Prevalence of Sexual dysfunction among psychosis patient is very high. Impaired sexual functioning is an inherent component of psychosis. Antipsychotics are first line treatment of psychosis. These drugs got adverse SD , leading to non compliance and impairment of their quality of life.
Pub med search was made, using key words schizophrenia ,antipsychotic, sexual dysfunction.
Sexual dysfunction among psychotics is twofold higher than normal population . 45 to 80 % patient on antipsychotic have SD. Sexual dysfunction among male patient under age of 50 in first episode of schizophrenia was 56 vs 6% in control. Higher proclactin is found in drug naive patient of schizophrenia patient vs control 12.5 ng/ml in patient vs 8.6nf/mg. Lower T3 is reported among these patient . Loss of libido In olanzapine treated is 17.8 % resperidone 35.5 % and in haloperidole 38.7% . There is relationship between longer duration of untreated psychosis and sexual dysfunction.
Among the psychosis patients It is presumed that Sexual functions are impaired due to positive and negative symptoms, smoking, medical illness and depression. Presynpatic dopamine dysfunction is found in drug naive schizophrenic. Due to high D2 occupancy typical antipsychotics produce more SD than atypicals. High prolactin level , and anti cholinergic effects cause libido reduction and ED. Aripirazole is partial antagonist of D2 and 5HT1A reduces prolactin levels without compromising antipsychotic efficacy.PDE5 inhibitors and testosterone boosting can address arousal issues. Treat depression with bupropion, with minimum sexual side effects.
Appropriate management of SD can improve QOL of psychosis patients.