Sex

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Sex drugsSexual dysfunctions in patients with
schizophrenia using depot antipsychotics a
cross-sectional study

• Rian Groen1-2, Marrit de Boer3, Marte Swart2-5,
  Rikus Knegtering2-4-5
• Lentis Center for Mental Health Care Groningen,
  1Linis FACT Winschoten and 2Lentis Research
  Center. University of Groningen, University
  Medical Center Groningen, 3Department of
  Psychiatry, 4Neuroimaging center and 5 Rob Giel
  Research,
• The Netherlands

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Content

• Background
• Practice
• The aim
• Expectation
• Research population

• Methods
• Demografics
• Results
• Discussion
• Conclusions

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Background

• Sexual dysfunctions (SD) are frequently occuring
  side effects of oral antipsychotic medication
  (30-60).
• Negative effects on self-image, compliance and
  the quality of life.
• SD related to long-acting injectable (depot)
  antipsychotics are infrequently studied.

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Practice

• Very common
• Ask
• Difficult
• Not much research

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The aim

• To compare the frequency and types of SD in
  patients using long-acting risperidone and
  paliperidone (group A) with patients using
  long-acting first-generation antipsychotics
  (group B).

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Expectation

• More SD expected in Risperidone en Paliperidone
  than First-generation antipsychotics
• Rising prolactin levels
• Higher dosages necessary for antipsychotic
  effect.
• Paliperidone metabolite Risperidone.

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I stopped taking the medicine because I prefer
the original disease to the side effects.
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Research Population

• Lentis / Groningen/ Winschoten.
• 38 outpatients
• Psychotic disorder
• Receiving treatment from Assertive
• Community Treatment teams
• Aged 18-60
• Using depot antipsychotics

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Methods

• Divided into 2 groups
• Group A risperidone and paliperidone
• Group B long-acting first-generation
  antipsychotics. Haloperidol, zuclopentixol,
  fluphenazine, broomperidol, flupentixol.

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Methods

• Informing patients
• On the day of depot injection.
• The Antipsychotics and Sexual Functioning
  Questionnaire (ASFQ), a semistructured interview.
• libido, orgasm, erection, ejaculation,
  lubrication, galactorrhea, gynaecomastia and
  pain.

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Demographics (1)
Groep A Risperidone en Paliperidone (n12) Groep B First generation antipsychotica (n26)
Sex male/female () 9/3 (75/25) 16/10 (61,5/38,5)
Average age (Range SD) 43(28-56 8,79) 46(26-61 9,02)
Diagnosis () Schizophrenia Schizoaffective disorder Psychotic Disorder NOS 10 (83,3) 1 (8,3) 1 (8,3) 19 (73,1) 6 (23,1) 1 (3,8)
Marital status () Married Living together Single Legally divorced Other 2 (16,7) 1 (8,3) 6 (50) - 3 (25) 2 (7,7) - 16 (61,5) 6 (23,1) 2 (7,7)
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Demographics (2)

• Next to depot oral psychotropic drugs
• -7 people (58,3 ) of group A.
• -18 people (69,2 ) of group B.
• Most common was clozapine
• Comedication
• 6 people (50 )
• - 16 people (61 )
• Most common co-medication
• - Antidiabetic and Anticholinergic(group A)
• - Protonpump inhibitors group B)

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Results
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Groep A Risperidone en Paliperidone N12 Groep A Risperidone en Paliperidone N12 Groep A Risperidone en Paliperidone N12 Groep B First generation antipsychotics N26 Groep B First generation antipsychotics N26 Groep B First generation antipsychotics N26
SD totaal () Man n9 Vrouw n3 Totaal Man n16 Vrouw n10 Totaal

1 or more SD 17 (44,7) 2 (22,2) 1 (33,3) 3 (25) 8 (50) 6 (60) 14 (53,8)
Libido 9 (23,1) 2 (22,2) - 2 (16,7) 3 (18,8) 4 (40) 7 (26,9)
Orgasm 7 (18,4) 2 (22,2) 1 (33,3) 3 (25) 2 (12,5) 2 (20) 4 (15,4)
Erection 5 (13,4) 2 (22,2) - 2 (16,7) 3 (18,8) - 3 (11,5)
Ejaculation 8 (21,1) 2 (22,2) - 2 (16,7) 6 (37,5) - 6 (23,1)
Lubrication 3 (7,9) - - - - 3 (30) 3 (11,5)
Pain - - - - - - -
Galactorrhea 3 (7,9) - - - - 3 (30) 3 (11,5)
Gynaecomastia 1 (2,6) - - - - 1 (10) 1 (3,8)
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Different SD per depot-group shown in percentages.
NB Group A risperidone en paliperidone and
group B first generation antipsycotics.
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Discussion

• Challenging research population
• Small sample size
• Oral psychotropic drugs
• Co-medication

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Conclusions

• No significant difference
• Frequently reported
• Almost half of the population
• Further research is necessary.
• Ask specifically about sexual side effects.
• Discuss side effects openly
• Consider them in the course of treatment.
• Treatment alternatives

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Questions?
Rian Groen GGZ VS i.o. e-mail
ag.groen_at_lentis.nl
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Demografische gegevens (2)
Group A Group B
Depot antipsychotica () Risperidone Paliperidone Haloperidol Zuclopentixol Fluphenazine Broomperidol Flupentixol 4 (33,3) 8 (66,7) - - - - - - - 1 (3,8) 7 (26,9) 5 (19,2) 2 (7,7) 11 (42,3)
Orale psychofarmaca () Most common Clozapine Quetiapine Aripiprazol Geen 7 (58,3) 3 (25) 1 (8,3) - 5(41,7) 18 (69,2) 10 (38,5) 3 (11,5) 3 (11,5) 8 (30,8)
Comedicatie () Most common Antidiabetic Anticholinergicum Lipidenverlagende middelen Protonpompremmers 6 (50) 3 (25) 3 (25) - - 16 (61) - 6 (23) 5 (19,2) 8 (30,8)