame. Our interest has also focused on the impact of this hypersexuality on patients' families. Among the six sets partners, four had symptoms requiring specific psychiatric care: depression, suicidal intention or post-traumatic stress disorder. PERSPECTIVE: Hypersexuality seems underestimated in patients receiving antiparkinsonian treatment. This underestimation is probably linked to some defense mechanisms such as denial or minimization, but also to the feelings generated by these behavioral problems, such as shame or guilt. On the other hand, some patients do not experience stress related behavioral changes (even though the family may complain). Systematic partner interview could be a solution to improving this screening.

The risk of elevated prolactin levels in pediatric patients exposed to antipsychotics for the treatment of schizophrenia and schizophrenia spectrum disorders: protocol for a systematic review and meta-analysis.

BACKGROUND: Antipsychotic medications, particularly second-generation antipsychotics, are increasingly being used to alleviate the symptoms of schizophrenia and other severe mental disorders in the pediatric population. While evidence-based approaches examining efficacy and safety outcomes have been reported, no review has evaluated prolactin-based adverse events for antipsychotic treatments in schizophrenia and schizophrenia spectrum disorders. METHODS/DESIGN: Searches involving MEDLINE, EMBASE, CENTRAL, PsycINFO, and clinical trial registries (ClinicalTrials.gov, Drug Industry Document Archive [DIDA], International Clinical Trials Registry Platform [ICTRP]) will be used to identify relevant studies. Two reviewers will independently screen abstracts and relevant full-text articles of the papers identified by the initial search according to the prospectively defined eligibility criteria. Data extraction will be conducted in duplicate independently. Pairwise random effects meta-analyses and network meta-analyses will be conducted on individual drug and class effects where appropriate. DISCUSSION: This systematic review will evaluate prolactin-based adverse events of first- and second-generation antipsychotics in the pediatric population with schizophrenia and schizophrenia spectrum disorders. It will also seek to strengthen the evidence base of the safety of antipsychotics by incorporating both randomized controlled trials and observational studies. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42014009506.

Patients' self-assessment versus investigators' evaluation in a phase III trial in non-castrate metastatic prostate cancer (GETUG-AFU 15).

BACKGROUND: Toxicity, which is a key parameter in the evaluation of cancer treatments, can be underestimated by clinicians. We investigated differences between patients and physicians in reporting adverse events of androgen deprivation therapy (ADT) with or without docetaxel in a multicentre phase III trial in non-castrate metastatic prostate cancer. METHODS: The 385 patients included were invited to complete a 26-symptom questionnaire 3 and 6 months after the start of treatment, among which eighteen symptoms were also assessed by physicians, reported in medical records and graded using the Common Toxicity Criteria of the National Cancer Institute. Positive and negative agreements as well as Kappa concordance coefficients were computed. FINDINGS: Data were available for 220 and 165 patients at 3 and 6 months respectively. Physicians systematically under-reported patients' symptoms. Positive agreement rates (at respectively 3 and 6 months) for the five most commonly reported symptoms were: 61.0% and 64.3% hot flushes, 50.0% and 43.6% fatigue, 29.4% and 31.1% sexual dysfunction, 24.4% and 14.4% weigh gain/loss, 16.7% and 19.3% for joint/muscle pain. For symptoms most frequently reported as disturbing or very disturbing by patients, the clinicians' failure to report them ranged from 50.8% (hot flushes) to 89.5% (joint/muscle pain) at 3 months, and from 48.2% (hot flushes) to 88.4% (joint/muscle pain) at 6 months. INTERPRETATION: Physicians often failed to report treatment-related symptoms, even the most common and disturbing ones. Patients' self-evaluation of toxicity should be used in clinical trials to improve the process of drug assessment in oncology. FUNDING: French Health Ministry and Institut National du Cancer (PHRC), Sanofi-Aventis, Astra-Zeneca, and Amgen.

Treating depression with antidepressants: drug-placebo efficacy debates limit broader considerations.

The core issue regarding antidepressants for many clinicians is whether they perform significantly better than placebos. However, this article suggests eight additional concerns beyond drug efficacy alone to consider regarding antidepressants including: (1) formulating only a one-dimensional, biological view of depression; (2) defining the client's role as passive in treatment; (3) economic corruption of the research and reporting; (4) false or misleading consumer advertising; (5) conflicting data that confuse practitioners and consumers alike; (6) over- and under-prescription of medications; (7) drug side-effects; and (8) harm to the environment. The enhanced effects of psychotherapy utilizing hypnosis offer a means of avoiding most, if not all, of the problems associated with the use of antidepressants as a primary form of treatment.

Non-neurological and metabolic side effects in the Cost Utility of the Latest Antipsychotics in Schizophrenia Randomised Controlled Trial (CUtLASS-1).

The impact of non-neurological and metabolic side effects (NNSEs) on the prescription of antipsychotics in real clinical practice remains unclear. We conducted an intention-to-treat, secondary analysis of data from a randomised, controlled trial (CUtLASS-1; n=227) to examine NNSEs emergent at 12 weeks and 52 weeks. A clinically significant difference was defined as double or half the symptoms in groups prescribed first- versus second-generation antipsychotics, represented by odds ratios greater than 2.0 (indicating advantage for first-generation drugs) or less than 0.5 (indicating advantage for the newer drugs). There were no differences between the treatment groups at baseline. At both 12 and 52 weeks follow-up, patients on second-generation drugs were more likely than their first-generation counterparts to experience cardiovascular problems and anticholinergic side effects, as well as increased sexual side effects in men. Objective weight gain was equivalent between the two groups at 12 weeks, but by one year fewer patients in the second-generation arm experienced weight gain and there was no significant difference with regard to percent change in BMI. These results suggest that there may be clinically significant increases in anticholinergic, cardiovascular, and sexual side effects for patients on second-generation drugs. The expected increased weight gain in the second-generation arm did not occur. This study provides evidence that clinicians should take a more nuanced approach toward expert antipsychotic prescription, rather than viewing the drugs as distinct classes.

Rates of 5 common antidepressant side effects among new adult and adolescent cases of depression: a retrospective US claims study.

BACKGROUND: Antidepressants are the first-line treatment for depression, yet medication-related side effects may be associated with antidepressant discontinuation before reaching a period of exposure believed to result in effectiveness. There is a gap in knowledge of the prevalence of side effects across commonly prescribed antidepressants and the effect of the type of antidepressant on the likelihood of side effects in real-world clinical practice. OBJECTIVE: The aim of this study was to estimate and compare the prevalence of headaches, nausea or vomiting, agitation, sedation, and sexual dysfunction among patients diagnosed with depression who initiated monotherapy across different classes of antidepressants and to estimate the effect of the type of antidepressant on the likelihood of each of the 5 side effects. METHODS: A retrospective cohort of patients aged ≥13 who were newly diagnosed with depression and began antidepressant monotherapy was created using LifeLink managed care claims from 1998 to 2008. Antidepressant groups included selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), bupropion, phenylpiperazine, and tetracyclic antidepressants. Prevalence of headache, nausea or vomiting, agitation, sedation, and sexual dysfunction were compared across antidepressant groups. Propensity-adjusted Cox proportional hazards regression was used to estimate the likelihood of each of the 5 side effects for each antidepressant group compared with SSRIs, adjusted for demographic, clinical, and treatment characteristics. RESULTS: The study cohort included 40,017 patients (3617 adolescents, aged 13-18 years, and 36,400 adults, aged ≥19 years; mean age = 45 years; 67% female) with a new episode of depression who were initiated on antidepressant monotherapy within 30 days of diagnosis (SSRI [66%], bupropion [14%], SNRI [12%], other [8%]). The most common side effects were headache (up to 17/1000 person-months of therapy in adults and adolescents) and nausea (up to 7.2/1000 in adults, 9.3/1000 in adolescents). Relative to adults receiving SSRIs, adults receiving SNRIs had a higher risk of nausea (hazard ratio [HR] = 1.26; 95%CI,1.05-1.51). Adults (HR = 0.78; 95% CI, 0.62-0.96) and adolescents (HR = 0.43; 95% CI, 0.21-0.87) taking bupropion were less likely to experience headaches compared with adults and adolescents, respectively, taking an SSRI. Adolescents receiving a tetracyclic were more likely to experience headaches than adolescents receiving an SSRI (HR = 3.16; 95%CI, 1.13-8.84). CONCLUSIONS: Prevalence and risk of the 5 side effects varied across types of antidepressants for both adults and adolescents. Results from this study were consistent with prior clinical trials, suggesting that variation in side effect profiles exists in a more generalized managed care population.

A review of the assessment of antidepressant-induced sexual dysfunction used in randomized, controlled clinical trials.

BACKGROUND: Sexual dysfunction is a well-known side effect of many antidepressants. Obtaining accurate data on sexual dysfunction from clinical trials is difficult because of methodological problems. This paper reviews the assessment and reporting of sexual dysfunction in clinical trials. METHODS: 79 randomized double-blind studies comparing efficacy and tolerability of new antidepressants in major depressive disorder were included. Papers were searched for the methodology of adverse event assessment and for any information on treatment-emergent sexual dysfunction. RESULTS: 74.7% of the reviewed studies relied on spontaneous reports, 17.7% on non-specific side-effect checklists and only 7.6% on specific assessment instruments. 31.6% of the reviewed studies reported sexual dysfunction as a side effect of antidepressant treatment. Detailed information on the kind of sexual dysfunction based on DSM-IV terminology was provided by only 10.1% of the papers. More recent studies published in 2000 or later reported sexual dysfunction more often (48.6%) than studies published before the year 2000 (18.2%). DISCUSSION: The specific assessment of sexual dysfunction should be adopted as a part of the safety and tolerability assessment in clinical trials. Future research is needed to elaborate the advantages and disadvantages of the available instruments for the assessment of sexual dysfunction.

Iatrogenic sexual dysfunction and the protective withholding of information: in whose best interest?

In recent years a growing body of evidence has highlighted the impact of neuroleptics and antidepressants on sexual function. Research from a service user's perspective suggested that service users are dissatisfied with the information that they received on drugs, and would like more education, in particular, on the side effects of medication that impact on sexual function. This paper reports some of the findings of a grounded theory study that explored how psychiatric nurses responded to issues of sexuality in practice. Emphasis within the paper is given to how nursing staff addressed the side effects of drugs that impact on sexual function. Findings suggested that nurse addressed the issue of prescribed medication and sexual function in practice, using a 'Veiling Sexualities Cycle', which had three subcategories: 'Hanging the Veil', 'Lifting the Veil' and 'Re-veiling'. In the light of contemporary mental health policy, findings from the study are discussed and recommendations for practice and education made.

Neuroleptic medication and sexuality: the forgotten aspect of education and care.

Discussing issues of sexuality is a challenging and difficult issue for many health care workers. When it comes to sexuality and people with mental health problems there seems to be a dual taboo. Mental health nurses are ideal members of the health care team to talk to service users about issues as sensitive as sexuality and the side effects of medication that impact on sexual health. However, in both clinical practice and the nursing literature, the side effects of medications that impact on sexual function are often ignored and unspoken about. This paper examines the impact of both conventional and atypical neuroleptic medication on sexual function and discusses the probable causes of such effects. The possible reasons why health care professionals are reluctant to discuss side effects impacting on sexual health with service users are explored and emphasis is placed on the need for mental health nurses to respond to requests from service users for more education and discussion in the area of sexuality and sexual health.

Longitudinal assessment of changes in sexual function and bother in patients treated with external beam radiotherapy or brachytherapy, with and without neoadjuvant androgen ablation: data from CaPSURE.

PURPOSE: To evaluate the effects of external beam radiotherapy (EBRT), with or without brachytherapy (BT) boost or brachytherapy monotherapy with and without short-term androgen ablation (<==6 months; STAD) on sexual function (SF) and sexual bother (SB) in men treated for localized prostate cancer. METHODS AND MATERIALS: A total of 992 men with newly diagnosed prostate cancer enrolled in the Cancer of the Prostate Strategic Urological Research Endeavor database were studied to assess treatment-related changes in SF and SB. Six treatment subgroups (EBRT - STAD, EBRT + STAD, BT - STAD, BT + STAD, EBRT + BT - STAD, EBRT + BT + STAD) were compared. RESULTS: The greatest reported changes in SF occurred during the first 2 posttreatment years. Patients receiving BT reported greater SF and the least change in SF overall; those receiving EBRT + BT reported the greatest decline in SF. SF scores associated with STAD were initially lower than in patients without STAD; however by 1 year no statistically significant difference in SF or SB was noted. CONCLUSION: Each treatment for prostate cancer can negatively affect SF and SB. Initial differences among treatment subgroups exist, but diminish with time. SF changes associated with EBRT +/- BT were statistically significant and those for BT were not. STAD appeared to confer only temporary and recoverable impairment of erectile function.

Prospective assessment of sexual function in women treated for recurrent major depression.

Although multiple factors may influence the sexual function of depressed women over the course of treatment, the independent contributions of these factors are poorly understood. The current study examined the effects of depression, SSRI treatment, and sexual partner availability on women's sexual function. The sexual function of 68 recurrently depressed women was assessed at 3-month intervals over a 1-year course of treatment with interpersonal psychotherapy with or without adjunctive SSRI treatment. Random regression models assessing changes in sexual function were conducted to test the effects of three time-dependent covariates: depression symptom scores, sexual partner availability, and SSRI medication status. Controlling for the other variables, depressive symptoms were associated with decrements in sexual desire, sexual cognition/fantasy, sexual arousal, orgasmic function, and global evaluations of sexual function. SSRI treatment was associated with orgasmic difficulty only. The availability of a sexual partner was associated with increased sexual arousal, orgasmic function, and sexual behavior. Among treatment remitters, patient reports of severe sexual dysfunction did not change over the course of treatment, although mild improvement was observed in patients' global assessment of the quality of their sexual function. This report illustrates the prevalence and persistence of sexual dysfunction in this sample, and highlights the importance of monitoring both pharmacologic and psychosocial variables that can affect the sexual function of recurrently depressed women throughout the course of treatment.

Changes in sexual function during acute and six-month fluoxetine therapy: a prospective assessment.

Sexual dysfunction has been reported as an unwanted effect associated with selective serotonin reuptake inhibitors therapy, but the nature and frequency of such effects have not been characterized systematically. Sexual function was assessed in depressed patients participating in a multicenter trial of acute and continuation fluoxetine therapy using a 4-item self-rated scale. Patients were evaluated at study entry, after 13 weeks of fluoxetine 20 mg daily, and during 25 weeks of continuation therapy with fluoxetine 20 mg daily, fluoxetine 90 mg weekly, or placebo. In a 13-week open-label trial, among 501 patients who met Diagnostic and Statistical Manual of Mental Disorders criteria for depression, 51.6% of women and 40.6% of men reported improvement, 35.0% of women and 41.9% of men reported no change, and 13.4% of women and 17.4% of men reported worsening in overall sexual function. During double-blind continuation therapy, there were no statistically significant differences in change in sexual function between treatments. Worsened sexual function that occurred during continuation treatment was strongly associated with worsened depressive symptoms. Depression is associated with sexual dysfunction, and improvement in sexual functioning related to the antidepressant effects of fluoxetine may be more common than drug-associated deterioration in sexual function. Among patients who report worsening, effects may be most pronounced on orgasm. Deterioration in sexual function does not appear to be a late-onset drug-specific event, but is strongly related to worsening depressive symptoms.

Psychotropic drug-induced sexual function disorders: diagnosis, incidence and management.

The human sexual response can be divided into 3 phases: desire (libido), excitement (arousal) and orgasm. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classifies sexual disorders into 4 categories: (i) primary; (ii) general medical condition-related; (iii) substance-induced; and (iv) 'not otherwise specified' sexual dysfunctions. Each of the 4 DSM-IV categories has disorders in all 3 sexual phases. Substance-induced sexual dysfunctions are caused by the use of either substances of abuse [alcohol (ethanol), amphetamines, cocaine, opioids or sedatives/hypnotics/anxiolytics], or prescription medications which include psychotropic drugs. Patients with psychiatric difficulties tend to experience more frequent sexual function disturbances. The literature provides more than anecdotal evidence that psychotropic drugs can induce sexual function disorders in the epidemiologically vulnerable population of psychiatric patients. Sexual dysfunctions caused by psychotropic drugs can be divided into 2 groups: sexual inhibition (inhibited desire, inhibited arousal and inhibited orgasm) and increased sexual function disorders (increased sexual desire, priapism and premature ejaculation). The diagnosis of psychotropic drug-induced sexual function disorders is easy if the psychiatrist is sensitive to the existence of these adverse effects. This mostly involves careful history taking, although several questionnaires have been developed for reliable and valid quantification of sexual functioning. Diagnosis is usually established if the sexual function disorders develop when the patient is receiving a psychotropic drug and then disappear when the offending drug is discontinued. The management of psychotropic-drug induced sexual inhibition can be divided into 6 steps: inform the patient about the possibility of sexual inhibition occurring before prescribing a psychotropic agent; wait for remission or tolerance of sexual inhibition; reduce the dosage of the psychotropic drug; switch the medication to one less likely to cause sexual inhibition; if possible, adjust the concomitant nonpsychotropic drugs; and add various pharmacological agents to the existing psychotropic drug to treat the sexual inhibition. Physicians should take sexual histories as a routine practice when prescribing psychotropic drugs. Through careful management and patience on the part of both the patient and the physician, psychotropic drug-induced sexual function disorders can be improved so that the patient's compliance with medication and quality of life can be optimised.

Medications that may contribute to sexual disorders. A guide to assessment and treatment in family practice.

Approximately 15% to 25% of family practice patients have concerns about sexual function and are most comfortable discussing these issues with their family physician. While many physicians have avoided this topic in the past, citing lack of knowledge and skill, the family practice setting is ideal for a preliminary evaluation of sexual dysfunction and treatment for certain etiologies. This especially is true for changes in sexual function secondary to medication effects. This article provides basic guidelines designed to assist physicians in evaluating the effects of medications and other substances on sexual function. Also included are lists of medications known or suspected to have adverse effects on sexual function. Physicians are encouraged to address the sexual concerns of their patients and to incorporate these guidelines and the medication lists into their evaluation.

[Impact of therapeutics on sex. Value of measurements of quality of life]. / Impact des thérapeutiques sur la sphère sexuelle. Intérêt des mesures de la qualité de vie.

Quality of Life is a new clinical dimension with the objective of evaluating the impact of a disease or of a treatment on patients well being. Quality of life is a measure of increasing interest. It is a global and cumulative measure, relevant for the evaluation of the therapeutic benefit of a treatment. It can be measured through "specific" or "generic" tools. Very few experimental literature exploring the impact of pathologies over the sexual sphere exists today. Only generic scales have been used, because no specific scale has been developed up to now. The impact of certain pathologies such as depression or diabetes has been documented, but very little objective information exists concerning the sexual repercussion of the chronic use of drugs (anti depressive, anxiolytics). Sexual quality or life as a risk factor for disease development is also dimension that has been explored, but only superficially. In a general way, no evidence exists concerning a reel correlation link between pathologies, treatments and sexual quality of life and this specific dimension of the quality of life still remains to be explored further.