Prolactin, Subjective Well-Being and Sexual Dysfunction: An Open Label Observational Study Comparing Quetiapine with Risperidone

Abstract

Introduction Sexual dysfunction is a frequent side effect of antipsychotic treatment. Increased prolactin levels are believed to be responsible for this sexual impairment despite contradictory results. Aim The primary objective of the present study was to examine the relationship between sexual dysfunction, subjective well-being and prolactin levels in patients with schizophrenia treated either with risperidone or quetiapine. The secondary objective was to explore the relationship between testosterone and the severity of positive and negative symptoms of schizophrenia in male patients. Methods In a 4-week nonrandomized open label observational study, 102 inpatients with schizophrenia were recruited. Sexual functioning, subjective well-being and endocrinological parameters were assessed as well as psychopathological characteristics. Main Outcome Measures Two self-rating questionnaires concerned with sexual functioning (“Essener Fragebogen zur Sexualität”) and Subjective Well-Being Under Neuroleptic Treatment Scale (SWN) were completed by the patients. Plasma levels of prolactin in male and female patients were measured. Furthermore, in male patients testosterone, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were determined. Positive and Negative Symptom Scale (PANSS) was applied. Results After 4 weeks, patients treated with quetiapine reported less severe sexual impairment, as well as lower PANSS negative and general score compared with patients treated with risperidone. Additionally, emotional regulation as measured with the SWN was higher in patients treated with quetiapine. Risperidone was significantly associated with elevated prolactin levels. Prolactin levels were not correlated either with sexual dysfunction or PANSS. However, in the group of patients treated risperidone, sexual impairment was significantly associated with the SWN subscale emotional regulation. Conclusions Increased prolactin levels do not seem to be decisive for antipsychotic induced sexual dysfunction. Improvement of severity of illness and regaining the ability to regulate one's own emotion have positive influence on sexual functioning.

The Effects of Novel and Newly Approved Antipsychotics on Serum Prolactin Levels: A Comprehensive Review

“…Although it is often suggested that increased PRL levels are responsible for sexual dysfunctions in schizophrenic patients, one is struck by the fact that the literature on this topic is limited [128, 428] and that the evidence is contradictory and inconclusive [128, 129, 429, 430]. Some studies have shown an association between sexual side effects and PRL elevation, while others have failed to support this [431].…”

Sexual Dysfunction in First-Episode Schizophrenia Patients

“…This may well be explained by a considerably smaller sample studied by this group. Westheide and colleagues 47 found an association between SD and subjective well-being in risperidone-treated patients, emphasizing the clinical relevance of sexual functioning in schizophrenia and its potential influence on compliance behavior, as also discussed by Montejo et al 15 In summary, our findings indicate that SD in first-episode schizophrenia patients is a common problem, as shown by its prevalence and chronicity. These adverse events were fairly evenly distributed between the 5 antipsychotics administered while patients on amisulpride presented with a clearly higher risk for amenorrhea and galactorrhea.…”

Hyperprolactinemia associated with neuroleptic treatment: clinical characteristics and an impact on sexual function

“…Сходные результаты о влиянии ГАН на сексуальную функцию у женщин были получены S. Smith [21] в отно- Журнал неврологии и психиатрии, 11,2016 шении снижения полового влечения и дефицита влага-лищной смазки, H. Knegtering [18] -трудности в дости-жении оргазма, M. Rettenbacher [19] -ослабления поло-вого влечения и трудности в достижении оргазма. Данные об ассоциации ГАН у мужчин со снижением полового влечения и нарушением эрекции совпадают с данными ряда других исследователей [20,23,25,31]. Представленная в данной статье информация может быть полезной как для практикующих эндокринологов, так и психиатров в отношении возможности своевремен-но диагностировать ГАН.…”

“…[24], кото-рые выявили значимую положительную ассоциацию меж-ду уровнем пролактина и суммарным баллом Аризонской шкалы сексуального опыта (ASEX), а также рядом суб-шкал ASEX (сила полового влечения, сексуальное воз-буждение, эректильная функция). В ряде работ [10,[24][25][26][27][28] у пациентов, получавших рисперидон, оланзапин, арипипразол, галоперидол, кветиапин, связь между ГАН и сексуальными нарушениями не была выявлена.…”