Attitudes of Italian Psychiatrists Toward the Evaluation of Physical Comorbidities and Sexual Dysfunction in Patients With Schizophrenia. Implications for Clinical Practice

Abstract

Treatment guidelines for patients with schizophrenia recommend evaluating their risk of physical comorbidities, especially since these patients are known to have decreased life expectancy due to comorbidities. Therefore, to the authors’ knowledge, this is the first national survey conducted to investigate how Italian psychiatrists deal with the risk of physical comorbidities and sexual dysfunction in patients with schizophrenia. A sample of 750 psychiatrists completed an ad hoc online survey investigating their decision making about performing blood tests, clinical and instrumental examinations, and scheduling follow-up appointments in relation to the different phases of the illness and possible pharmacological side effects. Compared to patients in therapeutic continuation, those diagnosed for the first time and those who received a therapeutic change were visited more frequently (every 15 to 17 days vs. every 40 days, respectively), and were more regularly prescribed blood tests and instrumental examinations (every 4.2 to 4.4 months vs. every 9 months, respectively). There was a high interest in the surveillance of cardiometabolic risk. In 54% of patients, prolactin testing was not requested before starting an antipsychotic. In terms of specialist referrals, only 5% of surveyed psychiatrists “never” sought for additional counseling. There was little attention given to sexual functioning assessment based on the survey results about patients' daily life and with regard to deciding to prescribe additional examinations. In fact, only up to 3% of psychiatrists reported assessing sexual functioning using specific psychometric tests. In summary, Italian psychiatrists describes themselves as careful healthcare providers for the physical illnesses of patients with schizophrenia but with several shortcomings. For instance, clinical attention toward patients’ sexual and reproductive healthcare needs remains a challenge. Psychiatrists should take the lead for the integrated education, assessment, and care of medical needs of their patients with mental illness. Based on the results of this survey, the authors also believe that a future challenge for the management of patients with mental illness will be the classification of patients based on their risk of comorbidities, to help ensure optimal healthcare provision for those at greater risk of other illnesses.

Management Strategies for Antipsychotic-Related Sexual Dysfunction: A Clinical Approach

“…Psychotic patients are a very heterogeneous group in terms of clinical evolutions, treatment response, and sexual activity, so being mindful of this issue and its possible repercussions on adherence becomes difficult at times for both the clinician [ 46 ] and the patient. For example, uncompensated patients with acute symptomatology that require hospitalization do not share the same concern for their sexuality as fully stabilized chronic patients do [ 130 , 131 , 132 ]; clinicians treating the former may overlook this issue at first while attempting to treat psychotic symptomatology.…”

“…Clinicians should be mainly interested in primary prevention and starting a treatment with APS that preserve sexual function should always be the first choice in sexually active patients who want to maintain their previous sexual activity. There is recent evidence that only 3% of psychiatrists routinely evaluate sexual functioning using specific psychometric tests [ 46 ], so psychiatrists’ interest in their patients’ sex life, as well as their specific skills to prevent, detect, and treat TESD, should be encouraged.…”

“…Most psychiatrists frequently underestimate the presence of sexual dysfunction, even when adjusting for different SD prevalence across populations [ 45 ]. It is not always considered a priority from a clinical perspective, and it is often disregarded almost completely [ 1 , 46 , 47 ]. However, when patients are asked directly about SD, they rank it as a relevant problem.…”

“…Multiple explanations are behind this, including shame, poor patient–clinician rapport, or physicians who have difficulties in discussing sexuality with their patients [ 42 , 55 ]. All these reasons contribute to the incidence of SD being underestimated and underreported [ 46 , 56 , 57 ]. This issue going unnoticed can cause difficulties in interpersonal relationships and sexual dissatisfaction for patients and their partners.…”

Sexuality in Ultra-High Risk for Psychosis and First-Episode Psychosis. A Systematic Review of Literature

“…Some interesting studies have indeed found that clinicians often fail to evaluate sexual problems, with this having dramatic repercussions on the partner, on the couple, on the therapy itself, and eventually on the overall quality of life (QOL) ( 17 ). In a recent article, the Authors surveyed a group of 750 psychiatrists, investigating their clinical care algorithms; the findings suggested how little importance is generally given to sexual health ( 18 ). In particular, only up to 3% of clinicians reported conduct a thorough sexual assessment on people with severe mental illnesses.…”